HLTAID001_ 003 Learning Resource Booklet

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First Aid

HLTAID001 & HLTAID003

Learning Resource Booklet | 21/04/2015 careersaustralia.edu.au

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CONTENTS

LEARNING RESOURCE BOOKLET ........................................... 13

Learning Objectives ............................................................................... 13

Student Instruction ............................................................................... 13

Section 1: Overview .............................................................................. 14

First Aid ............................................................................................... 14

Aim of first aid ........................................................................................................ 14

First aid management ............................................................................ 15

First aid must take into account ................................................................................. 15

Australian Resuscitation Council (ARC) Guidelines ..................................... 16

ARC’s purpose ......................................................................................................... 16

State/Territory regulations and workplace procedures ................................ 16

First Aid Code of Practice ....................................................................... 18

First aid kits ............................................................................................................ 18

Legal and ethical requirements ............................................................... 19

Duty of care ............................................................................................................ 19

Good Samaritan ...................................................................................................... 19

Negligence .............................................................................................................. 20

Consent .................................................................................................................. 20

Privacy and confidentiality requirements ..................................................................... 21

Privacy Act ............................................................................................................. 21

Confidentiality policies .............................................................................................. 21

Respond in a culturally aware, sensitive and respectful manner towards a casualty ............................................................................................... 21

Documentation & report details of incident to workplace supervisor as appropriate .......................................................................................... 21

Verbal reporting ...................................................................................................... 21

Written reports ........................................................................................................ 22

Workplace written reports ......................................................................................... 22

Documenting your treatment .................................................................................... 22


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Example injury report form ....................................................................................... 23

Notifiable incidents .................................................................................................. 25

Following an emergency situation ............................................................ 25

Evaluation of own performance ................................................................................. 25

Signs and symptoms of stress ................................................................................... 25

Importance of debriefing .......................................................................................... 26

In the workplace – stress management ...................................................................... 26

Outside the workplace – stress management .............................................................. 26

Seek assistance from the emergency response services ............................. 27

Australian emergency call service numbers ................................................................. 27

Making the call ........................................................................................................ 28

Making the casualty comfortable ............................................................. 28

Identify, assess and manage immediate hazards to health and safety of self and others ........................................................................................... 29

Emergency scene assessment ................................................................................... 29

Examples of dangers to be aware of when assessing safety .......................................... 29

Infection control .................................................................................... 30

Infectious diseases .................................................................................................. 31

............................................................................................................................. 31

Standard precautions ............................................................................................... 31

In the workplace procedures ..................................................................................... 32

In the workplace for healthcare providers: .................................................................. 32

Providing first aid .................................................................................................... 32

Accidental contamination .......................................................................................... 33

Contaminated items ................................................................................................. 33

Cleaning spills ......................................................................................................... 33

Manual handling .................................................................................... 33

Identify and assess the risks ..................................................................................... 33

Consider ................................................................................................................. 33

Steps for correct lifting or moving a load .................................................................... 34

Moving the injured ................................................................................ 34


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Safety .................................................................................................................... 35

Moving techniques ................................................................................................... 35

Spinal immobilisation ............................................................................................... 35

Aim to maintain casualties head aligned with body avoiding side to side movements .......................................................................................... 36

Types of spine boards or stretcher ............................................................................. 36

Recognise an emergency situation ........................................................... 37

Observations ........................................................................................................... 37

Priorities in an emergency ........................................................................................ 38

Emergency action Plan (Queensland Ambulance Services, 2014, p6) .............................. 38

Section 2: Basic Anatomy & Physiology .................................................... 40

Basic anatomy and physiology ................................................................ 40

Response/ consciousness .......................................................................................... 40

Breathing ............................................................................................................... 41

Body systems .......................................................................................................... 41

11 Main systems ..................................................................................................... 42

Section 3: Emergency Assessment .......................................................... 48

Management of an emergency situation ................................................... 48

Danger ................................................................................................................... 48

Response ................................................................................................................ 48

Send for Help .......................................................................................................... 49

Casualty assessment ............................................................................. 49

History ................................................................................................................... 49

Observations ........................................................................................................... 50

Secondary survey - .................................................................................................. 50

Levels of consciousness ............................................................................................ 52

The conscious casualty .......................................................................... 52

The unconscious breathing casualty ......................................................... 52

Management ........................................................................................................... 53

Airway ................................................................................................................... 53

Method for turning victim onto their side .................................................................... 54


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The unconscious non- breathing casualty ................................................. 54

Section 4: CPR ...................................................................................... 55

Cardiac arrest ......................................................................................................... 55

Chain of survival ...................................................................................................... 55

Cardiopulmonary resuscitation - (CPR) ....................................................................... 56

Compression-ventilation ratio .................................................................................... 56

Steps of resuscitation ............................................................................................... 56

Chest compressions only .......................................................................................... 57

Multiple rescuers ..................................................................................................... 57

Duration of CPR ....................................................................................................... 57

Risks ...................................................................................................................... 57

CPR ....................................................................................................................... 58

Skills assessment requirements HLTAID001: ............................................ 63

Section 5: First Aid - Trauma .................................................................. 65

Abdominal injuries ................................................................................ 65

Causes ................................................................................................................... 65

Signs or Symptoms .................................................................................................. 65

Management ........................................................................................................... 66

Basic wound care (Major & minor skin injuries) ......................................... 66

Types of wounds ..................................................................................................... 67

Management - minor skin injuries .............................................................................. 67

Management - Major skin Injuries .............................................................................. 67

Bandages during first aid ....................................................................... 68

Roller bandage ...................................................................................... 68

Used for: ................................................................................................................ 68

How to apply: ......................................................................................................... 68

Making an arm sling .............................................................................. 69

Bleeding .............................................................................................. 70

External bleeding .................................................................................. 70

Management ........................................................................................................... 70


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Direct Pressure ........................................................................................................ 70

Indirect Pressure ..................................................................................................... 70

Tourniquet .............................................................................................................. 70

Internal bleeding ................................................................................... 71

Management ........................................................................................................... 71

Nose bleed (Epistaxis) ........................................................................... 71

Burns .................................................................................................. 72

Types ..................................................................................................................... 72

Aim ........................................................................................................................ 72

Steps ..................................................................................................................... 72

General management procedures .............................................................................. 73

Chest injuries ....................................................................................... 75

Types of chest injuries ............................................................................................. 75

Management ........................................................................................................... 75

Choking and airway obstruction .............................................................. 76

Signs & symptoms for conscious casualty ................................................................... 76

Unconscious casualty ............................................................................................... 77

Techniques to clear FBAO ......................................................................................... 77

Management of conscious casualty ............................................................................ 78

Management Unconscious Casualty ............................................................................ 78

Management of airway obstruction flow chart .............................................................. 79

Crush injuries ....................................................................................... 79

Management ........................................................................................................... 80

Ears & Eye injuries ................................................................................ 80

Ear injuries ........................................................................................... 80

Causes of Ear Injuries .............................................................................................. 80

Symptoms .............................................................................................................. 81

Management ........................................................................................................... 81

Eye injuries .......................................................................................... 81

Management ........................................................................................................... 81


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Fractures & Dislocation .......................................................................... 83

Fractures ............................................................................................. 83

Causes ................................................................................................................... 83

Signs and symptoms ................................................................................................ 83

Management ........................................................................................................... 83

Dislocation ........................................................................................... 84

Symptoms .............................................................................................................. 84

Management ........................................................................................................... 84

Head injuries ........................................................................................ 85

Management ........................................................................................................... 85

Needle stick injuries .............................................................................. 85

Management ........................................................................................................... 86

Soft tissue injuries, including strains and, sprains ..................................... 86

Causes ................................................................................................................... 86


Symptoms of a strain can include: ............................................................................. 87

Management ........................................................................................................... 87

Spinal injury ......................................................................................... 87


Principles of management of a suspected spinal injury are: ........................................... 90

Managing a spinal injury for the conscious casualty...................................................... 90

Managing a spinal injury for the unconscious casualty .................................................. 91

Section 6: First Aid - Medical .................................................................. 92

Allergic reaction .................................................................................... 92

Causes of allergic reactions ....................................................................................... 92

Symptoms .............................................................................................................. 92

Management ........................................................................................................... 93

Anaphylaxis .......................................................................................... 93

Most Common substances can cause anaphylaxis ........................................................ 93

Symptoms and signs are highly variable and may include ............................................. 93


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Management ........................................................................................................... 94

How to use an EpiPen© ............................................................................................. 95

Asthma ................................................................................................ 96

Triggers for asthma can include ................................................................................. 96

Asthma signs and symptoms ..................................................................................... 96

Signs of a severe asthma attack ................................................................................ 96

Young children ........................................................................................................ 97

Managing an Asthma Attack ...................................................................................... 97

With Spacer ............................................................................................................ 98

Without Spacer ....................................................................................................... 99

Cardiac conditions, including chest pain .................................................. 100

Heart ................................................................................................................... 100

Angina ................................................................................................................. 101

Pulmonary oedema ................................................................................................ 101

Congestive cardiac failure ....................................................................................... 101

Heart attack ........................................................................................ 102

Sign and symptoms ............................................................................................... 102

Management ......................................................................................................... 102

Diabetes ............................................................................................. 103

Type 1 diabetes ..................................................................................................... 104

Symptoms of Type 1 Diabetes ................................................................................. 104

Type 2 diabetes: ................................................................................................... 104

Management ......................................................................................................... 105

Seizures, including epilepsy ................................................................... 105

A seizure may be associated with ............................................................................ 105

Symptoms ............................................................................................................ 106

Generalised seizures .............................................................................................. 106

Partial seizures ...................................................................................................... 106

Febrile convulsions ................................................................................................ 106

Management of a Seizure ....................................................................................... 107

Seizure in the water ............................................................................................... 108


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Shock ................................................................................................. 109

Condition which may result in Shock ........................................................................ 109

Hypovolemic Shock ................................................................................................ 109

Cardiogenic Shock ................................................................................................. 109

Distributive Shock (abnormal dilation of blood vessels) .............................................. 109

Obstructive Shock (blockage of blood flow in and out of heart) .................................... 109

Symptoms ............................................................................................................ 109

Signs ................................................................................................................... 110

Management ......................................................................................................... 110

Stroke ................................................................................................ 110

Recognition ........................................................................................................... 110

FAST .................................................................................................................... 111

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Other common symptoms of strokes include; ............................................................ 111

Management ......................................................................................................... 112

Section 7: First Aid - Environmental ....................................................... 113

Drowning ............................................................................................ 113

Symptoms ............................................................................................................ 113

Management ......................................................................................................... 113

Dehydration ........................................................................................ 114

Causes ................................................................................................................. 114

Symptoms ............................................................................................................ 114

Management ......................................................................................................... 115

Hyperthermia ...................................................................................... 115

Heat induced illness may be caused by ..................................................................... 115

Factors that may contribute to heat induced illness .................................................... 116

Recognition ........................................................................................................... 116

Management ......................................................................................................... 116

Hypothermia ....................................................................................... 117

Common causes .................................................................................................... 117

Symptoms ............................................................................................................ 117


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Management ......................................................................................................... 118

Section 8: First Aid - Envenomation ........................................................ 119

Pressure immobilisation treatment (PIT) ................................................. 119

Management ......................................................................................................... 119

Pressure bandage application .................................................................................. 120

Please Note ........................................................................................................... 121

Snake bites ......................................................................................... 122

Snake identification ............................................................................................... 122

Types of Venous Australian Snakes .......................................................................... 122

Effects Snake bites ................................................................................................ 122

Signs and symptoms .............................................................................................. 123

Management ......................................................................................................... 123

Spider bites ......................................................................................... 124

Tick, bee, wasp and ant stings ............................................................... 126

Marine stings ....................................................................................... 128

Box Jelly Fish ........................................................................................................ 128

Irukandji .............................................................................................................. 129

Blue Bottle ............................................................................................................ 130

Blue Ringed octopus .............................................................................................. 130

Cone Shell ............................................................................................................ 131

Stone fish ............................................................................................................. 132

Sting ray .............................................................................................................. 132

Section 9: First Aid – Poisoning .............................................................. 134

Poisoning and toxic substances .............................................................. 134

Symptoms ............................................................................................................ 134

Management ......................................................................................................... 135

Common substances causing poisoning .................................................................... 138

Prevention ............................................................................................................ 140

Skills assessment requirements HLTAID003: ........................................... 143

Section 10: References ......................................................................... 144


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LEARNING RESOURCE BOOKLET

Assessment: HLTAID001 Assessment One(1) or HLTAID003 Assessment One (1) and Two (2)

Due Date:

Learning Objectives

At the completion of this unit students will have an understanding of:

Responding to an emergency situation Performing CPR Applying Basic first Aid procedures Communicating details of the incident Evaluating own performance and the incident

Student Instruction

HLTAID001 is to read sections 1-4 learning resource and complete assessments sections 1. HLTAID003 is to read sections 1 – 9 and complete both assessments.

Check list Section Section Title

� Section 1- 4 Read sections 1 - 4 of the learning resource booklet and complete

assessment one (1). HLTAID001 to stop after completing assessment one (1) and will be required to undertake practical assessment on-site.

HLTAID003 is to keep progressing once assessment one (1) is complete.

� Section 5 -9 Section 7- 9

Read sections 5 - 9 of the learning resource booklet and complete assessment two (2).

HLTAID003 to require to undertake practical assessment on-site.


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Section 1: Overview First Aid

“Help given to a sick or injured person until full medical treatment is available,” Oxford Dictionary.

Aim of first aid

• Preserve life – includes the life of the casualty, bystanders and rescuer

• Protect the casualty from further harm

• Provide pain relief – use of ice packs etc.

• Prevent the condition from worsening – ensure the treatment you provide will not make the casualties condition worse

• Provide reassurance and promote recovery of the casualty

(Mckie 2011, p.6)

Preserve life

Protect casualty

Provide pain relief

Prevent the

condition from

worsening

Promote recovery


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First aid management

First aid must take into account

(Queensland Ambulance Services 2014, p1)

Workplace - policies & procedure, safe work practices, industry/site regulations, code of practice, WHS requirements, legislative requirements for State/territory

When first aid is delivered - location & nature of the incident, associated risks - hazards, location of emergency services

Australian Resuscitation council guidelines (ARC) Guidelines from Australian national peak clinical bodies Education & care services national law(as required)

The age, culture, ability or disability of the casualty Legal, social & community responsibilites - stress management techniques, duty of care, respectful behaviour, consent, confidentiality, debriefing, currency of skill & knowledge

Considerations - safety, use of available equipment & resources, duraction & cessation of CPR, use of defibrillator, infection control & any difference between adults & children


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Australian Resuscitation Council (ARC) Guidelines

In 1976 a voluntary coordinating board was formed to promote uniformity and standardisation in resuscitation and for the provision of first aid. Guidelines have been developed and can be accessed via the following link: http://www.resus.org.au/policy/guidelines/index.asp

ARC’s purpose

State/Territory regulations and workplace procedures

Organisations are required by law to have first aid procedures in place. First aid compliance comes under the relevant state or territory OH&S Act.

State OH&S Act Link

ACT Occupational Health & Safety Act 1989

Work safe Australian Capital Territory

New South Wales Occupational Health & Safety Act 2000

Work cover New south Wales

Northern Territory Work Health (Occupational Health and Safety) Regulations

Work safe Northern Territory

Queensland Workplace Health and Safety Act 1995

WorkCover Queensland

Develops and publishes guidelines

Reviews and updates guidelines

Reviews world literature and research

in resuscitation

Act as a resource for authoritative material

on resuscitation


http://www.resus.org.au/policy/guidelines/index.asp

http://www.worksafe.act.gov.au/health_safety

http://www.worksafe.act.gov.au/health_safety

http://www.workcover.nsw.gov.au/Pages/default.aspx

http://www.worksafe.nt.gov.au/home.aspx

https://www.worksafe.qld.gov.au/

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South Australia Occupational Health, Safety and Welfare Act 1986

Safe work South Australia

Tasmania Workplace Health and Safety Act 1995

Work safe Tasmania

Victoria Occupational Health & Safety Act 2004

Work safe Victoria

Western Australia Occupational Safety and Health Act 1984

Work safe Western Australia

First Aid policies and procedures for workplace or industry must include emergency plans, safe work practices for risk & hazard assessment, infection control & first aid procedures in accordance with ARC & clinical peak bodies.

A workplace first aider must be able to:

• Locate and have access to policies and procedures for safety requirements and the provision of first aid for the organisation

Workplace first aid requirements and arrangements will vary depending on:

• Number of people at the workplace

• The size of the workplace

• The location of the workplace

• The nature of work at the workplace

• The type of hazards at the workplace

(Queensland Ambulance Services 2014, p1)

Safe Work Australia was established by the Safe Work Australia Act 2008 with the primary role of improving work health and safety and workers’ compensation arrangements across Australia. Safe Work Australia consists of representatives of the Commonwealth, state and territory governments, the Australian Council of Trade Unions, the Australian Chamber of Commerce and Industry and the Australian Industry Group. It performs its functions in accordance with strategic and operational plans agreed annually by the Select Council on Workplace Relations.

(Safe Work Australia Act, 2008)


http://www.safework.sa.gov.au/

http://www.worksafe.tas.gov.au/home

http://www.worksafe.vic.gov.au/

http://www.commerce.wa.gov.au/WorkSafe/

http://www.comlaw.gov.au/Details/C2009A00084

http://www.safeworkaustralia.gov.au/sites/swa/about/corporateinformation/strat-op-plans/pages/strat-op-plans

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First Aid Code of Practice

Safe Work Australia – first aid in the workplace code of practice

http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/693/First%20aid%20in%20the%20workplace.pdf

Safe Work Australia released the new First Aid in the Workplace Code of Practice in 2015. It provides support and guidance regarding different issues in work, health and safety ensuring compliance with the Work Health and Safety Act (the WHS Act). All states with the exception of Western Australia (WA) and Victoria (VIC) have adopted this Code. However WA and VIC are expected to adopt the code of practice in the future.

Code of Practice on first aid in the workplace provides guidance for:

• Risk management

• The number of first aiders required in a workplace

• The training first aiders must receive

• Who can provide the training

• First aid kit content and location

• Other first aid equipment such as automatic defibrillators (AED),

• Procedures (record keeping & first aid requirements when managing an emergency)

(Safe Work Australia 2012)

First aid kits

Under state and territory legislation fully stocked first aid kits must be made accessible within a workplace. It is vital to ensure quick access to kits in the event of an injury within the workplace. The kits should be clearly labelled, maintained and regularly checked for current contents. The kit should contain basic equipment for administering first aid and workplace specific content will be based on a workplace risk assessment.

(Safe Work Australia 2012, pp.9-10)

WA http://www.vwa.vic.gov.au/__data/assets/pdf_file/0003/8706/First_aid_CC.pdf

VIC http://www.workcover.nsw.gov.au/newlegislation2012/general-risk-management/Pages/first-aid.aspx




http://www.vwa.vic.gov.au/__data/assets/pdf_file/0003/8706/First_aid_CC.pdf

http://www.workcover.nsw.gov.au/newlegislation2012/general-risk-management/Pages/first-aid.aspx

http://www.workcover.nsw.gov.au/newlegislation2012/general-risk-management/Pages/first-aid.aspx

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Legal and ethical requirements

Duty of care

The term ‘duty of care’ is used to describe any legal responsibilities and requirements for people to act in a certain way. As a first aider, when providing first aid to a casualty you have a duty to use the knowledge and skills that you obtained in your first aid training. If you decide to provide assistance to a casualty, you have a duty to provide care to the best of your abilities until the scene becomes unsafe, another trained first aiders takes over, qualified help arrives, the casualty shows signs of recovery or you become physically unable to continue.

(Mckie 2011, p.10-11)

It is important first aiders should not administer first aid management beyond their level of training and own capabilities and ensure they act in “good faith” and without recklessness to provide safe and effective first aid.

It is imperative to maintain currency of skills and knowledge of first aid practices and be aware of changes to legislation, policy and procedures and ARC guidelines in relation to first aid.

(Queensland Ambulance Services 2014, p.2)

Within a workplace – first aiders and staff have a duty of care in a workplace emergency. They should act within their own capabilities to; provide treatment and administer first aid in accordance to policies and procedures, report the incident and self-evaluate and debrief to improve on response for future incidents.


Good Samaritan

‘Good Samaritans’ and Volunteers

A ‘Good Samaritan’ is defined in legislation as ‘a person acting without expecting financial or other reward for providing assistance.’ ‘Volunteers’ are generally defined as ‘a member of a Volunteer organisation performing voluntary community work.’

(ARC guidelines 10.5 2012, p.1)

Lay persons or Volunteers acting as ‘Good Samaritans’ are under no legal obligation to assist a fellow being, that is, they have no legal ‘duty to rescue’. However in The Northern Territory, persons are required by Statute law to render assistance to any other in need.

If the decision is to assist, a standard of care appropriate to their training (or lack of training) is expected. Rescuers need not fear litigation if they come to the aid of a fellow human in need. No ‘Good Samaritan’ or ‘Volunteer’ in Australia, or probably elsewhere, has ever been successfully sued for consequences of rendering assistance to a person in need. Legal protection is provided as all Australian States and Territories have enacted Statutes which provide some measure of protection for the ‘Good Samaritan’ and/or the ‘Volunteer’.

