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First Edition - 2022
ASHRITHA MINES & MINERALS ASSOCIATION
FIRST AID TRAINING INSTITUTE
:: I N D E X ::
UNIT NAME PAGE
Foreword 01
Unit-1 Introduction to the First Aid 02-14
Unit-2 Dressing & Bandages 15-21
Unit-3 Introduction to Basic Anatomy 22-32
Unit-4 Fractures 33-41
Unit-5 Shock & Sprains 42-47
Unit-6 Wounds & Bleeding 48-55
Unit-7 Cardiovascular System 56-59
Unit-8 Respiratory System 60-67
Unit-9 Head & Spinal Injuries 68-71
Unit-10 Burn, Electrocution, Effects of Heat & Cold Management 72-81
Unit-11 Transportation of Injured Person 82-89
Unit-12 Ambulance & Equipment 90-91

Miscellaneous
Unit-13 (Drowning, Poisoning, Bites & Stings, 92-98
Convulsion & Epilepsy, Diabetes)
Unit-14 First Aid in Legislation 99-102
Contents of First Aid Box 103-104

FORE W OR D
From the Author
As unpleasant as it is to talk about, accidents and emergency situations are not completely
preventable or unavoidable. Accidents always happen despite any measure of preventative
procedure and care. If an accident happens in the workplace, in your home or in a public
space, being a helpless witness to an emergency situation can potentially worsen the situation.
Because of this, individuals who are properly trained and with the correct equipment, are a
huge help in ensuring better safety for everyone. Without proper First Aid, a simple injury
could become severe and in some cases fatalities can occur as a result of lack of immediate
medical treatment. First Aid does not just promote faster recovery, it helps save lives.
First Aid knowledge is invaluable for both you as the individual and for your community. It
enables you to assist persons who become injured in the event of an accident or emergency
situation until help arrives. First Aid skills can be applied in the home, the workplace or in
public locations, therefore the more First Aid certified people there are in a community the
safer that community becomes.
At any moment, you or someone around you could experience an injury or illness. Using
basic first aid, you may be able to stop a minor mishap from getting worse. In the case of a
serious medical emergency, you may even save a life.
That’s why it’s so important to learn basic first aid skills. To build on the information you
learn here, considering taking a first aid course. Many organizations offer first aid training,
including the ASHRITHA MINES & MINERALS ASSOCIATION FIRST
AID
TRAINING INSTITUTE. This course is suitable for professionals of any level. This
module should provide you with the basic knowledge to help someone in an emergency.
This book provides a valuable window on information assurance and covers the necessary
components – the key aims of first aid, how to react, and what to do in an emergency
situation.
- Author
1
Ashritha Mines & Minerals First Aid Training Institute
UNIT 1
INTRODUCTION TO FIRST AID
A. INTRODUCTION TO FIRST AID
1.0 FIRST AID is the first assistance given to a casualty for any injury or sudden illness before the arrival
of an Ambulance or a qualified Paramedical/Medical person. It may involve improvising with facilities and
materials available at the site.
2.0 AIMS OF FIRST AID:

➔ Preserve Life
➔ Prevent worsening of Casualty’s medical condition
➔ Promote recovery
GOLDEN RULES OF FIRST AID:

Do the first thing first; this includes assessing the situation for any immediate danger, quickly and
methodically without panicking, giving priority to the most urgent situation / condition.
Remove the victim from the cause of injury or the cause of injury from the victim.
Resuscitate the victim, if necessary and carry out general treatment of unconsciousness.
Loosen all tight clothing or materials around the victim’s neck waist, wrist, etc.
Arrest bleeding, cover all wounds, burns or scalds and immobilize all fractures.
Do not allow people to crowd a victim and do not move a victim unless you really have to (dangerous
environment, risk of falling debris, explosion etc.)
Reassure the victim and get help as soon as possible.
Improvise all necessary materials, which are not readily available.
Guide against or treat for shock.
Dispose/transport the victim properly.
4.0 FIRST AIDER: Any person who has received a Certificate from an Authorized Training Body indicating
that he/she is qualified to render First Aid is deemed to be a FIRST AIDER.
5.0 INSTRUCTIONS TO THE FIRST AIDER:

➔ Reach the spot as-fast-as possible and carry out the appropriate First-Aid quickly.
➔ Reassure and encourage the casualty.
➔ Work calmly and efficiently.
➔ Pay attention to any remark or requests that the casualty makes.
➔ After giving the necessary First Aid place the casualty in the appropriate position.
➔ Keep a watch until help arrives.
RESPONSIBILITIES OF THE FIRST AIDER:

➔ Assess the situation.
➔ ldentify the disease or condition (Provisional diagnosis).
➔ Give immediate and appropriate assistance.
➔ A casualty may have more than one injury and some may require more urgent attention than others
(prioritization).
➔ According to the seriousness of the casualty's condition arrange to shift to a medical centre.
The responsibility of the First aider ends when the casualty is handed over to the care of a doctor, a nurse
or a paramedic. One should not leave the incident/site, until somebody takes charge.
7.0 A-B-C RULE:
A – An Open Breathing Airway

When checking for breathing, ensure the victim’s airway is open. Perform a head-
tilt, chin-lift to open the airway. Once the airway is open, check
for normal breathing by placing the side of your cheek just above the victim’s
mouth. Look at the chest wall, listen for breath sounds and feel for exhaled air on
2
the side of your cheek. You should check for no longer than 10 seconds. If you
cannot detect normal breathing then immediately call EMS and commence CPR.
Opening the Airway Checking the Breathing Clearing the Airway
1. Opening the Airway:

• Open and clean the airway.
• If the casualty's breathing is noisy, his/her airway maybe obstructed and can lead to the death of
the casualty; so it is essential to establish a clear airway immediately.
• Hook your first two fingers covered with clean cloth/gloves and sweep round inside the mouth/
throat.
• One should not spend time searching for hidden obstructions.
• Care should be taken not to push any object further down the throat.
• Kneel beside the casualty
• Lift the chin forwards with the index and middle fingers of one hand while pressing the forehead
backwards with the palm of the other hand.
This manoeuvre will lift the tongue forward and clear the airways.
• Once the airway is cleared the casualty may begin breathing spontaneously. Once breathing starts,
place the patient in the Recovery Position. If the casualty still does not breathe, begin artificial
respiration immediately.
2. Checking the Breathing:

• Look for the chest/abdominal movement.
• Listen to the breathing sounds.
• Feel the air coming out of the nose or mouth.
3. Clearing the Airway:

• Turn the casualty's head to the side, keeping it well back.
• Hook first two fingers and sweep round inside the mouth. One
should not spend time searching for hidden obstructions. Care
should be taken not to push any object further down the throat.
• Check the breathing again.
Recovery Position
B – Breathing Adequacy
Breathing Restoration:
The technique of restoring breathing in a casualty who has stopped breathing is known as Artificial
Respiration.
The most efficient method is to transfer air from the rescuer's lungs into the casualty's by blowing air
through the mouth (mouth-to-mouth respiration) or through the nose (Mouth-to-nose respiration),
especially in the case of small children and infants.
1. Mouth-to-Mouth Respiration:
• Remove any obvious obstructions over the face or
constrictions around the neck; open the airway
and remove any debris seen in the mouth and
throat.
• Take a deep breath, pinch the casualty's nostrils
with fingers and open the mouth of the casualty
and place your mouth on the casualty's mouth.
• The rescuer breathes out and inflates the victim's
chest. Take a deep breath and repeat inflation.

Give two breaths. Each breaths should last one
second, with enough volume to make the chest
rise, inflation at a rate of 12-16 per minute until
natural breathing is restored.
2. Mouth-to-Nose Respiration:
• To carry out Mouth-to-Nose Respiration, close the casualty's mouth while placing the rescuer's
mouth on the nose of the casualty, and proceed as was carried out for Mouth-to-Mouth Respiration.
:: NOTE::
➢ If the casualty's chest fails to rise, first assume the airway is not fully open.
➢ Adjust the position of the head and jaw and try again Give two breaths, each breath should last one
second, with enough volume to make the chest rise.
➢ After two inflations, check the pulse to make sure the heart is beating. If the heart is beating and
a pulse is felt continue to give inflations at a rate of 12-16 times per minute until natural breathing
is restored, assisting it when necessary and adjusting it to the casualty's breathing rate.
➢ When the casualty is breathing independently place the person in the Recovery Position. If the heart
is not beating one must perform External Chest Compression immediately.
C – Circulation Sufficiency
Before commencing External Chest Compression it is important to establish that there is no circulation.
If the heart is not pumping the only reliable way of establishing a lack of circulation is to check the pulse
at the neck (Carotid Pulse). This pulse can be felt by placing the finger tips gently on the voice box and
sliding them down into the hollow between the voice box and the adjoining muscle. (The pulse at the wrist
is unreliable).
ASSESSING THE CONDITION:

Assess the situation by asking questions if the causality is conscious.
➢ History of the case is the story of the accident i.e. how the accident actually occurred. The casualty
will give the history if conscious. If he is unconscious, someone who saw the accident will help. The
surroundings will add to the information, like an abandoned vehicle or a damaged area near the place
and its condition.
➢ Symptoms are what the casualty tells the First Aider like pain, deformity, fainting etc. Pain described
by the casualty will lead the First Aider to the region of injury without wasting time.
➢ Signs are what the First Aider feels and finds out for himself- like paleness, swelling of parts injured,
bleeding, deformity of the limbs etc. Training helps in making these observations accurately.
Assessing the Symptoms – These are what a Victim can convey –

1. Pain: Loss of normal movement
4
2. Loss of Sensation: Cold, Heat, Thirst, Nausea, Weakness, Dizziness, Fainting, Temporary Loss
of Consciousness, Loss of Memory
3. Sensation of Breaking Bone
Assessing the Signs – Signs are to be observed by the First-Aider –

1. By checking for breathing, bleeding, color of face, lips, wounds etc.;
2. By feeling temperature, pulse, deformity;
3. By smelling gas, alcohol;
4. By hearing breathing sound.
PROCEDURE AFTER FIRST AID:

Observations in respect of the casualty must be sent in writing to the Doctor/Hospital.
First, take the casualty to the nearest shelter/ health facility. The carefully worded communication to the
relatives about his condition and also to which place he is being taken, must be sent.
RULES OF FIRST AID:

Reach the accident spot quickly. Immediate help is important to save lives.
Be calm, methodical and quick. By doing so, you can lessen the pain and the effects of injuries, which may
in turn save lives. Do not handle the casualty clumsily; eventual recovery might become difficult.
Look for the following:
(a) Is there failure of breathing?

(b) Is there severe bleeding?
(c) Is the heart beating?
Use the First Aid equipment, if available. Otherwise you will have to depend on the material at hand and
improvise it as per your requirements.
Inspect the area. Take the casualty away from live wires, fallen wall beams, fire, broken gas chambers,
moving machinery etc. to a safer place.
Do not allow people to crowd around the casualty. The casualty needs fresh air. Any other First Aider must
be asked to help, or the assistance of the bystanders may be taken.
Reassure the victim. Soft words and encouraging talk will make the casualty take things easy and lie quietly.
This will help in recovery.
Arrange for dispatch of the patient to the nearest health facility. At the same time intimate the relatives
where the casualty is being taken to.
Do not attempt too much. Restrict yourself to giving First Aid.
11.0 D-R-S-A-B-C-D TECHNIQUE:
D DANGER Check for Danger. Ensure safety.
R RESPONSE Check for Response. Ask name, squeeze shoulders.
S SEND Send for help. Call an Ambulance or ask a bystander to call.
A AIRWAY Open Mouth-look for foreign material. Maintain Airway.
B BREATHING Check for Breathing. Look-Listen-Feel
C CPR Start CPR – 30 Compressions, 2 Breaths. Perform Chest Compressions only

if unwilling or unable to perform breaths
D DEFIBRILLATION Apply Defibrillator (AED) as soon as available. Follow the Voice prompts
5
12.0 EMERGENCY SCENE MANAGEMENT:
Emergency scenes usually begin with a lot of confusion as people realize there is an emergency unfolding
in front of them; no one knows what to do first, who should be in charge or how they can help. In this
situation, the first aider needs to follow a sequence of actions that ensure safe and appropriate first aid is
given and everyone’s safety is protected.
ESM has four steps:

Take control of the scene, get an idea of what has happened and
Step 1 Scene Survey what is going on, and get things organized so you can start helping
any casualties.
Assess each casualty for life-threatening injuries or illnesses and give
Step 2 Primary Survey
the needed life-saving first aid.
Assess the casualty for injuries or illnesses that are not life
Step 3 Secondary Survey threatening and give appropriate first aid; sometimes you don’t have
to do this.
Step 4 Ongoing Casualty Care Stay with the casualty until medical help arrives and takes over.
B. PATIENT ASSESSMENT
STRUCTURE OF THE HUMAN BODY: To assess a Patient, the First Aider must be aware of the structure
and functioning of human body.
The Human Body Frame:-

(a) The Skeleton forms the supporting framework of the body and consists of
separate bones joined together by means of cartilage, ligaments and
muscles. The bones in different parts:
1. Head & Face : Skull, Two Cheek Bones and Lower Jaw Bone
2. Body : Backbone or Spine, the Ribs and Breast Bone
3. Upper Limbs : Arm, Forearm (Long Bones), Palm (Short Bones)
4. Hip : The Pelvis
5. Lower Limbs : Thigh and Leg; Long Bones, Feet - Short Bones
• THE SKULL – The bone of the head forms the skull and protects the brain inside.
Injury to the head causes bleeding from blood vessels inside the closed box; the
blood is unable to escape and gets collected and presses the soft brain tissue.
This leads to headache, irritability, unconsciousness and may cause death. To
avoid this it is important to place all persons of head injury under care of medical
supervision at the earliest.
One has to be familiar with the positions of the angle of the jaw because this has
to be pressed forward in case of an unconscious victim to prevent the falling back
of the tongue which obstructs the airway.
The Skull is made of the following bones:

➢ One in the front, corresponding to the face, called
Frontal
➢ Two-One on either side called the Parietals
➢ Two-One on either side below the Parietals at the
level of ears called the Temporal.
➢ One behind corresponding to the back of the head
called the Occipital.
➢ Two cheek bones and lower jaw bone all joined
together form the skull.
6
• THE BACK BONE OR SPINE (VERTEBRAL COLUMN) –
➢ It consists of thirty three small rounded pieces of
bones. The distribution in different region is as
follows:
➢ 07 in the Neck Region (Cervical)
7
➢ 12 in the Back Region (Thoracic or Dorsal)
➢ 05 in the Waist Region (Lumbar)
➢ 05 in the Hip Region (Sacral)
➢ In between each pair of vertebra there is a thick piece

of cartilage called Disc, which allows movement as
well as acts as a shock absorber.
12
➢ There is a Central Canal through which the spinal
cord passes and carries nerve impulses to and from
the brain.
➢ If there is any injury, one vertebra may be displaced
thus the spinal cord is pressed or cut causing paralysis
due to interruption in the pathway of nerves. This
damage may occur immediately at the time of injury 5
or may be caused by careless handling the person
after the accident. It is therefore extremely important
to handle with care all persons who have suffered
5
severe injury to their back or neck.
• THE RIBS & BREAST BONE (STERNUM) –

➢ This is called the Thoracic Cage which protects the
heart and the lungs.
➢ The chest is covered with twelve pairs of ribs which
are attached to the corresponding Vertebrae at the
back.
➢ The first seven pairs of these ribs are attached to
the breast bone in front.
➢ Eighth, Ninth and Tenth ribs are attached to the
rib above.
➢ Last two pairs of ribs i.e. eleventh and twelfth

have no attachment in front and are known as
'floating ribs'.
➢ The ribs and breast bone are liable to be fractured in

accidents due to either direct or indirect causes. An
injury of the rib should be taken seriously and
requires urgent hospitalization.
• THE UPPER LIMBS & SHOULDER –

➢ The Bones are:
(i) the Collar Bone (Clavicle) one on each side between upper part of the breast bone on the front
and shoulder blade and
(ii) the Shoulder Blade (Scapula).
➢ The Clavicle is a very brittle bone and is the common site of fracture. Shoulder Blade (Scapula) one on
either side in the upper and outer part of the back of the chest.
7
➢ The bones of the Upper Limbs are:-
(i) Upper arm bone (Humerus)
(ii) Forearm bones
(iii) Radius (outer side of forearm)
(iv) Ulna (inner side of forearm)
➢ The joint between Upper Arm and Forearm is called Elbow Joint .
➢ There are 8 carpal bones at the wrist and 5metacarpal bones in the palm of the hand.
➢ There are 3 small bones in each finger and 2 bones for each thumb, called Phalanges.
• THE PELVIS & LOWER LIMBS –

➢ The two hip bones one on either side, join together to form the Pelvis.
➢ The hip bones are attached at the back with the lower part of the vertebral column. At the front, it is
attached together with ligament called Symphysis Pubis.
➢ The pelvis forms a basin shaped cavity which contains Intestines,
Urinary Bladder and Reproductive Organs.
➢ There are two sockets one on either side of the pelvis, where the
thigh bones join forming the hip joint.
➢ Femur, the thigh bone is the longest and strongest bone in