(ARC guidelines 10.5 2012, pp.1-2)

Further information on this can be found at the following link

http://resus.org.au/download/section_10/guideline-10-5-%20july-2012.pdf



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To ensure protection from civil liability it is important:

The person acts in good faith

The persons action was without expectation or reward

They are not responsible for the injury in relation to the assistance provided

They exercised reasonable care and skill

They were not significantly impaired by alcohol or drugs

They was no false representation of their skill or expertise

(Mckie 2011, p.11)

Negligence

Is a breach of duty which has legal as well as ethical repercussions? A person may be deemed negligent if the following factors are present:

1. There was a duty of care between the first aider and the casualty

2. Reasonable care and skill was not exercised by the first aider

3. The first aider breached the relevant standard of care

4. As a result of an act or omission of the first aider the casualty sustained damage

(Mckie 2011, p.11)

Consent

Consent is defined as ‘permission for something to happen or agreement to do something,’ Oxford Dictionary Normally, the consent of an injured or ill person (parent or guardian of a minor) should be obtained before any assistance is rendered. The consent of a child’s parent or (legal) guardian should likewise be obtained. To treat without consent potentially constitutes ‘medical trespass’ (assault) and the victim could recover damages without requirement of proof of injury, causation or negligence

(ARC guidelines 10.5 2012, p.2)

However if the injured person is unconscious, the law allows for implied consent. Implied consent occurs when the first aiders is unable to communicate with the victim. Most commonly, this is because the victim is unconscious or otherwise unresponsive. If the injured person is under 18 the consent of the parent or legal guardian should be obtained (where possible). (Mckie 2011, p.11)


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Further information on consent can be found at the following link: http://resus.org.au/download/section_10/guideline-10-5-%20july-2012.pdf

Privacy and confidentiality requirements

Extreme care should be taken to ensure all information and documentation regarding the casualty remains confidential. It is imperative to abide by the privacy act and also relevant confidentiality policies. The first aider should only release information to authorised personnel.

Privacy Act

The Privacy Act 1988 is an Australian law ‘which regulates the handling of personal information about individuals. This includes the collection, use, storage and disclosure of personal information, and access to and correction of that information.’

(The Privacy Act, 1988)

Confidentiality policies

It is imperative to adhere to confidentiality policies. Each State and Territory will have a specific policy in regards to confidentiality. An example of these policies is the Queensland Government (Queensland Health) Health services Act 1991, Part 7: confidentiality guidelines. This policy can be found at: http://www.health.qld.gov.au/foi/docs/conf_guidelines.pdf

(Health Service Act, 1991’)

Respond in a culturally aware, sensitive and respectful manner towards a casualty

It is crucial to be aware and respectful to the casualties’ customs, traditions and beliefs. Always ensure you have obtained consent to examine or provide treatment to a casualty. Maintain the casualties’ privacy and dignity. You should observe and respect the casualties’ right not to be touched or treated.

(Mckie 2011, p.9)

Documentation & report details of incident to workplace supervisor as appropriate

Verbal reporting

This may be required when transferring information to:

• A supervisor

• A parent/caregiver

• Emergency services



http://www.comlaw.gov.au/Series/C2004A03712

http://www.health.qld.gov.au/foi/docs/conf_guidelines.pdf

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First aider's are required to give an accurate verbal report and convey any details of the first aid provided and the casualty’s response to the treatment. Ensure you give a quick, accurate handover so any appropriate further treatment can be initiated without delay.

(Queensland Ambulance Services, 2014, p.4)

Written reports

No matter how minor the incident it is always important to make notes or fill in a casualty report. These notes or reports will help you recall an incident at a later date.

Workplace written reports

All incidents within the workplace are required to be reported. This includes seemly insignificant incidences including near misses or dangerous occurrences where there is no apparent injury.

When reporting an incident ensure you are attentive to:

Policies and procedures,

State or territory legislation

Privacy and confidentiality requirements

Guidelines and timeframes

Records of incidents must be kept for at least 5 years from the date of the incidents.


Documenting your treatment

Accurate record of treatment

The date and time of incident

Brief personal details (name, address, date of birth)

History of illness/ injury

Observation( signs, symptoms and vital signs)

First aiders assessment of the injury/illness

Signature of first aider

Name of first aider

(Mckie 2011, p.14)


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Example injury report form


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Notifiable incidents

As per The Work Health and Safety Act (WHS) incidents deemed to be ‘dangerous’ or ‘serious’ must be reported to relevant state work health and state authorities or regulators such as work cover.

A ‘notifiable incident’ as outlined in the WHS Act is:

• The death of a person • A ‘serious injury or illness’, or • A ‘dangerous incident’

A ‘notifiable incident’ arises from conduct undertaken at a workplace. ‘Notifiable incidents’ may relate to any person — engaged in activities at the place of work regardless of whether this person is an employee or a contractor. A member of the public regulators must be notified immediately of notifiable incidents.

(The WHS Act, 2011)

Following an emergency situation

Evaluation of own performance

First aiders should always be aware of their skills and limitations. Evaluating your own performance can provide you with valuable opportunities for self-improvement. When involved in a critical incident it is extremely important to recognise there may be ongoing psychological impacts for all involved: yourself, other rescuers as well as children if involved in the incident. It may be beneficial for the first aider to talk to the paramedics who attend the incident.


Signs and symptoms of stress

It is an entirely normal reaction to feel stressed following a first aid response. It is important to pursue available support following a first aid response and to implement appropriate stress management techniques. If you experience difficulty dealing with ongoing emotions in relation to the first aid event, should seek professional health assistance.

Some signs and symptoms of stress following a first aid event include:

Physical Fatigue, headache, insomnia, muscle aches, stiff neck, heart palpitations, chest pains, abdominal cramps, cold extremities, flushing/ sweating, frequent colds

Mental Decreased concentration/ memory, indecisiveness, mind racing/ going blank, loss of sense of humour

Emotional Anxiety, nervousness, depression, anger, frustration, worry, fear, irritability, impatience, short temper

Behavioural Pacing, fidgeting, nervous habits, crying, yelling, swearing, blaming, throwing things, altered eating patterns, smoking, binge drinking, feeling anti-social towards others


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Importance of debriefing

People react differently to traumatic events and what may be a minor event to one person may constitute significant trauma for another. Strong emotions following an incident may affect an individual’s health, well-being and work performance. Symptoms of emotional of an emotional response to a first aid event may appear immediately or in some cases months or years after the original event. In some circumstances, symptoms develop into a chronic illness and require extensive and long-term treatment.

If an incident occurs in the workplace, a debriefing session should be conducted without delay. A debriefing session should be initiated and conducted by a supervisor allowing for an opportunity for discussion and evaluation. The session should be recorded for future improvement and referral. It is important for the supervisor to recognise whether the first aider is suffering emotionally as a result of the incident. It is the supervisor’s responsibility to implement a plan/referral to ensure that the first aider receives the required emotional support and treatment. Where multiple people are involved in a critical incident, the supervisor should initiate a group discussion, meeting or debriefing.


It is important to allow time for those involved to recover from an incident. In stepping forward and offering first aid you have assisted the casualty in dire circumstances. The wise words of the great humanitarian Albert Schweitzer said “the purpose of life is to serve and show compassion and the will to help others.” (Mckie 2011, p.9)

In the workplace – stress management

In workplaces there should be at least one worker in every section of the workplace who has specialist critical incident stress management training.

Critical incident stress management strategies in the workplace include:

Preparing workers for a possible critical incident in the workplace

Demobilisation (rest, information and time out – RIT)

Defusing (immediate small group support)

Debriefing (powerful event group support)

(Better Health Channel, Vic Government, 2011)

Outside the workplace – stress management

Stress management opportunities outside the workplace include:


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Debriefing - with paramedics or colleagues

Recognising the importance to having time out

Consulting professional service for support services

(Better Health Channel, Victorian Government, 2014)

For further information on stress management support available for go to beyond blue

http://www.beyondblue.org.au/

Seek assistance from the emergency response services

If there is available assistance at the emergency scene the first aider can employ help to call the ambulance and obtain appropriate resource such as masks, gloves and defibrillators, depending on the severity of the situation. If there is no assistance at hand the first aider will have to call for help and source resources to the best of their ability.

The ‘phone first,’ concept is recommended by the Australian Resuscitation council especially for suspected cardiac arrest. In cases of severe bleeding the first aider is advised to identify and immediately control any severe bleeding. Severe bleeding is defined as spurting or uncontrolled blood flow; this is a life-threatening condition that must be addressed as quickly as possible.

Australian emergency call service numbers

Triple Zero (000) The primary emergency service number should be used to access emergency assistance from all telephones. To make a call from a mobile on this number you must have reception.

112 The International standard emergency number – can be dialled from a digital mobile phone in areas of GSM network coverage. While a sim card or pin is not required to make a call, phone carriage (from any carrier) must be available to make the call.

106 Text based emergency call service is of assistance to those people who are deaf or have a hearing or speech impairment. This service operates using a teletypewriter service and does not accept voice calls or SMS message.

(An Australian Government Initiative, 2014)

Making a call to an emergency services

http://relayservice.gov.au/making-a-call/emergency-calls/





28

Making the call

• From a safe place dial the emergency service number

• Always ask for the service you need - police, fire or ambulance.

• You will need to state or confirm your location. This will help route the call to the closest emergency services operator as quickly as possible.

• Don't hang up. Wait for a reply from the emergency service.

• Be ready to explain the emergency

When a call is made to an Ambulance Service a trained emergency medical dispatcher will ask the caller a number of questions. Remain calm while answering these questions and ensure that your responses are clear and concise. The questions are likely to include the following:

What is the exact location of the incident/accident?

What is the phone number from which you are calling?

What has happened?

How many people are sick/hurt?

What is the nature of the casualty’s injuries?

Are you with the casualty now?

How old is the casualty?

Is the casualty conscious?

Is the casualty breathing?

Emergency medical dispatcher will provide you with first aid instructions and dispatch the paramedics. Do not end the call until you are told to do so by the emergency medical dispatcher.

(Queensland Ambulance Services, 2013)

Making the casualty comfortable

Ensure the casualty is as comfortable as physically possible. Covering the casualty to keep them warm or providing pain relief using bandages and slings, hot or cold packs etc.


If you are operating first aid equipment that is readily available you should comply with the manufacturer’s instructions. If first aid resources are not available at the scene you should improvise using appropriate items to achieving casualty comfort and safety.


29

Identify Hazards

A hazard anything likely to cause an injury or illness

A RISK - likelihood and consequence

of an injury or illness from a

hazard

Identify Risks

For a Hazard there may be one or more risk factors e. chemical - poses toxic risk if contact

is made with, it may also be highly flammable/ give off harmful fumes

Prioritise Take action, use safety precautions, remove, control & minimise hazards and associated risks. Inform and direct others in order to

make the area safe

Review controls

Safety is an ongoing process. Ensure control are working, if safe proceed. Make any

adjustment or improvements to controls if hazards or risks are still present, check again

and proceed

Ensure you consistently monitor and reassure the casualty. The first aider should respond to any changed in the casualties condition in accordance with first aid principles


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

Personal safety is of utmost importance when delivering first aid. To ensure the scene is safe consider:

• Quickly identifying hazards

• Conducting risk assessment for hazards

• Employing risk assessments measures to determine what action is required to make the scene safer

• Determine whether it is safe to proceed

Emergency scene assessment


Examples of dangers to be aware of when assessing safety


30

Hazards Risks they may pose Examples to minimise risk/s

Aggressive behaviour

Being attacked Get help, remain calm, be reassuring, don’t continue if they remain aggressive

Body fluids Being infected Personal protective equipment (PPE), gloves, eye wear, aprons etc.

Chemical fumes/ biological

Being poisoned Wait for professionals to declare the area safe, use PPE, shut down power, consult safety data sheet (SDS) to identify the substance

Environment (e.g. Storms, snow, wind, rain)

Falling or tripping

Being struck by falling or flying objects

Too hot or cold

Protect the area with a cover, move to a safer area

Fallen power lines Electrocution Contact authorities to shut down power, use non-conductive materials to remove casualty

Fire Being Burnt

Risk of explosion

Falling or collapse of building

Being trapped

Smoke

Extinguish fire if you are trained and it is safe to do so, remove sources or casualty to a safe are, call fire and emergency services & wait for them if unsafe

Lifting or moving heavy objects or casualties

Back injuries Safe manual handling, ask others for help, use devices such as back boards

Machinery Being injured by equipment

Failure of equipment

Shut down or shield dangerous moving parts

Needle stick injuries

Being stuck by needle and being contaminated

Relocate: move away from needles, advise others of danger, don’t pick up

Traffic Being hit by a vehicle Move to a safer location, put up warning signs, position vehicles, have other direct traffic, slow vehicles down or stop


Infection control


31

Precaution should always be taken when providing first aid to ensure your safety and the safety of others.

Infectious diseases

Infectious diseases are diseases which can be transmitted from one person to another.

Infectious agents (also called pathogens) are biological agents that cause disease or illness to their hosts Infection requires three main elements—a source of the infectious agent, a mode of transmission and a susceptible host.

Main modes for transmission of infectious agents are

• Contact (including blood borne),

• Droplet (sneezing or coughing)

• Airborne (ventilation and air-conditioning systems)

(Australian guidelines for the Prevention and control of infection in Health care, 2010)

Standard precautions

Includes:

• Hand hygiene

• Use of personal protective equipment (PPE)

• Appropriate handling and disposal of sharps

• Appropriate handling and disposal of waste

• Cleaning techniques

• Managing spills of blood and body substances

(Safe Work Australia, 2012)

infectious diseases

Contact

Droplet

Airborne


32

In the workplace procedures

To protect individual workplaces you should adopt the following procedures:

• Proper hand hygiene practices

• Correct handling and disposal of sharps

• Correct cleaning of surfaces and reusable equipment

• Appropriate management of spills and soiled laundry

• Appropriate handling and disposal of waste

• Appropriate use of personal protective equipment, for example, using resuscitation masks for cardiopulmonary resuscitation


http://www.healthtranslations.vic.gov.au/bhcv2/bhcarticles.nsf/pages/First_aid_basics

In the workplace for healthcare providers:

The World Health Organisation (WHO) has published a guide to hand washing based upon current best practice in reducing infections.

http://www.who.int/gpsc/5may/Guide_to_Implementation.pdf?ua=1

SAVE LIVES: ‘Clean Your Hands’ is an initiative that aims to ensure an ongoing global, regional, national and local focus on hand hygiene in health care. It encourages health-care workers to clean their hands

1. Before touching a patient

2. Before clean/aseptic procedures

3. After exposure to body fluid

4. After touching a patient

5. After touching patient surroundings

Providing first aid

Clean your

hands

before touching a

patient

before clean/aseptic proceudres

After body fluid

exposure

After touching a

patient

After touching a

paitent surroundings


http://www.healthtranslations.vic.gov.au/bhcv2/bhcarticles.nsf/pages/First_aid_basics

http://www.who.int/gpsc/5may/Guide_to_Implementation.pdf?ua=1

33

If required to deliver first aid where possible you should wash your hands with soap and water or apply alcohol based hand rub. Where available wear PPE, such as eye protection, a mask or protective clothing to protect you from any splashes from blood or body substances.

At the completion of first aid wash your hands with soap and water or apply alcohol based hand rub.


Accidental contamination

If any part of the body that comes in contact with blood or body substances you should immediately wash skin with soap and water. Prompt medical advice should be obtained in the event of: contact with blood or body substances contact with a person known to have a contagious illness or a sharps injury. All first aiders should be offered hepatitis B virus vaccination.


Contaminated items

Waste disposal should comply with state or local government requirements. Ensure you comply with organisational workplace policies and procedures. Contaminated sharps including scissors and tweezers should be disposed of in a rigid-walled, puncture-resistant sharps container by the person using them.

Cleaning spills

Cleaning should commence to remove any blood or body substances as soon as possible after an incident. Protection such as gloves, PPE: eye protection, plastic aprons and masks should be worn. Contaminated surfaces should be cleaved with warm soapy water.


Manual handling

Manual handling involves the active use of force by a person to lift, lower, push, pull, carry, move, hold or retain a person. Most injuries occur to the back as the spinal column is not designed to withstand abnormal flexion under load. Injuries are often the result of poor manual handling and therefore can often be avoided by following correct procedures.

(Active first aid 147, Qld ambulance 9)

Identify and assess the risks

• Is manual handling essential?

• What options are available?

• Is the right person involved?

Consider


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The weight, size and shape of the casualty, the distance the casualty is to be carried, the height the casualty will have to be lifted. Take into account lifting techniques, observe your personal limitations and employ available help or mechanical devices

(Mckie 2011, p.148)

Steps for correct lifting or moving a load

Assess the situation

Position legs apart – on foot level with the load

Keep back straight, look up and keep your head straight

Bend from hips, avoid ‘twisting’ the body

Bend the knees

Keep the casualty close to your body

Keep carrying distance short

Avoid changing grip or jerking the load

Deposit the load by bending the knees and keeping the back straight

If pushing or pulling let the legs do the work

(Mckie 2011, p.148)

Moving the injured

If possible do not move the casualty as movement may increase pain, injury, blood loss and cause their condition to deteriorate. There are reasons for the need to move the injured casualty and these include:

To ensure the safety of yourself and the casualty

To protect from extreme weather conditions

Difficult terrain – making it impossible to treat

To prepare for evacuation from a remote area (e.g. Helicopter)

Weight Size & shape

distance

height


35

To care for airway of casualty by turning them on their side or back for CPR

To gain access to casualty to control severe bleeding

To conduct a basic triage for a multiple casualty incident


If more than one first aider is present the most experienced first aider should take charge and clearly explain the method of movement to the casualty (if conscious) as well as to the assistants.

Safety

• Ensure safety

• Inform the casualty of your intentions – an uniformed casualty may suddenly attempt to grab onto something

• Use available resources – such as spine board, stretchers, blankets

• Use resources as per manufactures requirements

• Follow manual handling safe practices

• Avoid bending or twisting the casualties neck and spine

• If three (3) or more people are available have them assist with the support of the head and neck, chest, pelvis and limbs

Moving techniques

Emergency Moves

Clothing drag

Blanket/ sheet drag

Bent arm drag

Dragging the casualty by their clothing

Dragging the casualty using a blanket or sheet

Reach under the casualty’s armpits from behind, grasp the forearms or wrists and drag

Non- emergency Moves

Direct ground lift

Extremity lift

Blanket lift

Draw sheet method

Log roll

2-3 rescuers to lift with a stretcher

Not if spinal injury suspected, short distances

Not for head/spinal injury casualties

Roll casualty from bed to stretcher

Trained


Spinal immobilisation


36

Aim to maintain casualties head aligned with body avoiding side to side movements

Manual stabilisation

• Standing behind an upright/lying/kneeling casualty

• Hold casualties head firmly, stabilise arms by locking elbows together or resting elbows on the ground

Cervical collars

• To be used by those trained in application methods

• Should only be removed by trained personnel who can clinically assess the neck of a spinal injury

• Adverse effects associated with their use (discomfort, pain, restriction mouth, difficulty swallowing, compromising airway)

Spinal boards

• Rigid boards placed under casualty

• Casualty should be adequately immobilised prior to moving them

• Can be uncomfortable so do not leave casualties on for an extended period of time

Types of spine boards or stretcher

Short backboard Spinal injury suspected

Casualty in seated position

Long backboard Spinal injury suspected

Rapid extrication required

Provides secondary support to short backboard

Flexible stretchers Not for spinal injuries

For limited space, stairs, cramped corners etc.

Basket stretchers Rescue situation

Winching casualty with helicopter

Scoop (orthopaedic) stretcher

Not for spinal injuries

Lift patient from ground without changing their position

Good for confined spaces

Can be placed with casualty onto a wheeled stretcher for transfer

Stair chair Casualties that can sit up

Useful for stairs or narrow passageways


37

Transfer to ambulance stretcher once ambulance arrives

Portable/ folding stretchers

For use to when going downstairs, navigating rough terrain, moving from a narrow spot

Easily loaded on/ off ambulance

Basic/breakaway with folding wheels

Wheeled stretchers

2 basic types;

I person – special wheels to roll in with

2 person – lift in/ carry into narrow spaces with a rescuer on each side, it has adjustable height and angles and additional equipment can be attached

Children/Infants

• Following traffic accident – if possible conscious infants/children should be left in seat or capsule.

• Remove the child from car whilst still in seat.

(Queensland Ambulance Services, 2014)

Recognise an emergency situation

Observations

Examples

Medical Emergency

Sudden illness

Example heart attack

Requires immediate

medical attention

Injury

damage to body from a violet

force

eg. broken arm

If serious enough can be considered

an emergency situation


38

• Sound of someone in distress

• Spilled chemical container

• Unusual behaviour (e.g. panic)

• Casualty with signs and symptoms

Priorities in an emergency

Early recognition is a key step in initiating early management of an emergency situation.

In all emergencies, the rescuer should:

• Assess the situation quickly

• Ensure safety for the rescuer, casualty and bystanders (this may mean moving the casualty)

• Send for help (call an ambulance)

• If the casualty is unresponsive and not breathing normally, follow the australian resuscitation council basic life support flowchart

Emergency action Plan (Queensland Ambulance Services, 2014, p6)


39

CD (CPR, Defibrillation) Until help arrives

AB (Airway, Breathing) Open Airway, are they breathing YES- turn them on side,

NO - then CPR

ASSESS WHAT TO DO NEXT (Send for help)

If you need further assistance, coordinate others to call for help (ambulance) & get resources

Provide First Aid following first Aid procedures and principles, & continue monitor and reassure casualty unil help arrives

ASSESS THE CASUALTY (Response)

Obtain consent, assess casualty recognise need for first aid, check vital signs, injuries, signs & symptoms

Are they alive, responding, moving, are there signs of life, are they unconscious, if conscious seek consent, communicate

appropriately, sign & symptoms, are injuries/ illness serious or minor

ASSESS THE SCENE (Danger)

Identify, assess, manage immediate hazards. If not safe call for assistance from emergy services. Do not attempt to make

a response if dangerous

Check & remove hazards Protect yourseld & others

Use PPE Protect casualty from danger


40

Section 2: Basic Anatomy & Physiology

Basic anatomy and physiology

It is important and useful for a first aider to have a basic understanding of the body’s major systems and function. This knowledge will assist in assessment of the casualty in their diagnosis and provide a basis for the casualties care and treatment. There are differences between infants, children and adults. Body positioning and treatment aids for resuscitation and CPR will be different and will be discussed section 3 CPR. The differences in pulse and respirations for different age groups are listed below. It is important to note care is always needed to ensure that the casualty does not sustain damage or injury to airways when providing CPR. A child’s airway is narrower and tracheal cartilage is softer and smaller in length and diameter.

Average vital signs by age group

AGE PULSE

(per minute)

RESPIRATIONS

(per minute)

BLOOD PRESSURE

(MM HG)

Newborn 120-160 40-60 80/44

1 year 80-140 30-40 82/44

3 years 80-120 25-30 86/50

7 years 70-115 20-25 94/54

15 years 70-90 15-20 110/64

Adult 60-100 12-24 120/80


Response/ consciousness

If there is a sudden drop in oxygen and blood to the brain – this will cause the casualty to faint or fall unconscious. If the casualty is not breathing normally oxygen will not be able to travel to the brain via the blood, causing the brain to cease functioning.


41

Breathing

Breathing is essential to maintain life. Breathing may be absent or ineffective as a result of:

• Direct depression of/or damage to the breathing control centre of the brain

• Upper airway obstruction

• Paralysis or impairment of the nerves and/or muscles of breathing

• Problems affecting the lungs

• Drowning

• Suffocation

To assess breathing it is important to

• LOOK for movement of the upper abdomen or lower chest

• LISTEN for the escape of air from nose and mouth

• FEEL for movement of the chest and upper abdomen

(ARC Guidelines 5 2010, ‘Breathing,’ p. 1)

In an unconscious person, the muscles becomes relaxed – and the tongue can fall into the back of the throat blocking the airway. Other soft tissues in this areas may also contribute to airway obstruction. The mouth will often fall open which but tends to block rather than open the airway. An unconscious person is unable to swallow or cough out foreign materials.

Positioning an unconscious casualty on their side maintains a clear airway & allows fluid to drain. This reduces the risk of inhaling foreign objects i.e. stomach contents.

(ARC Guidelines 4 2014 ‘Airway,’ 2014, pp. 1-3)

Body systems

There are 11 main systems of the body. When a person is injured or becomes ill it affects one or more of the body systems.


42

11 Main systems

Integumentary Includes: skin, hair, fingernails & toenails

Skin is the largest organ & protects the body from infection

(Mckie 2011, p.15-17)

Skeletal Comprised of 206 name bones, cartilage, ligaments & tendons

The system is responsible for:

• Supporting the body against the pull of gravity

• Producing body movement by working together with muscles as a mechanical lever

• Protecting soft body parts

• E.g. Vertebrae protects spinal cord


(Waugh A & Grant A 2014, p.48)


43

Muscular System - comprised of special cells called muscle fibres.

3 types of muscle tissue

• Skeletal (helps body to move)

• Smooth (involuntary – located inside organs such as stomach)

• Cardiac (found in the heart has an involuntary motion)

Muscle tissue can contract & expand allowing the body to move & function. The system is responsible for

• Movement

• Heat production

• Protection

• Controlling the size of blood vessels & bronchioles

• Peristalsis (“milking” action of gastrointestinal organs)

• Posture & Joint stability

(Mckie 2011, pp.15-17)

(Waugh A & Grant A, 2014, p.14)

Endocrine Involves organs & glands that secrete chemicals in the form of hormones to stimulate and activate the body’s functions.

E.g. Pancreas – releases insulin & influences the bodies metabolic process

(Mckie 2011, pp.15-17)



44

Nervous Made up of central nervous system and peripheral nervous system

Central Nervous System

Brain & spinal cord

Brain – controls all functions of body & is most complex system

Brain regulates all body functions – including respiratory & cardiovascular system

Spinal cord – delivers the signals to all parts of the body

Peripheral Nervous System

Motor & sensory nerves – involves movement

Directed by brain

Breathing is attributable to these nerves

(Mckie 2011, pp.15-17)

(Waugh. A & Grant A, 2014, p.10 & p.145)

Digestive Includes: oesophagus, stomach & intestines

Oesophagus & stomach

- Fluids & solids pass through & are processed for further digestion

- These products are then absorbed through membranes of the intestines

(Mckie 2011, pp.15-17)



45

Cardiovascular/

Circulatory

Systems involves

• Heart

• Blood vessels (arteries, veins & capillaries)

• blood

Heart –pump that drives blood around the body

Arteries – take blood from the heart

Vein – return blood to the heart

Blood – medium that transports oxygen from respiratory system to the body’s cells. Also transports sugars, chemicals, proteins, hormones & other substances for the body to use or eliminate

Pulse can be found at various locations in the body, heart rate is the number of heart beats per unit of time – expressed as beats per minute (bpm)

(Queensland Ambulance Services, 2014, pp19-20)


Lymphatic Slow moving system – provides lymphatic fluids which drain from the body’s tissues

Flushing mechanism- which drains lymphatic fluid from the body’s tissues

Most absorbed or injected toxins & infections are collected by the lymphatic systems and strained through lymph nodes in the armpits, neck and groin. The lymphatic fluid does eventually drain into the blood system

(Mckie 2011, pp.15-17)



46

Respiratory Composed of Airways - mouth, nose, pharynx (throat), trachea, larynx (voice box), bronchi and bronchioles) & the lungs & a breathing muscles called the diaphragm

• Breathing (pulmonary ventilation)

• Provides oxygen to the blood & takes away the waste product carbon dioxide.

• Also helps regulate the pH of the blood

• The blood & tissue cells utilise the oxygen for specific activities

Inspiration (inhalation) – the process of taking air into the lungs

Expiration (Exhalation) – the process of letting air out of the lungs

IF THERE ARE NO SIGN OF INSPIRATION & EXHALATION – the situation is critical



Urinary Includes: kidney, bladder & urinary tract

Vital role in keeping the body healthy by flushing waste products suspended in fluid from the body

If this system fails a person will require external assistance to rid the waste products from the blood, especially for kidneys. This is called dialysis

(Mckie 2011, p.15-17)

(Waugh. A & Grant. A, 2014, p.10)


47

Reproductive Linked to endocrine systems

Female reproductive systems

- Ovaries (produce human egg)

- Uterus (where the fertilised egg is lodged)

- Vagina

Male reproductive system

- Testes (produce sperm)

- Seminal vesicles (provide fluid medium for sperm)

- Penis


(Mckie 2011, pp.15-17 & Queensland Ambulance Services 2014, pp.19-20)


48

Section 3: Emergency Assessment Management of an emergency situation

The rescuer should initiate early management of an emergency situation by following steps of DRS ABCD

(Australian Resuscitation Council Guidelines 8, 2010, p. 4)

Danger

• Assessing the situation quickly

• Ensuring the area is safe for the first aider, the victim and bystanders (this may require moving the victim)

• Send for help (call an ambulance)

Where there is more than one victim – the care of an unconscious victim has priority.

Response

• Try to get a response using verbal and tactile stimuli (‘talk and touch’)

• Gently shake the casualty’s shoulders if they appear unconscious and ask firmly “can you hear me?”

• Ask the casualty to squeeze your hand

• If the casualty responds assess the state of consciousness (slurred speech, dizzy etc.)

D • Dangers?

R • Responsive?

S • Send for help

A • Open Airway

B • Normal Breathing?

C • Start CPR

D • Attach Defibrillator (AED)


49

Send for Help

• If they are not responding treat as unconscious and immediately call the ambulance

(Queensland Ambulance Services, 2014 p.12)

Casualty assessment

1. Primary Assessment – follows the DRSABCD – try to get a response from victim

2. Verbal secondary survey – “no touch technique” – visual & verbal examination of injuries. Consent should be gained from conscious victim or carers.

Evaluate treatment required with injuries found during assessment

History

• Complete story of accident or illness

• Vital to work out what’s wrong with the casualty

• Included previous or current health conditions and medications

• Casualty, bystanders or relatives – suggested questions to ask

“Does the casualty suffer from any allergies?”

“Are there any previous relevant illnesses?”

“Is the casualty on any medications?”

“Has this happened before?”

“What was the casualty doing at the time?”

“What signs or symptoms were they showing?”

Remember using AMPLE history

A Allergies

M Medication (anticoagulants, insulin and cardiovascular medication)

P Previous medical/ surgical history

L Last meal (time)

E Events/Environment surrounding the injury: i.e. Ask the casualty/ bystander exactly what happened?



50

Observations

Signs

Look for visible signs of injury or illness – e.g. Is the casualty pale, sweaty or bleeding?

Symptoms How does the casualty feel?

If the casualty is conscious ask if they are suffering from a headache? Or are you in pain?

Blood loss If person losses blood, blood pressure falls & casualty will have a pale, cold, clammy skin.

Pulse is faster than normal and they may be thirsty

Another indicator of blood loss is the colour of the tongue- pale means blood loss

If blood pressure is adequate – the colour of the skin would immediately return when you press and release pressure. If pressure area is pale after 2 seconds it indicates blood pressure is low which may be a cause for concern

Skin Colour

Pale skin colour – significant blood loss

Blue colour to ear lobes, lips or fingers – indicate reduced oxygen


Secondary survey -

Site Survey & check for

Head Bleeding

Fractures

Bruising

Swelling

Tenderness or pain

Clear colourless fluid from ears

Loose teeth – or inability to open mouth or talk

Neck Bleeding

Fractures

Bruising

Swelling


51

Deformity

Tenderness or pain

Numbness or tingling

Check for medical alert necklace

As casualty to wiggle fingers and toes

As casualty to squeeze your hands – to check for strength

Chest & shoulders

Bruising

Swelling

Look for rise & fall of the chest (both sides)

Listen for noisy breathing (obstructed airway)

Look for deformity of the ribcage or rapid breathing

Ask – “Do you have pain when you move or breathe?”

Abdomen & pelvis

Bruising

Swelling

Ask – “DO you feel pain in the abdomen, if so where is the pain?”

Arms & Legs

Bleeding

Fractures

Soft tissue inquiries

Loss of strength

Check for medical alert bracelet

Check for circulation in extremities

Ask – “Do you feel any unusual sensation,” e.g. numbness, coldness or tingling?

Ask- “Do you feel any pain?”

Back & Spine

Ask how the back feels, any pain, tingling, numbness?

If you are completely sure there is no injury to the spinal cord & there are no injuries which require attention – log roll the casualty carefully and look for:

Bleeding

Deformity

Bruising

(Mckie 2011, p.24)


52

Levels of consciousness

Conscious A person talking walking, doing normal things

Unconscious The casualty cannot be roused, is unresponsive is unaware of their surroundings and no purposeful response can be obtained.

The casualty is unable to be woken – unresponsive, appears to be asleep. Still breathing with a pulse

Cardiac Arrest A collapsed casualty – unconscious & not breathing normally or at all


The conscious casualty

Complete

1. Primary survey or initial assessment

2. Follow the secondary survey – where possible do not touch the casualty. Ask the casualty questions and observe and note the answers given

3. Ensure you complete a thorough examination – to avoid not missing something serious like a spinal injury


The unconscious breathing casualty

The causes of unconsciousness can be classified into four broad groups:

• Low brain oxygen levels

• Heart and circulation problems (e.g. fainting, abnormal heart rhythms)

• Metabolic problems (e.g. overdose, intoxication, low blood sugar)

• Brain problems (e.g. head injury, stroke, tumour, epilepsy).

May be a combination of causes, to help evaluated follow AEIOUTIPS

A Alcohol (i.e. Too much)

E Epilepsy (e.g. a seizure)

I Insulin (e.g. too much or too little insulin in the body)


53

O Overdoses (e.g. Heroin/ sleeping tablets/ medication)

U Under dose (e.g. insufficient dose of medication) or Uraemia (renal failure – difficult to diagnose)

T Trauma (e.g. Accidents, falls, severe blood loss)

I Infections (e.g. to the brain)

P Poisoning (e.g. poisonous substance or substance misuse, or Psychiatric (e.g. Mental health issues or pretending to be unconsciousness to receive or avoid medical attention)

S Stroke


Management

With an unconscious breathing victim, care of the airway takes precedence over any injury, including the possibility of a spinal injury. All unconscious victims must be handled gently and every effort made to avoid any twisting or forward movement of the head and spine.

1. Ensure safety of victim and rescuer.

2. Assist victim to the ground and position the victim lying on the side. Ensure the airway is open (see below)

3. Call an ambulance.

4. Stop any bleeding promptly

5. Constantly re-check the victim’s condition for any change.

6. Ideally, the most experienced rescuer should stay with the victim

(ARC Guidelines 3, 2012, pp.1-2)

Airway

It is essential to maintain the airway and ensure the tongue, fluids or other objects do not cause an obstruction. In an unconscious person, muscle becomes relaxed and the casualties tongue can fall into the back of the throat and block the airway. Other soft tissues of the airway may worsen this. The mouth will often fall open but tends to block rather than open the airway.

Positioning an unconscious casualty on side maintains a clear airway & allows fluid to drain & reduces the risk of inhaling foreign objects (i.e. stomach contents). If possible have an extra person support the head of the casualty however no time should be wasted


54

Method for turning victim onto their side

Single first aider

• Kneel beside casualty

• Make sure both legs are straight

• Place arm nearest to you at right angles (90◦) to body

• Bring arm farthest from you across the chest and place back of hand under casualty’s cheek

• Using other hand grasp farthest leg just above knee and pull it up, ensuring foot on ground

• Keeping hand under casualty’s cheek, pull leg towards you to toll casualty on their side

• Adjust upper leg so both the hip and knee are bent at right angles

(Mckie 2011, p.6)

Multiple first aiders

• Head support and spinal alignment is much easier to maintain with two (2) or more first aiders

(Mckie 2011, p.6)

The unconscious non- breathing casualty

If the victim is unresponsive and not breathing normally, immediately follow the steps for the chain of survival (covered in section 3) and follow Australian Resuscitation Council and New Zealand Resuscitation Council basic life support flowchart (ARC Guidelines 3 2012, pp1-2).

(ARC Guidelines 8 2010, p.4)


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Section 4: CPR Breathing may be absent or ineffective as a result of:

Upper airway obstruction Cardiac arrest

Problems affecting the lungs Drowning

Suffocation Paralysis or impairment of the nerves and/or muscles used for breathing

Cardiac arrest

Cardiac arrest is the single largest cause of death. Cardiac arrest is a term that describes when the casualty who is unconscious, unresponsive not breathing normally or at all and not moving. To increase the chance of saving a cardiac arrest casualty outside of a hospital setting, ensure you follow the chain of survival.

Chain of survival

(Australian Defibrillators 2014)

Early Access Early activation of the ambulance service

Access to advanced skills and equipment

Early CPR Casualty chance of survival significantly increases if CPR commences promptly

CPR- maintain blood flow & supply of oxygen to the body’s vital organs until ambulance arrives

Early defibrillation

Defibrillation – designed to stop dangerous heart rhythms & assist the heart to regain a normal rhythm and recommence effective circulation to oxygenate the vital organs.

Success to survival is to initiate defibrillation as soon as possible

Some major sporting grounds, public venues, service clubs and shopping centres have their own defibrillators & staff trained to use them


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Early advanced care life support

Arrival of ambulance – paramedics carry and are trained in the use of advance cardiac drugs and life support equipment – to increase chance of survival and stabilisation of casualty prior to departing to hospital

Definitive care is available at hospital – higher


Cardiopulmonary resuscitation - (CPR)

In victims who need resuscitation, bystander CPR dramatically increases the chance of survival Cardiopulmonary resuscitation is the technique of chest compressions combined with rescue breathing. The purpose of cardiopulmonary resuscitation is to temporarily maintain a circulation sufficient to preserve brain function until specialised treatment is available.

Rescuers must start CPR if the victim is unresponsive and not breathing normally. Even if the victim takes occasional gasps, rescuers should start CPR. CPR should commence with chest compressions. Interruptions to chest compressions must be minimised. Bystander CPR rarely leads to harm in victims who are eventually found not to have suffered cardiac arrest: bystander CPR should be actively encouraged.

Compression-ventilation ratio

Current consensus is that a universal compression-ventilation ratio of 30:2 (30 compressions followed by two ventilations) is recommended for all ages regardless of the numbers of rescuers present.

Compressions must be paused to allow for ventilations.

No human evidence has identified an optimal compression-ventilation ratio for CPR in victims of any age.

Steps of resuscitation

Initial steps of resuscitation are:

DRS ABCD

• Check for danger (hazards/risks/safety)

• Check for response (if unresponsive)

• Send for help

• Open the airway

• Check breathing (if not breathing / abnormal breathing)

• Give 30 chest compressions (almost two compressions/second) followed by two breaths

• Attach an AED (automated external defibrillator) if available and follow the prompts.

When providing 30 compressions (at approximately 100/min) and giving two breaths (each given over one second per inspiration), this should result in the delivery of five cycles in approximately two minutes.


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Chest compressions only

If rescuers are unwilling or unable to do rescue breathing they should do chest compressions only. If chest compressions only are given, they should be continuous at a rate of approximately 100/min

Multiple rescuers

When more than one rescuer is available ensure:

• An ambulance has been called;

• All available equipment has been obtained (e.g. AED).

Duration of CPR

Rescuers should minimise interruptions of chest compressions and CPR should not be interrupted to check for response or breathing. 1 Interruption of chest compressions is associated with lower survival rates.

The rescuer should continue cardiopulmonary resuscitation until: 1

• The victim responds or begins breathing normally

• It is impossible to continue (e.g. exhaustion)

• A health care professional arrives and takes over CPR

• A health care professional directs that CPR be ceased

Risks

The risk of disease transmission during training and actual CPR performance is very low. A systematic review found no reports of transmission of hepatitis B, hepatitis C, human deficiency virus (HIV) or cytomegalovirus during either training or actual CPR when high-risk activities, such as intravenous cannulation were not performed.

If available, the use of a barrier device during rescue breathing is reasonable.

After resuscitation all victims should be reassessed and re-evaluated for resuscitation-related injuries.

(Queensland Ambulance Services 2014, pp.16-17)


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CPR

Manage airway

Roll onto their back

Open airway – adults (use head tilt/chin lift manoeuvre),

infants under 1 year old (do not tilt head – just support jaw and keep mouth open)

Backwards head tilt/ chin lifts – ADULTS:

Place one hand on their forehead, the other hand providing a chin lift. Hold chin up – with a pistol grip using thumb and fingers

Tilt head backwards (NOT the neck) – the jaw is held slightly open and pulled away from the chest

Avoid excessive force

(ARC Guidelines 4 ‘Airway’ 2014, pp. 1-3)

For Infants <1years old gently support the lower jaw a t the point of the chin maintaining an open mouth

(ARC Guidelines 4 ‘Airway’ 2014, pp. 1-3)


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Breathing After unconscious casualty airway is cleared – check whether the casualty is breathing

Look & feel – for movement of upper abdomen or lower chest

Listen – for escape of air from nose and mouth

It is important to note: movement of lower chest & upper abdomen does not necessarily mean the victim has a clear airway.

(ARC Guidelines 5 2010, ‘Breathing,’ p. 1)

CPR Alternate 30 compressions: 2 rescue breaths alternatively & continuously until recovery, defibrillator arrives, someone else takes over or you are directed to stop by a medical professional

During CPR if airway becomes obstructed – roll onto side & clear & reassess response & breathing then recommence CPR

CPR can be conducted as a single operator or 2 operators

Rescue Breaths

Chest compressions: should be paused when doing rescue breaths & defibrillation

The casualty should be on their back on a firm surface. Compressions should be applied to the centre of the chest, rhythmically 100 compressions per minute & one third depth of the chest. This equates to more than 5cm in adults, approximately 5cm in children and 4 cm in infants

(ARC Guidelines 6 ‘Compressions,’ 2014, p. 1)

If 2 operators are available rotate every 2mins to reduce fatigue

Rescue breaths- mouth to mask (preferable), mouth to mouth, mouth to nose (infants/small children) or rarely mouth to stoma

Steps:

Kneel beside head

Maintain open airway

Blow a rescue breath (either with mask ensure tight seal/ or mouth create a seal with your mouth over theirs). Draw away slightly from the casualty to allow exhalation. Turn your head to listen & feel for release of air

If chest does not rise, it may be due to

• Obstruction in the airway


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• Insufficient air being blown in the lungs

• Inadequate air seal around mouth or nose

If this is the case recheck head tilt again, lift chin & ensure adequate seal & ventilation

Administer two (2) breaths & go back to compression

Protection:

Use mask & gloves if available (not mandatory). The risk of disease transmission is very low

(ARC Guidelines 5, 2010, ‘Breathing,’ p. 3)

For mouth to mask – position yourself at the victims head & use both hands to maintain an open airway & hold the mask in place to maximise the seal. The narrow end of mask should be on the bridge of the nose, applied firmly, whilst maintaining head tilt and chin lift.