the body. Its upper end forms a part of the hip joint while its lower
end forms a part of the knee joint. The upper end of the femur is
easily liable to fracture in old age even to minor falls.
➢ The Knee Joint in the front is covered with a small bone called the
Knee Cap (Patella) which is easily felt under the skin.
➢ The two bones of the leg are the Shin Bone (Tibia) and the
outer bone (Fibula).
➢ The Tibia extends from the knee joint to the ankle joint. Its sharp
edge can be felt immediately beneath the skin of the front of the
leg. The Fibula lies on the outer side of the Tibia. It does not enter
into formation of the knee-joint but its lower end forms the outer
part of the ankle-joint. Both joints play an important role.
➢ The bones of the foot comprise 7 irregular bones called
Tarsal. It is the largest, and the uppermost (heel bone) forms the
lower part of the ankle joint. 5 long bones (Metatarsals)
support the toes in front.
➢ The toe bones (phalanges) are 14 in number; 2 in the big toe and 3 each of the other four toes.
• JOINTS – Joints are at the junction of two or more bones. There may be no movement, as in skull or
there may be free movements, as in knee, elbow, shoulder and hip Joints. In movable joints, the ends of
the bones are covered by cartilage and joint is overall encased in capsule with some lubricant material
inside the joint.
• MUSCLES –
➢ There are two types of muscles: muscles attached to
the bones and the muscles of the internal organs.
➢ Muscles to the layman mean flesh and meant to
produce movement of the limbs and organs.
➢ The muscles which are attached to bones are called
Voluntary Muscles which can cause movement under
the control of will and involuntary muscles like those
found in the heart intestines etc., which continue to
work even without the control of the will.
8
➢ The muscles go into action (called contraction) by stimulation of nerves arising from brain and spinal
cord carrying motor impulses. Damage to nerves results in paralysis of the muscles.
• LIGAMENTS – Thickened portions of the joint capsule are called ligaments. They check movements
beyond normal permissible limits. If there is simple injury to the ligaments of the joints it is called “Sprain”.
• CONNECTIVE TISSUE – Connective tissue consists of yellow elastic and white fibrous tissue intermixed
in varying proportions. It is present in many parts of the body and forms a layer between the skin and
underlying flesh. All over the body fat is being contained between its meshes, often in large quantities.
The chief use of connective tissue is to bind parts together.
• SKIN – The skin is a sensory organ as it gives sensation like pain, touch and temperature. It covers the
whole of the body and protects the underlying structures. It consists of two layers, the outer or hard layer
(Epidermis) and the inner layer (true skin or Dermis). In the latter are numerous glands which secrete
sweat (consisting of water and impurities from the blood). The evaporation of which from the surface of
the skin cools it and helps to regulate the temperature of the body.
• EYE –
➢ The eyeballs are covered with folds of skin (the eyelids) from which the eyelashes project.
➢ The outermost parts of eyes are covered by a smooth membrane (conjunctiva) and are kept moist by
tear produced by the tear-glands.
➢ The transparent portion of the eye is called cornea through which the light from the object passes and
forms the image at the back of the eye. Behind the Cornea are seen a coloured circular diaphragm (the
iris) with a round opening (hole), the pupil. The latter varies in size with the amount of light passing
through it.
➢ Behind the pupil is the lens of the eye which focuses rays of light on to the light sensitive part of the
eye (retina).
• EAR –
➢ The Ear consists of three parts:
❖ The Outer Ear is that part which can be seen projecting from the side of the Skull, together with
the canal which leads to the eardrum.
❖ The Middle Ear, situated inside the skull, receives and transmits sound waves concerned in hearing
to the inner ear. It also communicates with the back of the nose and throat through the Eustachian
tube, which opens during swallowing.
❖ The Inner Ear is embedded inside the skull and is concerned with the sense of balance in addition
to the sense of hearing.
➢ The Outer Ear is separated from the Middle Ear by the Eardrum.
• TONGUE – The tongue is the muscular organ which lies on the floor of the mouth; it assists in tasting,
and swallowing of food. In an unconscious casualty, by falling back on the throat, the tongue tends to
obstruct it and thus prevent breathing.
9
FUNCTIONS OF THE HUMAN BODY: To assess a Patient, the First Aider must be aware of the structure
and functioning of human body.
The study of the normal function and activities which go on in living beings is known as PHYSIOLOGY.
The body consists of distinct parts such as the heart, lungs, kidneys, etc. which carry on the special kinds
of work. Such a distinct part is called an Organ and its special work is called a Function.
The essential functions of the life such as respiration, circulation, digestion, excretion, etc. are carried on
by a set of organs of closely related parts that form a system e.g. the digestive system which includes the
mouth, the gullet, the stomach, the liver, the pancreas and the intestines.
The Cell is the smallest functional unit of the body. A group of cells performing similar function form
a Tissue. The cells are continually undergoing changes and become worn out, dying and being replaced.
During its life a cell undergoes change and gives off carbon dioxide and other waste products and has to
be supplied with glucose and oxygen.
Oxygen is essential for the support of life and is obtained from the air while we breathe. It is carried to
the lungs through the air passage into the blood stream and is circulated throughout the body to the tissue
level where exchange of gases takes place and oxygen is absorbed.
Oxygen along with the glucose from the digested materials is carried by the blood stream to the tissues to
supply for their growth, repair and to produce heat and energy.
• RESPIRA TION –
➢ The objective of respiration is to provide oxygen to the body and wash out carbon-dioxide. The
oxygen provided by breathing is utilized in the combustion of end products of the digested food
which, in its turn generates carbon dioxide.
➢ With each inspiration we take in approximate ly 500cc of air with higher contend to oxygen and
lesser content of carbon-dioxide and give out 500cc of air with higher content of carbon-dioxide
and lesser content of oxygen.
➢ During the process of inspiration the chest cavity expands creating a negative pressure which inflates
the elastic lungs, which are two in number and are situated in the chest cavity on either side of the
heart. When the chest and abdominal muscles relax the chest cavity becomes smaller and the lungs
go back to their normal position due to their elasticity.
➢ Interference with the respiration may cause serious consequences like asphyxia and unconsciousness
due to lack of oxygen and increase in Carbon dioxide accumulation.
10
• HEART AND BLOOD CIRCULA TION –
➢ The heart is a muscular organ situated at the centre of the chest cavity. It acts as a pump.
➢ It is divided into 4 Chambers. The right upper chamber, called the Right Atrium receives impure
blood from all parts of the body through blood vessels called Veins.
➢ When the heart beats this impure blood is passed into the Right Lower Chamber called Right Ventricle,
and finally finds its way to the lungs where it is purified.
➢ The blood so purified finds its way into the Left Upper Chamber called Left Atrium. It then passes
to the Left Lower Chamber, called Left Ventricle, and from there, in the course of the beating of
the heart the purified blood is discharged into various blood vessels called Arteries and Capillaries which
convey this purified blood for the nourishment for the body as a whole. Thus each Heart has two pumps
put together.
➢ The pressure in the arteries varies with the beating of the heart. When the heart, contracts the pressure
in the arterial system increases; when the heart relaxes the pressure in the arteries decreases. This
pressure exerted on the arteries known as the 'Blood Pressure' and is recorded by the blood pressure
instrument or a rough estimate made by feeling the pulse.
➢ With each heartbeat blood is ejected into the arterial system. Most of the arteries are placed deep in
the body except on the wrist, elbow, neck, groin and ankle. So Arterial Pulse is normally felt over the
lateral side of the wrist, in the neck, temples, and groin and near the ankle.
➢ The average adult has a Pulse Rate of 72 per minute.
11
PATIENT ASSESSMENT: In any emergency and when it is safe to do so, the First Aider should:
Before assessing the patient, it is vital to check that the area

Assess the Area
is safe for you, the patient, and bystanders
Assess the nature of any injury or illness and set priorities for
Assess the Patient
the care required
ASSESSMENT OF THE AREA –

➢ Before assessing the patient, it is vital to check that the area is safe for you, the patient, and bystanders.
➢ Hazards might include:
• Vehicles
• Electricity, both High and Low Voltage
• Deep Water or Rough, Fast-flowing Water
• Poisonous Gases, Chemicals or Fumes
• Fire
➢ The general rule is to remove the danger to make the scene safe.
➢ Where this is not possible, the patient may need to be moved to a safe area.
ASSESSMENT OF THE PATIENT –

➢ Assess the nature of any injury or illness and set priorities for the care required.
➢ If the patient appears collapsed, first check their response to a shouted command and to a firm squeeze
of the shoulders. If the collapsed patient does not respond, then CPR may be required.
➢ If the patient responds to your voice, then it is possible to obtain important information and plan any
emergency treatment required.
1. Ask the patient and any bystanders for the history of the problem, outlining what happened, the time
of onset, and whether there is any known underlying health problem, such as asthma, diabetes, epilepsy
or a heart condition.
2. Ask the patient to describe any symptoms, including pain, soreness or discomfort, and any other unusual
sensations such as numbness or tingling in the fingertips.
3. Check the patient carefully, looking for any signs of injury or illness, basing your observations on the
history and any symptoms described. After an injury, look for bleeding, bruising, wounds, swelling,
deformity (when one side is compared with the other), loss of power or function.
➢ The OBSERVATIONS shall be:
1. Conscious state: If help is going to be delayed, check the conscious state every few minutes and
note any changes. Use the ‘AVPU’ code:
A ALERT Is the patient alert and responding to you?
V VOICE Does the patient respond to your voice?
P PAINFUL Does the patient respond to a painful stimulus?
U UNRESPONSIV E Is the patient unresponsive?
2. Airway: Ensure that it is clear and open and that the patient does not have any secretions that might
obstruct breathing.
3. Breathing: Check for normal breathing – note the rate and rhythm for any changes. Check whether
the breathing is deep or shallow, quiet or noisy, and whether there are any abnormal sounds such as
wheezing on breathing out. This is especially important with the unconscious patient because any
change may be a warning of deterioration.
12
4. Skin: Look at the skin and note the colour (whether tinged with blue), and feel whether it is hot (with
fever) or cold and clammy (as in shock).
THE PRIMARY SURVEY –

➢ The objective of the Primary Survey is to ensure your own safety and to determine any immediate life-
threatening impairments. The process is best described using the helpful acronym DRABC which you have
learnt in Chapter 1.
Before making any attempt to assist, your own safety must come first. You
cannot help if you become ill or injured yourself. The most common
D DANGER
precaution is to simply put on a pair of latex gloves to protect from body
fluids. Nevertheless it will always remain a case of ‘Safety First’.
Check the Patients response. A Patients level of responsiveness can be gauged
using the AVPU scale. At this point it is helpful to note that if the patient
R RESPONSE
responds in an alert fashion, able to speak, this means that their airway is
open and they are breathing – a good sign.
If the patient is unresponsive you can ensure their Airway as learnt in Chapter
A AIRWAY 1. However do not perform a blind finger sweep. Only take something out of
the Patients mouth if you can see it and it is easy to do so.
Watch the Patients chest to see if they are breathing. Take a minimum of 5
B BREATHING
but no longer than 10 seconds to check for chest rise.
Is the patient bleeding heavily? If so we need to treat immediately by calling
C CIRCULA TION
Emergency & applying direct pressure to the wound.
THE SECONDARY SURVEY –

➢ The objective of a Secondary Survey is to identify any further illness or injury that may require treatment.
There are several components to help first aiders conduct a successful secondary survey as part of their
patient assessment:
1. S-A-M-P-L-E
2. Vital Signs
3. Head-to-Toe Survey
Signs relate to what can you see, hear, feel or smell to indicate the
Signs &
S Symptoms
persons condition. Symptoms refer to what the patient can tell you
about how they feel i.e. dizzy, cold, nauseous.
This could explain difficulty breathing in relation to a bee sting or after
A Allergies eating a food they have an allergy to. It may also reveal a contraindication
to medication, for example aspirin.
This could be an inhaler to relieve an asthmatic episode or tablets to
M Medications
relieve angina. We can help by getting them for the patient.
Pertinent Medical Does the patient suffer from any known medical condition e.g. epilepsy
P History or has the patient experienced the same symptoms before e.g. chest pain.
L Last Meal What did they last eat or drink & when?
Events that led to Can the patient tell you what led to their condition or was anyone else
E Accident around that can tell you?
HEAD-TO-TOE SURVEY → The title ‘head to toe’ survey can feel quite daunting for the First Aid Responder.
Contrary to assessing the patient fully from head to toe, a better description is to assess visually and
physically as the event history dictates. Depending on the events leading to the injury or illness as well as
the signs and symptoms, you may feel it helpful to examine a particular area of the patients body to
determine if there are any further signs indicating the need for treatment.
These can include:
Head & Neck Deformities, blood, cuts or any sign of trauma. Fluid oozing from ear or mouth. Pupil
Area size and reaction.
Again checking visually for deformities, blood or any sign of trauma. A physical check
Torso &
may include very gently checking tenderness appropriately or asking the patient to
Extremities
clench fingers and toes in order to check sensation or motor control.
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Figure: Patient Assessment Triangle
14
UNIT 2
DRESSING & BANDAGES
A. DRESSING →
Definition: A dressing is a protective covering applied to a wound to:

- Prevent infection
- Absorb discharge
- Control bleeding
- Avoid further injury
Types of Dressing:
1. Adhesive Dressing - Band Aids
2. Non-Adhesive Dressing - Gauze Dressing, Improvised Dressing
1. ADHESIVE DRESSING (Band Aid) –

These sterile dressings are of different kind and consist of a pad of
absorbent gauze of cellulose held in place by a layer of adhesive
material. The Surrounding skin must be dry before application and all
the edges of the dressing pressed firmly down. Sterile adhesive
dressings are supplied in paper or plastic covers.
2. NON-ADHESIV E DRESSING –
Ready-made sterile dressing the dressing consists of layers of gauze
covered by a pad of cotton wool and with an attached roller bandage to
hold it in position. The dressing is enclosed and sealed in protective
covering and is supplied in various sizes.
(A) Gauze Dressing

Gauze in layers is commonly used as a dressing for large wounds,
as it is very absorbent, soft and pliable. It is liable to adhere to the
wound; however this may assist the clotting of blood. The dressing
should be covered by one or more layers of cotton wool.
(B) Improvised Dressing

These can be formed from any clean soft absorbent material such
as a clean handkerchief, a piece of linen, a clean paper, or cellulose
tissue. They should be covered and retained in position by such
materials as are available.
Applications of Dressing:
➢ You should always cover a wound with a dressing because this helps to prevent infections. If possible
carry protective disposable gloves.
➢ Great care must be taken in handling and applying dressing.
➢ Wash your hands thoroughly with soap and water.
15
➢ Avoid touching any part of the wound with the fingers or any part of the dressing which will be in contact
with the wound.
➢ During dressing do not talk or cough over the wound.
➢ The dressing must be covered with adequate pads of cotton wool, extending well beyond them and retained
in position by a bandage or strapping.
➢ If a dressing adheres to wound do not try to remove it. Cover it with sterile dressing after cutting away
whatever can be removed. Badly injured tissues should be removed after wetting them with sterile saline
solution.
B. BANDAGES →
These are made from flannel, calico, and elastic net or special paper. They can be improvised by any of
the above material, or inception stocking or ties. Bandages are used to:
➢ Maintain direct pressure over a dressing to control bleeding.
➢ Retain dressing, slings and splints in position.
➢ Prevent or reduce swelling.
➢ Provide support for a limb or joint.
➢ Restrict movement.
➢ Assist in lifting and carrying casualties.
➢ Bandages should not be used for padding when other materials are available.
Bandages should be applied firm enough to keep dressing and splints in position but not so tight as to
cause injury to the part or to impede the circulation of the blood. A bluish ting of the finger or nails may
be a danger sign indicating that the bandages are too tight. Loss of sensation is another sign; such
bandages should be loosened or removed.
TYPES OF BANDAGES:
➢ There are a number of different First Aid uses for bandages: they can be used to secure dressings, control
bleeding, support and immobilize limbs, and reduce swelling in an injured part.
➢ There are three main types of bandages:
Roller Bandages Secure dressings and support injured limbs
Tubular Bandages hold dressings on fingers or toes or support injured joints
Triangular Bandages used as large dressings; as slings; to secure dressings; or to immobilize limbs
Roller Bandages –
➢ Roller Bandages are used in hospitals and First Aid Posts. They are made out of cotton material with loose
mesh. They are of various lengths and widths.
➢ Roller bandages are also meant to keep dressings in position. The rolled part is called the Head, the unrolled
portion the Tail. The Roller bandages should be applied firmly and evenly.
➢ Width of Roller Bandages:
PART WIDTH
Finger 2.5cm (1 Inch)
Hand 5.0cm (2 Inch)
Arm 5.0cm/6.0cm (2 Inch/2.5 Inch)
Leg 7.5cm/9.0cm (3 Inch/3.5 Inch)
Trunk 10cm/15cm (4 Inch to 6 Inch)
➢ General Rules for application of Roller Bandages:

1. Face the patient.
16
2. When bandaging left limb, hold the head of the bandage in the right hand and vice versa.
3. Apply the outer surface of the bandage over the pad and wind it around the injury twice so that it is
firm.
4. Bandage from below upwards over the limb. Also make it a rule to apply bandage from the inner side
to the outer side.
5. See that the bandage is neither too loose nor too tight.
6. Roll bandage so that each layer covers two thirds of the earlier layer.
7. Fix the bandage by pinning it up or using adhesive plaster. The usual practice of tearing the final end
into two long tails and tying them up is quite satisfactory and practical.
Triangular Bandages –
➢ A Triangular Bandage is made by cutting a piece of calico 100cm
square comer to corner so as to give two triangular bandages.
➢ It has three borders. The longest is called the BASE and the
other two the SIDES. There are three Corners. The one opposite
the base is called the POINT and the other called the ENDS.
➢ Uses of Triangular Bandage:
1. As a whole cloth (spread out fully).
2. As a broad bandage. Bring the point to the center of the base
and then fold again in the same direction.
3. As a narrow bandage. Fold broad bandage once again.
4. When a smaller size bandage is needed fold the original so as
to bring the ends together. The size is now reduced by half the
original.
➢ For tying bandages a 'Reef Knot' must always be used. To make a
Reef Knot, take the ends of the bandage one in each hand; cross
the end in the right hand under and then over the end in the left
hand thus making a turn. Then cross the end now in the right hand
over and then under the end in the left hand thus making a second
turn.
➢ The usual ‘Granny Knot’ should not be used as it is likely to become
loose.
➢ The knot should be made where it does not hurt the skin or cause discomfort.
➢ Tuck the loose ends of the bandage out of sight.
➢ The triangular bandage should be folded narrow when not in use. Bring the two ends to the center and
fold.
➢ It becomes a packet which measure 16cm x 9cm handy to carry.
➢ Slings:
❖ Uses of Slings-
1. To support injured arms, and
2. To prevent pull by upper limb to injuries of chest, shoulder and neck.
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❖ Different types of Slings-
1. Arm Sling
2. Collar & Cuff Sling
3. Triangular Sling
1. ARM SLING: It is used in cases of fractured ribs, injuries of arm, wrist and hands after application of
splints or plaster casts and bandaging.
➢ Face the casualty, put one end of the spread triangular bandage over the uninjured shoulder with point
on the injured side.
➢ Pass the end around the neck and bring it over the injured side shoulder. The other end will now be
hanging down over the chest.
➢ Place the forearm horizontally across the chest and bring the hanging end up. The forearm is now
covered by the bandage.
➢ Tie the two ends in such a way that the forearm is horizontally or slightly tilted upward in the knot is
placed in the pit above the collar-bone.
➢ Tuck the part of the sling which is loose at the elbow behind the elbow and bring the fold to the front
and pin it up to the front of the bandage.
➢ Place the free base of the bandage in such a way that its margin is just at the base of the nail of the
little finger. The nails of all the fingers should be exposed.
➢ Inspect the nails to shows find if there is any bluish colour. A bluish colour shows that there is a
dangerous tightening of splints or plasters and therefore free flow of blood is not possible.
➢ If the casualty is not wearing a coat, place a soft pad under the neck portion of the sling to prevent
rubbing of the skin in that place.
2. COLLAR & CUFF SLING: This Sling is used to support the

WRIST only.
➢ The elbow is bent; the forearm is placed across the chest in
such a way that the fingers touch the opposite shoulder. In
this position the sling is applied.
➢ A clove hitch is made with narrow bandage. Two loops are
made and are laid on top of the other the front loop is laid
behind the back loop without turning.
➢ A clove-hitch is passed round the wrist and the ends tied in
the hollow above the collar bone on the injured side.
3. TRIANGULAR SLING: It is used to support the fracture of the collar bone, arms or injured shoulder. It
helps to keep the hand raised high up giving relief from pain due to the fracture.
18
➢ Place the forearm across the chest with the fingers pointing towards the opposite shoulder and the palm
over the breast-bone.
➢ Place an open bandage over the chest, with one end over the hand and the point beyond the elbow.
➢ Tuck the base of the bandage comfortably under the forearm and hand.
➢ Fold the lower end also around the elbow and take it up and across the back over to the injured shoulder
and tie it with the other free end into the hollow above the collar bone.
➢ Tuck the point between the forearm and bandage.
➢ Tuck the fold so formed backwards over the lower half of the arm and fix it with a safety pin.
4. IMPROVISED SLING: Slings may be improvised –

- By turning the free end of a coat and pinning it to the sleeve.
- By passing the hand inside the buttoned coat or shirt.
- By using mufflers, ties, soft cloth etc.
-
Bandaging with a Triangular Bandage:

❖ For the Scalp –
• Fold a narrow hem of the base of an open bandage and place it on the forehead just above the level
of the eye-brows.
• Take the two ends backwards, after placing the body of the bandage over the head, the point
hanging near the nape of the neck.
• Cross the two ends and take them forward above the ears to meet on tie forehead, where they are
tied.
19
• Press on the head of the patient, draw the point firmly downwards and put it to the bandage after
taking it upwards.
❖ For the Forehead, Eye, Cheek or any part which is round in shape –
• Use narrow or broad bandage, depending upon the size of the wound.
• Apply the centre of the bandage over the pad and wind the bandage round the part.
• Tie in a suitable place.
❖ Front or Back of the Chest –

• Place the center of the open bandage over the dressing point over the sound shoulder.
• Carry the ends of the bandage around the body and tie it in such a way that one end is longer than
the other.
• Draw the 'Point' over shoulder and tie to the longer end.
• If back of chest has the wound-reverse all the steps.
❖ For the Shoulder –

• Stand facing the injured side.
• Place the centre of the open bandage on the shoulder with the point over the side of the neck
reaching the ear.
• Carry the ends, after hemming the base inward around the middle of the arm and tie the knot on
the outer side, so that the lower border of the bandage is fixed firmly in position.
• Apply a Sling.
• Turn down the point of the bandage over the sling knot; draw tight and pin it.
❖ For the Elbow –

• Bend the elbow to a right angle if it is advisable to do so.
• Folding a suitable hem of the base of a triangular bandage and apply it as follows:
o Lay the point on the back of the upper arm and the middle of the base on the back of the
forearm.
o Cross the ends in front of the elbow, then round the arm and tie the ends above the elbow.
o Turn the point down and pin it low down.
o When the elbow cannot be bent use an ordinary bandage with figure of eight technique.
❖ For the Wrist –

• Place the open bandage in such a way that the injury is uppermost.
• The point should be towards the fingers and the base across the wrist.
• Now bring the point over to the wrist.
• Make a narrow inward hem as usual pass the ends around the wrist, cross over and tie it up over
the point.
• Turn the point over the knot and pin it.
❖ For the Hip & Groin –