Blow through mouth piece

The most common cause of obstruction during resuscitation is caused by a failure to maintain head tilt and chin lift

(ARC Guidelines 5, 2010, ‘Breathing,’ p. 3)

Compression Only CPR:

If unwilling / unable to do recue breaths – do compressions only. DO compressions continuously only pausing if a response or breathing returns or for defibrillation handover


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Infants under 1 year old

Children

Pregnant women

Two finger technique should be used by lay (untrained) rescuers in order to minimise transfer time from compression to ventilation. Having obtained the compression point the rescuer places two fingers on this point and compresses the chest


One or two hand technique can be used for performing chest compressions in children


“There are no published studies of optimum positioning


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in pregnant women undergoing cardiopulmonary resuscitation so recommendations to date are extrapolated from manikin studies or studies of pregnant women who are not in cardiac arrest. Good quality, uninterrupted chest compressions as described above should be the immediate priority in all pregnant women who are unresponsive and not breathing normally.”

(ARC Guidelines 6 ‘Compressions’ 2014, p. 3)

“In noticeably pregnant women, standard CPR should be commenced immediately. Once CPR is in progress, if there are sufficient resources available, rescuers should place padding such as a towel, cushion or similar object under the right hip to tilt the casualties hips slightly (approximately 15-30 degrees) to the left but leave the victim’s shoulders flat to enable good quality chest compressions. The reason for this position in pregnant women is to move the weight of the pregnant uterus off the victim’s major blood vessels in the abdomen. If a tilted position is not possible or tilting the victim’s hips compromises the quality of chest compressions, then chest compressions should be performed as described as above with the victim on their back.”



Defibrillation with AED

Automated external defibrillator (AED) – accurately identify

Use as soon as possible

Continue CPR until AED turned on & pads attached (to


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cardiac rhythm as “shockable” or “non-shockable”

Anyone can use

Formal training can assist with confidence in use & increase the speed of use& correct pad placement

bare chest),

Attach leads to AED, allow AED to analyse & stand clear (do not touch casualty during the shock delivery)

Continue to follow AED prompts – AED decision on what to do until responsiveness & normal breathing returns, ambulance arrives & takes over CPR

Pad Placements – on bare chest – have diagrams on outer covering to demonstrate placement – avoid placing over implantable devices


Standard AED pads – suitable for children older than 8 years of age

Paediatric pads – used for children 1 – 8 years old – if not available use standard adult pads

STOP HLTAID001 – complete assessment one (1) and finish

HLTAID003 - complete assessment one (1)

Continue to read remaining sections,

Complete assessment two (2).

Skills assessment requirements HLTAID001:

Follows DRSABCD in line with ARC guidelines, including:


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� Performed at least 2 minutes of uninterrupted single rescuer cardiopulmonary resuscitation (CPR) (5 cycles of both compressions and ventilations) on an adult resuscitation manikin placed on the floor

� Performed at least 2 minutes of uninterrupted single rescuer CPR (5 cycles both compressions and ventilations) on an infant resuscitation manikin placed on a firm surface

� Responded appropriately in the event of regurgitation or vomiting

� Managed the unconscious breathing casualty

� Followed single rescue procedure, including the demonstration of a rotation of operators with minimal interruptions to compressions

� Followed the prompts of an automated external defibrillator (AED)

Responded to at least one (1) simulated first aid scenario contextualised to the candidate’s workplace/community setting, including:

� Demonstrated safe manual handling techniques

� Provided an accurate verbal or written report of the incident

Educators please print up to here for HLTAID001 CPR


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Section 5: First Aid - Trauma Abdominal injuries

Abdominal cavity – is the largest cavity in body and is occupied by glands and organs of the digestive system. These organs – react differently to trauma

Hollow organs- e.g. bladder tends to rupture & release contents into surrounding space, less blood, body prone to infection

Solid organs – e.g. liver – tends to tear and bleed a at slow enough rate to be overlooked, however they can bleed quickly in trauma

(Waugh. A & Grant. A, 2014, p.51 & 52)

Causes

Blunt trauma wheel, motorcycle/ bicycle accidents – hand bars, falls & assault (esp., gunshot

Penetrating knife/ impalement

Illness/ infection abdominal pain – sign illness – appendicitis infection/ internal bleeding prompt evaluation

Signs or Symptoms

Often difficult to diagnose if suspected immediate medical attention to ensure no internal bleeding

Feel sick Present with Shock

Site specific pain Fever


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Management

Check response/ assess for shock

If in shock, lay casualty down & keep warm

Call an ambulance for - severe pain, injuries or bleeding or shock

Assist casualty into a comfortable position, flexed knees may help reduce pain

Do not allow to eat or drink

Monitor until ambulance arrive

If no open wound is apparent then lay the casualty flat with knees bent and treat as for shock until medical help arrives

Bleeding – control bleeding using direct pressure of bandages

Embedded object – leave it in place, pad around the object

If internal organs protrude outside abdominal wall do not push back in – cover with a moist sterile dressing that will not stick or a plastic wrap


Basic wound care (Major & minor skin injuries)

Skin is largest organ of human body, which is made up of 2 main layers.

Epidermis – superficial layer

Dermis – which contain blood vessels, lymph vessels, sensory nerve endings, sweat glands and there ducts, hairs, arrector pili muscles and sebaceous glands.

Wound should be treated and cleaned in accordance to type and severity of wound & severity of bleeding. Open wounds – prone to infection reduce risk wash hands & use gloves, avoid breathing or coughing over the wound. Some wounds are more likely to encourage growth of tetanus bacteria. If it has been more than five (5) years since the casualty’s last dose of tetanus or they are not immunised they should get tetanus shot as soon as possible.

(Waugh. A & Grant. A, 2014, p.354)


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Types of wounds

Abrasions

(Minor skin injury)

Surface layers of skin have been broken, areas that are more prone areas – e.g. knees, ankles & elbows

Scraped skin can contain particles of dirt – wounds should be cleaned (not scrubbed) and antiseptic applied

Incised wounds

(Major skin Injury)

Sharp objects’ – slicing into the skin - underlying blood vessels can be punctured leading to significant blood loss.

A severed artery is a medical emergency as muscular action of blood vessel will pump entire blood supply out of wound in just a few minutes

Chronic wounds Skin fails to heal, heals slowly or tend to recur,

Include skin wounds from trauma, burns, skin cancer, infection or underlying conditions i.e. diabetes

Medical attention required if wound won’t stop bleeding, increasing pain, pus, discharge from wound and casualty has a fever


Management - minor skin injuries

Wash hands (or use antibacterial hand sanitiser) and use gloves if available

Avoid breathing coughing or sneezing on wound

Clean with non-fibre shedding material or sterile gauze soaked in normal saline/clean water. Do not use cotton wool or material that will fluff

Don’t scrub embedded dirt –as it will traumatise site

See a Doctor if dirt can’t be removed to reduce chance of infection

Apply antiseptic

Trying not to touch the wound. Apply a non-stick sterile dressing band aid or non-adhesive dressing with non-allergic tape

Seek medical advice or ambulance depending on the type of wound

Management - Major skin Injuries

In an emergency, if the injured person is bleeding heavily, don’t waste time. DO not clean a wound that is severely bleeding as cleaning may dislodge a blood clot and cause the casualty to bleed more.


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Immediately apply pressure to a heavily bleeding wound (or around the wound if there is an embedded object)

Monitor the casualty until the ambulance arrives


Bandages during first aid

There are two (2) main types of bandages: a roller bandage and a triangular bandage.

Roller bandage

Used for:

Holding dressing in place, control the bleeding, control swelling, to provide support, pressure for strains & sprains, pressure immobilisation technique (PIT) for snake bites

How to apply:

• The injured person should be sit or lie down

• Position yourself in front of the injured person on their injured side.

• Ensure their injured body part is supported in position before you start

• The injured person may be able to help by holding the padding in place,

• Wrap the ‘tail’ of the bandage one full turn around the limb, so that the bandage is anchored.

• If there is no assistance, wrap the ‘tail’ of the bandage directly around the padding over the wound.

• Bandage up the limb, making sure each turn overlaps the turn before. Alternatively, you can bandage in a ‘figure eight’ fashion.

• Make sure the bandage is not too tight so you don’t reduce blood flow to the extremities (hands and feet). Check if the pressure is correct by pressing on a fingernail or toenail of the injured limb. If the pink colour returns within a couple of seconds, the bandage is not affecting the person’s circulation. If the nail remains white for some time, loosen the bandage. Keep checking and adjusting the bandage, especially if swelling is a problem.

http://www.youtube.com/watch?v=Vj94QiQvpo4



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Making an arm sling

• Create a triangular bandage to create an upper arm sling, lower arm sling and a collar and cuff sling.

• After being bandaged, an injured forearm or wrist may require an arm sling to lift the arm and keep it from moving. Steps include:

• Arrange the person’s arm in a ‘V’ so that it is held in front of their body and bent at the elbow, with the hand resting in the hollow where the collarbone meets the shoulder.

• With the point of the triangular bandage positioned at the elbow, place the bandage over the top of the arm, tuck the upper point under the casualty’s fingertips

• Open a triangular bandage and place it on top of the injured arm. The longest edge needs to be lengthwise along the person’s body and the point of the bandage should be towards the person’s elbow on their injured side. You only need enough material to tie a knot at the fingertip end.

• Create a cradle (hammock) around the injured arm by folding the upper half of the long edge under the injured arm.

• Gently gather the material together at the elbow and pull it tight without pulling the bandage off the injured arm. Twist the material into a long spiral.

• Bring the long spiral around and then up the person’s back.

• Tie the two ends together firmly at the person’s fingertips


http://www.youtube.com/watch?v=9Cifk_ohsDo

http://www.bing.com/images/search?q=pictures+of+a+arm+sling+for+first+aid&id=069587BBE64B37E1439358D4107B7F31A76FDFD5&FORM=IQFRBA





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Bleeding

External bleeding

Application of external pressure on or near the wound usually controls external bleeding until help arrives. The aim of this process is to limit blood loss from the casualty. Direct pressure is the most efficient way to minimise blood loss, however in some cases e.g. if there is an embedded object you should use indirect pressure to control the bleeding

Management

• Use standard precautions

• Control bleeding

• Call for ambulance

Direct Pressure

Identify bleeding point

• Apply direct and firm pressure

• Apply pressure using hands or a pad and maintain pressure. If bleeding is not controlled place another pad and a tighter bandage

• If a tight bandage has been applied to a limb: check in regular intervals for adequate circulation to the hand or foot

To assist in control of bleeding in some cases you may be able to

• Elevate the bleeding point

• Immobilise the bleeding point

• Restrict movement

• Advise the casualty to remain still

Please note if bleeding continues you may have to remove pad to check that you have not missed the bleeding point and follow through the appropriate steps again.

Indirect Pressure

Embedded object

• Do not remove the object; the object may be restricting blood loss

• Place padding above, around or under the object and place pressure over the pads

Tourniquet

When other methods of controlling the bleeding have failed, use a tourniquet may be applied as a last resort.

Example: amputation of a limb or a major injury with life threatening blood loss.

• Wide bandage – 5 cm above the bleeding point


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• Tight enough to stop all circulation to the injured limb and control bleeding

• Tourniquet should not be removed until casualty received specialist care

• The time of application should be noted and passed onto emergency personnel

• The tourniquet SHOULD NOT be applied over joint or wound and should not be covered up by bandage or clothing

(ARC Guidelines 9.1.1 2008, ‘Bleeding,’ pp. 1-3)

Internal bleeding

Internal bleeding is difficult to identify but should be suspected when there are signs of shock

Signs and Symptoms

• Around affected area - pain or tenderness or swelling

• Appearance of blood from a body opening

o Bright red and/or frothy blood coughed up from the lungs

o Vomited blood – bright red or dark brown “coffee grounds”

o Blood stained Urine

o Vaginal bleeding

o Rectal bleeding – may be bright red or black and tarry

Management

• Casualty will require urgent medical treatment in hospital – call an Ambulance

(ARC Guidelines 9.1.1 2009, ‘Bleeding,’ p. 1-3)

Nose bleed (Epistaxis)

• Apply pressure over the soft part of the nostrils below the bridge of the nose

• Casualty should lean forward to avoid blood running into the throat

• Casualty should remain seated for at least 10 minutes. It may be necessary to keep pressure for 20 minutes – on a hot day or after exercise

• If bleeding continues for more than 20 minutes seek medical assistance

(ARC Guidelines 9.1.1 2008, ‘Bleeding,’ p. 1-3)


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Burns

Types

Injury caused by:

Heat Cold Electricity

Chemical/ Gases Friction Radiation (Including sunlight)

A significant burn

• Greater than 10% of total body surface area (TBSA)

• Burns of special area – face, hands, feet, genitalia, perineum and major joints

• Full thickness burns greater than 5% TBSA

• Electrical burns

• Chemical Burns

• Burns associated with inhalation injury

• Circumferential burns of the limbs or chest

• Burns in very old or young

• People with pre-existing medical disorders – This may cause complications, prolong recovery, increase mortality

• Burns associated with trauma

• ALL burns to infants and children should be medically assessed

Aim – stop the burning process, cool the burn and cover the burn

Steps

1. Ensure the safety of the rescuer, bystanders and casualty

2. Ensure appropriate protection prior to entering a burning or toxic atmosphere

3. The casualty should be removed to a safe environment as soon as possible

4. Stop the burning process

• Stop, drop, cover and roll • Use blanket to smother the flames • Move away from burn source

5. Assess the airway and breathing of the casualty

6. Check for other injuries

7. If safe give oxygen to all casualties with smoke inhalation and facial injuries

8. Call for ambulance (Dial triple 000)

(ARC Guidelines 9.1.1, 2008, ‘Burns,’ p. 1-5)


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General management procedures

• Immediate cooling of the affected area with water

• Remove all watches, jewellery or constricting items if you can do so without causing further tissue damage

• Where feasible elevate limb to minimise swelling

• Cover the burnt area with loose non-stick dressing, preferably clean, dry, lint free material e.g. cling film

• If water is not available use hydrogel products

DO NOT

• Peel off adherent clothing or burning substances

• DO NOT use ice or ice water as further tissue damage will result

• DO NOT break blisters

• DO NOT apply lotions, ointments, creams or powders other than hydrogel

TYPE OF BURNS MANAGEMENT OF BURNS

Heat/ Thermal Burns

Flame • Immediate Cold water – 20 minutes to reduce further

tissue damage and relieve pain

Scald • Immediate Cold water – 20 minutes

• Rest casualty, remove wet clothing, cover areas of skin that are not burnt

• If cool water is not available remove all wet, non-adherent clothing (as clothing will retain heat of liquid on skin)

Inhalation

(suspected if burns to face, nasal hairs, eyebrows or eyelashes and deposits of CO2 around areas of mouth)

• Give oxygen (if possible)

• Call for Ambulance

Electrical Burns

Electric Shock • Isolate power supply without touching the victim

• Commence CPR in accordance to ARC guidelines


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• Cool burns if safe to do so

• Give oxygen

• Call for an Ambulance

Lightning • Commence CPR if required

Radiation Burns

Solar Ultraviolet light (Sunburn), welders arc, lasers, industrial microwave equipment, nuclear radiation

• Cool with water for up to 20 minutes

Chemical

Over-view chemical • Avoid Contact with chemical or contaminated material (USE PPE)

• If available refer to the Material Safety Data Sheets (MSDS) for specific treatment

• Call the poisons information line 131126

• Remove chemicals or contaminated clothing as soon as practical

• Brush powdered chemicals from skin

• IMMEDIATELY run cool tap water on area for 20 minutes

• If chemicals enter the eye/s, open and flush the affected eye/(s) with water for 20 minutes & refer victim for urgent medical attention

• DO NOT attempt to neutralise with acid or alkali burns – this will result in further damage to the casualty

Phosphorus (Found in flares, fireworks & weapons)

• Dress wounds with saline soaked dressings to prevent ignition of the phosphorus with air

Hydrofluoric Acid (Used as cleaning agent

• Most dangerous and corrosive acids – cause a full thickness burn & excruciating pain

• Even a small area or persistent pain requires URGENT medical attention as it may be life threatening

• Copious irrigation water

• Apply calcium gluconate gel ASAP

Bitumen • Should not be removed from the casualty’s skin

• Irrigate with cool water (as bitumen retains heat) for at


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least 30 minutes

• Consider Scoring or cracking the bitumen if encompasses a limb or digit

Petroleum Products • Prolonged exposure can cause organ failure or death

• Copious irrigation with water

(ARC Guidelines 9.1.1, 2008, ‘Burns,’ p. 1-5)

Chest injuries

Chest injuries are difficult to recognise and many injuries can for unnoticed.

Types of chest injuries

Open chest injuries or penetrating chest wound

Chest wall penetrated by (bullet, knife, falling onto a sharp object)

Fractured ribs damage the soft tissues

Treatment must commence immediately as injury can result in a lung to collapse and create significant breathing difficulties

Closed chest injuries Internal bleeding or damage to organs and bones

Rib injuries An indication of a rib injury is if the casualty is taking very shallow breaths as their body tries to prevent the pain from taking a full breath.

Fractured ribs – can be a simple or complicated injury, fracture may be isolated to just bone damage or may damage underlying lung causing bleeding

Flail segment – Occurs when several ribs are fractured in two or more places and can result in part of the ribcage becoming loose. Fractured ribs can move in the opposite direction to the rest of the ribcage making breathing painful and less effective. It can potentially result in serious damage to the lungs.

Punctured lung

Lung collapses and can become a very serious injury. It may be caused from a broken rib piercing the lung (or layers of the lung) or being pierced by a knife or a bullet

Management

Medical assistance is required immediately for a chest injury as a casualties condition may deteriorate very quickly.

Keep the casualty sitting upright, lean the injured side down


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Conduct a verbal survey secondary survey

Do not remove any embedded objects, place pads around the object to control the bleeding

Cover any wounds with a dressing

Escaping air wound – place a ‘Flutter valve’ over wound:

• Get some sort of plastic that is bigger than the wound

• Tape the plastic patch over the wound on only 3 sides. The 4th side is left open, allowing the blood to drain and air to escape. This opening should be at the bottom, as determined by the casualty’s position)

• When the casualty inhales, the bag will be sucked in, but when the casualty exhales, the air will exit through the un-taped side.

If a fail segment is suspected, tightly secure a bulky dressing (such as a tightly folded hand towel) to help stabilise the injury

Treat for shock as required and monitor carefully until help arrives


Choking and airway obstruction

Partial or complete airway obstruction may be present in the conscious or the unconscious victim. Airway obstruction may be gradual or sudden in onset and may lead to complete obstruction within a few seconds. A Foreign Body Airway Obstruction (FBAO) is a life-threatening emergency and some typical causes of airway obstruction may include, but are not limited to:

Relaxation of the airway muscles due to unconsciousness;

Inhaled foreign body;

Trauma to the airway Anaphylactic reaction

The symptoms and signs of obstruction will depend on the cause and severity of the condition.

(ARC Guidelines 4, ‘Airway,’ 2014, p. 4-7)

Signs & symptoms for conscious casualty

Inhalation of a foreign body may result in:

Extreme anxiety

Agitation

Gasping sounds


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Coughing /loss of voice

Progress to the universal choking sign (clutching the neck with the thumb and fingers).

Airway obstruction will cause the diaphragm muscle to work harder to achieve adequate ventilations.

The abdomen will continue to move out but there will be loss of the natural rise of the chest (paradoxical movement), and in-drawing of the spaces between the ribs and above the collar bones during inspiration

(ARC Guidelines 4, ‘Airway,’ 2014, p. 4-7)

Partial Obstruction Complete Obstruction

• Breathing is laboured; • There may be efforts at breathing;

• Breathing may be noisy; • There is no sound of breathing;

• Some escape of air can be felt from the mouth

• There is no escape of air from nose and/or mouth.

Unconscious casualty

Airway obstruction may not be apparent in the non-breathing until rescue breathing is attempted.

Techniques to clear FBAO

32 case reports have reported life-threatening complications associated with use of abdominal thrusts. Therefore, the use of abdominal thrusts in the management of FBAO is not recommended and, instead back blows and chest thrusts should be used.

These techniques should be applied in rapid sequence until the obstruction is relieved.

(ARC Guidelines 4 ‘Airway,’ 2014, p. 5)

Back blows – Conscious adults and children > 1 year of age, apply sharp strikes with the heel of one hand in the middle of the back between the shoulder blades. An infant may be placed in a head downwards position prior to delivering back blows, i.e. across the rescuer’s lap


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Chest thrusts - Identify the same compression point as for CPR and give up to five chest thrusts. These are similar to chest compressions, however are sharper and delivered at a slower rate. Children and adults may be treated in the sitting or standing position. An infant should be placed in a head downwards supine position across the rescuer’s thigh.

Severity of a FBAO is determined by ability to cough

Effective cough (mild airway obstruction)

• Reassure and encourage casualty to keep coughing to expel the foreign material.

• If the obstruction is not relieved the rescuer should call an ambulance.

Ineffective cough (severe airway obstruction)

• Commence management of conscious casualty

Management of conscious casualty

Call an ambulance

Perform up to five sharp back blows,

Check to see if each back blow has relieved the airway obstruction. The aim is to relieve the obstruction with each blow rather than to give all five blows.

If back blows are unsuccessful the rescuer should perform up to five chest thrusts.

Check to see if each chest thrust has relieved the airway obstruction. The aim is to relieve the obstruction with each chest thrust rather than to give all five chest thrusts.

If the obstruction is still not relieved, continue alternating five back blows with five chest thrusts.

Management Unconscious Casualty

The finger sweep can be used in the unconscious casualty, if solid material is visible in the airway

Call an ambulance

Commence CPR.


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Management of airway obstruction flow chart

(ARC Guidelines 4, 2014, ‘Airway,’ p. 4-7)

Crush injuries

Crush injuries may result from a variety of situations including vehicle entrapment, falling debris, an industrial accident or as a result of prolonged pressure to particular area of the body (this can be due to the casualty’s own body weight if the casualty is immobile).

Crush syndrome – refers to the multiple problems that may result from crush injuries. The result is a disruption of the body’s chemistry and can lead to kidney and other problems. Commonly is the result of crush injuries to the limbs, particularly the legs. The development of crush syndrome is directly related to the compression time.

Assess Severity

Ineffective COugh Severe airay obstruction

Unconscious

Call Ambulance Commence CPR

Conscious

Call ambulance Give up to 5 back

blows if not effective give

up to 5 chest thrusts

Effective Cough Mild Airway obstruction

Encourage Coughing Continue check

If casualty deterioates Call

Ambulance


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Management

1. Ensure the scene is safe: minimise risks to the rescuer or bystanders

2. Call an ambulance

3. If safe and physically possible remove all crushing forces from a casualty ASAP. A crushing force may result in the death of the casualty

4. Be aware that the casualty may not complain of pain or there may be no external signs of trauma

5. Treat any bleeding and keep the casualty warm

6. Monitor the casualty’s condition. If the casualty becomes unresponsive/ is not breathing follow ARC guidelines for basic life support

DO NOT leave the casualty except if necessary to call an ambulance

DO NOT use a tourniquet for first aid management of a crush injury

(ARC Guidelines 9.1.1, 2013 ‘Emergency management of a crush casualty,’ p. 1-2)

Ears & Eye injuries

There are many different types of ear injuries and a long list of causes but they should all be treated as an emergency. Ears and eyes are two parts of the human body that you should seek immediate attention: If you suspect injury, seek medical treatment without delay.

Ear injuries

Internal and external ear injuries can occur when a substance or foreign object blocks or damages the ear canal. Any time pressure is applied to your ear canal, the eardrum can be damaged. There are also external injuries such as damage or lacerations, commonly caused by infected piercings or those that have been ripped out.

Causes of Ear Injuries

Foreign Object Object inside ears: insects, debris or dirt. This may occur when playing sport or young children may insert an object into the ear

Injury ‘Blows’ from an accident or sport injury, cuts etc.

Ruptured eardrum

From an object or pressure change. Object - inserting cotton swab, toothpick, pins, and pens inside ear. Sudden changes in pressure from an explosion, blow to the head flying, scuba diving, falling while water skiing or being slapped on head or ear, loud noises e.g. gunshot

Illness Infection, excessive wax build up, infected ear from piercing


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Symptoms

Depend on type of injury

Sick/dizzy Fever Bleeding

Bruising Swelling Redness

Earache Severe pain Suffer loss of hearing

Management

Ambulance called if ear drum ruptured – if part of ear is cut off or if there is a clear liquid coming out of the ear (brain fluid). If there is foreign object is inside ear seek medical attention

Call ambulance – ruptured ear

Monitor patient

Calm & reassure casualty

Do not block any drainage coming from ear

Do not try to clean or wash inside of the ear

do not put any liquid into the ear

Do not attempt to remove object by probing, if you do so you risk pushing object further into ear and causing further damage

Do not reach inside ear canal with tweezers

If there is an insect in ear turn the casualty’s head so that the affected side is up and wait to see if an insect flies or crawls out


Eye injuries

Management

• Ensure your hands are clean

• Do not allow casualty to rub injured eye


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Type Injury Management

Black eye • Cold compress, ice pack wrapped in thin towel/ covered ice

• Do not attempt to remove contact lenses

• Blurred vision/ black eye sign of damage inside the eye

• Seek Medical attention

Burns

• Gently open eyelid and wash eye with cold flowing water for 20 mins.

• Place eye pad or light clean dressing over the injured eye only without applying pressure on the eye when bandaging

• Ensure ambulance has been called

Embedded objects

• Cover the injured eye only without applying pressure from the bandage on the eye

• Seek medical aid

Penetrating • Do not try to remove any object which is penetrating the eye

• Place thick pads above and below injured eye or cover object with paper cup.

• Without placing pressure on eyelids , bandage the pads in place

• Cover injured eye only.


Small object

• Ask patient to look up.

• Draw lower eyelid down and if object visible, remove with corner of moist cloth.

• If not visible, pull upper lid down.

• Wash eye with sterile saline or clean water to assist in removal of object

• If still unsuccessful, cover injured eye only and seek medical aid.

Smoke

• Wash eyes with sterile saline or cold tap water.

• Seek medical aid if necessary.

Wounds • Lie patient on their back.

• Place light dressing over injured eye only. (without placing pressure on eye)

• Ask the patient to try not to move eye.




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Fractures & Dislocation

Fractures

Breaking of bone, bend in bone, associated soft tissues damage around the bone

Causes

Most common site: wrist, ankle & hip – due to falls, sporting and motor vehicle accidents account for the majority of broken bones.

Closed (simple) – broken bone has not pierced the skin

Open (compound) – bone juts through skin or a wound leads to the fracture site

Complication – damage to vein, arteries, nerves – injury to lining of the bone

Signs and symptoms

Pain at or near the site of the injury Difficult or impossible to move normally

Loss of power Deformity or abnormal mobility

Tenderness Swelling

Discolouration Bruising

Management

Do not attempt to force a fracture back into place, this could cause further injuries. Moving broken bones can increase pain and bleeding and can damage tissues around the injury. This can lead to complications in the ongoing repair and healing of the injury later on.

It can be difficult for a first aider to tell whether the injury is a fracture, dislocation, sprain or strain. If in doubt, always treat the injury as a fracture.

• Keep the person still – do not move them unless there is any further immediate danger

• Attend to any bleeding wounds first. Stop the bleeding by pressing firmly on the site with a clean dressing. If a bone is protruding, apply pressure around the edges of the wound

• If bleeding is controlled, keep the wound covered with a clean dressing. Control any bleeding and cover any wounds

• Ensure an ambulance has been called

• Never try to straighten broken bones

• If medical aid is delayed & you have been trained apply a splint to support


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Steps to immobilise fracture:

o Splints do not have to be professionally manufactured. Items like wooden boards and folded magazines can work for some fractures

o Use broad bandages (where possible) to immobilise the limb above and below the fracture

o Support the limb, carefully passing bandages under the natural hollows of the body

o Place a padded splint along the injured limb

o Place padding between the splint and the natural contours of the body and secure firmly

o In the case of a leg fracture, immobilise foot and ankle

• Check that bandages are not too tight or too loose. Check at regular intervals every 15 minutes

• Use a sling to support an arm or collarbone fracture

• If possible apply a cold pack to reduce swelling and pain

• Watch for signs of circulation loss to hands and feet

• The casualty should not eat or drink anything until they have been seen by a doctor (in case they will need surgery).

• Monitor the casualty until the ambulance arrives

(Better Health Channel, Victorian Government, 2012, ‘Bone fracture,’)

Dislocation

Dislocation results when a bone has been dislodged from a joint and cannot be moved. Result of trauma – frequently affected areas shoulders, elbows, fingers, hips, ankles and kneecaps. Dislocations are still considered an urgent situation requiring medical care, however a dislocation can be treated until the casualty can receive medical help

Symptoms

Severe pain

Deformity of the joint area

Tenderness

Inability to move limb without pain

Shortening of the limb

Management


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Do not attempt to straighten or put the dislocated joint back in place

If possible apply a cold pack to reduce swelling and pain

Provide comfort and support

Reassure the casualty and keep them warm

The casualty should not eat or drink anything until they have been seen by a doctor (in case they will need surgery).

Ensure casualty receives medical help

Head injuries

A casualty may sustain a significant head injury without loss of consciousness or loss of memory (amnesia). Therefore, loss of consciousness or memory loss should not be used to define the severity of a head injury or to guide management. Advise all casualties who have sustained a head injury, regardless of severity, to seek assessment by a health care professional.

If the casualty has a reported or you witnessed injury or has obvious signs of injury to the head or face such as bruises or bleeding a brain injury should be suspected. A casualty may have a brain injury without obvious external signs of injury to the head or face and serious problems may not be obvious for several hours after the initial injury

Management

• Assessing and managing the airway and breathing, whilst

• Care for the neck and maintaining in-line spine immobilisation until expert help arrives.

• Call an ambulance if there has been a loss of consciousness or altered consciousness at any time, no matter how brief

• A casualty who has sustained a head injury (including minor injuries) should still be assessed by a health care professional if there is hasn’t been loss of consciousness or altered consciousness.

• Check for response – unconscious casualty should be managed according to section1....

• Ensure the airway is clear

• Protect the neck from moving – whilst maintaining a clear airway

• Identify and control any significant bleeding with direct pressure if possible.

• If the casualty is unresponsive and not breathing normally follow the ARC guidelines for basic life support

(ARC Guidelines 9.1.4, 2012, ‘Head injury,’ p. 1-2)

Needle stick injuries


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A needle stick injury occurs when a person’s skin gets punctured or scratched by a used needle. This carries the risk of transmission of a Blood-borne virus (BBV); Human immunodeficiency virus (HIV), Hepatitis C virus (HCV), Hepatitis B virus (HBV).

Management

• Assist the casualty to cease any blood flow

• Immediately wash the infected area gently and thoroughly with mild soap and clean running water for at least 30 seconds.

• Apply antiseptic and a sterile dressing to the wound.

• Place the needle and syringe in a rigid-walled plastic container and take it with you to the doctor.

• Take the infected person and bottled needle and syringe to a medical practitioner or emergency department of the local hospital for BBV antibody testing.

• If incident has occurred within workplace complete any necessary forms

All tests should be conducted within 24 hours of the injury occurring. Taking the bottled needle and syringe may help with documenting the nature and extent of the needle stick injury

(WA Department of Health/Education, ‘Needles and Syringes,’)

Soft tissue injuries, including strains and, sprains

Injuries may be sudden or may gradually worsen. Injuries can often take between 2-12 weeks to heal depending on the type of injury, the initial and subsequent treatment, the age and general health of the person. Depending on the type and severity of the injury will determine if further treatment is required. If pain persists after a couple of days medical professional advice is required.

Causes

Soft tissue injuries are caused by a sudden jolt or twist – at a greater force than the normal tissue can tolerate. Fibres overstretch beyond their capacity: tearing, bleeding & swelling results from broken blood vessels.

A sprain – joint injury – tearing of ligament and join t capsule – common areas – thumb, ankle, wrist are common sites

A strain – is an injury to muscles or tendons. Groin, calf and hamstring are common sites.

Signs and symptoms


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Symptoms of a sprain can include:

Intense pain

Restricted mobility

Swelling and bruising around injury joint develops quickly

Symptoms of a strain can include:

Sharp, sudden pain in the injury region

Loss of power

Tender muscle

Management

1. Follow the RICE management plan:

o Rest the person and the injury part

o Apply an icepack (cold compress) wrapped in a wet cloth to the injury for 15 minutes every 2 hours for 24 hours and then for 15 minutes every 4 hours for 24 hours

o Apply a compression elastic bandage firmly to the injury that extends well beyond the injury. You may soak the bandage in cold water. This will immediately reduce blood flow to the bruise – which will assist the healing process

o Elevate the affected area if the injury permits. Elevate above the level of their heart where possible

2. Seek medical advice

(Better Health Channel, Victorian Government, 2014, ‘Sprains and strains,’)

Spinal injury


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The spine is made up of 33 vertebrae bones, extending from the base of the skull to the coccyx (tailbone). Each vertebra surrounds and protects the spinal cord (nerve tissue).

Spinal cord- mass of nerve fibres which allow communication to the rest of the body

How the spinal cord works

http://www.youtube.com/watch?v=zxpb1-okVig

The direct injury from the traumatic impact can compress or sever the nerve tissue and is followed by secondary injury caused by ongoing bleeding into the spinal cord as well as continued swelling at the injured site and surrounding area.

The possibility of spinal injury must be considered in the overall management of all trauma victims to minimise the extent of the secondary injury. Caution must be taken when moving a victim with a suspected spinal injury.

Spinal injuries can occur in the following regions of the spine:

• Cervical Spine (the neck)

• Thoracic spine (the back of the chest)

• Lumbar spine (the lower back)

(Waugh. A & Grant. A, 2014, p.43)

The most vulnerable area is the cervical spine and more than half of spinal injuries occur in the cervical area. If faced with a casualty with injuries above the shoulders a spinal injury must be suspected. Suspected spinal injuries of the neck, particularly if the casualty is unconscious, pose a dilemma for the rescuer because correct principles of airway management often cause some movement of the cervical spine.



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Damage to the spinal cord –

The extent of paralysis

• Depends on the location of the injured spinal cord.

http://www.spinal.com.au/information/about-the-spine/

Levels of function following a spinal cord injury

http://www.youtube.com/watch?v=PseUxltIw_U

RECOGNITION

Most common causes of spinal cord injury are:

Motor vehicle, motor cycle or bicycle accident Industrial accident (workplace)

Dive/jump into shallow water with obstacles/ being dumped in the surf

Falls in the elderly population

Sporting accidents A fall greater than standing height

A significant blow to the head Severe penetrating wound (e.g. gunshot)

Signs and symptoms

The signs and symptoms depends on two factors: firstly the location of the injury and secondly, the extent of the injury – whether there is just bone injury or associated spinal cord injury, and whether the spinal cord injury is partial or complete. It will be difficult to elicit symptoms and signs in a casualty with an altered conscious state.


http://www.spinal.com.au/information/about-the-spine/

http://www.youtube.com/watch?v=PseUxltIw_U

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Signs Symptoms

Head or neck in an abnormal position Pain in the injured region

Signs of an associated head injury Tingling, numbness in the limbs and area below the injury

Altered conscious state Weakness or inability to move the limbs (paralysis)

Breathing difficulties Nausea

Shock Headache or dizziness

Change in muscle tone, either flaccid or stiff Altered or absent skin sensation

Loss of function in limbs

Loss of bladder or bowel control

Priapism (erection in males)

Principles of management of a suspected spinal injury are:

• Calling for an ambulance

• Management of airway, breathing and circulation

• Management of the spine (careful handling of the casualty to ensure harm is minimised)

Managing a spinal injury for the conscious casualty

• Tell the casualty to remain still, do not physically restrain

• Those with significant spinal pain will likely have muscle spasm which acts to splint their injury.

• Keep casualty comfortable

• If the casualty needs to be moved to avoid further danger/injury care must be taken to support the injured area to minimising the movement of the spine in any direction.

• Ideally, first aiders or health care providers trained in the management of spinal injuries should move the casualty. Ideally first aiders should use specific equipment to assist them when moving the casualties with spinal injuries.


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Managing a spinal injury for the unconscious casualty

• Airway management takes precedence over any suspected spinal injury.

• It is acceptable to gently move the head into a neutral position to obtain a clear airway. If the casualty is breathing but remains unconscious, it is preferable that they be placed in the recovery position.

• Handled the casualty gently with no twisting

• Maintain spinal alignment of the head and neck with the torso

• Use manoeuvres which are least likely to result in movement of the cervical spine

• If a casualty needs their airway opened try jaw thrust and chin lift should be tried before head tilt.

(ARC Guidelines 9.1.6, 2012, ‘Management of a suspected spinal injury,’ p. 1-5)


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Section 6: First Aid - Medical

Allergic reaction

Allergy occurs when a person's immune system reacts to substances in the environment. A mild allergy is normally harmless for most people. A small number of people may experience a severe allergic reaction called anaphylaxis. This is a serious condition which requires immediate lifesaving medication and immediate treatment. If a person is known to have a very severe allergy, they should have an Anaphylaxis Management Plan from their doctor, which should include an Australasian Society of Clinical Immunology and Allergy (ASCIA) action plan for anaphylaxis. Anaphylaxis will be covered on page 87 – resource booklet.

Most allergic reactions are mild to moderate, and do not cause major problems, even though for many people they may be a source of extreme irritation and discomfort.

(Australian Society of Clinical Immunology and Allergy, 2010)

Causes of allergic reactions

Dust mites

Pollen

Foods such as peanuts, cow's milk, soy, seafood and eggs

Cats and other furry or hairy animals such as dogs, horses, rabbits and guinea pigs

Insect stings

Moulds

Medicines

(Australian Society of Clinical Immunology and Allergy, 2010)

Symptoms

Nose and/or eyes - hay fever (allergic rhinitis/conjunctivitis)

Skin - eczema, hives

Eczema (dry, red, itchy skin) and urticaria (also known as hives) often occur. Hives are white itchy bumps which look and feel like insect bites.

Stomach or bowel upset


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Management

Careful monitoring of the casualty to ensure the allergic reaction does not develop into anaphylaxis – if anaphylaxis results follow management on page 88

Remove any visible hazards i.e. If a sting present from bit – remove and consider management for anaphylaxis/ envenomation

Move the casualty to a safe area away from cause

If mild reaction – consider having the casualty administer antihistamines

Continue to monitor the casualty


http://www.allergy.org.au/

http://www.allergyfacts.org.au/

Anaphylaxis

Anaphylaxis should be treated as a medical emergency. It is the most severe form of allergic reaction and is potentially life threatening. It requires immediate treatment and urgent medical attention. Anaphylaxis is a generalised allergic reaction, which often involves more than one body system. A severe allergic reaction usually occurs within 20 minutes of exposure to the trigger; however onset can range from minutes to hours after exposure to a substance. Anaphylaxis is characterised by rapidly developing airway and / or breathing and / or circulation problems and is usually associated with skin and mucosal changes.

(ARC Guidelines 9.2.7, 2012 ‘Anaphylaxis First Aid Management,’ p.1)

Most Common substances can cause anaphylaxis

Foods (especially peanuts, tree nuts, cow’s milk, eggs, wheat, seafood, fish, soy, sesame)

Drugs (e.g. penicillin)

Venom from bites (ticks) or stings (e.g. bees, wasps or ants).

Symptoms and signs are highly variable and may include

Difficult / noisy breathing




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Wheeze or persistent cough

Swelling of face and tongue

Swelling / tightness in throat

Difficulty talking and /or hoarse voice

Persistent dizziness / loss of consciousness and / or collapse

Pale and floppy (young children)

Abdominal pain and vomiting

Hives, welts and body redness

(ARC Guidelines 9.2.7, 2012, ‘Anaphylaxis First Aid Management,’ pp. 1-2)

Management

The first line drug treatment is the injection of adrenaline. If someone has suffered a prior episode of anaphylaxis often they will have prescribed medication including adrenaline in the form of an auto-injector.

1. Lay the casualty flat, do not allow them to stand or walk, if breathing is difficult, allow them to sit

2. Prevent further exposure to the triggering agent if possible allergic reaction or anaphylaxis

has occurred from an insect allergy or tick bite, immediately remove the sting or carefully remove the tick

3. Administer adrenaline (e.g.: auto injector)

4. Child less than 5 years - 0.15 mg intramuscular injection.

5. Older than 5 years - 0.3mg intramuscular injection

6. Call an ambulance

7. Administer oxygen and /or asthma medication for respiratory symptoms.

8. Further adrenaline should be given if no response after five minutes.

9. If breathing stops follow the Australian Resuscitation Council and New Zealand

Resuscitation Council Basic Life Support Flowchart (Guideline 8)

(ARC Guidelines 9.2.7, 2012, ‘Anaphylaxis First Aid Management,’ pp. 1-2)


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How to use an EpiPen©

Go to the following link to receive up to date information on How to use an EpiPen©

http://www.allergy.org.au/images/stories/anaphylaxis/2015/ASCIA_Action_Plan_Anaphylaxis_EpiPen_General_2015.pdf

(Australian Society of Clinical Immunology and Allergy, 2014) © ASCIA 2014

http://www.allergy.org.au/images/stories/anaphylaxis/Action_Plan_anaphylaxis_general.pdf

http://www.allergy.org.au/images/stories/anaphylaxis/2014/ASCIA_FIRST_AID_FOR_ANAPHYLAXIS_2014.pdf

UTUBE Video link - http://www.allergy.org.au/health-professionals/anaphylaxis-resources/how-to-give-epipen

http://www.allergy.org.au/health-professionals/anaphylaxis-resources/first-aid-for-anaphylaxis










http://www.allergy.org.au/health-professionals/anaphylaxis-resources/how-to-give-epipen






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Asthma

Asthma is a disorder of the smaller airways of the lungs. People with asthma have sensitive airways which can narrow when exposed to certain ‘triggers’, leading to difficulty in breathing.

Three main factors cause the airways to narrow:

• The muscle around the airway tightens (bronchoconstriction). • The inside lining of the airways becomes swollen (inflammation). • Extra mucus (sticky fluid) may be produced.

Triggers for asthma can include:

Colds and flu Exercise

Cigarette smoke Inhaled allergens (e.g. pollens, moulds, animal dander and dust mites)

Environmental factors (e.g. dust, pollution, wood smoke, bush fires

Changes in temperature and weather

Certain medications (e.g. aspirin) Chemicals and strong smells (e.g. perfumes, cleaning products)

Emotional factors (e.g. laughter, stress) Some foods and food preservatives, flavourings and colourings (uncommon)

(ARC Guidelines 9.2.5, 2014, ‘First Aid for Asthma,’ p. 1-4)

Asthma signs and symptoms

A dry, irritating, persistent cough, particularly at night, early morning, with exercise or activity.

Chest tightness

Shortness of breath

Wheeze (high pitched whistling sound during breathing).