• Kneel facing the hip and tie a narrow bandage around the waist with the knot on the injured side.
• Take a second open bandage and pass its point under the knot bring it over the knot and pin it.
• Make a suitably broad hem of the base bring the ends round the thigh, cross and tie a knot on the
outer part, so as to hold the lower hemmed border in position.
❖ For the Knee –

• Bend the knee to a right angle.
• With a narrow inward hem, place the open bandage in front of the knee with the point upon the
thigh.
• Cross the ends, take them upwards on the back of the thigh bring them to the front of the thigh and
tie up.
• Bring the point down over the knot and the knee and pin it up.
• In case the knee is not to be bend a figure of eight bandage, using a narrow or a broad bandage is
applied.
20
❖ For the Foot –
• Place the foot in the centre of an open bandage with the point beyond the toes.
• Draw the point over the foot on to the leg.
• Cover the heel with the ends.
• Cross the ends around the ankle at the back.
• Bring the ends forward and tie them in front of the ankle.
• Bring the point down and pin it up.
❖ For the Stump –

• Place the base of a bandage well up on the inside of the stump hanging downwards.
• Draw up the point over the stump and cross the ends in front, over the point.
• Carry the ends behind the stump cross them and bring them forward, tying off in front.
• Draw the point firmly downwards over the knot and secure with a safety pin.
21
UNIT 3
INTRODUCTION TO BASIC ANATOMY
A. INTRODUCTION TO BASIC ANATOMY
1.0 First Aiders must be familiar with the basic structure and functions of the Human Body. Using the proper
medical terms allow you to communicate more effectively with the person and with medical care providers.
2.0 The Directional Terms of Human Body are as follows:
DIRECTIONAL TERM AREA
Right and Left The person’s Right and Left
Anterior Front of Body
Posterior Back of Body
Superior Closer to Head
Inferior Closer to Feet
Lateral Farther from the Middle
Proximal Close to where the Limb is attached to the Body
Distal Distant from the point of attachment
Superficial Closer to or on the Skin
Deep Farther inside the Body
Section of the abdominal cavity divided by horizontal and vertical lines

Quadrant
intersecting at the umbilicus; four equal areas
Anterior View Lateral View
22
Quadrant View
TYPES OF BODY SYSTEMS →

The key body systems are:
1. Respiratory System;
2. Circulatory System; and
3. Nervous Systems.
Most important and sensitive organs are Lungs, Heart, Brain, Spinal Cord.
1. RESPIRA TORY SYSTEM –
➢ Oxygen is essential to life. Every time
we breathe in, air containing oxygen
enters the lungs. This oxygen is then
transferred to blood to be around the
body. Breathing and transported
exchange of oxygen and carbon dioxide
(a waste product from body tissues) are
described as "Respiration", and the
structures that enable us to breathe
make up the Respiratory System.
➢ Respiration means breathing in and out
of air. This function is necessary to
supply oxygen (from the air) to all the
organs in the body. Stoppage of oxygen
supply to the organs may result in death.
Death will result in about 4 to 6 minutes
if the body’s Oxygen supply is cut off.
➢ Mechanism of Respiration:
➢ During Inspiration (breathing in), the
diaphragm (the muscle separating the
chest from the abdominal cavity)
flattens and increases the chest capacity
from above downwards.
➢ The ribs move upwards and forwards
increasing the capacity of the chest
cavity from front to back by the action of
the muscles situated between the ribs;
the lungs thus expand and air enters
them. This is an active process.
23
➢ During Expiration (breathing out) the reverse process takes place. The diaphragm comes back to its
original state and the ribs fall back thus forcing the air out of the lungs. This is a passive process.
➢ Small blood vessels (capillaries) surround the alveoli. The exchange of oxygen and carbon dioxide take
place through the blood circulating in these capillaries. Oxygen is absorbed by the red blood corpuscles
of the blood, water vapour and carbon dioxide are let out from the blood plasma into the alveoli and
expelled out. The lungs are also supplied with nerves which are connected to an area in the brain
called respiratory centre. This centre controls respiration.
➢ The Organs connected with respiration are:
1. The Air Passages consist of nose, throat (Pharynx), wind pipe (Trachea) and two air-tubes
(Bronchi). The bronchi divide into minute branches (Bronchioles) which end in the lung substance
(Alveoli)
2. The Lungs are two in number and are situated on the right and left sides of the chest cavity. Each
lung is made up of a number of small sacs, called “Alveoli”. The lungs are covered by a membrane
called “Pleura” which lines the inner wall of the chest cavity.
3. The Muscles, Diaphragm, Intercostals and Abdominal breathing muscles help to contract and
expand the lungs to facilitate the breathing.
➢ ASPHYXIA (Suffocation):
o Asphyxia is a condition in which the lungs do not get sufficient supply of air for breathing. If this
continues for some minutes, breathing and heart action stops and death occurs.
o Causes of Asphyxia:
1. Obstruction - Foreign Body, Food or Water in Air Passage, Irritant Gases in to the Air Passage,
Tongue falling back, Swelling of Tissues of Throat.
2. Compression - Type of Rope/Scarf around the Neck, Hanging or Throttling, Smothering like
covering face & nose.
o Conditions affecting the Respiratory Mechanism:

- Epilepsy, Tetanus, Rabies etc.
- Nerve diseases causing paralysis of chest wall or diaphragm.
- Poisonous snake bite (e.g. Cobra).
o Conditions affecting the Respiratory System:

- Over doses of Morphia, Barbiturates (Sleeping tablets)
- Electric Shock.
- Stroke
o Compression of the Chest:

- Caving in of earth or sand, in mines, quarries, pits or compression by grain in a silo or big beam
and/or pillars in house-collapse.
- Crushing against a wall or other barrier or pressure in a crowd (Stampede).
o Lack of Oxygen at High Altitudes:

- With low atmospheric pressure where the oxygen content in the atmospheric air is low due to lack
of acclimatization.
o Management:
- Remove the cause, if possible or remove the casualty to environment where the suffocating agent
is not there.
- Loosening the tight clothing e.g. collar belt etc., and expose the chest and neck.
- Resuscitations:
1. Opening the Airway
2. Checking the breathing
3. Clearing the Airways
4. Artificial Respiration mouth to mouth/mouth to nose respiration.
5. Circulation- External Chest Compressions
- Gently shake casualty's shoulders and ask what happened.
24
- Check the breathing by- Observing movement of the chest and also observing air coming out during
expiration.
- Clearing the Airways by backward tilt of head and chin lift-opening the air way.
- Providing rescue breath.
- Check for heart beat and movement of chest for recovery of respiration and heart beat, if achieved
put the casualty in recovery position; if not start compression activity.
- External Chest Compressions: Lean over the casualty, with your arms straight Press down vertically
on the chest, and depress by about 4-5cm. Release pressure and let chest recoil. Compress 30
times at the rate of 100 compressions per minute.
- Mouth-to-Mouth Respiration: If No recovery of respiration and heart beat, close the nose, open the
mouth ensuring tilting of head, blow in the air from your mouth to mouth of the casualty. And
allow the chest recoil; after 5 times again check for recovery.
- Check the Pulse.
➢ DROWNING:
o This is another consequence of disaster especially during flooding. Drowning causes asphyxia by
water weeds and mud entering into the lungs. It may also cause the throat to go into spasm
(constricting the air passage dry drowning). Congestion of the lungs can occur very quickly but it
may be several hours before it is apparent.
o All casualties rescued from drowning should be sent to a hospital. If a casualty has been
immersed in cold water there is also a danger of hypothermia. It is important that the casualty is
kept warm.
o Symptoms & Signs →

1. General symptoms and signs of asphyxia.
2. Froth around the casualty's lips, mouth and nostrils.
o Aims → Get air into the casualty's lungs as fast as possible, even in water. If necessary arrange
removal to hospital.
o Management →
1. Quickly remove any obstruction such as weed from the casualty's mouth and begin artificial
respiration immediately.
2. If in deeper water give the occasional breath of air while towing the casualty ashore.
3. Place casualty on a firm surface, check breathing and pulse and continue Resuscitation.
4. As soon as the casualty begins breathing place him in the recovery position.
5. Keep him warm. If possible, remove wet clothing and dry him off. Cover with spare clothes and
or towels to keep the body warm.
6. Arrange shifting to hospital. Transport as a stretcher case, maintaining the recovery position.
:: NOTE ::
If the casualty stops breathing, give two initial rescue breaths and thirty Chest Compressions.
If you are alone, give CPR for 1 minute before calling Ambulance.
➢ STRANGULATION & HANGING:

o Strangulation is constriction or squeezing around the neck or throat. Sometimes, hanging or
strangulation may occur accidentally – for example, by ties or clothing becoming caught in
machinery.
o Hanging may cause a broken neck; for this reason, a casualty in this situation must be handled
extremely carefully.
o STRANGULATION is usually the result of throttling by hands or a rope or scarf being tied round the
neck.
o In HANGING the fracture of spine at the junction of head and neck causing compression or tear of
the spinal cord lending to respiratory failure.
25
o Aim of First Aider should be to restore adequate breathing, to arrange urgent removal to hospital.
:: NOTE ::
Do not move the casualty unnecessarily, in case of spinal injury. Do not destroy or interfere with any
material that has been constricting the neck, such as knotted rope; police may need it as evidence.
o Management →
1. Cut or remove the band constricting the throat.
2. If suspended raise the body and loosen or cut the rope.
3. Give artificial respiration.
4. Do not wait for the policeman to arrive, start immediately.
5. Lay the casualty on the ground. Open the airway and check breathing. If he is not breathing,
be prepared to give chest compressions and rescue breaths if necessary for saving life.
6. If the casualty is breathing, place the person in the Recovery Position.
➢ CHOKING (Asphyxia due to obstruction in Windpipe): The airway is the passage that connects
the nose and mouth with the lungs. If anything blocks the airway, the person chokes and cannot get
enough oxygen. This is a life-threatening emergency, and you must give First Aid to remove whatever
is blocking the airway.
o Mild Choking → Coughing may indicate a mild airway obstruction. Coughing is a natural way to
clear the airway, and it is a sign that the person is still getting enough at Encourage the person to
keep coughing and stay close by in case you need to help. An object may become more firmly
stuck in the airway, stopping the person from breathing.
o Severe Choking → Severe choking happens when a foreign object or swelling blocks the airway
completely. The object may get stuck at any point in the airway from the throat to the lungs. This
is a severe airway obstruction. A foreign object that is stuck at the back of the throat may block
the throat or cause muscular spasm. If blockage of the airway is mild, the casualty should be able
to clear it; if it is severe he will be unable to speak, cough, or breathe and will eventually lose
consciousness. Be prepared to begin rescue breaths and chest compressions. This is most
common with children. A marble, a seed or button may get struck in the air passage. In adults,
food may go down the airway and choke it.
o Aim → Is to remove foreign body or obstruction.
o Management → In case of Adults & Children
Step 1
If you think someone is choking, ask them ‘Are you choking?' If they
can breathe, speak or cough then they might be able to clear their own
throat. If they cannot breathe, cough, or make any noise, then they
need your help straight away.
Step 2
Cough it out. Encourage them to cough and remove any obvious
obstruction from their mouth.
Step 3
Slap it out. If coughing fails to work, you need to give five sharp back
blows.
To do this, help them to lean forwards, supporting their upper body

with one hand. With the heel of your other hand give them five sharp
back blows between their shoulder blades. After each back blow,
check to see if there’s anything in their mouth.
26
Step 4
Squeeze it out. If back blows fail to clear the obstruction, give five
abdominal thrusts.
To do this, stand behind them and put your arms around their waist.
Place one hand in a clenched fist between their belly button and the
bottom of their chest. With your other hand, grasp your fist and pull
sharply inwards and upwards up to five times. Check their mouth
again, each time.
Step 5
If the blockage has not cleared, call for Ambulance help straight
away. Repeat five back blows and five abdominal thrusts until help
arrives, re-checking their mouth each time.
If they become unresponsive at any point, prepare to start Adult CPR.
➢ SWELLING WITHIN THE THROAT: Swelling within the throat may occur as a result of trying to
drink very hot liquid or swallowing corrosive poisons or may be due to inflammation.
o Management →
1. Make the patient sit up.
2. If breathing continues normally or is restored to normal, give ice to suck, or cold water to sip.
3. Butter, olive oil or medical paraffin may also be given in small quantity.
4. Apply cloth wrung out of hot water to the front of the neck.
5. If breathing has stopped, give artificial respiration.
6. An early hospitalization is advised.
➢ SUFFOCATION BY SMOKE: Protect yourself by a towel or a cloth (preferably wet) over your mouth
and nose. Keep low and remove the casualty as quickly as possible away from the area.
➢ SUFFOCATION BY POISONOUS GASES like Carbon Monoxide (Lighter than Air): This gas
which is lighter than air is present in car-exhaust fumes, in house hold Coal gas, during incomplete
combustion charcoal stoves and in coal mines.
o Management →
1. The First Aid treatment consists of removing the person and applying artificial respiration and
giving pure oxygen, if available.
2. Ensure circulation of fresh air before entering the room on doors and windows.
3. Before entering the enclosed space take two or three deep breaths and your breath as long as
you can and hold
4. Crawl along the floor (as the gas is lighter than air).
5. Remove the casualty as quickly as possible to the area of fresh air
6. Loosen his clothes at neck and waist and give artificial respiration casualty is asphyxiated.
➢ SUFFOCATION BY POISONOUS GASES like Carbon Dioxide & Others (Heavier than Air):
Such gases are found in coal mines, deep unused wells and sewerage. Various other gases such as
leaking refrigerator gases, compressed gasses used for cooking and lighting coul d also cause
suffocation.
o Management →
1. Observe all the precautions mentioned above.
2. Enter in upright position (as the gas is heavier than air and collects near the floor).
3. Remove the casualty as quickly as possible to fresh air.
4. Wherever ventilation is not possible and deadly poisonous gas is suspected use a gas mask for
protection.
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➢ ASTHAMA: This is a condition where sudden constriction of airways causing difficulty in breathing
especially in breathing out occurs. Allergy, infection, anxiety or tension can trigger an attack.
o Management →
1. Reassure the patient
2. Make him sit up in bed or chair and allow him to lean forward with a couple of pillows and/or a
small table on which to rest his head.
3. Ensure fresh air by opening the windows.
4. Seek medical aid from a nearby doctor.
➢ Asphyxia of a severe degree with unconsciousness:

o This could be due to:
1. The tongue might have fallen back into the throat.
2. Vomit might have collected in the throat.
3. Some foreign material (like weeds, mud etc.) might have collected and obstructed the air
passages.
o Begin to work immediate ly as every second counts. Do not delay.
o Management when not breathing →

1. Loosen all clothing at waist, chest and neck.
2. Tilt the head backwards, while supporting the back of neck with your palm. This will lift the
tongue to its normal position. Thus the air passage will be cleared and the casualty may begin
to breathe after a gasp.
3. If breathing does not begin after the above treatment. Mouth-to-mouth or Mouth-to-nose
breathing should be given.
o If the heart is not beating, the following will be noticed →

1. The face is blue or pale.
2. Pupils are dilated.
3. Heartbeats and pulse at root of neck (carotid) are not felt.
4. Place the casualty flat on his back on a hard surface (bench, table etc.).
5. Give a smart hit with the edge of your hand on the lower and left angle of the sternum. This
usually stimulates the heart to restart.
6. In case heart does not work continue the striking for 10-15 seconds, at the rate of one stroke
a second. Feel for the pulse when it becomes regular and continuous, stop thumping.
7. All the while artificial respiration has to go on.
8. Even if the casualty is breathing but the breathing is not normal, it is wise to start artificial
respiration.
9. Do not begin thumping the heart or compression until you are sure that the heart has stopped
beating.
10. To restore circulation External chest compression is to be started.
➢ EXTERNAL CARDIAC COMPRESSION (ECC):

o If only one First Aid Provider is available, artificial respiration and external cardiac compressions
both are done alternately.
o If two First Aiders available. First Aider giving mouth-to-mouth breathing to sit to the right of the
casualty and place the other to give External Cardiac Compression on the left side.
o Feel and mark the lower part of the sternum.
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o Place the heel of your hand on the marked part the lower part of sternum (make sure that the
palm and fingers are not in contact with the chest).
o Place the heel of the other hand over it.
o With your right arm press the sternum backwards towards the spine (it can be pressed back in
adults).
:: Note ::
➢ An Adult should be given about 60 Compressions per minute.
➢ For Children from 2-10 years of age, Compression with one hand will be enough but it should be 80-90 times
per minute.
➢ For Babies up to 2 years, Compression with fingers is good enough, applied 100 times per minute.
➢ Press firmly but carefully. Carelessness may cause injury to ribs and deeper tissues.
➢ If the treatment is effective:
a) Colour will change to normal;
b) Pupil will start becoming normal as improvement begins;
c) Carotid pulse beats with each compression will be felt.
➢ When pulse is not restored, continue compression till the patient reaches the hospital. If there are two First
Aiders, the first one should make 15 heart compressions and then the se cond one should give one lung
inflation. These are then repeated. At the same time one can watch the pupils and the second can feel the
carotid pulse.
➢ CARDIO PULMONARY RESUSTICATION (CPR):

o Essential when both breathing and heart beat are affected.
Step 1: Thumping the Heart Region.
Step 2: External Cardiac Compression (ECC).
Step 3: Mouth-to-Mouth Respiration.
o If two First Aiders are available one does ECC 30 times followed by the other mouth to mouth
respiration twice, repeat. If there is only a single First Aider, ECC 30 times followed by mouth to
mouth respiration twice given by the same person.
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2. CIRCULA TORY SYSTEM –
➢ The Circulatory System comprises and involves Blood, Heart and Blood Vessels.
➢ HEART: The Heart pumps blood through Vessels. It is the size of a human’s clenched fist shaped like
a Pear and located in the left center of the Chest. Heart is divided by a wall to create the right and
left compartments which are further divided into Chambers viz., Atrium above and Ventricle below.
o During each contraction:
- The Heart pumps blood high in Carbon Dioxide from the Right Ventricle to the Lungs.
- Oxygen-rich blood is returned to the Left Atrium from the Lungs.
- Left Ventricle pushes oxygen-rich blood to the rest of the body.
- Right Atrium receives oxygen-poor blood.
o At each relaxation:
- Blood flows into the Left Atrium from the Lungs.
- Blood flows into the Right Atrium from the rest of the body.
➢ BLOOD VESSELS: They comprise of Arteries, Capillaries and Veins.

o Arteries –
- Arteries are elastic, muscular tubes that carry blood away from the Heart.
- Arteries begin at the Heart as two large tubes viz.,
- Pulmonary Artery – Carries blood to the Lungs.
- Aorta – Carries blood to other parts of the body and divides into Capillaries.
o Capillaries –
- Capillaries is a network of extremely fine vessels.
- Oxygen and nourishment pass out of the bloodstream into the body’s cells.
- Cells discharge waste into the bloodstream.
- In the lungs, Carbon Dioxide is released and Oxygen is absorbed.
o Veins –
- Become larger and larger.
- Form major trunks that empty blood returning from the body into the Right Atrium.
- Blood returning from the Lungs goes into the Left Atrium.
➢ PULSE RATE:
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➢ PULSE:
o Surge of blood that occurs each time the heart
contracts is known as Pulse.
o It can be felt at any point where an Artery lies

near the skin surface.
o Blood from a cut Artery spurts.
o Blood from a cut Vein flows.
o Location for feeling Pulse –

- Carotid Artery
- Femoral Artery
- Radial Artery
- Brachial Artery
- Posterior Tibial Artery
- Dorsalis Pedis Artery
➢ BLOOD PRESSURE:
o Blood Pressure is a measure of the pressure
exerted by the blood on the walls of the flexible
Arteries.
➢ BLOOD: There are two portions of Blood viz., Solid & Liquid Portions.
o Solid Portion –
- Contains Red Blood Cells which carry Oxygen.
- Contains White Blood Cells which defend against infection.
-Contains Platelets which are essential for blood clot formation.
o Liquid Portion –
- Contains Plasma which is 90% water. It carries food & waste materials.
3. NERVOUS SYSTEM –
➢ The Nervous System is a complex collection of nerve cells that coordinate all parts of the Human
Body.
➢ It contains of Neurons which –

- Receive Stimuli
- Transmit Impulses
- Produce Nerve Impulses
- Cannot be regenerated.
➢ The Central Nervous System includes the Brain and Spinal Cord.
➢ The Peripheral Nervous System is a network of nerve cells divided into voluntary and autonomic
(involuntary) systems.
➢ CENTRAL NERVOUS SYSTEM →

o The Brain –
- The Brain is the headquarters of the Nervous System containing of three subdivision:
1. Cerebrum
2. Cerebellum
3. Brainstem
- Cerebrospinal Fluid is similar to Blood Plasma which circulates through the brain and spinal
cord, serves as a protective cushion exchanging food & waste materials.
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o The Spinal Cord –
- The Spinal Cord is a soft column of nerve tissue.
- It is continuous with the lower part of the brain enclosed in the bony Vertebral Column.
- There are 31 pairs of Spinal Nerves attached with Spinal Cord.
- The Spinal Cord is highly and easily vulnerable to injury.
➢ PERIPHERAL NERVOUS SYSTEM →

o Made up of nerves that exit the Spinal Cord and are of two types viz., Sensory Nerves and Motor
Nerves.
o If a nerve is seriously damaged, that body part becomes non-functioning.
o The PNS is well protected against injuries.
➢ AUTONOMIC NERV OUS SYSTEM →

o Autonomic Nervous System controls Heart Rate, Digestion, Sweating, other automatic body
processes.
B. THE MUSCULAR SYSTEM
1.0 The Muscular System comprises of Voluntary Muscles, Smooth Muscles, Cardiac Muscles .
✓ Under control of the person.