(ARC Guidelines 9.2.5, 2014, p.1)

Signs of a severe asthma attack

An asthma attack can take anything from a few minutes to a few days to develop and may include some or all of the following:

Gasping for breath (may have little or no wheeze due to little movement of air).


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Severe chest tightness

Inability to speak more than one or two words per breath

Feeling distressed and anxious

Sucking in’ of the throat and rib muscles, use of shoulder muscles or bracing with arms to help breathing

Little or no improvement after using “reliever” medication

Blue discolouration around the lips (can be hard to see if skin colour also changes).

Pale and sweaty skin.

Symptoms rapidly getting worse or using reliever more than every two hours.


Young children

Appear restless Unable to settle

Become drowsy Suck’s in muscles around the ribs

May have problems eating or drinking due to shortness of breath

Severe coughing and vomiting


Managing an Asthma Attack

If the casualty has a personal written asthma action plan then that plan should be followed.

If there is no action plan in place then use the ©2014 National Asthma Council Ltd following Asthma First Aid plan. (National Asthma Council Australia, 2014)

If 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

Sit the person comfortably upright. Be calm and reassuring. Do not leave the person alone.

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


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Ask the person to take four breaths from the spacer after each puff of medication

Use the casualty’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

Wait four minutes & if there is little or no improvement give another four puffs

If there is still no improvement, call an ambulance immediately. Keep giving four puffs every four minutes until the ambulance arrives

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 the Basic Life Support Flowchart If a severe allergic reaction is suspected, refer Anaphylaxis – First Aid Management


No harm is likely to result from giving a “reliever” puffer to someone without asthma.

Asthma medication: most common is Salbutamol. Alternatively for adults terbutaline or eformoteral plus budesonide

With Spacer

• Assemble spacer

• Remove inhaler cap & shake well

• Place inhaler upright into spacer

• Place mouthpiece of spacer into the casualty mouth

Between the teeth & sealing with their lips around it

• Fire one puff into the spacer and ask the casualty to breath in and out normally for 4 breaths

• Shake inhaler and repeat process so 4 puffs in total have been delivered.




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Without Spacer

• Shake the inhaler.

• Place the mouthpiece into the casualty’s mouth, between the teeth with the lips sealed around it

• Administer one puff as the casualty inhales slowly and steadily.

• Slip the inhaler out of the casualty’s mouth.

• Ask the casualty to hold their breath for four seconds or as long as conformable. Breathe out slowly away from the inhaler.

• Repeat until four puffs have been given.

• Shake the inhaler before each puff.


http://www.nationalasthma.org.au/uploads/content/53-NAC-Asthma-First-aid-chart-FINAL.pdf

(National Asthma Council Australia, 2014)




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©2014 National Asthma Council Ltd

http://www.nationalasthma.org.au/uploads/content/53-NAC-First-Aid-for-Asthma-Chart-Kids-FINAL.pdf

(National Asthma Council Australia, 2014)

©2014 National Asthma Council Ltd

For further reading go to National Asthma website

http://www.nationalasthma.org.au/understanding-asthma/during-an-attack

Cardiac conditions, including chest pain

Heart

The heart lies in the front and middle of the chest, behind and slightly to the left of the breastbone. Your heart is about the size of your clenched fist. The right and left side of the heart are separated by a wall and each side has a small chamber called the atrium which leads into a large pumping chamber called a ventricle.

There are four (4) chambers:

• Left atrium

• Left ventricle

• Right atrium

• Right ventricle

(Heart Foundation, 2014)






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The right side of your heart collects blood on its return from the rest of the body. The blood entering the right side of your heart is low in oxygen as oxygen is removed from your blood as it circulates through your body's organs and tissues. The heart then pumps the blood to your lungs so it can receive more oxygen. Once it has received oxygen, your blood returns directly to the left side of your heart, which then pumps it out again to all parts of your body.

The left side of your heart is larger and thicker than the right ventricle as it has to pumps the blood further around the body, and against higher pressure. Valves guard the entrance and exits of your hearts chambers to make sure your blood flows in the correct direction.


Angina – chest pain or discomfort caused by insufficient blood flow and oxygen to the muscle of the heart. In most cases the lack of blood flow is due to a narrowing of the coronary arteries, it is usually the symptom of symptom of coronary heart disease (CHD), also called coronary artery disease. Angina may occur during exertion, severe emotional stress, or after a heavy meal. During these periods, the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver:

Pain or discomfort in the middle of the chest

Pain may be accompanied by breathlessness and sweating

Pressure or a feeling of tightness in the chest

Radiating pain to the neck, jaw and left arm, or both arms

Sometimes, radiating pain in the upper back and shoulders

Nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness also may occur


Pulmonary oedema – a serious condition requiring prompt medical attention. It occurs where the heart and lungs are unable to pump the blood around the body, causing backup of fluid in the lungs

Congestive cardiac failure – the heart is no longer able to pump effectively and the casualty becomes seriously ill. Requires immediate medical attention



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Heart attack

A heart attack can occur in a casualty without chest pain or discomfort as one of their symptoms. The most common symptom of heart attack in a casualty without chest pain is shortness of breath. A casualty who experiences a heart attack may pass off their symptoms as ‘just indigestion.’ Warning signs – if they increase in severity or last longer than 10 minutes get immediate help.

Sign and symptoms

pain or discomfort shortness of breath

pale skin nausea or vomiting

sweating feeling dizzy or light-headed

(ARC Guidelines 9.2.1 2012, pp. 1-2)

Discomfort or pain in the centre of the chest may be described as

Tightness, heaviness and fullness or squeezing

May start suddenly, or come on slowly over minutes.

Pain may be limited to, or spread to, the neck, throat, jaw, either or both shoulders, the back, either or both arms and into the wrists and hands.

May be severe, moderate or mild

Atypical chest pain is defined as pain that does not have a heaviness or squeezing sensation (typical angina symptoms), precipitating factors (e.g., exertion), or usual location.

Atypical or minimal symptoms are likely to be described by: the elderly, women, people with diabetes, members of the Australian Indigenous population and Maori and Pacific Island people. It is important that people in this category seek urgent assessment by a health care professional if they have any warning signs of heart attack, no matter how mild.

ARC Guidelines 9.2.1, 2012, ‘Recognition and first aid management of a heart attack,’ p. 2)

Management

Encourage the casualty to rest in a comfortable position

Check if the casualty has been prescribed medication such as a tablet or oral spray to treat episodes of chest pain or discomfort associated with angina, assist them to take as directed


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Call an ambulance

Stay with the casualty until the ambulance or on-site resuscitation team arrives

Give Aspirin (300 mg) if directed. Dispersible aspirin is preferred

Administer oxygen if there are obvious signs of shortness of breath and you are trained to do so

If the casualty is unresponsive and not breathing normally commence CPR

(ARC Guidelines 9.2.1 2012, ‘Recognition and first aid management of a heart attack,’ p. 2)

National Heart Foundation (Australia)

(National Heart Foundation, 2014)

Warning signs of heart attack action plan go to the following link: http://www.heartattackfacts.org.au/action_plans/HeartAttackActionPlan-english.pdf

For further reading go to Australia Heart Foundation website

http://www.heartattackfacts.org.au/

Diabetes

A hormone called insulin is essential for the conversion of glucose into energy for our bodies to work normally. However in people with diabetes, insulin is no longer produced or not produced in sufficient amounts by the body.

So when people with diabetes eat glucose it can’t be converted into energy. Instead of being turned into energy the glucose stays in the blood. This is why blood glucose levels are higher in people with diabetes.

• 280 Australians develop diabetes every day

• Over 100,000 Australians have developed diabetes in the past year.

• Diabetes is the fastest growing chronic condition in Australia

• Almost 1.1 million Australians currently have diagnosed diabetes. This includes: 120,000 people with type 1 diabetes 956,000 people with type 2 diabetes 23,600 women with gestational diabetes


http://www.heartattackfacts.org.au/action_plans/HeartAttackActionPlan-english.pdf



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Type 1 diabetes

In Type 1 diabetes, the pancreas, stops making insulin. This means that the body’s cells are unable to turn glucose (sugar), into energy and the body burns its own fats as a substitute. Daily injections of insulin are required (up to four times a day) otherwise dangerous chemical substances accumulate in their blood from the burning of fat. This can cause a condition known as ketoacidosis and is potentially life threatening if not treated. People with type 1 diabetes are required to test their blood glucose levels several times daily.

Symptoms of Type 1 Diabetes

The following are symptoms of type 1 diabetes:

Being excessively thirsty

Passing more urine Feeling tired and lethargic

Always feeling hungry Having cuts that heal slowly

Itching, skin infections

Blurred vision Unexplained weight loss Mood swings

Headaches Feeling dizzy Leg cramps

Type 2 diabetes:

• Occurs when the pancreas does not produce enough insulin and/or the insulin does not work effectively and/or the cells of the body do not respond to insulin effectively (known as insulin resistance)

• Usually develops in adults over the age of 45 years but is increasingly occurring in younger age groups including children, adolescents and young adults

• Likely to be found in people with a family history of type 2 diabetes or from particular ethnic backgrounds

• For some the first sign may be a complication of diabetes such as a heart attack, vision problems or a foot ulcer

• Managed with a combination of regular physical activity, healthy eating and weight reduction. As type 2 diabetes is often progressive, most people will need oral medications and/or insulin injections in addition to lifestyle changes over time.

Type 2 diabetes results from a combination of genetic and environmental factors. Although there is a strong genetic predisposition, the risk is greatly increased with high blood pressure, being overweight or obese, insufficient physical activity, poor diet and the classic ‘apple shape’ body where extra weight is carried around the waist.

(Diabetes Australia, 2014)


http://www.diabetesaustralia.com.au/Understanding-Diabetes/What-is-Diabetes/Ketoacidosis-/

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Management

Conscious casualty

Make them comfortable

If safe to swallow give them a high energy food – sugar/honey/glucose tablet

The casualty should respond quickly if low blood sugar is problems

Casualty may be a little confused – ensure they are eating a normal meal immediately

Unconscious, drowsy/ unable to swallow

This is an emergency

Place them on their side , clear airway

Call ambulance immediately stating ‘diabetic emergency’

Do not give them any food or drink

Monitor casualty until the ambulance arrives


For further reading go to Diabetes Australia website

http://www.diabetesaustralia.com.au/

Seizures, including epilepsy

Up to 10% of the population is likely to experience a seizure at some time in their life. A seizure is a sign of abnormal brain activity and it may occur when the normal pattern of electrical activity of the brain is disrupted. Seizures can cause changes in sensation, awareness and behaviour, or sometimes convulsions, muscle spasms or loss of consciousness. Symptoms vary greatly and most are usually over in less than 5 minutes. Not all seizures are considered epilepsy and seizures may affect all or part of the body

A seizure may be associated with:

Lack of oxygen (hypoxia)

Onset of cardiac arrest

Medical conditions affecting the brain, e.g. low blood sugar, low blood pressure, head injury, neurological diseases, epilepsy;


http://www.diabetesaustralia.com.au/

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Trauma to the head

Some poisons and drugs

Withdrawal from alcohol and other substances of dependence

Fever in children under six years


Symptoms

Sudden spasm of muscles producing rigidity. If standing the casualty will fall down

Jerking movements of the head, arms and legs

Shallow breathing or breathing may stop temporarily

Dribbling from the mouth; sometimes the tongue may be bitten leading to bleeding

Incontinence: urine and/or faeces

Changes in conscious state from being fully alert to being confused, drowsy, losing consciousness

Changes in behaviour where the casualty may make repetitive actions like fiddling with their clothes.

(ARC Guidelines 9.2.4 2008, p.1)

Generalised seizures

• Usually involve the entire body

• Cause a loss or marked alteration in consciousness

• Life-threatening problems with airway or breathing

• Risk of trauma from muscle spasms or loss of normal control of posture and movement

Partial seizures

• Usually only part of the body is affected and the person retains consciousness but may be frightened or confused

Febrile convulsions

• Related to high temperature (fever) and usually resolve without treatment

• Approximately 3% of children are effected between the age of six months and six years

• It does not result in an increased risk of epilepsy


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Management of a Seizure

If the casualty is unresponsive and not breathing normally, follow Australian Resuscitation Council and New Zealand Resuscitation Council Basic Life Support Flowchart (ARC Guideline 8).

If the casualty is unconscious and actively seizing, the rescuer should:

Follow the casualty’s seizure management plan, if there is one in place;

Manage the casualty according to ARC Guideline

Call an ambulance

Managed as for any unconscious person

Remove the casualty from danger or remove any harmful objects which might cause secondary injury to the casualty

Note the time the seizure starts

Protect the head

Avoid restraining the casualty during the seizure unless this is essential to avoid injury

Lay the casualty down and turn the casualty on the side when practical

Maintain an airway

Reassure the casualty who may be dazed, confused or drowsy

Frequently reassess the casualty


Protect the head Place casualty on side when practical (Epilepsy Action Australia 2011) (Epilepsy Action Australia 2011)


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© The Epilepsy Association 2011

http://www.epilepsy.org.au/sites/default/files/First%20aid%20for%20seizures%20poster_1.pdf

(Epilepsy Action Australia 2011)

© The Epilepsy Association 2011

NEVER put a child in a bath (to lower their temperature) during a convulsion this is dangerous and DO NOT force the casualty’s mouth open nor attempt to insert any object into the mouth.

Seizure in the water

• Life threatening situation

• Support the casualty in the water with the head tilted so the face is out of the water

• Remove the casualty from the water as soon it is safe to do so

• Call an ambulance

• If the casualty is unresponsive and not breathing normally, follow ARC Basic Life Support Flowchart


For Further readings on epilepsy and first aid requirements go to:

http://www.epilepsyaustralia.net/Seizure_First_Aid/Seizure_First_Aid.aspx




http://www.epilepsyaustralia.net/Seizure_First_Aid/Seizure_First_Aid.aspx

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Shock

Shock can result in life threatening organ failure. It results from a loss of effective circulation from impaired tissue oxygen and nutrient delivery.

Condition which may result in Shock

Hypovolemic Shock (loss of circulating blood volume)

• Severe bleeding

• Major or multiple fractures or major trauma

• Severe burns or scalds

• Severe diarrhoea and vomiting

• Severe sweating and dehydration

Cardiogenic Shock (cardiac causes)

• Heart attack

Distributive Shock (abnormal dilation of blood vessels)

• Severe infection

• Allergic reactions

• Severe brain/spinal injuries

Obstructive Shock (blockage of blood flow in and out of heart)

• Tensions pneumothorax

• Cardiac tamponade

• Pulmonary embolus

(ARC Guidelines 9.2.3 2009, ‘Shock,’ p. 1)

Symptoms

Dizziness Muscle weakness

Thirst Anxiety

Restlessness Nausea

Shortness of breath Feeling cold



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Signs

Collapse Cool, sweaty skin that appears pale

Rapid breathing Confusions & deterioration of level of consciousness

Rapid pulse which may become weak or slow Vomiting


Management

Control bleeding

Call an ambulance (Dial 000)

If unconscious manage using ARC guidelines Basic Life Support Flowchart

Rest casualty in a comfortable position, ideally lying down

Provide oxygen is available

Maintain body temperature

Provide reassurance

(ARC Guidelines 9.2.3, 2009, ‘Shock,’ p. 1-3)

Stroke

A stroke is a medical emergency and is the second most common cause of death after heart disease. A stroke results when the supply of blood to part of the brain is suddenly disrupted or when bleeding from a blood vessel within the skull occurs. When brain cells do not get enough oxygen or nutrients, the brain is damaged and may die. Approximately 80% of strokes are caused by an acute blockage of a blood vessel supplying part of the brain.

If the blockage can be rapidly cleared and blood supply restored, the amount of damage to brain tissue can be significantly reduced. To reduce long term damage from a stroke - rapid recognition, protection and support of the airway, breathing and circulation, and rapid access to definitive stroke care is required.

(ARC Guidelines 9.2.2, 2014, ‘Stroke,’ p. 1)

Recognition

A sudden blockage of blood flow to an area of the brain or bleeding will produce symptoms of stroke. Symptoms may seem to improve but should still be considered as a stroke. FAST is a simple way for remembering the signs of stroke.


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FAST

Facial weakness - can the person smile? Has their mouth or eye drooped?

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 – Call for an ambulance.

(ARC Guidelines 9.2.2 2014, ‘Stroke,’ p. 1-2)

(Stroke foundation, 2014) © 2014 National Stroke Foundation - Australia

Other common symptoms of strokes include;

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

Difficulty speaking or understanding

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 onset or unexplained change in the pattern of headaches

Drowsiness

Confusion



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Symptoms of stroke conditions such as

• Epilepsy

• Diabetes with low blood sugar, however the casualty should be treated as suffering a stroke until proven otherwise

It is important a casualty suffering from symptoms of stroke should be transported by ambulance. Paramedics can start the management of stroke, ensuring the casualty is taken to the most appropriate hospital for specialist stroke management.


Management

Call an ambulance and stay with the casualty: no matter how brief or if symptoms have resolved

If casualty is conscious, provide reassurance, and do not give anything to eat or drink

Administer oxygen if available and trained to do so

Check for response

If the casualty becomes unconscious follow the ARC guidelines Basic Life Support Flowchart section 3

Ensure that the airway is clear

If the casualty is unresponsive and not breathing normally follow ARC guidelines as per section 3

(ARC Guidelines 9.2.2, 2014, ‘Stroke,’ p.2)

A transient ischaemic attack (TIA) happens when there is a temporary interruption to the blood supply to the brain. It causes the same symptoms as a stroke, but these go away completely within 24 hours. Even though symptoms may go away it is also important to get treatment as quickly as possible by calling 000.

(Stroke foundation, 2014)

For Further readings on Stroke and first aid requirements go to:

http://strokefoundation.com.au/what-is-a-stroke/


http://strokefoundation.com.au/what-is-a-stroke/types-of-stroke/transient-ischaemic-attack-tia/

http://strokefoundation.com.au/what-is-a-stroke/

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Section 7: First Aid - Environmental Drowning

Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. The most important consequence of drowning is interruption of the oxygen supply to the brain. Early rescue and resuscitation by trained first responders or first aiders at the scene offer the casualty the best chance of survival.

Symptoms

Unconscious

Abnormal breathing

No breathing

Spinal injury/ other injuries

Hypothermia

(ARC Guidelines 9.3.2, 2014, ‘Resuscitation of a drowning victim,’ p.1)

Management

Remove the casualty from the water as soon as possible but do not endanger your own safety. Throw a rope or something to provide buoyancy to the casualty. Call for help; plan and effect a safe rescue.

Call an ambulance for all casualties of an immersion event, even if seemingly minor or the casualty appears recovered.

If unconscious or not breathing normally, commence resuscitation

Assess the casualty on the back with the head and the body at the same level, rather than in a head down position. This decreases the likelihood of regurgitation and vomiting and is associated with increased survival.

Assessing the airway of the casualty without turning onto the side - this has the advantages of simplified teaching, taking less time to perform and avoids movement

The exceptions to this would be where the airway is obstructed with fluid (water or blood) or particulate matter (sand, debris, vomit). In this instance the casualty should be promptly rolled onto the side to clear the airway. The mouth should be opened and turned slightly downwards to allow any foreign material to drain using gravity


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Vomiting and regurgitation often occur during the resuscitation of a drowned casualty. If the casualty has been rolled to the side to clear the airway, then reassess their condition. If breathing commences, the casualty can be left on the side with appropriate head tilt. If not breathing normally, the casualty should be promptly rolled onto the back and resuscitation recommenced as appropriate

Continue CPR (if not breathing) or if breathing continue to monitor casualty until the ambulance arrives.

(ARC Guidelines 9.3.2, 2014, ‘Resuscitation of a drowning victim,’ pp.1-2)

IMPORTANT

• Do not delays or interruptions CPR.

• Do not empty a distended stomach by applying external pressure

• Do not attempt to expel or drain clear water or frothy fluid that may re-accumulate in the upper airway during resuscitation.

Compression-only CPR is not the recommended resuscitation method

The primary cause of cardiac arrest in drowning is a lack of breathing. Compression-only CPR circulates oxygen-poor blood and fails to address the casualty’s need for immediate ventilation. It is not the recommended resuscitation method in a casualty of drowning and should only be used temporarily if the rescuer is unable or unwilling to perform rescue breathing before the arrival of a barrier device, face mask or bag-valve-mask device.

(ARC Guidelines 9.3.2, 2014, ‘Resuscitation of a drowning victim,’ p.3)

Dehydration

Dehydration is the loss of water and salts from the body. In most cases, a casualty can correct dehydration by drinking water. Young children and the elderly are particularly at risk of dehydration. In the elderly often there is insufficient signally mechanism – they do not feel thirsty although they may be dehydrated.

Causes

Heat (during periods of hot weather) Exercise (increased sweating)

Infection Recovery from burns

Excessive diarrhea or vomiting Increased output of urine due to a hormone deficiency, diabetes, kidney disease, medication

Symptoms

Lips and nasal passages dry Headache


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Not passing urine or only passing small amounts of dark yellow urine

Not sweating as much

Irritable, respond slowly, feel confused

or have hallucinations

Tired and weak


Management

Untreated, dehydration may lead to shock. If a casualty of dehydration has a low blood pressure or very rapid pulse, the casualty may need to get intravenous fluids. It is also important to note that too much water can be lethal if given to the casualty too quickly.

Rest

Cool place

Lie the casualty down

Loosen & remove excess clothing

Moisten the skin with a moist cloth

Cool by fanning

Give a drink of water if conscious

Casualty may need medical attention depending on age and level of dehydration

Monitor casualty if condition deteriorates call ambulance

(ARC Guidelines 9.3.4, 2008 ‘Heat induced illness (hyperthermia) first aid management’ p. 1-3)

Hyperthermia

Heat induced illness may be caused by

• Excessive heat absorption from a hot environment

• Excessive heat production from metabolic activity

• Failure of the cooling mechanisms

• Alterations in the body’s set temperature


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Factors that may contribute to heat induced illness

• Excessive physical exertion

• Hot climatic conditions with high humidity

• Inadequate fluid intake

• Infection

• Inappropriate environments

• Wearing heavy dark clothing

• Drug use – which may affect heat regulation

• Very old and very young are prone to heat induced illness

(ARC Guidelines 9.3.4, 2008 p.1)

Recognition

Mild temp elevation – normally controlled by sweating

Heat exhaustion Recognised by fatigue – associated with headache, nausea, vomiting, malaise and dizziness, which may be accompanied by collapse. In the case of heat exhaustion the body temperature is less than 40 degree & the conscious state becomes normal once the casualty is lying down

Heat Stroke Serious form of heat related illness, which may lead to unconsciousness or death. Affects all organs, recognition – lack of sweating, temp above 40 degrees, central nervous system (CNS) involvement, hot dry skin, collapse

Management

Heat Exhaustion • Lie the casualty down • Loosen & remove excess clothing • Moisten the skin with a moist cloth • Cool by fanning • Give a drink of water if conscious • Call for ambulance • Keep in the shade

Heat Stroke • Call an ambulance • Resuscitate following basic life support guidelines • Moisten skin with a moist cloth and fan • Apply wrapped ice packs to neck, groin & armpits

(ARC Guidelines 9.3.4, 2008 ‘Heat induced illness (hyperthermia) first aid management’ p. 1-3)


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Hypothermia

Normal human body system and function at a body temperature of 37 degrees. If the body’s temperature falls below 35 degrees, it is known as hypothermia. Body systems and organs progressively fail with a fall in body temperature and will result in death usually from cardiac arrest, the elderly and infants are most at risk.

(ARC Guidelines 9.3.3, 2009, ‘Hypothermia first aid management’)

Common causes

Environmental – exposure to cold, wet or windy conditions, cold water immersion/ submersion; exhaustion

Trauma, immobility or burns

Drugs: alcohol and /or sedatives

Neurological: stroke and altered consciousness

Endocrine: impaired metabolism

Systemic Illness: severe infections, malnutrition

(ARC Guidelines 9.3.3, 2009, ‘Hypothermia first aid management,’ p.1)

Symptoms

Mild Hypothermia Moderate to severe hypothermia

Casualty shivering Absence of shivering

Pale, cool skin Increasing muscle stiffness

Impaired coordination Progressive decrease in consciousness

Slurred speech Slow irregular pulse

Responsive but with apathy or confusion Hypotension

In more severe cases

• Dangerous cardiac arrhythmias and cardiac arrest,

• Fixed dilated pupils and the casualty may appear dead.

(ARC Guidelines 9.3.3, 2009, ‘Hypothermia first aid management,’ pp.1-2)


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Management

Call an ambulance

Remove the casualty from the cold

General and supportive treatment of the casualty with general basic life support (BLS) as required

Remove the casualty from windy or wet conditions. If you have a blanket remove wet clothing from casualty

Dry the casualty if they are wet

Give warm oral fluids (not alcohol) only if the casualty is conscious

If the casualty is in a remote location & not shivering – initiate rewarming.

• Application of heat packs or body to body contact

• Ensure the source of heat is warm not hot

• Do not place the casualty in a warm bath

(ARC Guidelines 9.3.3, 2009, ‘Hypothermia first aid management,’ p.2)


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Section 8: First Aid - Envenomation Pressure immobilisation treatment (PIT)

Introduced for the treatment of Australian snake bites and is suitable for other elapid snake bites and is also recommended for envenomation by a number of other animals. The PIT retards the flow of lymph by which venoms gain access to the circulation and research has shown that very little venom reaches the circulation, even after several hours, if PIT is applied immediately and maintained.

There is also evidence that there may be inactivation of certain venoms and venom components when the injected venom remains trapped in the tissues by the pressure bandage

(ARC Guidelines 9.4.8 2011, ‘Envenomation – pressure immobilisation technique’ p. 1)

PIT is recommended for the first aid management to bites and stings by the following creatures:

All Australian venomous snakes, including sea snakes Funnel Web spider

Blue-ringed octopus Cone shell

PIT is NOT recommended for the first aid management of:

Other spider bites including Redback Jellyfish stings

Fish stings including stonefish bites Stings by scorpions, centipedes or beetles

(ARC Guidelines 9.4.8 2011, p. 1)

Management

If resuscitation is required it takes precedence over the PIT

Aim to use PIT as soon as possible to potentially minimise further venom flow

If the bite is on a limb, apply a broad pressure bandage. Elasticised bandages (10-15cm wide) are preferred over crepe bandages. Clothing or other material should be used if no bandages are available.

Ensure the bandage is firm and tight, you should be unable to easily slide a finger between the bandage and the skin.

To further restrict lymphatic flow and to assist in immobilisation of the limb, apply a further pressure bandage, commencing at the fingers or toes of the bitten limb and extending upward covering as much of the limb as possible.

Apply bandage over existing clothing if possible.


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Alternatively, a single bandage may be used to achieve both pressure on the bite site and immobilisation of the limb. See flowchart below

To restrict limb movement splint the limb including joints on either side of the bite. The splint material can be incorporated under the layers of the bandage. For the upper limb, use a sling.

Ensure the casualty and the limb completely at rest.

If possible bring transport to the casualty

Transport the casualty to medical care, preferably by ambulance.

If alone, the casualty should apply the pressure immobilisation bandage over the bite site and affected limb. If alone, the casualty should seek urgent help to come to them. If help is not on hand, immobilisation is contraindicated and they should move themselves to seek urgent help.

If the bite is not on the limb, firm direct pressure on the bite site may be useful

(ARC Guidelines 9.4.8, 2011, p. 2-3)

Pressure bandage application

Application of a single bandage to the lower limb

• Apply a broad pressure bandage from

• Below the bite site, upward on the affected limb (starting at the fingers or toes, bandaging upward as far as possible).

• Leave the tips of the fingers or toes unbandaged to allow the casualty’s circulation to be checked

• Bandage firmly, but not so tight that circulation is prevented

• Continue to bandage upward from the lower portion of the bitten limb

• Apply the bandage as far up the limb as possible to

• compress the lymphatic vessels

• Apply a splint using a stick/suitable rigid item over the initial bandage to splint the limb.

• Secure to the bandaged limb by using another bandage

• It is very important to keep the bitten limb still


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• Bind the splint firmly, to as much of the limb as possible

• Muscle, limb and joint movement will be restricted

• Restrict venom movement.

• Seek urgent medical assistance

Application of a single bandage to the lower limb

• Apply a broad pressure bandage from the fingers of the affected arm, bandaging upward as far as possible.

• Bandage the arm with the elbow in a bent position, leave the tips of the fingers unbandaged to check circulation

• Bind a splint along the forearm & use a sling to further prevent limb movement

(Australian Venom Research Unit, 2007, Pressure Immobilisation Bandaging (PIB))

Please Note

Do NOT remove the bandages or splints before evaluation in an appropriate hospital environment.

Do NOT restrict breathing or chest movement and do not apply firm pressure to the neck or head

DO NOT cut/excise the bitten area, or attempt to suck venom from the bite site

DO NOT wash the bitten area

DO NOT apply an arterial tourniquet (they can cut off circulation to the limb, are potentially dangerous and are not recommended for any type of bite or sting in Australia).

(ARC Guidelines 9.4.8 2011, ‘Envenomation – pressure immobilisation technique’ pp. 1-4)

Australian Venom research unit website:

http://www.avru.org/




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Snake bites

Many of the snakes found in Australia are capable of lethal bites to humans. Antivenom is available for all venomous Australian snake bites.

Tiger Snake

(Australian Venom Research Unit, 2014)

Snake identification

Venomous snakes can be identified from venom present on clothing or the skin using a Venom Detection Kit. Medical services do not rely on visual identification of the snake species so it is not recommended to kill the snake for purposes of identification.

Types of Venous Australian Snakes

Brown snakes Tiger snakes Copperhead snakes

Death Adders Black snakes many Sea snakes

many Sea snakes

Effects Snake bites

• Snake venoms are complex mixtures of many toxic substances

• The life-threatening early effects; neurotoxic muscle paralysis which results in breathing failure.

• Can cause bleeding due to coagulation failure

• Result in muscle damage causing kidney failure

(ARC Guidelines 9.4.1 2011, ‘Envenomation – Australian Snake bite’ p.1)


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Signs and symptoms

The bite may be painless and without visible marks and life-threatening effects may not be seen for hours. When massive envenomation occurs, especially in children, symptoms and signs may appear within minutes. Other symptoms and signs may include:

Paired fang marks or sometimes only a single mark or a scratch mark

Headache

Nausea and vomiting

Occasionally, initial collapse or confusion followed by partial or complete recovery

Abdominal pain Blurred/ double vision, or drooping eyelids

Difficulty in speaking, swallowing or breathing

Swollen tender glands in the groin or axilla of the bitten limb

Limb weakness or paralysis Respiratory weakness or respiratory arrest.


Management

• Ensure the casualty is at rest, reassured and under constant observation

• Commence resuscitation if necessary, following the ARC guidelines

• Apply the Pressure Immobilisation Technique (PIT)

• Transport the casualty to a medical facility, preferably by ambulance

• DO NOT cut or incise the bite. DO NOT use an arterial tourniquet. DO NOT wash or suck the bite



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Spider bites

Bites from funnel web spiders and mouse spider are potentially serious and require different first aid.

Spider type Description Signs & symptoms Management

Funnel Web

(Australian Museum, 2014)

• Large >2cm

• Dark coloured

• Regions- Sydney, Blue Mountains, central northern, southern highlands or South coast NSW, or South-Eastern QLD

• Dangerous & casualty will require immediate medical treatment

• Pain at bite site, but little location reaction

• Tingling around mouth

• Profuse sweating

• Copious secretion of saliva

• Abdominal pain

• Muscular twitching

• Breathing difficulty

• Confusion

• Unconsciousness

• Call Ambulance

• Apply pressure immobilisation

• Follow ARC basic life support guidelines

• Antivenom is available

(ARC Guidelines 9.4.2 ‘Envenomation – Spider Bite’ 2014 p. 1-2)

Red Back Spider


• Approx. 1cm body length

• Red, orange or pale stripe on back

• Threaten life of a child

• Pain is normally most serious affect for an adult

• Immediate pain at bite site

• Bite site – hot, red & swollen

• Intense local pain

• Nausea, vomiting, abdominal pain

• Profuse sweating at the bit site

• Swollen tender glands in groin/armpit of affected limb

• Slowly acting venom – serious illness unlikely in less than 3 hours

• Casualty requires constant observation

• Apply ice or compress to lessen pain (no longer than 20 mins)

• Transport casualty to medical facility

• Ambulance – if young, or casualty has collapsed

• NO NOT use Pressure Immobilisation technique

• Antivenom is available (to treat pain)


http://australianmuseum.net.au/image/Blue-Mountains-Funnel-web-Spider-female/

http://australianmuseum.net.au/image/Redback-Spider-Latrodectus-hasselti/

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White- Tailed Spider


• Dark reddish to grey, cigar-shaped body and dark orange-brown banded legs

• Grey dorsal abdomen bears two pairs of faint white spots (less distinct in adults) with a white spot at the tip

• Bites have been controversially implicated in causing severe skin ulceration in humans

• 2 species - Lampona cylindrata and L. murina

• Males 12 mm, Females 18 mm

• Lampona cylindrata - found across southern Australia (south east Queensland, New South Wales, Victoria, South Australia, Tasmania, Western Australia)

• Lampona murina - eastern Australia from north-east Queensland to Victoria (Queensland, New South Wales, Victoria,

• Severe inflammation

• Very few cases – severe local destruction

• Neurotic ulcers

• initial burning pain followed by swelling and itchiness at the bitten area

• The available evidence suggests that skin ulceration is not a common outcome of White-tailed Spider bite

• Pressure immobilisation should not be used

Please note: Other spider bites treat symptomatically – apply ice or cold compress to less the pain

(ARC Guidelines 9.4.2 ‘Envenomation – Spider Bite’ 2014 pp. 1-2)


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Tick, bee, wasp and ant stings

Description Signs & Symptoms Management

Tick


• Insidious danger to humans

• Not readily detected when they first attach.

• Infants are particularly at risk. Ticks may attach in any body crevice or folds of skin, one of the most common places being behind the external ear.

• Envenomation progressive process as the attached tick releases more saliva.

• Condition may worsen over several days, and even result in death caused by respiratory muscle paralysis.

• Earliest signs and symptoms are typically:

• Diplopia (double vision)

• Photophobia (extreme sensitivity to light)

• Nystagmus (rapid involuntary movement of the eyes)

• Pupillary dilation

• Walking unsteady

• Lethargy

• Enlargement of regional lymph nodes

• Progressive paralysis

• Find and removing the tick, levered out using a pair of curved scissors

• Apply cold compress to reduce swelling

• Call for ambulance – depending on circumstances & support the patient until antivenom can be administered

• In some susceptible people tick bite may cause a severe allergic reaction or anaphylaxis, which can be life threatening – in this case follow anaphylaxis management process

• Commence resuscitation if necessary

Bee


• Stings an injects its toxin

• If someone has a known allergy to bee venom, most likely carry adrenaline injection

Single/ few stings in a normosenstive patient cause

• localised pain,

• Swelling & redness at the site.

Numerous stings, can be accompanied by:

• Headache

• Nausea and Vomiting

• Oedema

• Thirst

• Pain

• Removal of the sting if present & move casualty to a safe area

• The application of cold compress to reduce swelling & pain

• Numerous stings is a problem, the patient should be referred to hospital

• A single sting to a hypersensitive patient, immediately call ambulance

• Commence CPR if necessary


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• Haematuria and/or myoglobinuria

• Death has occurred in cases where several hundred stings are received, but a casualty may become very ill after as few as 10

• Hypersensitive patients can develop rapid and catastrophic anaphylaxis

• Airway obstruction result from anaphylaxis or result of swelling of face & tongue from sting around or in mouth - **requires urgent medical attention

• Follow anaphylaxis management process

• If casualty has be stung to face or tongue will also require medical attention

Wasp

Ant


• Bull ants can deliver painful stings and are aggressive

• Immediate & intense local pain

• Local redness & swelling

• Allergic reaction/ anaphylaxis

• Abdominal pain & vomiting (in the case of an allergic reaction to the venom)

• Airway obstruction result from anaphylaxis or result of swelling of face & tongue from sting around or in mouth - **requires urgent medical attention

• Remove sting from skin & move casualty to a safe place

• Apply a cold compress to reduce pain & swelling

• Commence CPR if necessary

• Follow Anaphylaxis guidelines if allergic reaction occurs

• Refer casualty to hospital if stung on face

(ARC Guidelines 9.4.3, 2010, ‘Envenomation – Tick bites & bee, wasp & ant stings’ p.1-2)


http://australianmuseum.net.au/Transfer/ToGalleryItem/?id=6016&path=image/Wasp

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Marine stings

Advice concerning any marine envenomation contact Australian Venom Research Unit 1300 760 451 or Poisons Information Centre 131126

Description Signs & Symptoms Management

Tropical Jelly fish stings

Box Jelly Fish

(Australian Venom research unit, 2014)

• The box jellyfish (Chironex fleckeri)

• Found estuarine & on-shore coastal waters

• It is the most dangerous jellyfish, & one the most dangerous venomous creatures, in the world.

• Large bell - 20-30 cm

• The tentacles may stretch up to 2 metres. Multiple tentacles each containing many millions of nematocysts or stinging cells which discharge venom through the skin on contact.

• Approx. 80 deaths have been recorded

• Found between Bundaberg (QLD) to Geraldton (WA)

• A sting with several metres of tentacles cause respiratory and cardiac arrest within minutes

• Pain is immediate & varies in intensity from mild to severe sharp pain

• Generalised muscle aches

• Sever muscle cramps in limbs, chest & abdomen

• Severe stings

• Difficulty/ cessation of breathing

• Cardiac arrest

• Sever pain

• Restlessness & irrational behaviour

• Nausea & vomiting headache

• Physical collapse

• Profuse sweating, at the sting area


• Remove casualty from water & restrain if necessary

• Casualty looks/feels unwell call ambulance

• Commence resuscitation if required

• Vinegar should be poured over the adhering tentacles to inactivate stinging cells as soon as possible. Tentacle material may then be removed.

• If vinegar is not available pick off tentacles & rinse with sea water

• Apply cold pack or ice – DO NOT apply fresh water onto sting as it may cause discharge of nematocysts

• Antivenom is available

(ARC Guidelines 9.4.5 ‘Envenomation – Jelly fish stings’ 2010 p. 1-5)


http://www.avru.org/?q=general/general_boxjelly.html


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Irukandji


• Approx. 10 small to medium sized off shore and onshore jelly fish are known/suspected to produce irukandji syndrome

• 4 tentacles & transparent, small and usually not observed

• Irukandji is unusual as its bell also features stinging capsules (nematocysts)


A minor sting with no tentacle visible – followed by 5-40 minutes of

• severe generalised pain,

• nausea & vomiting,

• difficulty breathing,

• sweating,

• restlessness

• Feeling of “impending doom”

Casualty may:

• Develop heart failure

• Pulmonary oedema

• Hypertensive stroke



• Remove casualty from water & restrain if necessary

• Casualty looks/feels unwell call ambulance

• Commence resuscitation if required

• Vinegar should be poured over the adhering tentacles to inactivate stinging cells as soon as possible. Tentacle material may then be removed.

• If vinegar no available pick off tentacles & rinse with sea water

• Apply cold pack or ice – DO NOT

apply fresh water onto sting as it

may cause discharge of

nematocysts

• Medical assistance should be

sought for all cases

Please note may be suffering

irukanji syndrome if a casualty for

may initially appear stable but

experiences severe symptoms in

the following 30minutes, they

require urgent medical care


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Non tropical Jelly fish stings

Blue Bottle


• The Portuguese man-o-war or bluebottle, is well known throughout Australian waters causing painful stings.

• No fatalities have been confirmed in Australia.

• The bluebottle is not a jellyfish sensu stricto, but a colony of animals closely related to jellyfish.

• The float measures 2-15 cm. The main or fishing tentacle may be up to 10m long and is responsible for most of the stings.

• A sting with localized pain & redness

• Systemic symptoms are uncommon but may include headache, nausea and vomiting, abdominal pain and occasionally collapse.



• Remove the casualty

• Keep them at rest & under constant observation

• Do not rub at the sting are

• Pick off tentacles (not dangerous to rescuer) & rinse with sea water. Vinegar is not recommended –If you are unable to identify the type of jellyfish - it is safer to treat the casualty with vinegar as bluebottle is identified as a harmless sting.

• Place stung area in hot water (not scalding) if unavailable apply a cold pack/ ice in a dry plastic bag

• If pain persists or generalised or area large or involves sensitive are i.e. Eyes call ambulance & seek advice from life guard if available the area in water may alleviate pain.

Blue Ringed Octopus & Cone Fish

Blue Ringed octopus

• Hapalochlaena spp

• Inhabit all Australian coastal waters & often found in tidal pools

• Blue-ringed octopus’s salivary glands contain tetrodotoxin, which causes paralysis and

• Painless bite, a spot of visible blood

• Within about 10 minutes, however, symptoms of envenomation begin to develop:

• Numbness of the lips and tongue

• Nausea and vomiting


• Keep casualty at rest, reassured &

under constant observation

• Use pressure immobilisation

technique

• Transport casualty to medical Learning Resource Booklet | 21/04/2015 careersaustralia.edu.au



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respiratory failure. Death may occur in as little as thirty minutes.

• Difficulty in breathing

• Followed by complete paralysis of the breathing muscles.

• Casualty may appear to lose consciousness (as they cannot respond to their name being called). However, upon recovery many casualties have reported being able to hear everything around them.

(ARC Guidelines 9.4.6 ‘Envenomation – Blue ringed octopus & cone shell’ 2014 p. 1-2)

facility preferably by ambulance

• Commence CPR/ basic life support

as required

• The patient may be completely

paralysed and unable to respond,

sometimes with fixed dilated

pupils, but may still be completely

aware of their surroundings

There is no antivenom available

Cone Shell


• Conus spp - found in tropical water

• Cone or cylindrical-shaped shell with a muscular foot

• Deliver venom when handled by Firing a dart-like barb

• Venom can cause paralysis & death from respiratory failure within 30 minutes

• Painless bite, with a spot of visible blood

• Numbness of the lips and tongue

• nausea and vomiting

• difficulty in breathing

• Followed by complete paralysis of the breathing muscles.

(ARC Guidelines 9.4.6 ‘Envenomation – Blue ringed octopus & cone shell’ 2014 p. 1-2)


• Keep casualty at rest, reassured &

under constant observation

• Use pressure immobilisation

technique

• Transport casualty to medical

facility preferably by ambulance

• Commence CPR/ basic life support

as required

• Despite being unable to move, the

casualty may still be able to hear

spoken comments


http://australianmuseum.net.au/image/Blue-lined-Octopus-in-tank/

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Fish stings

Stone fish


• Stonefish (Synanceia spp) lie motionless on the seabed, camouflaged as a rock and half buried in sand or mud

• Difficult for humans to avoid stepping on. Even if the person has footwear, any of the thirteen tough spines may penetrate the foot to a considerable depth.