Voluntary Muscles ✓ Called Skeletal Muscles.
✓ Can be injured in many ways.
✓ Very little control by the person

Smooth Muscles
✓ Line the walls of tube-like structures.
✓ Found only in the Heart.

Cardiac Muscles
✓ Needs continuous Oxygen and Glucose.
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UNIT 4
FRACTURES
A FRACTURE is a break or crack in a bone. Generally, considerable force is needed to break a bone, unless it
is diseased or old. However, bones that are still growing are supple and may split, bend, or crack hence the term
greenstick fracture. A fracture may be partial or complete bend, crack or breakage of a bone.
1.0 CAUSES OF FRACTURE →

a) Direct Force: The bone breaks at the spot of application of the force e.g. bullet passing into bones,
severe fall on a projecting stone or a wheel passing over the body etc.
b) Indirect Force: The bone breaks away from the spot of application of force e.g. collar-bone fracture
when the fall is on outstretched hands etc.
c) Muscular Force: Occurs when there is a violent contraction of a group of rarely muscles; happens very
e.g. fracture of ribs on violent cough.
2.0 TYPES OF FRACTURE →

a) Simple Fracture / Closed Fracture: The broken ends of the bone do not cut open the skin and show
on the outside.
b) Compound Fracture / Open Fracture: When the fractured bone is in contact with outside air as a result
of an injury (so that dirt, dust and germs get into the protruding bone and the wound).
c) Complicated Fracture: In addition to the fracture, an important internal organ like the brain or major
injured blood vessels, the spinal cord, lung, liver, spleen etc. may also he. Furthermore a complicated
fracture may be simple or compound.
d) Greenstick Fracture: When the fractured bone is in contact with outside air as a result of an injury (so
that dirt, dust and germs get into the protruding bone and the wound).
SIMPLE FRACTURE COMPOUND FRACTURE COMPLICATED FRACTURE GREENSTICK FRACTURE
3.0 SIGN & SYMPTOMS →

1. Pain at the spot of fracture and/or around it.
2. Tenderness i.e. pain on gentle pressure over the injured spot (Do not press hard).
3. Swelling of the area and discoloration.
4. Loss of normal movements of the part.
5. Deformity of limb: The limb may lose its normal shape. Sometimes the muscles will pull up the lower
free ends causing apparent shortening of the limb.
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6. Irregularity of the bone: If as in the leg bone, the break is under the skin,
L-Loss of Power
the irregular outline of the bone can be felt easily.
7. Crepitus (Grating): When one end of the broken bone moves against the I-Irregularity
other, a crackling sound is heard. This is known as crepitus. P-Pain
8. Unnatural movement at the spot fracture can be felt. D-Deformity
U-Unnatural Movement
Note: The last two sign should never be tried by the First Aider. S-Swelling or Bruising
To confirm diagnosis compare with the sound limb; look for tear of clothing or of T-Tenderness
skin at the fracture area; and the patient himself may sometimes state that he heard
the snap of the bone.
4.0 AIMS OF FIRST AID →

1. To prevent further damage.
2. To reduce pain.
3. To make the patient comfortable and manage shock.
4. To get medical aid as soon possible.
5.0 MANAGEMENT →
1. Fractures often occur in major accidents. Therefore it is common to find other injuries also. Heavy bleeding
and severely wounded parts are more urgent and should be treated first.
2. There may be more than one fracture in the same patient or even in the same limb.
3. Support the fracture on the spot, so that the fractured ends are established and patient is ready for
transport.
4. Handle very gently; avoid all unnecessary movements of the injured parts.
5. Send for medical aid or send the patient to hospital as quickly as possible.
6. Treat for shock.
7. If the broken ends of the bones are shown out, do not wash the wound or apply antiseptics to the ends of
the bone.
8. Do not handle the fracture unnecessarily.
9. Never attempt to bring the bones to normal position.
10. Do not give anything by mouth as this might delay treatment under anaesthesia.
6.0 TREATMENT FOR FRACTURES →

1. Provide support to the injured area
2. Expose the site of the injury
3. Treat any wounds
4. Immobilize effectively
5. Reassure and monitor
STABILIZATION OF FRACTURED BONE END →

❖ Steady and support the injured part immediately, so that no movement is possible.
❖ This stops further injury and helps to stop the bleeding moreover the danger of the broken ends of
bone damaging arteries, nerves and muscle, is prevented.
❖ Immobilize the fracture area and the joints on both side of fracture (above and below fracture site)
- By using bandages, and/or
- By using splints where available and where a
❖ First Aider is confident of their use.
❖ By using Bandages:-
- Usually it is enough to use the other (uninjured) limb
or the body of the patient as the splint. The upper limb
can be supported by the body, the lower limb by the
other limb (provided that also is not fractured) most
fractures (except Forearm) can be immobilized thus.
- Do not apply bandage on the site of

fracture.
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- The bandaging should be fairly firm so that there is no movement of the
fractured ends; but not too tight in which case the circulation of blood to the
area will be stopped. If there is further swelling of the injured a bandage is
too tight therefore loosen the bandages slightly.
- Always place padding material between the ankles and knees and other
hollows, if they have to be tied together, so that when together they are
comfortable and steady.
- As the patient will be lying down the bandage should be passed through the
natural hollows like the neck, the lower part of trunk, knees and just above
the ankles to avoid jolts.
- Always tie knots on the sound side.
❖ By using Splints:- (when available and necessary expertise is there)

- A splint is a rigid piece of wood or plastic material or metal applied to a fractured limb, to support
it and to prevent movement of the broken bone.
- Reasonably wide splints are better than narrow ones.
- They should be long enough so that the joints above and below the fractured bones can be made
immobile.
- The Splints should be well padded with cotton or cloth so as to fit softly and snugly on the injured
limb.
- Splints are best applied over the clothing.
- In an emergency splints can be improvised with a walking stick, an umbrella, a piece of wood, a
book or even firmly folded newspaper.
- Use of splints becomes obligatory only when either legs or both thigh bones are broken.
FRACTURES OF BODY PARTS AND THEIR MANAGEMENT →

SKULL:- Fracture of the skull may injure the brain, nervous system or the arteries an may cause
concussion and compression. These are usually depressed fracture. There are two varieties of skull
fractures:
1. Fracture of the dome or sides – This is caused by direct blow or fall upon the head. There will be
swelling with a longish or circular irregularity of the bone. The First-Aider, however should not attempt
to look for these fractures.
2. Fracture of the base – This is caused by indirect injury, for example, fall on the feet, and fall on the
lower part of the spine, severe blow on the side of the head. Blood or brain fluid may flow from the
ear, or nose, which may be swallowed and later vomited. If the injury affects the bony socket of the
eye, the eyes become blood-shot. It is often missed.
➢ Management:
1. If breathing is normal:
a) Lay the casualty on his back with head and shoulder slightly raised by cushions.
b) Turn the head to one side (if there is bleeding from the ear, the head should be turned so that
the bleeding side is down).
2. If breathing is noisy with bubbling of air through secretions in the chest.
a) Lay the casualty in the three-quarter-prone position. Support him in this position by pads in front
of the chest and draw up the casualty's upper knee.
b) Keep the air passages clear.
35
c) In cases with bleeding from the ear, arrange the position of casualty so as to keep bleeding side
down. Do not plug the bleeding ear.
3. Treat for shock.
4. Keep a careful watch on the casualty.
5. Do not give anything to drink.
6. Do not rouse him.
7. Transport the casualty to hospital.
8. Maintain the same position in transport: avoid disturbing the casualty.
LOWER JAW:- This is mostly the result of direct force. Usually one side is affected. But rarely both sides
can be fractured. In most cases this fracture is a compound one. There is usually a wound inside the
mouth also.
➢ Signs & Symptoms:-

1. The casualty has difficulty in speaking/opening mouth.
2. Saliva becomes blood-stained.
3. There is pain which is increased by speaking and swallowing.
4. The face and lower jaw becomes swollen.
5. The teeth look irregular: Some teeth may have fallen out.
6. There may be crepitus, it can be felt both by the patient and First-Aider, when they try to steady the
jaw.
7. If there is an injury to the tongue, it may fall back and block the air passage and there will be profuse
bleeding.
➢ Management:-
1. Ask the casualty not to speak, and do not give anything by mouth.
2. Remove false teeth, if any. Make sure the tongue does not fall back. Ensure and open airway.
3. With the patient leaning forward place the palm or your hand on chin and gently press the lower jaw
upwards against the upper jaw (which acts as splint).
4. Place a narrow bandage under the chin. Carry one end up and over the top the head, cross with the
other end over the ear. Carry the shorter end across the front of forehead and the longer and in the
opposite direction around the back of the head. Tie just above the opposite ear.
5. If the casualty show signs of vomiting, remove the bandage and tie it up again after vomiting stops.
6. Remove him to hospital as early as possible.
➢ Transport:-
1. If the patient can sit, make him bend his head forwards and downwards so that the tongue may not
slip back and choke him.
2. When the fracture is compound or extensive, turn casualty face down on a blanket, load him on the
stretcher with the blanket with head projecting beyond the canvas and forehead supported by
hammock-like bandages tied to the handles of the stretcher and a blanket under the chest so that the
head hangs forward.
SPINE:- Vertebrae which together form the spine are small bones which bear the weight of the head and
the trunk. They are commonly fractured:
1. Indirectly by:-
- Lifting a heavy weight
- Landing on the feet or buttocks in a heavy fall
- Being thrown forward suddenly (e.g. a car driver during a collision) or
- Neck fractures in whip-lash injuries.
2. Directly by:-
- The fall of a heavy weight on the back or
- Falling from a height on the back across a bar
- Injuries in occurrence of landslides, earthquakes etc., when a heavy mass falls on the spine.
➢ The fracture will be more serious if the spinal cord is injured. As a result there may be loss of power
of the muscles (paralysis) and loss of sensation of the skin below the level of the injury. Injury to the
spine is always a serious emergency.
36
➢ Fracture of the spine should be suspected in all cases of back injury. There will be pain and shock in
all cases.
➢ Just because there is no paralysis, do not neglect the case. Treat it as fracture until the case is in
medical hands.
➢ Management:-
1. Try to get a doctor immediately.
2. Make the casualty lie still. Never allow him/her to get up.
3. If unconscious see that the tongue does not fall back and choke the casualty.
4. If medical aid is not immediately available.
a) Do not move the casualty; cover with a light bed sheet or a thin blanket.
b) Keep under observation till the doctor arrives.
5. If medical help is not available, prepare the casualty for shifting on a stretcher.
a) Place pads between thigh, knees and ankles.
b) Tie a figure of eight bandage over ankle and feet with the knot on sole of foot.
c) Apply broad bandages on knees and thighs.
d) Be ready to shift to a nearby shelter.
:: Note ::
Carry patient face upwards, for in this position the spinal cord is not likely to be damaged further.
➢ Transport:-
1. The canvas stretcher must be made hard, surfaced by short boards placed across the stretcher or a
long board placed lengthwise. A sufficiently long board can be used by itself if stretcher is not available.
2. Cover the stretcher with a blanket, place small pillow for neck and small for the back so that the hollow
of neck and the back rest in the normal position.
3. Do not disturb the position of the casualty when loading on the stretcher. One person must hold the
head and support firmly but gently: the aim is not to disturb the neck. A second helper should hold
the legs just above ankles; the aim is not to disturb the trunk.
4. If casualty is not on a blanket:
a) Place the blanket or rug on the ground in line with the patient and roll half its width.
b) Instruct two bearers to keep the head and ankles firm and steady. Two other First Aiders then
very gently turn the casualty on to his side. Taking care not to disturb the fractured part.
c) Now move the rolled part of blanket to be in contact with the casualty and gently roll him over
so that the other side of his body is in contact with ground.
d) Now it is easy to unroll the rolled pat of the blanket and place the casualty on his back on the
centre of the blanket.
Note: During all these changes in position the bearers at neck and ankles work in unison with the other
two so as not to disturb the spine.
➢ Loading the Stretcher :- The two methods used for loading on the stretcher are:
a) Blanket Lift: This method is used when a blanket has been placed under the patient.
• If poles of good length and rigidity are available roll the blanket over the until the poles are
pressed to the sides of the casualty.
• With two bearers supporting the neck and ankle, the others stand on each side and lift the
casualty. Now the stretcher is placed exactly under the casualty, who is gently lowered on the
stretcher.
• Now make sure that neck and back pads in correct position and supported to avoid undesired
movement.
• If poles are not available, the blanket is rolled tightly up to the sides of the casualty. If necessary,
board bandages are placed around the body, one at the level of thigh and another at the level of
the shoulders. Lift the casualty adopting the same method described above.
b) Emergency Lift: When no blanket or poles are available the following method is used.
• Open the casualty's coat or bush-coat and roll the free ends firmly close up to the side of the
casualty's body or improvise stretcher.
• Loading to the stretcher is identical to the method described under blanket lift.
• In the case of neck injuries place sand bags on either side of the neck to steady it.
• Place folded blankets under the neck, of the back, and under the knees.
• Wrap the casualty in a thin bed-sheet or a thin blanket.
37
• If a long journey over uneven ground is needed bind the body to the stretcher firmly, around the
hips, thigh, below the knees and over the body above the elbow level.
• On reaching the shelter, do nothing; except wait for medical help.
RIBS:- Ribs are broken by:

1. Direct Force: from a blow or fall upon the chest or hit against the driving wheel of a car. The broken
end may be given inwards causing injury to the lung, which then becomes a complicated fracture.
2. Indirect Force: As a crush caused by pressure over the front and back of chest at the same time.
The broken ends are pushed outwards, thus there is no fear of injury to lungs.
➢ Signs and Symptoms:-

1. There is pain at the injury area increased by coughing and deep breathing.
2. The casualty takes short, shallow breaths so that the ribs do not move and increase the pain.
3. Crepitus may usually be felt if the hands are placed flat over the chest particularly the broken rib. But
the First Aider should not try to elicit this sign at all.
4. Signs of internal bleeding such as paleness of face, lips, and palm, sole and a weak pulse should be
looked for.
5. If there is an open wound in the chest, air is sucked in and blown out through the wound like the
bellows. Cover the wound with a clean sterile cloth. This is a serious condition.
➢ Management:-
1. If the fracture is not complicated –
• Two broad bandages should be applied around the chest. The center of the first should be below the
area of pain and the center of the second above it. The upper bandage should overlap the lower by
half its width.
• Instruct the casualty to breathe out as much as he can and then tie a knot firmly so as to support the
broken rib. The knots should be tied near the front of the chest on the uninjured side.
• Support the arm on the sides of injury in a sling.
• If there is no relief of pain by this treatment remove the bandages and send the case to the nearest
hospital.
2. If the fracture is complicated –

• Do not apply bandage, except in case where air is sucked in through an open wound, in the chest.
• Lay the patient with raised head and shoulders, and turned towards the injured side. Keep in position
with a blanket folded lengthwise and tucked to the back of the casualty.
• Apply sling to the arm of the injured side place him on a stretcher.
• Transport to the nearest hospital.
BREAST BONE:- The breast-bone is usually fractured in crush injuries. The danger is that the heart and
the blood vessels under it may be injured as well.

1. Pain at the area of fracture.
2. Difficulty in breathing.
3. Irregularity of the bone (felt by running fingers along it).
➢ Management:-
1. Loosen tight clothing
2. Place the casualty on his back in the most comfortable position.
3. Cover him with light material.
4. Transport on a stretcher.
COLLAR BONE:- The collar bone is broken when the person falls on the tip of the shoulder or on the
palm of the outstretched hand.

1. The arm on the injured side is partially helpless. The casualty usually supports it at the elbow with the
other hand.
2. His head is inclined towards the injured side.
3. The broken ends can be seen and felt. They overlap the outer end being lower.
38
➢ Management:-
1. Support the arm of the injured side with the help of the casualty himself or an assistant.
2. Do not remove the coat or shirt.
3. Place a pad in the arm-pit.
4. Leaving the forearm free and bandage the upper arm to the side of the chest with a broad bandage.
5. Support the upper limb in the triangular sling.
6. Feel the pulse to make sure that circulation in the limb is free.
7. Shock is not usually severe; the casualty may be transported even as a walking case to the nearest
hospital.
AROUND THE ELBOW:-

➢ If elbow can be bent, strap arm to the chest and support forearm in a triangular sling.
➢ If elbow cannot be bent, strap arm and forearm on the side of body in extended position.
FOREARM:-
➢ Single or both the bones may be fractured. Shortening is not possible unless both bones are broken.
LOWER END OF THE RADIUS:-

➢ Care must be taken not to mistake it for a sprain of the wrist.
➢ Do not mobilise or bend the elbow forcefully.
➢ Support the forearm with triangular bandage.
➢ Strap the upper arm with roller bandage before mobilizing the casualty to hospital.
➢ Casualty can be moved in a sitting posture or lying down Position in a stretcher.
HAND AND THE FINGERS:-

➢ These are mostly due to direct injury.
➢ There may be severe bleeding in the palm.
➢ Do not hang down injured hand by the side of the body.
➢ Keep the hand at the chest level in a sling.
PELVIS:- This is mostly due to direct force like fall of beams crush accident etc. Indirect force very rarely
results in fracture of the pelvis, (as by a fall from a great height on the feet with lower limbs stiff). The
bladder and urinary passages may also be injured producing grave complications.

1. Pain in the hip and joints increased by cough and/ or movement.
2. Although the lower limbs are not injured the casualty will be unable to stand.
3. Internal bleeding is possible.
4. There will be difficulty in passing urine. Urine may be mixed with blood.
➢ Management:-
1. Allow the casualty to lie in the position most comfortable to him preferably on his back with lower
limbs stretched.
2. Ask him to avoid passing urine.
a) If a hospital is near, transport on stretcher in the most comfortable position. No need to bandage.
b) If the journey is long and on rough roads:-
(i) Place centre of the broad bandage on the hip joint of the injured side, pass one end round
the Pelvis and tie on the other side. Tie another broad bandage so that it overlaps the first
by half its breadth and tie similarly. The bandage should be firm but not too tight, avoid
pressing the broken parts more inwards.
(ii) Put pads between knees and ankles.
(iii) Apply figure-of-eight bandage around the ankles and the knees with a broad bandage if
needed.
LOWER LIMB:-
Fracture of the Thigh Bone (Femur):-
➢ This bone could break at any place along its length.
➢ Fracture of neck of the thigh-bone occurs quite frequently in old people with small cause like tripping.
Do not take it for a bruise of the hip, suspect a fracture.
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➢ Fracture of the thigh bone is always serious because:
(i) Great shock results from it.
(ii) There will be bleeding into the surrounding tissues.
(iii) Healing is prolonged especially in old people.
(iv) It will be more serious when it is a compound fracture.

1. Pain, swelling and shock
2. A shortening of the limb can be noted
3. The foot on the side lies flat and turned to the outer side and may or may not be lifted by the casualty
to upright position.
➢ Management:-
1. Treat shock and reassure the patient.
2. Immobilize the thigh by bandaging to the sound limb up to and e below knees with padding below
knees. If splint is easily available and expertise is there.
a) Apply a well padded splint between the legs from the crotch to the foot.
b) Tie the feet and ankles to the splint with a figure-of-eight bandage if needed.
c) Apply seven broad bandages at the following places:
- Chest, below the arm pits
- Pelvis at the level of hip joints.
- Both ankles and feet (fig of eight)
- Both thighs above fracture if the shaft is broken
- Below the fracture, including both thighs
- Both legs
- Both knees.
- Transfer to a hospital at the earliest.
Fracture of the Knee Cap:- The knee-cap can be broken by direct force, but usually the fracture is due
to muscular force causing it to snap across into two bits.