• Deposit venom causing excruciating pain

• Cardiovascular effect can occur but are rare

• Potentially dangerous to handle

• Intense pain, leading to irrational behaviour

• Swelling

• Sometimes a local grey/ blue discolouration

• An open wound

• Bleeding

• The result of stonefish envenomation is immediate and excruciating pain, but a delayed effect may be tissue damage.


(ARC Guidelines 9.4.7 ‘Envenomation – Fish stings’ 2014 p. 1-2)


• Assess casualty for signs of bleeding & treat as per management for control of bleeding

• If the sting is to a limb immerse the stung area in very warm water

• Stonefish antivenom required in cases which present with more than mild to moderate local pain or with systemic symptoms reduces the pain and the likelihood of tissue damage

• If casualty unresponsive & not breathing normally commence CPR

(ARC Guidelines 9.4.7 ‘Envenomation – Fish stings’ 2014 pp. 1-2)

Sting ray

(Australian venom research unit, 2014)

• Stingrays respond to someone stepping on them or swimming above them with an upward flick of the tail.

• The venomous spine located on the tail can inflict a serious gnash or penetrating stab injury with subsequent venom induced tissue death

• Often the more serious effect is that of the wound than that of the venom. They are known

• Intense pain, leading to irrational behaviour

• Swelling

• Sometimes a local grey/ blue discolouration

• An open wound

• Bleeding




• Assess casualty for signs of bleeding & treat as per management for control of bleeding

• If barb from stingray is embedded do not remove as it maybe restricting bleeding, apply padding & pressure above & below the object

• If the sting is to a limb Immersing


133

to have killed three people in Australian waters

the stung area in very warm water

• If casualty unresponsive & not breathing normally commence CPR


For Further readings go to




134

Section 9: First Aid – Poisoning Australian Poisons Information Centre on 13 11 26 anywhere in Australia 24 hours a day, 7 days a week

(Sir Charles Gairdner Hospital, 2014)

Poisoning and toxic substances

A poison is a substance (other than an infectious substance) that is harmful to human.

Methods through which poisons can enter the body:

• ingestion

• inhalation

• injection

• absorption through the skin

Toxins are poisons that are produced by living organisms.

Venoms are toxins that are injected by an organism.

Symptoms

Unconsciousness Nausea

Vomiting Burning pain in the mouth or throat

headache blurred vision

seizures difficulty breathing

respiratory arrest cardiac arrest

In some cases it may be difficult to pin point poison as the result of an incident as a person may not be aware that they were exposed to a poison and they may complain of physical symptoms, exhibit abnormal behaviour. It may be misinterpreted as alcoholic confusion or psychiatric disturbance.

Pharmaceuticals are poisonous in overdose. Poisons – rapid effect but also may have delayed effects. It is important to seek medical assistance after a significant exposure even if symptoms are initially mild or absent.

(ARC Guidelines 9.5.1 2011, pp.1-2)


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Management

Prevention of poisoning of the rescuer

• Suspected poison should be identified and safely handled to minimise further exposure.

• Poisoning occurs in an industrial, farm or laboratory setting. Take precautions when dealing with particularly dangerous agents and to avoid accidental injury

• If more than one person appears affected by a poison simultaneously, there is a high possibility of dangerous environmental contamination

• If the poisonous substance can be transferred to the rescuer from contaminated clothing

• Rescuer may need to wear personal protective equipment (PPE) during decontamination & resuscitation.

• PPE will be guided by knowledge of the likely poison

• If equipment is not available to safely decontaminate and treat a casualty, rescue may not be possible

Decontamination

• Separate the casualty from the poisonous substance.

• This will depend on the type of poison & how exposure occurred

o Swallowed

o Inhaled

o Eye contact

o Skin Contact

Swallowed Poison

• Give the person who has swallowed the poison a sip of water to wash out their mouth.

• Do NOT try to make them vomit.

• Do NOT use Ipecac

Inhalation

• Without placing yourself at risk immediately place give casualty access to fresh air

• Avoid breathing fumes.

• Special breathing apparatus may be required, for example, with cyanide or agricultural chemicals poisoning.

• If it is safe to do so, open doors and windows wide


136

Poison enters the eye

• Flood the eye with saline or cold water from a running tap or a cup/jug.

• Holding the eyelids open continue to flush for 15 minutes

Skin contact

• Taking care to avoid contact with the poison remove contaminated clothing

• Flood skin with running cold water

• Wash gently with soap and water and rinse well

Resuscitation and supportive care

• If the casualty is unconscious or is not breathing normally, commence resuscitation if necessary, following Basic Life Support Flowchart

• Mouth to mouth ventilation is unlikely to result in a risk to the rescuer unless the casualty is contaminated with the liquid phase of the inhaled poison.

• Quickly wipe obvious contamination from around the mouth Before commencing resuscitation,

• Ensure that an ambulance has been called

• A self-inflating bag-valve-mask apparatus is the safest way to provide ventilation for the BLS rescuer if not available, mouth-to-mask or mouth-to-mouth ventilation may be considered depending on the chemical ingested.

• If cyanide or organophosphate poisoning is suspected mouth-to-mouth ventilation should be avoided.

Specific management of particular poisons

• The source of medical advice will depend on the situation it is important to ascertain:

o what poison or pharmaceutical has been taken,

o the level of exposure/ ingestion

o the time of exposure/ ingestion

Options include:

• Australian Poisons Information Centre on 13 11 26 anywhere in Australia 24 hours a day, 7 days a week.

• Occupational health facilities

• Some poisons have specific antidotes, but (with some exceptions, such as cyanide) these are


137

• Then obtain medical advice promptly. rarely used outside hospital. If there are packets or bottles they should go with the casualty to hospital. Poisons with antidotes include:

o Cyanide

o Organophosphates

o Iron

o Paracetamol

o Antifreeze

o Methanol

o Some antidepressants

o Digoxin

o Warfarin

If unable to get advice or while waiting for help to arrive

• If the casualty is unconscious or is not breathing normally, commence resuscitation

Monitor the casualty,

• especially the Airway,

• Breathing and

• Circulation

Manage according to the Australian Resuscitation Council

(ARC Guidelines 9.5.1 2011, pp.1-2)


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Common substances causing poisoning

Type Substance Result & Effects Treatment requirements

Common pharmaceutical

Paracetamol Most common pharmaceutical overdose leading to hospital admission

Responsible for most calls to Australian poisons information centre

Large proportion of poisoning to children

Without treatment – small amounts are sufficient to cause significant liver damage and death

Requires immediate medical attention

Treatment is effective if administered early


Organic Substances

Glues

Hair spray

Aerosol paints

Lighter fluid

Dry cleaning fluid

Nail polish remover

Petrol

Effects of inhalation include:

• Hyperactivity, drowsiness, unconsciousness

• Irregular heartbeat, followed by cardiac arrest

• Difficulty breathing

Dangers are increased by exercise, confined space & inhalation from a bag



Household chemical

Dishwasher detergent 3rd most common cause of poisoning of children

Risk of damage to oesophagus & lung


Do not induce vomiting – as it may result in further damage to the oesophagus & result in possible lung damage through aspiration

Required immediate medical attention

Fungi Mushrooms Some are poisonous & grow widely throughout Australia.



139

Toadstools They can cause

• Hallucinations

• Vomiting

• Diarrhoea

Ingestion of amanita phalloides mushrooms can cause:

• Liver damage

• Death

Cooking will not neutralise the toxin

Most reported cases involve children


Chemical compound

Cyanide Inhalation of fume

• House fire

• Industrial fire

• Occupational exposure

Workplace at risk of exposure should

• Frequently inspect work practices

• Have plans for containment/ decontamination

• Have access to resuscitation devices – oxygen

• Have a cyanide antidote

Early treatment with antidote can be lifesaving


(ARC Guidelines 9.5.1 2011, pp. 4-5)


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Prevention

Storage

• All medicines and chemicals must be out of reach and out of sight of children

• Store in a locked or child-resistant cupboard

• Keep poisons in their original containers. Do not transfer poison to drink or food containers

• Always store medicines separately from household products

• Only buy household products and medicines in child-resistant packaging ensure the child-resistant closure is working correctly. Clean around the neck of the container.

• Do not leave medications on a bedside table.

• Empty bottles of medicine or cleaning products should be placed into an outside bin immediately

(Queensland Health, 2013, ‘Poisoning First Aid’)

Medicines

• Read and follow the directions for use.

• Take medicines in a well lit room.

• Wear your glasses.

• Do not take other people’s medicines.

• Avoid taking medicines in child’s presence, so they do not try to copy.

• Refer to medicines by their proper names

• Store visitor’s bags out of reach of children in case they contain medicines.

• If medicines require refrigeration, keep in a tightly closed or locked container at the back of the fridge.

• Clean out your medicine cupboard regularly.

• Unwanted or out-of-date medicines should be taken to your nearest pharmacy for disposal.

(Queensland Health, 2013, ‘Poisoning First Aid’)

Other risks

• Always follow instructions when using chemicals and cleaning products. Use PPE

• Ensure there is good air circulation whilst using cleaning products.

• Button batteries can cause life-threatening injuries if swallowed. Check the battery compartments on devices and toys are secure, and lock away spare batteries.

• Ensure you supervise children when using toys or devices containing button batteries. If you suspect a child has swallowed a battery, go to the nearest hospital immediately. Do not let the child eat or drink. Do not induce vomiting.


141

• Be aware of the plants in your garden and remove any that are known to be poisonous

(Queensland Health, 2013, ‘Poisoning First Aid’ & ARC Guidelines 9.5.1, 2011, ‘Emergency Management of a casualty who has been poisoned’ p.5)

http://www.health.qld.gov.au/poisonsinformationcentre/plants_fungi/default.asp

© The State of Queensland (Queensland Health) 1996-2014

http://www.health.qld.gov.au/poisonsinformationcentre/docs/fs-poisons-info-ctr.pdf


(Queensland Health, 2013)

Poisons information centre

QLD: http://www.health.qld.gov.au/PoisonsInformationCentre/

NSW - http://www.chw.edu.au/poisons/

VIC - http://www.austin.org.au/poisons

WA - http://www.scgh.health.wa.gov.au/OurServices/WAPIC/index.html





http://www.health.qld.gov.au/PoisonsInformationCentre/

http://www.chw.edu.au/poisons/

http://www.austin.org.au/poisons

http://www.scgh.health.wa.gov.au/OurServices/WAPIC/index.html

142

Tour a house and see the common dangers

http://www.health.qld.gov.au/poisonsinformationcentre/house.asp


(Queensland Health, 2006, ‘Tour of a house’)

Button batteries – read further on dangers to

Children:

http://thebatterycontrolled.com.au/

U-tube video – on dangers of button batteries

© 2000-2014 Energizer

(The battery controlled, 2014)




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Skills assessment requirements HLTAID003:

Followed DRSABCD in line with ARC guidelines, including:

� Performed at least 2 minutes of uninterrupted single rescuer cardiopulmonary resuscitation (CPR) (5 cycles of both compressions and ventilations) on an adult resuscitation manikin placed on the floor Performed at least 2 minutes of uninterrupted single rescuer CPR (5 cycles both compressions and ventilations) on an infant resuscitation manikin placed on a firm surface

� Responded appropriately in the event of regurgitation or vomiting

� Managed the unconscious breathing casualty � Followed single rescue procedure, including the demonstration of

a rotation of operators with minimal interruptions to compressions

� Followed the prompts of an Automated External Defibrillator (AED)

Responded to at least two (2) simulated first aid scenarios contextualised to the candidate’s workplace/community setting, including:

� Conducted a visual and verbal assessment of the casualty � Demonstrated safe manual handling techniques � Post-incident debrief and evaluation � Provided an accurate verbal or written report of the incident

Applied first aid procedures for the following: � Allergic reaction � Anaphylaxis � Bleeding control � Choking and airway obstruction � Envenomation, using pressure immobilisation � Fractures, sprains and strains, using arm slings, roller bandages

or other appropriate immobilisation techniques � Respiratory distress, including asthma � Shock

Assessment One (1) and Two (2) completed and practical assessment to finish.


144

Section 10: References

Allergy and Anaphylaxis Australia, 2010, Available from: <http://www.allergyfacts.org.au/> [27 November 2014]

An Australian Government Initiative, 2014, ‘Calls to emergency services,’ <http://relayservice.gov.au/making-a-call/emergency-calls/> [2 December, 2014]

‘Anatomy on how the spinal cord works,’ 2011 (video file), <http://www.youtube.com/watch?v=zxpb1-okVig> [24 November 2014]

Australian Defibrillators, 2014, ‘Sudden Cardiac Arrest,’ Available from: <http://www.aeds.com.au/Sudden-Cardiac-Arrest.html> [19 November, 2014]

Australian Museum, 2012, ‘Ants, Wasps, Bees and Sawflies: Order Hymenoptera’, Available from: <http://australianmuseum.net.au/Sawflies-Wasps-Bees-Ants-Hymenoptera> [12November 2014]

Australian Museum, 2012, ‘Bees Suborder Apocrita’, Available from: <http://australianmuseum.net.au/Bees-Suborder-Apocrita> [12 November 2014]

Australian Museum, 2013, ‘Australian Paralysis Tick,’ Available from: <http://australianmuseum.net.au/Australian-Paralysis-Tick/> [12November 2014]

Australian Museum, 2010, ‘Cone shells’, Available from :< http://australianmuseum.net.au/Cone-shells-conus/> [12November 2014]

Australian Museum, 2014, ‘Funnel Web Spider,’ Available from: <http://australianmuseum.net.au/Funnel-web-Spiders-group/> [12November 2014]

Australian Museum, 2014, ‘Redback Spider,’ Available from: <http://australianmuseum.net.au/image/Redback-Spider-Latrodectus-hasselti/> [12November 2014]

Australian Museum, 2012, ‘Wasps: Suborder Apocrita,’ Available from: <http://australianmuseum.net.au/Wasps-Suborder-Apocrita> [12November 2014]

Australian Resuscitation Council Guidelines 3, 2012, ‘Recognition and first aid management of an unconscious victim,’ Available from: <http://resus.org.au/download/section_3/guideline-3-nov-12.pdf> [26 November 2014]

Australian Resuscitation Council Guidelines 3, 2012, ‘Recognition and first aid management of an unconscious victim,’ p. 4, Available from: <http://resus.org.au/download/section_8/guideline-8dec2010.pdf > [3 December 2014]

Australian Resuscitation Council Guidelines 4, 2014, ‘Airway,’ p. 1-5, Available from: <http://resus.org.au/download/section_4/guideline-4-june-2014.pdf > [1 December 2014]

Australian Resuscitation Council Guidelines 4, 2014, ‘Airway,’ p. 4-7, Available from: <http://resus.org.au/download/section_4/guideline-4-june-2014.pdf > [15 November 2014]

Australian Resuscitation Council Guidelines 6, 2014, “Compressions,” p. 1-3, Available from: <http://resus.org.au/download/section_6/arc-guideline-6-compressions-july-2014.pdf > [1 December 2014]





http://www.aeds.com.au/Sudden-Cardiac-Arrest.html

http://australianmuseum.net.au/Sawflies-Wasps-Bees-Ants-Hymenoptera

http://australianmuseum.net.au/Bees-Suborder-Apocrita

http://australianmuseum.net.au/Australian-Paralysis-Tick/

http://australianmuseum.net.au/Cone-shells-conus/

http://australianmuseum.net.au/Cone-shells-conus/

http://australianmuseum.net.au/Funnel-web-Spiders-group/

http://australianmuseum.net.au/image/Redback-Spider-Latrodectus-hasselti/

http://australianmuseum.net.au/Wasps-Suborder-Apocrita

http://resus.org.au/download/section_3/guideline-3-nov-12.pdf


http://resus.org.au/download/section_8/guideline-8dec2010.pdf

http://resus.org.au/download/section_8/guideline-8dec2010.pdf

http://resus.org.au/download/section_4/guideline-4-june-2014.pdf

http://resus.org.au/download/section_4/guideline-4-june-2014.pdf

http://resus.org.au/download/section_6/arc-guideline-6-compressions-july-2014.pdf

145

Australian Resuscitation Council Guidelines 8, 2010, ‘Cardiopulmonary resuscitation,’ p. 4, Available from: <http://resus.org.au/download/section_3/guideline-3-nov-12.pdf > [26 November 2014)

Australian Resuscitation Council Guidelines 9.1.1, 2008, ‘Bleeding,’ p.1-3, Available from: <http://resus.org.au/download/9_1_trauma/guideline-9-1-1nov08.pdf > [6 November 2014]

Australian Resuscitation Council Guidelines 9.1.3, 2008, ‘Burns,’ p.1-5, Available from: <http://resus.org.au/download/9_1_trauma/guideline-9-1-3nov08.pdf > [6 November 2014]

Australian Resuscitation Council Guidelines 9.1.4, 2012, ‘Head injury,’ p.1-2, Available from: <http://resus.org.au/download/9_1_trauma/guideline-9-1-4-nov-12.pdf > [6 November 2014]

Australian Resuscitation Council Guidelines 9.1.6, 2012, ‘Management of a suspected spinal injury,’ p.1-5, Available from :< http://resus.org.au/download/9_1_trauma/guideline-9-1-6-july12.pdf > [6 November 2014]

Australian Resuscitation Council Guidelines 9.1.7, 2013, ‘Emergency management of a crush victim,’ p. 1-2, Available from: <http://resus.org.au/download/9_1_trauma/guideline-9-1-7march2013.pdf > [5 November 2014]

Australian Resuscitation Council Guidelines 9.2.1, 2012, ‘Recognition and first aid management of a heart attack,’ p.1-4, Available from: <http://resus.org.au/download/9_2_medical/guideline-9-2-1-nov-12.pdf > [25 November 2014]

Australian Resuscitation Council Guidelines 9.2.2, 2014, ‘Stroke’ p.1-3 Available from: <http://resus.org.au/download/9_2_medical/guideline-9-2-2-march-2014.pdf > [8 November 2014]

Australian Resuscitation Council Guidelines 9.2.3, 2009, ‘Shock,’ p.1-3 Available from: <http://resus.org.au/download/9_2_medical/guideline-9-2-3feb09.pdf > [6 November 2009]

Australian Resuscitation Council Guidelines 9.2.4, 2008, ‘First Aid management of a seizure,’ p. 1-3 Available from :< http://resus.org.au/download/9_2_medical/guideline-9-2-4-nov-14.pdf> [10 November 2014]

Australian Resuscitation Council Guidelines 9.2.5, 2014, ‘First Aid for Asthma,’ p.1-4 Available from: <http://resus.org.au/download/9_2_medical/guideline-9-2-5-march-2014.pdf> [6 November 2014]

Australian Resuscitation Council Guidelines 9.3.2, 2014, ‘Resuscitation of a drowning victim’ p.1-4 Available from: <http://resus.org.au/download/9_3_environment/guideline-9-3-2-march-2014.pdf> [10 November 2014]

Australian Resuscitation Council Guidelines 9.3.3, 2009, ‘Hypothermia first aid management,’ p.1-2 Available from :< http://resus.org.au/download/9_3_environment/guideline-9-3-3feb09.pdf> [6 November 2014]

Australian Resuscitation Council Guidelines 9.3.4, 2008, ‘Heat induced illness (hyperthermia) first aid management,’ p.1-3 Available from: <http://resus.org.au/download/9_3_environment/guideline-9-3-4nov08.pdf> [6 November 2014]

Australian Resuscitation Council Guidelines 9.4.1, 2011, ‘Envenomation – Australian Snake bite,’ p. 1-4 Available from: <http://resus.org.au/download/9_4_envenomation/guideline_9-4-1-july11.pdf> [11 November 2014]



http://resus.org.au/download/9_1_trauma/guideline-9-1-1nov08.pdf

http://resus.org.au/download/9_1_trauma/guideline-9-1-3nov08.pdf

http://resus.org.au/download/9_1_trauma/guideline-9-1-4-nov-12.pdf

http://resus.org.au/download/9_1_trauma/guideline-9-1-6-july12.pdf

http://resus.org.au/download/9_1_trauma/guideline-9-1-6-july12.pdf

http://resus.org.au/download/9_1_trauma/guideline-9-1-7march2013.pdf

http://resus.org.au/download/9_1_trauma/guideline-9-1-7march2013.pdf

http://resus.org.au/download/9_2_medical/guideline-9-2-1-nov-12.pdf


http://resus.org.au/download/9_2_medical/guideline-9-2-2-march-2014.pdf

http://resus.org.au/download/9_2_medical/guideline-9-2-3feb09.pdf


http://resus.org.au/download/9_2_medical/guideline-9-2-5-march-2014.pdf

http://resus.org.au/download/9_3_environment/guideline-9-3-2-march-2014.pdf

http://resus.org.au/download/9_3_environment/guideline-9-3-2-march-2014.pdf

http://resus.org.au/download/9_3_environment/guideline-9-3-3feb09.pdf

http://resus.org.au/download/9_3_environment/guideline-9-3-4nov08.pdf

http://resus.org.au/download/9_4_envenomation/guideline_9-4-1-july11.pdf

http://resus.org.au/download/9_4_envenomation/guideline_9-4-1-july11.pdf

146

Australian Resuscitation Council Guidelines 9.4.2, 2014, ‘Envenomation – Spider Bite,’ p.1-2 Available from: <http://resus.org.au/download/9_4_envenomation/guideline-9-4-2-july-2014.pdf> [11 November 2014]

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HLTAID001_ 003 Learning Resource Booklet

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