1. The limb is helpless as the important extensor, muscle is out of action.
2. There will be lot of swelling and bleeding.
3. The gap between the two bits can often be felt.
➢ Management:-
1. Lay the casualty flat with head and shoulders raised. The injured limb should be raised to an easy
position. This will relax the thigh muscles.
2. Apply a padded splint under the limb from the buttocks to beyond the heel. The ankles should be
raised from the splint by pads.
o Apply a broad bandage around the upper part of the thigh.
o Apply a narrow figure-of-eight bandage around the Knee.
o Place a narrow bandage with its center on the upper fracture piece, cross it behind the knee and
bring it up over the lower fractured bit behind the knee and tie off.
3. During transport also the limb should be kept raised on a box, blanket or similar material.
Fracture of Leg:-
➢ This is due to direct: force on the leg.
➢ One or both of the bones may be broken. When both the bones are broken, or when tibia is fractured
all signs of fracture such as pain swelling deformity and shock are seen. But when Fibula only is broken
no deformity is visible because it is splinted by the Tibia.
➢ Fracture of bones of ankle should be suspected when swelling around the ankle is present.
40
➢ Management:-
1. The limb should be tied to sound limb with suitable padding from thigh to ankle. Pads should be
between knees and ankles.
2. Make long well padded splint and place it between the lower limbs extending from the groin to feet.
3. Without causing disturbance or pain bring the two limbs close to the splint.
4. Placing additional pad between the ankles and knees tie the feet and ankles with a figure-of-eight
bandage.
5. Place a broad bandage at upper part of the thighs.
6. Apply a broad bandage on the knees.
7. Finally apply two bandages of required size, one above and one below the fracture.
Fracture of Bones of the Foot and Toes:- This is caused by direct injury like a crush injury or wheel
passing over the foot. Suspect fracture when there is pain, swelling and loss of power.
➢ Management:-
1. When there is a wound, remove footwear, cut or remove the socks.
2. Treat the wound. Use the other foot as splint. Tie the feet and legs together below knee with padding
between ankles, feet and knee.
3. Apply a padded splint reaching the heel to the toe over the sole of the foot.
4. Bandage:
5. Place the center of a broad bandage over the foot. Cross the ends over the instep and carry them to
the back of the ankles.
6. Cross once more to bring them to the front of the ankles (double figure-of-eight bandage)
7. Cross once more to bring the ends on the back of the ankles and tie it off.
8. Raise the foot to make the casualty feel comfortable.
9. If no wound is present or suspected and if the casualty wears shoes, do not remove them, secure as
describe above with a broad bandage and keep foot raised to a comfortable position.
10. But in India most person wear chappals, quite a few do not have footwear at all. In such cases treat
as in the case of wounded crushed foot.
11. Transport on a stretcher with the foot raised.
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UNIT 5
SHOCK & SPRAINS
A. SHOCK
SHOCK is a life-threatening condition that occurs when the Circulatory System (which distributes oxygen to the
body tissues and removes waste products) fails and, as a result, vital organs such as the heart and brain are
deprived of oxygen. It requires emergency treatment to prevent permanent organ damage and death. Shock can
be made worse by fear and pain. Whenever there is a risk of shock developing, reassuring the casualty raising the
lower limbs by about 2 feet and making him comfortable may be sufficient to prevent him from deteriorating.
RECOGNITION OF SHOCK →
Initially:
- A rapid pulse,
- Pale, Cold, Clammy Skin, Sweating
As Shock Develops:
- Grey-blue skin (cyanosis), especially inside the lips.
- Weakness and dizziness.
- Nausea and possibly vomiting, Thirst.
- Rapid, shallow breathing.
- A weak, "thready" pulse. When the pulse at the wrist disappears, about half of the blood volume will
have been lost.
As the brain's oxygen supply weakens:

- Restlessness and aggressiveness
- Yawning and gasping for air.
- Unconsciousness.
Finally, the heart STOPS
CAUSES OF SHOCK → The most common cause of shock is severe blood loss. If this exceeds 1.2L (2
pints) (which is about one-fifth of the normal blood volume), Shock will develop. The main causes are:
1. Wounds
2. Internal bleeding
3. Damaged blood vessels due to closed fracture
4. Loss of other body fluids like diarrhoea
5. Severe Burns
6. Non-pumping of blood by Heart due to heart disease/attack or acute heart failure.
7. Overwhelming infection
8. Lack of harmones
9. Low Blood Sugar (Hypoglycemia)
10. Hypothermia
11. Anaphylactic Shock (Allergic Reaction)
12. Drug Overdose
13. Spinal Cord Injury
TYPES OF SHOCK → There are two types of Shock:

Nervous Shock: It may be due to strong emotional upset like fear, pain; and not be due to an injury.
Nervous Shock does not need treatment, requires only reassurance and sympathetic handling.
42
True Shock: It may be due to severe bleeding, severe burns, heart attack, abdominal injuries, crush
injuries, loss of body fluids, bacterial infections.
4.0 MANAGEMENT OF SHOCK →

1. Reassure the Casualty (when conscious).
2. Put him comfortably on his back. However, in cases of injury of the head, chest or of the abdomen, lower
the head slightly and turn it to a side. In cases of vomiting place in the three-quarter prone position
(Recovery Position).
3. Loosen the tight clothing do not remove the clothing.
4. Wrap in light bed sheet or thin rug.
5. Never use hot water bottles or very warm rugs. Do not rub any part of the body with anything.
6. In case of injuries to chest or abdomen, nothing should be given by mouth as he may later need an
operation or blood transfusion.
7. Observe all the above quickly as even a minute's delay may mean death. If there is no chest or abdominal
injury and the patient is conscious, give sips of water, hot tea, coffee or coconut milk (Never give any
alcoholic drinks).
8. Transfer to hospital on priority basis.
ELECTRICAL INJURIES / SHOCK →

Causes →
1. If any part of the body comes in contact with a "live" wire which is exposed and not covered by an
insulator or with a cable or rail in which current is leaking, a person gets an Electric Shock.
2. Electrical shock is produced only when an electric current passes through the human body which is in
contact with earth. It passes even more quickly if the part is wet. In wet conditions even lower voltage
is dangerous.
3. A very strong current passing to earth through lower limbs may be less dangerous than a weaker
current passing through the chest, especially so when it enters through the hands and arms.
Effects →
1. The electric current may affect the beating of heart leading to stoppage of heart.
2. There may be sudden stoppage of breathing due to paralysis of muscles used in breathing.
3. Heart may continue to beat, while breathing has stopped. In this condition the face appears blue.
4. There may be burns either superficial or deep. That depends on the strength of the electric current
causing the injuries.
Management →
1. Intelligent and prompt action is required if the First Aider is not cautious he may also receive
severe electric shock or even die along with the casualty.
2. lf the casualty is still in contact with the source, switch off the current. If the switch is not found,
remove the plug or cut off the current by breaking circuit (MCB). Before cutting off the current,
ensure that you stand on a dry piece of wooden board. Do not use scissors or knife.
3. When the current is of low voltage the First Aider should stand on an insulated material which is
dry. Insulating materials are rubber/soled shoes, wooden planks or piles of newspaper. Rubber gloves,
if available should be worn. If not, dry coat, cap or other clothing may be used.
4. When the current is of a very high voltage, as in the cases of over-head (high tension) lines,
there is greater danger. The casualty may not be in actual contact with the wire as the current can
pass through the gap (causing an arc). The First Aider in such circumstances should keep as far away
as possible from the electric wires. The casualty is to be dragged out by means of a non/conducting
material such as walking stick, dry bamboo, wooden plank or dry rope is to be used.
5. If the casualty is not breathing normally, or heart has artificial stopped beating, give respiration and
External Cardiac Compression for long time.
- Treat for shock.
- Treat for burns, if any.
- Transfer to a hospital, or seek the help of a nearest medical practitioner.
43

B. STRAINS, DISLOCATIONS & SPRAINS
Before we get into the subject of Dislocations and Sprains, let us know the organs that cause dislocations
and sprains:
MUSCLES → Muscles are the fleshy part of the body. They give the body its shape. All movements of
the body are done with the help of muscles. There are two types of muscles – Voluntary and Involuntary.
Voluntary Muscles are found in the head, the neck the limbs and the walls of trunk. They are attached
to the bones either directly or by white fibrous bands called Tendons. Voluntary muscles are under
the control of the will. Movements of the body take place by the contraction and relaxation of these
muscles.
Involuntary Muscles are found on the walls of the stomach and intestines, in the air passages, the blood
vessels and the heart. They are not controlled by the will. They work constantly under the influence of
the Autonomous Nervous System.
A Muscle Strain is caused by overstretching of muscles. It generally happens as a result of twist or a

sudden effort, such as lifting a heavy weight. A few muscle fibers or tendon might be torn.
A Rupture (or tear) is a more serious injury in which a muscle bundles or tendon is torn across. The
sudden pulling of the calf muscle is a common example of a rupture.
MUSCLE STRAIN RUPTURE
Signs & Symptoms:-

1. There is a sudden sharp pain in the muscle.
2. The muscles may swell and feel stiff.
3. In a rupture, there is severe pain and the casualty cannot move the injured part.
Management:-
1. Place the casualty in the position most comfortable to him.
2. Support the injured part. Use a sling in case of an upper limb fracture and, crutch or stick for lower limb.
3. Apply a cold compress (a handkerchief, towel or a piece of cloth soaked in cold water).
4. Take the casualty to a hospital.
2.0 JOINTS → The junction of two or more bones is called a Joint. There are two types of joints:
Immovable Joints and Movable Joints.
2.1 In Immovable Joints, the bones are permanently fixed and no
movement is possible. E.g.: Several bones of the skull.
2.2 In Movable Joints, two or more bones are held together by

means of muscles, tendons and ligaments, and movement
between the bones is possible. Three kinds of movable joints are
found in the body:
44

1. Ball and Socket Joint: as found in the shoulder in the
shoulder joint and in the hip joint. In this case, the round head
of the bone enters the socket of another bone thus allowing
free movement in several directions and planes.
2. Hinge Joint: as found in elbow and knee joints allow movements of the bones on one plane only
(bending and extending) like hinge of a door.
3. Gliding Joint: as in the wrist, the feet and also between the ribs and the vertebras of the spinal
column. These joints allow light movements only.
SPRAINS → A Sprain is the tearing of the ligaments of joint

and the tissues around the joint. It is caused by a sudden wrench
or twist at the joint. A sprain of the ankle is quite common.
Signs & Symptoms:-

1. There is pain at the joint.
2. There is swelling and may be bruising also.
3. Movement of the joint is painful.
Management:-
1. Place the limb in the position most comfortable to the casualty,
preferably elevated.
2. Do not allow him to move the joint.
3. Apply a firm bandage on the joint. This will lessen pain and give
support to the Joint.
4. Take the casualty to the Doctor.
It is sometimes difficult to say whether the casualty has a Sprain, Dislocation or a Fracture. When in doubt, treat
as a Fracture.
45
DISLOCATION → A Dislocation is the displacement of one or more bones at a Joint. This happens to
the Shoulder Joint by heavy fall on the hand, to the Elbow to the Jaw due to yawning or blows on the Chin,
and to the Thumb and Fingers.
Signs & Symptoms:-

1. There is severe pain and swelling at or near the Joint.
2. The casualty cannot move the joint.
3. The joint looks deformed and the limb assumes an unnatural position.
4. Later there is swelling.
Aim of First Aider for Dislocation:-

1. To immobilize the joint.
2. To reduce pain.
3. To get medical aid.
Management:-
1. In the case of the Shoulder:
• Support the limb in the most comfortable position.
• Place a pad of folded newspaper or cloth between the arm and the Body. Bandage the arm to the body.
• If indoors, place the casualty on a bed in the position most comfortable to him, support the limb on pillows
or cushion.
2. In the case of the Lower Jaw:

• Remove false teeth, if any
• Support the lower jaw by a bandage tied over the top of the head.
• Nothing must be given by mouth.
• Advise the casualty not to speak.
3. In the case of the Elbow Joint:

• Apply a large arm sling and take the casualty to a hospital.
Fig: SHOULDER DISLCOATION
46
Fig.: LOWER JAW DISLOCATION
Fig.: ELBOW JOINT DISLOCATION
47
UNIT 6
WOUNDS & BLEEDING
A. WOUND
A WOUND is a break in the continuity of skin of the body. There will be bleeding from the injured part and it
also forms an opening through which germs can get into the body. The depth of a wound is often more im portant
than its area; small deep wounds caused by knives, bullets etc. are often more dangerous.
TYPES OF WOUNDS →
Incised Wounds are caused by sharp instruments like knife, razor etc. The blood vessels are clean cut
and so these wounds bleed very much.
Contused Wounds are caused by blows by blunt instruments or by crushing. The tissues are bruised.
Lacerated Wounds are caused by machinery, fall on rough surfaces, places of shells, claw of animals etc.
These wounds have torn and irregular edges and bleed less.
Punctured Wounds are caused by stabs by any sharp instrument like a knife or a dagger. They have
small openings, but may be very deep.
Fig.: Incised Wound Fig.: Contused Wound
Fig.: Lacerated Wound Fig.: Punctured Wound
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COMPLICAITONS OF WOUNDS →
Wounds cause two great dangers – Bleeding and Infection.
1. Bleeding –
➢ When the blood comes out of a blood vessel it is called Bleeding. Bleeding is the immediate
complication of wound and must be treated promptly.
➢ A wound is not initially infected even though it may be contaminated by the dirt and infected material
which contain germs. These germs are microscopic and not visible to naked eye. Infection only occurs
after a lapse of time when the germs have time to multiply and invade the tissues.
➢ This time was formerly arbitrarily fixed at 6 hours but varies with the number of bacteria and their
virulence and body resistance.
➢ Pus formation is part of body's method to fight the infection.
2. Infection – It is caused by germs getting into the body through the broken skin. The germs multiply
in wound and make it infected or septic. They may then get into the blood stream and cause blood-
poisoning (Septicemia).
AIMS OF FIRST AID →

The aim of First Aid is to stop bleeding and minimize the number of germs that get into the wound.
We should remember that germs come from the object that causes the wound (knife, stone, etc.), the skin
of the person, the clothes of the person, hands of the First Aider, dirty dressing, air and contaminated
water.
4.0 MANAGEMENT →
1. Stop bleeding. Apply direct pressure to the wound with a sterile dressing or a clean cloth piece. If
necessary, press the relevant arterial pressure-point.
2. Handle the injured part as gently as possible.
3. Make the patient sit or let him/her lie down. If the wound is on a limb and there are no broken bones, raise
the limb. This will reduce the bleeding.
4. Wash your hands thoroughly or clean them with an antiseptic lotion.
5. Remove any foreign objects like glass, stones, etc., if you could see them easily.
6. Do not disturb any blood clot already formed. Place a clean dressing over the wound and bandage firmly.
7. Take the Casualty to the Hospital.
B. BLEEDING
As you are aware, Blood circulates in vessels called arteries, veins, and capillaries. When a blood vessel is
damaged, several mechanisms are activated to control blood loss: the vessel constricts, and a series of
chemical reactions occur to form a blood clot - a "plug" over the damaged area. If blood vessels are torn
or severed, uncontrolled blood loss may occur before clotting and shock may develop.
BLEEDING is also termed as Hemorrhage.
- If the bleeding is from the surface of the body it is called External Bleeding.
- If the bleeding is within the chest, skull or abdomen etc. it is called Internal Bleeding. This cannot
be seen immediately but later the blood may ooze out through the nose or ear or coughed up from
the lungs, or vomited from the stomach.
TYPES OF BLEEDING → Bleeding (hemorrhage) is classified by the type of blood vessel that is damaged.
By Arteries: Arteries carry bright red, oxygen-rich blood under pressure from the heart. If an artery is
damaged, bleeding may be profuse. Blood will spurt out of it time in with the heartbeat. If a main artery is
severed, it may jet blood several feet high. In this case, the volume of circulating blood will fall rapidly.
By Veins: Blood from Veins, having given up its oxygen into the tissues, is dark red. It is under less
pressure than arterial blood, but vein walls can widen greatly and the blood can "pool" inside them. If a
major vein is damaged, blood may gush from it profusely.
By Capillaries: Bleeding from Capillaries occurs with any wound. At first, bleeding may be brisk, but blood
loss is usually slight. A blow may rupture capillaries under the skin, causing bleeding into the tissues
(bruising).
49
2.0 CLOTTING OF BLOOD →
When a blood vessel is severed or damaged, it constricts (narrows) in order to prevent excessive amounts
of blood from escaping. Injured tissue cells at site of the wound, together with specialized blood cells
called platelets, trigger a series of chemical reactions that result in the formation of a substance ca lled
Fibrin. Strands (filaments) of fibrin come together to form a mesh, which traps blood cells to make a
blood clot. The clot releases a pale-colored fluid known as Serum, which contains antibodies and
specialized cells. This serum begins the process of repairing the damaged area.
At first, the blood clot is a jelly-like mass. Later, it dries into a crust (scab) that seals and protects the site
of the wound until the healing process is completed.
In the first stage of clotting, cells in the blood called platelets come into
Platelet Activation contact with the damaged vessel wall. They become sticky and start to
clump at the site of the injury.
The clumped platelets and the damaged tissue release chemicals that
Release of Chemicals trigger a complex chain of reactions. This process creates substances that
enable clotting.
Threads of fibrin forma mesh at the site of the injury. The fibrin mesh traps
Fibrin Formation more blood cells at the site to form a jelly-like clot, usually within about 10
minutes.
3.0 SIGNS & SYMPTOMS →

1. The casualty feels faint and may even collapse.
2. Skin becomes pale cold and clammy.
3. Pulse gets rapid but very weak.
4. Breathing becomes shallow, casualty gasps for breath and sighs deeply.
5. There is profuse sweating.
6. The casualty feels thirsty.
AIMS OF FIRST AID FOR BLEEDING →

When bleeding is severe, it can be dramatic and distressing. Shock is likely to develop, and the casualty
may lose consciousness. If bleeding is not controlled, the casualty's heart could stop. Bleeding at the face
or neck may impede the air flow to the lungs. When treating severe bleeding, first check if there is an
object embedded in the wound; take care not to press on the object.
AIMS:
- To control bleeding.
- To prevent and minimize the effects of shock.
- To minimize infection.
- To arrange urgent removal to Hospital.
MANAGEMENT →
Minor Bleeding: Minor Bleeding is usual at work and play. It results from injured capillaries. There is no
need to get frightened. The bleeding will stop by itself or by firm pressure and bandaging, keeping the limb
raised.
Major Bleeding: Major Bleeding is the result of an injury to a large blood vessel or when the person
suffers from some blood disease.
In case of Severe External Bleeding:

1. Put on disposable gloves if available. Remove or cut clothing as necessary to expose the wound.
2. Apply direct pressure over the wound with your fingers or palm, over a clean piece of cloth or over. A
sterile dressing or non-fluffy clean pad.
3. Raise and support the injured Limb above the level of the Casualty's Heart to reduce blood loss. Handle
the Limb very gently if you suspect that there is a Fracture.
4. Help the casualty to lie down on a blanket, if available, to protect her from the cold. If you suspect that
shock may develop, raise and support her legs so that they are above the level of her Heart.
5. Secure the dressing with a bandage that is tight enough to maintain pressure but not so tight that it impairs
the circulation.
50
6. If further bleeding occurs, apply a second dressing on top of the first. If blood seeps through this dressing,
remove both dressings and apply a fresh one, ensuring that pressure is applied accurately to the point of
bleeding.
7. Support the injured part in a raised position with a sling or bandaging.
8. Call for an Ambulance and shift the Casualty to the Hospital.
In case of Severe Internal Bleeding:

1. Make the casualty lie down. Raise his/her legs by use of pillows etc.
2. Keep him/her calm and relaxed. Reassure him. Do not allow him/her to move.
3. Keep the body warm with thin blankets, rugs or coats.
4. Do not give anything to eat or drink because he/she may have to be given an anesthetic later.
5. Do not apply hot water bottles or ice-bags to chest or abdomen. This might make things worse.
6. Take him/her to a hospital as quickly as possible.
:: NOTE ::
➢ Do not apply a tourniquet. If there is an embedded object in the apply pressure on either side of the wound,
and pad around it before bandaging.
➢ Do not allow the Casualty to eat, drink and smoke.
BLEEDING FROM VARIOUS PARTS →

HEAD INJURY:- As a result of head injury, blood and brain fluid (Cerebrospinal Fluid) may flow out of
the Nose, Ear or Mouth.
➢ Management:
1. Ask the patient not to blow his/her nose.
2. Do not pack ear or nose, but place a dressing on ear or nose and strap it in position.
3. Lay the patient on the affected side.
4. Remove him to a hospital immediately.
SCALP INJURY:- These wounds bleed freely and may be alarming.

➢ Management:
1. This may be with or without fracture of skull.
2. Apply a large pad and a bandage which will help stop bleeding.
NOSE:-
➢ Habitual bleeding during dry/hot weather is common among youngsters and this is not caused by any
injury.
➢ Adults may bleed from the front portion of the nostril due to minor injury like blowing the nose, or
picking out crusts.
➢ High blood pressure may also cause bleeding through the nose. Head injury affecting base of skull
gives rise to bleeding from the nose
➢ Management:
1. Bleeding usually stops in 10 to 15 minutes.
2. Seat the casualty with the head bent slightly forward.
3. Ask him/her to breathe through the mouth.
4. Loosen clothing at neck.
5. Pinch the soft part of the nostrils together firmly
6. Apply a cold compress to the nose for 10 minutes.
7. Ask patient not to blow his/her nose for some time.
8. Advise the doctor's consultation.
9. Suspected skull injury, immediately transfer to the hospital.
51
GUMS:- Injury to face, spongy gums leads to gum bleeding. After teeth extraction, bleeding from teeth
socket may occur immediately or after a few hours.
➢ Management:
1. Rinse mouth with water or saline.
2. Place a thick cotton wool ball in the socket and ask him to give pressure by biting it.
3. Send the patient to a dentist or a doctor
PALM:- Injury to face, spongy gums leads to gum bleeding. After teeth extraction, bleeding from teeth
socket may occur immediately or after a few hours.
➢ Management:
1. Grasp the wrist with your hand tightly for 10 to 15 minutes.
2. Put a suitable pad over the wound, close the fingers over it, and bandage firmly up to the Wrist.
3. Support limb in a Triangular Sling.
4. Send him to a Hospital.
VARICOSE VEINS (Swollen Knobbly Veins):- Varicose veins of the leg may burst and severe bleeding
may occur.
➢ Management:
1. Lay casualty flat and raise the leg high.
2. Apply a pad to the part and bandage firmly.
3. Send him to a Hospital.
CLOSED ABDOMINAL INJURIES:- Blood may flow into the abdomen as a result of injury to the spleen,
kidney, intestine or the liver etc. Get a correct history of accident- note the time of the accident. Find out
the level of consciousness (fully conscious, partly conscious totally unconscious).
➢ Management:
1. Control external bleeding, if any.
2. Treat other wounds and injuries like fractures, bruises etc.
3. Do not give any food or drink. Note pulse and respiration every half hour or earlier.
4. Loosen tight clothing.
5. Reassure patient
6. Cover him up with a light sheet or blanket.
7. Transport him quickly to a hospital.
CRUSH INJURY:-
➢ In major accidents like landslides etc. people are caught under machinery, masonry or beams and are
possibly under pressure for hours due to landslides, earth quake etc. The injuries may appear simple,
with swelling, redness or blister formation or numbness of the whole limb. But after some time of
release, the swelling increases, becomes hard.
➢ There is loss of blood substance (plasma) and in addition poisonous (toxic) products from crushed
cells pour into the blood stream. This leads to 'shock' i.e. lowered blood pressure, cold clammy skin
pallor and fast thready pulse.
➢ If this is not promptly and properly treated, kidney failure can result
➢ Management:
1. Keep head low and raise the lower limbs.
2. If conscious, give a little of water or tender coconut water. Then repeat the same but in small
quantities at a time.
3. Transfer to a hospital immediately.
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CHEST INJURY:- Injuries to chest should always be treated as serious for without any visible injury there
may be fracture of ribs, tear of lung, Injury to heart or blood vessels.
➢ Management:
1. Send all such cases as "Priority" to hospital.
2. Reassure the casualty.
3. Never give any stimulant.
4. Give ice to suck or ice water to sip.
5. Transport gently in the most comfortable position.
BLAST INJURY:- Are caused by explosions, gases or bursting of bombs. The high pressure waves may
damage the lungs, Ear Drums and internal organs without showing a wound outside. The falling debris and
splinters may cause additional external wounds, burns and fractures.
➢ Signs & Symptoms: General signs of shock, Marked restlessness, Asphyxia, Frothy blood stained
sputum, Bleeding from ruptured ear drum, Other injuries
➢ Management:
1. Reassure.
2. Examine thoroughly for other injuries and treat them accordingly i.e., Asphyxia, burns, wounds
and fractures.
3. If possible help him/her into half sitting position supporting the head and shoulders.
4. Loosen constricting clothes around the neck, chest and waist.
5. Evacuate to the hospital continuing treatment along the way.
ABDOMINAL WOUND:-
➢ Adjust the patient’s position so that the wound does not gape e.g., if the wound is horizontal, place
him on his back with head and shoulders raised and a pillow under his knees.
➢ If the intestines have come out: Cover with clean pads, don’t give anything to eat or drink, Obtain
medical aid: till then give casualty absolute rest in bed.
➢ Casualty has to be transported to hospital. There may be severe associated internal haemorrhage
when patient's pulse becomes feeble and eventually goes into shock. In that case casualty should be
sent to hospital as a priority case.
7.0 PRESSURE POINTS TO STOP EXTERNAL BLEEDING →
7.1 The second method of indirectly stopping of

haemorrhage is the use of pressure points. This is
adopted when direct pressure becomes a failure.
There are quite a large number of pressure points
which must be remembered by First Aider so that he
can use the method in emergencies.
7.2 The Broad guideline it to press the artery before the

injury so that blood does not flow to the injured site. A
Pressure point is an area where an artery along its
course can be pressed against an underlying bone so
as to prevent the flow of blood beyond that point.
Generally, you can feel pulsations at such points.
7.3 CAROTID PRESSURE POINT:

➢ Two in number one on either side, these arteries arise
from the Aorta and pass up the neck on either side of
the trachea or windpipe to supply blood to the head
area.
53
➢ Pressure is applied by the thumb placed in the hollow between the voice box and the prominent stern
mastoid muscle nearby. It is pressed against the vertebral column behind it.
➢ In cut-throat cases, in addition to the digital pressure to be applied describe as above, the First Aider has
to apply digital pressure on the jugular vein (large vein) above the wound from which blood will be oozing
out, because this vein is also usually injured along with the artery in these cases. In the event of bleeding
not stopping even then digital pressure has to be applied below the wounds, also cover the wound. Cover
the wound, treat for shock and take the casualty immediately to a Hospital.
SUBCLAV IA N PRESSURE POINT:

➢ As the name indicates these (two) arteries run behind the clavicles on either side.
➢ These are branches of the aorta, which run from behind the inner and of the clavicle across the first ribs
on the armpits.
➢ Pressure is applied by pressing one thumb on top of the other in the hollow above and behind the middle
of the collar bone, so that the artery is pressed against the first rib.
➢ Before applying pressure bare the neck and upper part of chest; depress shoulder and bend his head to
the injured aids. These make it easy to see the area and get the muscles relaxed making the work easy.
FACIAL PRESSURE POINT:

➢ The palm is placed across the upper part of the neck in such a way that the thumb is on the lower portion
of the lower jaw and the fingers on the back of the head and neck.
➢ Pressure is applied on the artery at a point which is the junction between the mid-third of jaw and posterior
third under the line of the lower jaw.
TEMPORAL PRESSURE POINT:

➢ The palm is placed so that the thumb is a line with upper margin of the ear and the rest of palm over the
back of the head.
➢ Pressure is applied about an inch in front of the upper part the ear backwards against the temporal bone.
The temporal artery runs at this place before it gives off branches.
BRANCHIAL PRESSURE POINT:

➢ The brachial arteries run along the inner border of the biceps and branches out to supply the upper limb.
➢ Apply pressure on the middle third of the arm by passing the fingers.
➢ It is compressed against the humerus.
RADIAL OR ULNA PRESSURE POINT:

➢ As their names indicate these lower parts of the radial/ulnar artries pass over the wrist into palm to form
the palmer arch.
➢ Each of them should be compressed simultaneously by pressing the thumb against the bone just above
the wrist.
PALMER ARCH PRESSURE POINT:

➢ As noted above, the arch is formed by anastamosis of the terminal points of the Radial and Ulna arteries
beyond the middle of the palm.
➢ Pressure is applied by a single thumb which is placed flat across whilst the rest of the palm and fingers are
on the back of the injured palm.
FEMORAL PRESSURE POINT:

➢ Femoral arteries are in the thigh. They help to supply the lower limbs with blood.
➢ The artery enters the thigh about midway in the groin fold and runs a little inwards up to the upper two
thirds of the thigh and then passes to the back of the knee.
➢ To apply pressure, lay the patient, bend the knees slightly grasps the thigh with both hands so that each
of the thumb is at about the centre of the groin. Place the left thumb over the right and apply pr essure
directly backwards against the pelvic bone.
AMPUTATION OF LIMBS →
Recent advances in surgery have made the re-attachment of amputated limbs, fingers and toes possible.
The chances of a good result are greater the sooner the casualty and the severed part are taken to hospital.
Always place the severed part in a suitable container to protect it. Avoid use of liquid/antiseptic while
carrying the severed part.
AIM: Control bleeding and arrange urgent removal to hospital with severed part.
54
TREATMENT:
1. Control bleeding using elevation and direct pressure, take great care not to damage the stump.
2. Place the severed part in a clean plastic bag to keep it clean and prevent drying out. If possible, put
the bag in a container of ice. However the bag must be wrapped in suitable material to prevent the
severed part touching the ice.
3. Arrange urgent removal to hospital.
55
UNIT 7
CARDIOVASCULAR SYSTEM
INTRODUCTION:
➢ The heart is a muscular organ situated at the centre of the chest cavity. It acts as a pump.
➢ It is divided into 4 Chambers. The right upper chamber, called the Right Atrium receives impure
blood from all parts of the body through blood vessels called Veins.
➢ When the heart beats this impure blood is passed into the Right Lower Chamber called Right Ventricle,
and finally finds its way to the lungs where it is purified.
➢ The blood so purified finds its way into the Left Upper Chamber called Left Atrium. It then passes to
the Left Lower Chamber, called Left Ventricle, and from there, in the course of the beating of the heart
the purified blood is discharged into various blood vessels called Arteries and Capillaries which convey
this purified blood for the nourishment for the body as a whole. Thus each Heart has two pumps put
together.
➢ The pressure in the arteries varies with the beating of the heart. When the heart, contracts the pressure in
the arterial system increases; when the heart relaxes the pressure in the arteries decreases. This pressure
exerted on the arteries known as the 'Blood Pressure' and is recorded by the blood pressure instrument
or a rough estimate made by feeling the pulse.
➢ With each heartbeat blood is ejected into the arterial system. Most of the arteries are placed deep in the
body except on the wrist, elbow, neck, groin and ankle. So Arterial Pulse is normally felt over the lateral side
of the wrist, in the neck, temples, and groin and near the ankle.
➢ The average adult has a Pulse Rate of 72 per minute.
56
CORONARY HEART DISEASES →
The narrowing of the Coronary Arteries that prevents adequate blood supply to the heart muscle is called
Coronary Artery Disease.
It is also known as Coronary Heart Disease.
Usually caused by Atherosclerosis, which may progress to the point where the heart muscle is damaged
due to lack of blood supply. Such damage may result in heart failure.
Atherosclerosis is the abnormal accumulation of lipid or fatty substances or fatty plaque in the lumen of
Coronary Artery.
Risk factors of Coronary Heart Diseases are:

1. Modifiable: High Blood Cholesterol Level, Cigarette Smoking, Tobacco use, Hypertension,
Diabetes Mellitus, Lack of Estrogen in Women, Physical Activity, Obesity
2. Non-Modifiable: Family History, Increasing Age, Gender (Male), Race (Non-White Populations)
SIGNS & SYMPTOMS:- Chest Pain, Myocardial Infarction, Diaphoresis, ECG Changes, Dysarrithmias, Chest
Heaviness, Dyspnea, Fatigue.
DIAGNOSIS:- History collection, Physical Examination, Cardiac Enzymes, Electrocardiograms,

Echocardiograms, Stress Tests, Nuclear Imaging, Angiography.
COMPLICATIONS:- Chest Pain, Heart Attack, Heart Failure, Abnormal Heart Rhythm.
FIRST AID FOR ANGINA:-

Angina is pain in the chest. It occurs when arteries supplying blood to the heart become narrowed and
restrict blood flow. This can happen when doing exercise, including walking. It can also happen with
increased excitement.
SIGNS & SYMPTOMS:-

1. The casualty may have a dull, heavy or vice-like central chest pain, that may spread to their jaw and down
one or both arms.
2. The casualty may have pain which may ease with rest.
3. The casualty may have shortness of breath.
4. The casualty may experience sudden and extreme tiredness.
5. The casualty may feel anxious.
FIRST AID:-
1. Instruct the casualty to stop what they are doing and help them to sit down. Try to reassure them and make
them comfortable. The best position is on the floor with their knees bent and their head and shoulders
supported. You could place cushions behind them or under their knees. If this is their first angina
attack, they have no angina medication on them, the pain comes on at rest, is more frequent, worse or
different to previous attacks, advise them to seek urgent medical aid.
2. Ask if the casualty has any angina medication, like a spray or tablets. If they do, let them take it
themselves but help them if needed.
3. If the pain is still there five minutes after taking the medication, suggest they take a second dose
and keep any bystanders away.
4. If they are still in pain after another five minutes, or the pain returns, suspect it’s a Heart Attack.
Call for an Ambulance.
5. If the pain subsides within 15 minutes after they’ve rested or taken medication, they should usually be
able to go back to what they were doing. If they are worried, tell them to seek medical advice.
FIRST AID FOR HEART ATTACK:-

A Heart Attack happens when the supply of blood to part of the heart is suddenly blocked, usually
by a blood clot. You can make a full recovery following a heart attack, but this may depend on how mu ch of
the heart is affected.
57
SIGNS & SYMPTOMS:- Someone having Heart Attack may:
1. have crushing pain in the centre of their chest, that may spread to their jaw, and down one or both arms.
2. be breathless or gasping for breath.
3. be sweating profusely.
4. experience pain similar to indigestion.
5. collapse without warning.
6. complain of dizziness.
7. have pale skin and their lips may have a blue tinge .
8. have a rapid, weak or irregular pulse.
9. have a feeling of impending doom.
FIRST AID:-
1. Call for emergency help straight away and tell them you think someone is having a heart attack.
2. Help move the casualty into a comfortable position. The best position is on the floor, with their knees bent
and their head and shoulders supported. You could place cushions behind them or under their knees.
3. Give them one Aspirin tablet (300mg) and ask them to chew it slowly. Do not give aspirin to the casualty if
they are under 16 or if they are allergic to it.
4. Ask the casualty to take their own Angina medication, if they have some.
5. Keep monitoring the casualty’s level of response until emergency help arrives. If they become unresponsive
at any point, prepare to start CPR.
1 2 3 4 5
EXTERNAL CARDIAC COMPRESSION (ECC):-

➢ If only one First Aid Provider is available, artificial respiration and external cardiac compressions both are
done alternately.
➢ If two First Aiders available. First Aider giving mouth-to-mouth breathing to sit to the right of the casualty
and place the other to give External Cardiac Compression on the left side.
➢ Feel and mark the lower part of the sternum.
➢ Place the heel of your hand on the marked part the lower part of sternum (make sure that the palm and
fingers are not in contact with the chest).
➢ Place the heel of the other hand over it.
➢ With your right arm press the sternum backwards towards the spine (it can be pressed back in adults).
:: NOTE ::
• An Adult should be given about 60 Compressions per minute.
• For Children from 2-10 years of age, Compression with one hand will be enough but it should be 80-90 times
per minute.
• For Babies up to 2 years, Compression with fingers is good enough, applied 100 times per minute.
• Press firmly but carefully. Carelessness may cause injury to ribs and deeper tissues.
• If the treatment is effective:
a) Colour will change to normal;
b) Pupil will start becoming normal as improvement begins;
c) Carotid pulse beats with each compression will be felt.
• When pulse is not restored, continue compression till the patient reaches the hospital. If there are two First
Aiders, the first one should make 15 heart compressions and then the second one should give one lung
carotid pulse.
58
CARDIO PULMONARY RESUSCITATION (CPR):-
➢ Essential when both breathing and heart beat are affected.
➢ If two First Aiders are available one does ECC 30 times followed by the other mouth to mouth respiration
twice, repeat. If there is only a single First Aider, ECC 30 times followed by mouth to mouth respiration
twice given by the same person.
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UNIT 8
RESPIRATORY SYSTEM
A. RESPIRATORY SYSTEM
➢ Oxygen is essential to life. Every time we breathe

in, air containing oxygen enters the lungs. This
oxygen is then transferred to blood to be around
the body. Breathing and transported exchange of
oxygen and carbon dioxide (a waste product from
body tissues) are described as "Respiration", and
the structures that enable us to breathe make up
the Respiratory System.
➢ Respiration means breathing in and out of air.

This function is necessary to supply oxygen (from
the air) to all the organs in the body. Stoppage of
oxygen supply to the organs may result in death.
Death will result in about 4 to 6 minutes if the
body’s Oxygen supply is cut off.
➢ Mechanism of Respiration:
• During Inspiration (breathing in), the diaphragm
(the muscle separating the chest from the
abdominal cavity) flattens and increases the chest
capacity from above downwards.
• The ribs move upwards and forwards increasing

the capacity of the chest cavity from front to back
by the action of the muscles situated between the
ribs; the lungs thus expand and air enters them.
This is an active process.
• During Expiration (breathing out) the reverse process takes place. The diaphragm comes back to its original
state and the ribs fall back thus forcing the air out of the lungs. This is a passive process.
• Small blood vessels (capillaries) surround the alveoli. The exchange of oxygen and carbon dioxide take place
through the blood circulating in these capillaries. Oxygen is absorbed by the red blood corpuscles of the blood,
water vapour and carbon dioxide are let out from the blood plasma into the alveoli and expelled out. The lungs
are also supplied with nerves which are connected to an area in the brain called respiratory centre. This centre
controls respiration.
• The Organs connected with respiration are:

1. The Air Passages consist of nose, throat (Pharynx), wind pipe (Trachea) and two air-tubes (Bronchi). The
bronchi divide into minute branches (Bronchioles) which end in the lung substance (Alveoli)
2. The Lungs are two in number and are situated on the right and left sides of the chest cavity. Each lung
is made up of a number of small sacs, called “Alveoli”. The lungs are covered by a membrane called
“Pleura” which lines the inner wall of the chest cavity.
3. The Muscles, Diaphragm, Intercostals and Abdominal breathing muscles help to contract and expand the
lungs to facilitate the breathing.
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➢ ASPHYXIA (Suffocation):
• Asphyxia is a condition in which the lungs do not get sufficient supply of air for breathing. If this continues for
some minutes, breathing and heart action stops and death occurs.
• Causes of Asphyxia:
1. Obstruction - Foreign Body, Food or Water in Air Passage, Irritant Gases in to the Air Passage, Tongue
falling back, Swelling of Tissues of Throat.
2. Compression - Type of Rope/Scarf around the Neck, Hanging or Throttling, Smothering like covering face
& nose.
• Conditions affecting the Respiratory Mechanism:

- Epilepsy, Tetanus, Rabies etc.
- Nerve diseases causing paralysis of chest wall or diaphragm.
- Poisonous snake bite (e.g. Cobra).
• Conditions affecting the Respiratory System:

- Over doses of Morphia, Barbiturates (Sleeping tablets)
- Electric Shock.
- Stroke
• Compression of the Chest:

- Caving in of earth or sand, in mines, quarries, pits or compression by grain in a silo or big beam and/or
pillars in house-collapse.
- Crushing against a wall or other barrier or pressure in a crowd (Stampede).
• Lack of Oxygen at High Altitudes:

- With low atmospheric pressure where the oxygen content in the atmospheric air is low due to lack of
acclimatization.
• Management:
- Remove the cause, if possible or remove the casualty to environment where the suffocating agent is not
there.
- Loosening the tight clothing e.g. collar belt etc., and expose the chest and neck.
- Resuscitations:
1. Opening the Airway
2. Checking the breathing
3. Clearing the Airways
4. Artificial Respiration mouth to mouth/mouth to nose respiration.
5. Circulation- External Chest Compressions
- Gently shake casualty's shoulders and ask what happened.
- Check the breathing by- Observing movement of the chest and also observing air coming out during
expiration.
- Clearing the Airways by backward tilt of head and chin lift-opening the air way.
- Providing rescue breath.
- Check for heart beat and movement of chest for recovery of respiration and heart beat, if achieved put the
casualty in recovery position; if not start compression activity.
- External Chest Compressions: Lean over the casualty, with your arms straight Press down vertically on the
chest, and depress by about 4-5cm. Release pressure and let chest recoil. Compress 30 times at the rate
of 100 compressions per minute.
- Mouth-to-Mouth Respiration: If No recovery of respiration and heart beat, close the nose, open the mouth
ensuring tilting of head, blow in the air from your mouth to mouth of the casualty. And allow the chest
recoil; after 5 times again check for recovery.
- Check the Pulse.
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➢ DROWNING:
• This is another consequence of disaster especially during flooding. Drowning causes asphyxia by water weeds
and mud entering into the lungs. It may also cause the throat to go into spasm (constricting the air passage
dry drowning). Congestion of the lungs can occur very quickly but it may be several hours before it is apparent.
• All casualties rescued from drowning should be sent to a hospital. If a casualty has been immersed in
cold water there is also a danger of hypothermia. It is important that the casualty is kept warm.
• Symptoms & Signs →

• Aims → Get air into the casualty's lungs as fast as possible, even in water. If necessary arrange removal to
hospital.
• Management →
1. Quickly remove any obstruction such as weed from the casualty's mouth and begin artificial respiration
immediately.
5. Keep him warm. If possible, remove wet clothing and dry him off. Cover with spare clothes and or towels
to keep the body warm.
:: NOTE ::
➢ STRANGULATION & HANGING:

• Strangulation is constriction or squeezing around the neck or throat. Sometimes, hanging or strangulation may
occur accidentally – for example, by ties or clothing becoming caught in machinery.
• Hanging may cause a broken neck; for this reason, a casualty in this situation must be handled extremely
carefully.
• STRANGULATION is usually the result of throttling by hands or a rope or scarf being tied round the neck.
• In HANGING the fracture of spine at the junction of head and neck causing compression or tear of the spinal
cord lending to respiratory failure.
• Aim of First Aider should be to restore adequate breathing, to arrange urgent removal to hospital.
:: NOTE ::
Do not move the casualty unnecessarily, in case of spinal injury. Do not destroy or interfere with any material
that has been constricting the neck, such as knotted rope; police may need it as evidence.
• Management →
1. Cut or remove the band constricting the throat.
2. If suspended raise the body and loosen or cut the rope.
3. Give artificial respiration.
4. Do not wait for the policeman to arrive, start immediately.
5. Lay the casualty on the ground. Open the airway and check breathing. If he is not breathing, be prepared
to give chest compressions and rescue breaths if necessary for saving life.
6. If the casualty is breathing, place the person in the Recovery Position.
62

➢ CHOKING (Asphyxia due to obstruction in Windpipe): The airway is the passage that connects the nose
and mouth with the lungs. If anything blocks the airway, the person chokes and cannot get enough oxygen.
This is a life-threatening emergency, and you must give First Aid to remove whatever is blocking the airway.
• Mild Choking → Coughing may indicate a mild airway obstruction. Coughing is a natural way to clear the
airway, and it is a sign that the person is still getting enough at Encourage the person to keep coughing and
stay close by in case you need to help. An object may become more firmly stuck in the airway, stopping the
person from breathing.
• Severe Choking → Severe choking happens when a foreign object or swelling blocks the airway completely.
The object may get stuck at any point in the airway from the throat to the lungs. This is a severe airway
obstruction. A foreign object that is stuck at the back of the throat may block the throat or cause muscular
spasm. If blockage of the airway is mild, the casualty should be able to clear it; if it is severe he will be unable
to speak, cough, or breathe and will eventually lose consciousness. Be prepared to begin rescue breaths and
chest compressions. This is most common with children. A marble, a seed or button may get struck in the air
passage. In adults, food may go down the airway and choke it.
• Aim → Is to remove foreign body or obstruction.
• Management → In case of Adults & Children
Step 1
If you think someone is choking, ask them ‘Are you choking?' If they can
breathe, speak or cough then they might be able to clear their own throat. If
they cannot breathe, cough, or make any noise, then they need your help straight
away.
Step 2
Cough it out. Encourage them to cough and remove any obvious obstruction from
their mouth.
Step 3
Slap it out. If coughing fails to work, you need to give five sharp back blows.
To do this, help them to lean forwards, supporting their upper body with one
hand. With the heel of your other hand give them five sharp back blows
between their shoulder blades. After each back blow, check to see if there’s
anything in their mouth.
Step 4
Squeeze it out. If back blows fail to clear the obstruction, give five abdominal
thrusts.
To do this, stand behind them and put your arms around their waist. Place one
hand in a clenched fist between their belly button and the bottom of their chest.
With your other hand, grasp your fist and pull sharply inwards and upwards up
to five times. Check their mouth again, each time.
Step 5
If the blockage has not cleared, call for Ambulance help straight away.
Repeat five back blows and five abdominal thrusts until help arrives, re-checking
their mouth each time.
If they become unresponsive at any point, prepare to start Adult CPR.
63
➢ SWELLING WITHIN THE THROAT: Swelling within the throat may occur as a result of trying to drink very
hot liquid or swallowing corrosive poisons or may be due to inflammation.
• Management →
1. Make the patient sit up.
2. If breathing continues normally or is restored to normal, give ice to suck, or cold water to sip.
3. Butter, olive oil or medical paraffin may also be given in small quantity.
4. Apply cloth wrung out of hot water to the front of the neck.
5. If breathing has stopped, give artificial respiration.
6. An early hospitalization is advised.
➢ SUFFOCATION BY SMOKE: Protect yourself by a towel or a cloth (preferably wet) over your mouth and nose.
Keep low and remove the casualty as quickly as possible away from the area.
➢ SUFFOCATION BY POISONOUS GASES like Carbon Monoxide (Lighter than Air): This gas which is
lighter than air is present in car-exhaust fumes, in house hold Coal gas, during incomplete combustion charcoal
stoves and in coal mines.
• Management →
1. The First Aid treatment consists of removing the person and applying artificial respiration and giving pure
oxygen, if available.
2. Ensure circulation of fresh air before entering the room on doors and windows.
3. Before entering the enclosed space take two or three deep breaths and your breath as long as you can and
hold
4. Crawl along the floor (as the gas is lighter than air).
5. Remove the casualty as quickly as possible to the area of fresh air
6. Loosen his clothes at neck and waist and give artificial respiration casualty is asphyxiated.
➢ SUFFOCATION BY POISONOUS GASES like Carbon Dioxide & Others (Heavier than Air): Such gases
are found in coal mines, deep unused wells and sewerage. Various other gases such as leaking refrigerator
gases, compressed gasses used for cooking and lighting could also cause suffocation.
• Management →
1. Observe all the precautions mentioned above.
2. Enter in upright position (as the gas is heavier than air and collects near the floor).
3. Remove the casualty as quickly as possible to fresh air.
4. Wherever ventilation is not possible and deadly poisonous gas is suspected use a gas mask for protection.
➢ ASTHAMA: This is a condition where sudden constriction of airways causing difficulty in breathing especially in
breathing out occurs. Allergy, infection, anxiety or tension can trigger an attack.
• Management →
1. Reassure the patient
2. Make him sit up in bed or chair and allow him to lean forward with a couple of pillows and/or a small table
on which to rest his head.
3. Ensure fresh air by opening the windows.
4. Seek medical aid from a nearby doctor.
64
• Asphyxia of a severe degree with unconsciousness:
o This could be due to:
1. The tongue might have fallen back into the throat.
2. Vomit might have collected in the throat.
3. Some foreign material (like weeds, mud etc.) might have collected and obstructed the air passages.
o Begin to work immediate ly as every second counts. Do not delay.
o Management when not breathing →

1. Loosen all clothing at waist, chest and neck.
2. Tilt the head backwards, while supporting the back of neck with your palm. This will lift the tongue to
its normal position. Thus the air passage will be cleared and the casualty may begin to breathe after
a gasp.
3. If breathing does not begin after the above treatment. Mouth-to-mouth or Mouth-to-nose breathing
should be given.
o If the heart is not beating, the following will be noticed →

1. The face is blue or pale.
2. Pupils are dilated.
3. Heartbeats and pulse at root of neck (carotid) are not felt.
4. Place the casualty flat on his back on a hard surface (bench, table etc.).
5. Give a smart hit with the edge of your hand on the lower and left angle of the sternum. This usually
stimulates the heart to restart.
6. In case heart does not work continue the striking for 10-15 seconds, at the rate of one stroke a second.
Feel for the pulse when it becomes regular and continuous, stop thumping.
7. All the while artificial respiration has to go on.
8. Even if the casualty is breathing but the breathing is not normal, it is wise to start artificial respiration.
9. Do not begin thumping the heart or compression until you are sure that the heart has stopped beating.
10. To restore circulation External chest compression is to be started.
➢ EXTERNAL CARDIAC COMPRESSION (ECC):

• If only one First Aid Provider is available, artificial respiration and external cardiac compressions both are done
alternately.
• If two First Aiders available. First Aider giving mouth-to-mouth breathing to sit to the right of the casualty and
place the other to give External Cardiac Compression on the left side.
• Feel and mark the lower part of the sternum.
• Place the heel of your hand on the marked part the lower part of sternum (make sure that the palm and fingers
are not in contact with the chest).
• Place the heel of the other hand over it.
• With your right arm press the sternum backwards towards the spine (it can be pressed back in adults).
:: Note ::
➢ An Adult should be given about 60 Compressions per minute.
➢ For Children from 2-10 years of age, Compression with one hand will be enough but it should be 80-90 times
per minute.
➢ For Babies up to 2 years, Compression with fingers is good enough, applied 100 times per minute.
➢ Press firmly but carefully. Carelessness may cause injury to ribs and deeper tissues.
➢ If the treatment is effective:
d) Colour will change to normal;
e) Pupil will start becoming normal as improvement begins;
f) Carotid pulse beats with each compression will be felt.
➢ When pulse is not restored, continue compression till the patient reaches the hospital. If there are two First
Aiders, the first one should make 15 heart compressions and then the second one should give one lung
carotid pulse.
65
➢ CARDIO PULMONARY RESUSTICATION (CPR):
• Essential when both breathing and heart beat are affected.
• If two First Aiders are available one does ECC 30 times followed by the other mouth to mouth respiration twice,
repeat. If there is only a single First Aider, ECC 30 times followed by mouth to mouth respiration twice given
by the same person.
B. FOREIGN BODIES IN ORGANS
FOREIGN BODIES IN EYE → Foreign objects (such as grit, a loose eyelash or a contact lens) that lie on
the surface of the eye can easily be rinsed out. Sharp fragments like metal or glass may cut or penetrate the
eye and become embedded. If this is the case, the person should not attempt to remove the object but cover
the eye and seek medical help as soon as possible.
Signs and Symptoms:- Look for:

1. pain or discomfort in the eye or eyelid
2. redness and watering of the eye
3. a visible wound or a bloodshot appearance
4. blurred, partial or a total loss of vision.
Management:-
1. Wash your hands with soap and water.
2. Seat the person in a well-lighted area.
3. Advise the casualty not to rub their eye as this could make it worse. Ask them to sit down facing a light.
4. Stand behind them and gently open their eyelids with your thumbs. Ask them to look right, left,
up and down as you look closely at the eye.
5. If you can see something, ask them to tip their head backwards and wash it out by pouring clean
water from the inner corner from a glass or jug.
6. If this doesn’t work and the object is still on the surface of the eye, try to remove it with a moist piece
of gauze or the damp corner of a clean handkerchief or tissue. If the object isn’t easy to remove
or the eye is very painful, seek medical advice.
FOREIGN BODIES IN EAR → A foreign object in the ear can cause pain, infection and hearing loss.
Usually you know if an object is stuck in your ear, but small children may not be aware of it.
Management:-
1. Don't probe the ear with a tool such as a cotton swab or matchstick. You risk pushing the object farther
in and damaging the ear.
2. Remove the object if possible. If the object is clearly visible, pliable and can be grasped easily with
tweezers, gently remove it.
3. Try using gravity. Tilt the head to the affected side to try to dislodge the object.
4. Try using oil for an insect. If the foreign object is an insect, tilt the person's head so that the ear with
the insect is upward. Try to float the insect out by pouring mineral oil, olive oil or baby oil into the ear.
The oil should be warm, but not hot. Don't use oil to remove an object other than an insect. Don't use
this method for a child if ear tubes are in place or if you think the eardrum may be perforated. Signs
and symptoms of a perforated eardrum are pain, bleeding or discharge from the ear.
5. Try washing the object out. Use a rubber-bulb ear syringe and warm water to irrigate the object out of
the canal, again provided no ear tubes are in place and you don't suspect the eardrum is perforated.
If these methods fail or the person continues to experience pain, discharge from the ear canal, reduced
hearing or a sensation of something lodged in the ear, seek medical assistance.
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FOREIGN BODIES IN NOSE → If a foreign object becomes lodged in your nose:
- Don't probe at the object with a cotton swab or other tool.
- Don't try to inhale the object by forcefully breathing in. Instead, breathe through your mouth until the
object is removed.
- Blow out of your nose gently to try to free the object, but don't blow hard or repeatedly. If only one
nostril is affected, close the opposite nostril by applying gentle pressure and then blow out gently through
the affected nostril.
- Gently remove the object if it's visible and you can easily grasp it with tweezers. Don't try to remove an
object that isn't visible or easily grasped.
- Call for emergency medical assistance or go to your local emergency room if these methods fail.
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UNIT 9
HEAD & SYPINAL INJURIES
1.0 What is a SPINE:- Vertebrae which together form the spine are small bones which bear the weight of
the head and the trunk. They are commonly fractured:
1. Indirectly by:-
- Lifting a heavy weight
- Landing on the feet or buttocks in a heavy fall
- Being thrown forward suddenly (e.g. a car driver during a collision) or
- Neck fractures in whip-lash injuries.
2. Directly by:-
- The fall of a heavy weight on the back or
- Falling from a height on the back across a bar
- Injuries in occurrence of landslides, earthquakes etc., when a heavy mass falls on the spine.
➢ The fracture will be more serious if the spinal cord is injured. As a result there may be loss of power of the
muscles (paralysis) and loss of sensation of the skin below the level of the injury. Injury to the spine is
always a serious emergency.
➢ Fracture of the spine should be suspected in all cases of back injury. There will be pain and shock in all
cases.
➢ Just because there is no paralysis, do not neglect the case. Treat it as fracture until the case is in medical
hands.
2.0 MANAGEMENT:-
1. Try to get a doctor immediately.
2. Make the casualty lie still. Never allow him/her to get up.
3. If unconscious see that the tongue does not fall back and choke the casualty.
4. If medical aid is not immediately available.
a) Do not move the casualty; cover with a light bed sheet or a thin blanket.
b) Keep under observation till the doctor arrives.
5. If medical help is not available, prepare the casualty for shifting on a stretcher.
a) Place pads between thigh, knees and ankles.
b) Tie a figure of eight bandage over ankle and feet with the knot on sole of foot.
c) Apply broad bandages on knees and thighs.
d) Be ready to shift to a nearby shelter.
:: Note ::
Carry patient face upwards, for in this position the spinal cord is not likely to be damaged further.
3.0 CAUSES OF SPINAL INJURY:-

1. Falling from a motor bike or horse,
2. a heavy object falling across their back,
3. a collapsed rugby scrum,
4. falling awkwardly, for example, while doing gymnastics,
5. falling from a height, for example, from a ladder,
6. an injury to the head or face,
7. sudden deceleration in a vehicle,
8. diving into a shallow pool and hitting the bottom.
4.0 SIGNS & SYMPTOMS:-

1. Pain in the neck or back at the site of injury.
2. Irregular shape or twist in the normal curve of the spine.
3. Tenderness and/or bruising in the skin over the spine.
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4. Movement of limbs may be weak or absent.
5. Loss of sensation, or abnormal sensations, e.g. burning or tingling.
6. Loss of bladder and/or bowel control.
7. Breathing difficulties.
→ NOTE 
When the vertebrae are damaged, there may be:
❖ Pain in the neck or back at the injury site; this may be masked by other, more painful injuries.
❖ Take step to avoid twisting of the normal curve of the spine.
❖ When the spinal cord is damaged, there may be:
▪ Loss of control over limbs; movement may be weak or absent.
▪ Loss of sensation, or abnormal sensations such as burning or tingling. The casualty may say that limbs
feel stiff, heavy, or clumsy.
▪ Loss of bladder and/or bowel control.
▪ Breathing difficulties.
ASSESSMENT OF CONDITION OF THE CASUALTY:- The Casualty could be either conscious or may be
unconscious. To assess gently tap the shoulder and observe by gently asking the question to see the
response, if casualty response indicates consciousness.
A. FOR A CONSCIOUS CASUALTY –
1. Aims of the First Aider –
➢ To prevent further injury.
➢ To arrange urgent shifting to hospital.
If you suspect neck injury place rolled-up blankets, towels, or items of clothing on either side of the
casualty's head and neck, while you keep her head in the neutral position. Continue to support the
casualty's head and neck throughout until emergency medical services take over.
2. Management –
➢ Reassure the casualty and advise him/her not to move.
➢ Kneel behind the casualty's head. Grasp the sides of the casualty's head firmly, with your
hands over the ears. Do not completely cover her ears he/she should still be able to hear
you. Steady and support her head in the neutral head position, in which the head, neck, and
spine are aligned. This is the least harmful head position for a casualty with a suspected
spinal injury.
➢ Continue to support the casualty's head in the neutral position until emergency medical
services take over, no matter how long this may be. Get help to monitor and record vital
signs -level of response, pulse, and breathing.
➢ Examining for any other injury on the body.
➢ lf casualty is moving limbs because of pain before preparing to transport the casualty suitably
put bandages on the legs so that it becomes easy to apply Log- Roll technique.
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B. FOR A UNCONSCIOUS CASUALTY –
1. Aims of the First Aider –
➢ To maintain an open airway.
➢ To resuscitate the Casualty if necessary.
➢ To prevent further spinal damage.
2. Management –
➢ Kneel behind the casualty's head. Grasp the sides of her head firmly with your hands over
the ears. Steady and support her head in the neutral head position, in which the head, neck,
and spine are aligned.
➢ If necessary, open the casualty's airway using the jaw thrust method. Place your hands on
each side of her face with your fingertips at the angles of her jaw. Gently lift the jaw to open
the airway. Take care not to tilt the casualty's neck.
➢ Transport the casualty with spinal injury with special care to neck, head and spine from hard
plank or stretcher as stated above to the ambulance.
3. Transportation –
➢ Prepare the stretcher, the soft bed of the canvas type of stretcher must be stiffened,
preferably by placing short boards across the stretchers, or long ones lengthwise on the
canvas if only these are available. If no stretcher is available, a narrow shutter, door or board
of at least the same width and length as the patient may be used.
➢ Cover the stretcher with a folded blanket and then "blanket the stretcher“ by one of the
methods.
➢ Place pillows or pads in readiness on the stretcher in a position to support the neck, and
small part of the back. Those should be sufficiently large, but not too large, to preserve the
normal curves of the spine.
➢ Whenever the casualty is to be moved or lifted he must not be bent, twisted or over
extended. One bearer must apply firm but gentle support to the head and face, so as to
prevent neck movement and another bearer must steady and support the lower limbs to
prevent trunk movement. This must be continued until the casualty has been placed on the
stretcher.
➢ When the casualty is not already laying on a blanket or rug.
a) Place the blanket or rug on the ground in line with the casualty, and rolled lengthwise
for half its width.
b) While the two bearers maintain control of the head and lower limbs, other bearers
very carefully turn the casualty on to his side every precaution being taken against
movement at the site of the fracture. Place the roller portion of the blanket or rug
close to the casualty's back and gently rolls him over the roll until he is lying on his
opposite side. Unroll the rolled portion of the blanket or rug gently lowering the
casualty on his back so that he lies on the centre of the open blanket or rug. The
bearers at the head and at the lower limbs conform to the rolling of the casualty
throughout.
➢ Loading the stretcher. There are two methods of loading a stretcher, a standard method
(when there is a blanket under the casualty) and an Emergency Method (When there is no
blanket under the casualty) in which case the stretcher can be pushed under the casualty it
will be necessary for the bearer at the feet to keep his legs wide apart to allow the stretcher
to be placed between them.
• "Blanket lift" is the standard method for loading fractures of the spine when there
is blanket under the casualty.
• Roll the two edges of the blanket up against the casualty's side. If poles of
sufficient length and rigidity are available the edges of the blanket should be
rolled around them. This will make the lifting of the casualty very much easier.
• While two bearers maintain support of the head and lower limbs, the remaining
bearers distribute themselves as required on each side of the casualty facing one
another. On the word of command they raise him by grasping the rolled edges
of the blanket and, acting together, carefully and evenly lift him to a sufficient
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height to enable the stretcher to be pushed underneath him. If this is for any
reason impossible the stretcher should be brought as near to the casualty as
circumstances permit and the bearers should move short even side paces until
the casualty is directly over the stretcher, when he should be gently and
cautiously lowered onto it.
• Ensure that the pads are in the correct position.
b) Emergency method for loading fractures of the spine when there is no blanket under
the Casualty and none is available –
• Open out the casualty jacket and roll it firmly so that the rolls are close to each
side.
• Place the casualty on the stretcher adopting the same procedure as described for
the standard Method except that the bearers grasp the rolled up jacket and/or
the clothing and /or bandage round the casualty's thighs instead of the rolled
edges of the blanket. When the clothing is insecure, a broad bandage must be
placed round the body just below the shoulder for the bearers to grasp.
➢ In the case of cervical injuries, place firm supports such as rolled-up blankets or sandbags
on each side of the head to steady it.
➢ Place a folded blanket in the hollow above the heels so as to relieve pressure on them.
➢ Wrap the casualty.
➢ If he is to be carried over rough ground, reduce his body movements to a minimum by
binding him firmly but not too tightly to the stretcher, with broad bandages. These should
be applied round the pelvis, thighs and calves, and round the body and arms, just above the
elbows.
➢ On reaching shelter, do nothing further until the arrival of medical aid. The above method
of transportation of spinal injury case is to be used only if hard board is not available.
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UNIT 10
BURN, ELECTROCUTION,
EFFECTS OF HEAT & COLD MANAGEMENT
A. BURNS & SCALDS
Burns are injuries that result from dry heat like fire, flame, a piece of hot metal, the sun, and contact with
wire carrying high tension electric current or by lightning or friction.
Scalds are caused by moist heat due to boiling water, steam, oil, hot tar, etc.
TYPES OF BURNS →
Chemical Burns are caused by strong acids (Sulfuric Acid. Nitric Acid) or by strong Alkalies (Caustic Soda,
Caustic Potash, Quick lime or Strong Ammonia).
Nuclear Burns are caused by the instantaneous flash of intense heat given off by a nuclear explosion. It is
capable of causing superficial burns on the exposed skin of person several miles away.
Radiation Burns are caused by over-exposure to X-ray or Radiation Therapy. This casualty is to be referred
to Hospital immediately.
TYPE OF BURN CAUSES
Flames: Contact with hot objects, such as domestic appliances or cigarettes.

Dry Burn
Friction: in Rope burns.
Scald Steam: Hot liquids, such as tea and coffee, or hot fat.
Low-Voltage Current: as used by domestic appliances

Electrical Burn
High-Voltage Current: as carried in mains overhead cables, Lightning strikes.
Frostbite: Contact with freezing metals. Contact with freezing vapors, such as
Cold Injury
liquid oxygen or liquid Nitrogen.
Industrial Chemicals: including inhaled fumes and corrosive gases

Chemical Burn Domestic Chemicals and agents, such as paint stripper, caustic soda, weed
killers, bleach, oven cleaner, or any other strong acid or alkali.
Sunburn: Over-exposure to ultraviolet rays from a sunlamp.

Radiation Burn
Exposure to a radioactive source, such as an A-ray
RESULTS OF BURNS →
Immediate: Intense pain, Shock.
Later: There may be infection in the damaged area,
After heating, it will leave scars causing disfigurement and / or restriction of movements.
DEGREE OF BURNS → The degree of burns indicates the degree of damage to the tissues. There are
three degrees of burns.
DEGREE OF BURN DESCRIPTION
FIRST DEGREE When the skin is only reddened.
SECOND DEGREE When there are blisters on the skin.
THIRD DEGREE When the destruction is deeper damaging nerves, tissues, muscles etc.
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The danger from burns depends on the area of the burns rather than the degree.
Superficial burns over a large area of the body are more dangerous than the complete charring of a part of
the limb. It must be noted that in the same person, different parts of the body may show different degree
of burns.
(a) FIRST DEGREE BURN:- First Degree Burns are usually limited to (Erythema), a white plaque and
minor pain at the site of injury. These burns usually extend only into the Epidermis.
(b) SECOND DEGREE BURN:- Second Degree Burns additionally fill with clear fluid, have superficial
blistering of the skin, and can involve more or less pain depending on the level of nerve involvement.
Second-degree burns involve the superficial (Papillary) dermis and may also involve the deep
(Reticular) dermis layer.
(c) THIRD DEGREE BURN:- Third Degree Burns additionally have charring of the skin, and produce
hard, leather-like escarps. An escarps is a scab that has separated from the unaffected part of the
body. Frequently, there is also purple fluid. These types or burns are often painless because nerve
endings have been destroyed in the involved areas.
The first two degree is seen in scalds also.
When the chemicals fall on the skin or cloth worn by the person on any of the three degrees of burn may be
produced. When swallowed, the chemicals, if strong, will damage the tissues with which they come into
contact while swallowing viz., lips, tongue, throat, food passages, and stomach. There may be damage to
the skin around the mouth.
The severity of a burn depends upon both the area it covers and depth.
5.0 RULE OF NINE →
Any burn over 15% in Adults and 10% in Children of

deep degree should be hospitalized as priority.
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6.0 RESCUE FROM FIRE →
❖ Helping a person whose clothes caught fire:
1. Put out the flames by whatever means available. Most of the causes of burns occur in homes and water is
readily available to quench the flames, water also cools the burnt area causing less damage to occur.
2. Do not allow the person to run about. This only fans the fire and makes the flame spread.
3. Hold a rug, blanket, coat or table cover in front of you, while approaching a man whose clothing have caught
fire.
4. Lay him down quickly on the ground and wrap tightly with any thick piece of cloth, rug or coat. Smother
the flame by gentle pats over the covering but do not role the casualty.
5. If the clothes in front of the body have caught fire, lay him down on his back and vice versa, till suitable
material is brought to smother the flame.
❖ Rescuing a person from fire:

1. In rescuing persons from a room which has caught fire, speed and clear thinking are required.
2. Remember, clean air is at ground level. So crawl along the floor to pull out a person who is lying unconscious
or is disabled.
3. Have a wet Hand Kerchief round your face when you rescue.
4. If there is smoke in the room, these precautions do not protect the rescuer from Carbon Monoxide poisoning.
When there is fire in a closed room, there is always some amount of Carbon Monoxide, therefore, quick
action is also important.
5. When there is fire in a room in which the doors and windows are closed, do not open the windows and doors
to let in air. The rush of air will increase the fire and it will burn more intensely.
7.0 MANAGEMENT →
❖ Management of Serious Burns and Scalds:
1. Keep the casualty quiet and reassure him.
2. Wrap him in clean cloth.
3. Do not remove adhering particles of charred clothing.
4. Cover burnt area with sterile or clean dressing and bandages or with, clean sheet or towel.
5. Keep him warm but do not overheat him.
6. If the hands are involved, keep them above the level of the victim's heart.
7. Keep burnt feet hands or legs elevated.
8. If victim's face is burnt, sit up or prop him up and keep/under continuous observation for breathing difficulty.
If respiration problems develop, an open airway must be maintained.
9. Remove quickly from the body anything like rings, bangles, belts or boots. If this is not done early, it would
be difficult to remove them later as the limb begins to swell.
10. Do not immerse the extensive burnt area or apply ice water over it because cold may intensify the shock
reaction. However a cold pack may be applied to the face or to the hands or feet.
11. Shift the casualty to the nearest hospital as soon as possible.
12. If you cannot take him/her to a hospital, wait for the doctor to arrive.
13. Do not open blisters.
14. Keep him wrapped up in clean cloth.
15. Treat for Shock.
16. If medical help of trained Ambulance personnel cannot reach the scene for an hour or more and the victim
is conscious and not vomiting, give him a weak solution of salt and soda at home and enrooted; one level
tea spoon full of salt and half level tea spoon full of baking soda to each glass of water, neither hot nor cold.
Allow the casualty to sip slowly. Discontinue fluid if vomiting occurs. Do not apply ointment or any form of
grease or other home remedy.
❖ Management of Minor Burns and Scalds:

1. Wash the area gently with clean cold water.
2. Submerge the burnt area in cold water.
3. Remove burnt clothes but do not forcibly remove adherent portion of charred clothing.
4. Cover with dry dressing.
5. Do not apply cotton wool
6. Do not apply any greasy substance or adhesive dressing.
7. Give warm drinks for example sweetened tea or coffee.
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❖ Management of Chemical Burns:
1. Wash off the chemical with a large quantity of water by using a shower or hose if available as quickly as
possible. This flooding with water wash away most of irritant.
2. Cut out contaminated clothing.
3. Do not touch the burnt area with bare fingers.
4. Treat as for burns as described above.
❖ Management of Burns of the Eye:

1. First aid for acid burns of the eye should be given as quickly as possible by thoroughly washing the face,
eyelids and the eye for at least five minutes.
2. If the casualty is lying down, turn his head to the side, hold the eyelids open and pour water from the inner
corner of the eye outward. Make sure that the chemical does not get into the other eye. Cover the eye with
a dry clean protective dressing and bandage. Do not use cotton.
3. Caution the victim against rubbing his eye.
4. Get medical help immediately.
❖ Management of Burns in the Mouth and Throat:

1. They occur from drinking very hot liquid, inhaling hot air (fire in the room) or drinking corrosive chemicals.
They cause severe and dangerous damages by producing swelling of the mouth, tongue or the air passages.
2. The casualty may show:
o Damaged skin around the mouth.
o Difficulty in breathing may be symptoms of shock and the casualty may be unconscious.
o Immediately evacuate to the Hospital.
❖ Electric Burns:
• These are caused by High Voltage Current at the point of contact and going through the body and at the
point of exit (that part of the body which touches ground/earth point).
• High Voltage Industrial Power current can jump 16-18m and kill the Rescuer. Therefore, do not approach
the casualty till the switch has been turned off.
• These currents not only cause local damage but affect the respirator and cardiac centers. They produce
superficial or deep burns including charring, but also cause stoppage of breathing and heart beat.
• Management:-
1. Cut Off or Switch Off the source of current.
2. Separate the casualty from the cause of injury.
3. Cover the burns.
4. Treat the shock.
5. If breathing or heart beat has stopped, resuscitate.
6. Put in Recovery Position.
7. Evacuate speedily to the Hospital.
❖ Sun Burns:
• Direct exposure of a person to Sun rays can have ill effects on Skin and Eyes.
• Skin – The injury to the Skin known as Sunburn is due to Ultraviolet Rays. The burn is produced by
over exposure to sun rays, when the body is covered with sweat, sea water or the wind is blowing
strongly. However, high up in the mountains, burns can be produced even on a dull overcast day with
strong winds.
The Skin becomes red, itchy and painful. It may go into blisters formation with marked swelling and
become very painful.
Management:- Remove the casualty to a shaded cool place and bathe the skin with cold water.
Cover the burn area and evacuate to hospital giving frequent sips of cold water.
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• Eyes – Reflected light from the sun produces Thermal and Photochemical burns in the front and back
of the eye depending upon the duration of exposure. Reflected light from snow (snow -blindness),
Welder’s Flash and looking at the solar eclipse also produces the same. The eyes becomes red.
Prevention:- Wear dark glasses; protect eyes by protective helmets and goggles while doing welding.
Management:-
1. Wash eyes with cold water.
2. Lightly dress the eyes with sterile non fluffy pad.
3. Send to the eye specialist.
8.0 PREVENTION OF BURNS → Most of the conditions under which burns occur can be prevented.
1. Women and Children get burnt more often than men, women get burnt while cooking in the kitchen. They
should take the following precautions:
a) Ovens or Stoves should be kept at a higher level about two feet above the ground.
b) While working near fire, see that you clothes are not hanging free, or flapping about.
c) Never go near fire when wearing material made out of nylon or similar fibers as these clothes catch
fire easily and quickly. It is a good practice to use a cotton overall while cooking.
d) Do not put kettles or other vessels with hot liquid near the edge of a stove, sink or the table or the
spout pointing towards you.
2. Never leave children alone in a room where there is a fire or a naked lamp burning.
3. Keep matches out of the reach of children.
4. Never sleep with a kerosene lamp near the bed.
5. Do not hang clothes near an open fire.
BURNS THAT NEED HOSPITAL TREATMENT →
❖ If the casualty is a Child, call a Doctor or take the child to Hospital, however small the burn appears. For
other people, medical attention should be sought for any serious burn. Such burns include:
1. All full-thickness burns.
2. All burns involving the face, hands, feet, or genital area.
3. All burns that extend right around arm or a leg.
4. All partial-thickness burns larger than 1% of the body surface (an area the size of the palm of the
casualty’s hand).
5. All superficial burns larger than 5% of the casualty’s body surface (equivalent to 5 Palm Areas).
6. Burns with a mixed pattern of varying depths.
7. If you are unsure about the severity of any burn, seek medical attention.
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B. ELECTROCUTION
ELECTRICAL INJURIES / SHOCK →
Causes →
➢ If any part of the body comes in contact with a "live" wire which is exposed and not covered by an insulator
or with a cable or rail in which current is leaking, a person gets an Electric Shock.
➢ Electrical shock is produced only when an electric current passes through the human body which is in contact
with earth. It passes even more quickly if the part is wet. In wet conditions even lower voltage is dangerous.
➢ A very strong current passing to earth through lower limbs may be less dangerous than a weaker current
passing through the chest, especially so when it enters through the hands and arms.
Effects →
➢ The electric current may affect the beating of heart leading to stoppage of heart.
➢ There may be sudden stoppage of breathing due to paralysis of muscles used in breathing.
➢ Heart may continue to beat, while breathing has stopped. In this condition the face appears blue.
➢ There may be burns either superficial or deep. That depends on the strength of the electric current causing
the injuries.
Management →
➢ Intelligent and prompt action is required if the First Aider is not cautious he may also receive severe
electric shock or even die along with the casualty.
➢ lf the casualty is still in contact with the source, switch off the current. If the switch is not found, remove
the plug or cut off the current by breaking circuit (MCB). Before cutting off the current, ensure that you
stand on a dry piece of wooden board. Do not use scissors or knife.
➢ When the current is of low voltage the First Aider should stand on an insulated material which is dry.
Insulating materials are rubber/soled shoes, wooden planks or piles of newspaper. Rubber gloves, if available
should be worn. If not, dry coat, cap or other clothing may be used.
➢ When the current is of a very high voltage, as in the cases of over-head (high tension) lines, there is
greater danger. The casualty may not be in actual contact with the wire as the current can pass through
the gap (causing an arc). The First Aider in such circumstances should keep as far away as possible from
the electric wires. The casualty is to be dragged out by means of a non/conducting material such as walking
stick, dry bamboo, wooden plank or dry rope is to be used.
➢ If the casualty is not breathing normally, or heart has artificial stopped beating, give respiration and External
Cardiac Compression for long time.
1. Treat for shock.
2. Treat for burns, if any.
3. Transfer to a hospital, or seek the help of a nearest medical practitioner.
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C. EFFECTS OF HEAT & COLD MANAGEMENT
DEHYDRA TION →
Dehydration occurs when someone loses fluid from the body and does not replace it. If untreated, someone
with dehydration can develop heat exhaustion.
Possible causes include:

1. excess sweating during exercise,
2. too much exposure to the sun or humid conditions,
3. sweating from a raised body temperature. For example, a fever,
4. loss of fluid from severe diarrhoea and vomiting.
Signs & Symptoms:

1. a headache or light-headedness,
2. dizziness or confusion,
3. a dry mouth and dry eyes,
4. dry or cracked lips,
5. reduced amounts of dark urine,
6. muscle cramps, such as to the calves.
Special attention should be paid to babies and young children as they may also have pale skin with sunken
eyes and can deteriorate very quickly.
Management:
1. Reassure the casualty and help them to sit down.
2. Give them plenty of water. You can also use an oral rehydration solution. These can help to replace
fluid as well as the correct salt and other minerals they’ve lost.
• Do not mix regular cooking salt into water and give it to the casualty, this will make the condition
worse.
3. If they have any painful cramps, encourage them to rest. Help them to stretch and massage the
muscles that are affected.
4. Monitor the casualty’s level of response.
• If the casualty appears to be unwell, seek medical advice.
HEAT EXHAUSTION→
Heat exhaustion usually happens to people who aren't used to hot, humid weather. Heat exhaustion is
caused by a loss of salt and water, usually through excessive sweating. It develops slowly and usually
happens to people who aren’t used to hot, humid weather.
Signs & Symptoms:

1. a headache, dizziness and confusion,
2. a loss of appetite and feeling sick,
3. sweat with pale, clammy skin,
4. cramps in the arms, legs and stomach ,
5. a fast, weakening pulse and breathing.
Management:
1. Help the casualty to a cool place, out of the sun and encourage them to lie down with their legs raised
and supported.
2. You then need to give them lots of water to drink.
• You could also give them an isotonic sports drink or oral rehydration solution, to help replace the
salt and fluid they have lost though sweating.
• Do not mix regular cooking salt into water and give it to them to drink, this will make their condition
worse.
3. Monitor their level of response. Even if they recover quickly, suggest they seek medical advice.
• If their condition seems to be getting worse, call for emergency help.
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HEAT RASH→
Heat rash is sometimes called prickly heat. Heat rash consists of small red spots or raised bumps that can
cause a stinging or prickling feeling on the skin, sometimes called prickly heat. It occurs when sweat glands
are blocked due to the casualty sweating more than normal. It can appear anywhere on the body, but usually
appears on the face, chest, back and thighs.
Signs & Symptoms:

1. a rash of tiny red spots, blisters or bumps,
2. a prickling or burning feeling on their skin,
3. itchy skin,
4. redness and mild swelling.
Management:
1. Tell them to drink lots of water to prevent them becoming dehydrated.
2. Take a cool bath or shower to cool the skin and prevent further sweating.
• Do not use perfumed shower gels or creams as this could irritate the skin.
3. Apply a cold ice pack wrapped in a tea towel for up to 10 minutes.
4. Wear lose clothing, preferably made of cotton, which will not trap the heat as much as synthetic
fibres.
5. Suggest they avoid excessive heat such as a fire, heater or sitting in the sun, to prevent aggravating
the rash.
6. Advise them to see a pharmacist or healthcare professional for further treatment if required.
• They may prescribe calamine lotion, an antihistamine or low strength hydrocortisone cream.
7. If they are concerned or unwell, seek medical advice.
HYPOTHERMIA IN ADULTS →
Hypothermia can become life-threatening quickly, so it’s important to treat someone with hypothermia
straight away. Hypothermia is a condition that occurs when someone’s body temperature drops below
35°C (95°F). Normal body temperature is around 37°C (98. 6°F). Hypothermia can become life-threatening
quickly, so it’s important to treat someone with hypothermia straight away.
Signs & Symptoms:

1. shivering, cold and pale with dry skin,
2. unusually tired, confused and have irrational behavior,
3. reduced level of response,
4. slow and shallow breathing,
5. slow and weakening pulse.
Management: Treating Hypothermia Outdoors

1. If the casualty is outside, try to get them indoors. If you are unable to get them indoors, try to take
them to a sheltered place as quickly as possible, shielding the casualty from the wind.
2. Remove and replace any wet clothing and make sure their head is covered.
• Do not give them your clothes - it is important for you to stay warm yourself.
3. Try to protect the casualty from the ground. Lay them on a thick layer of dry, insulating material such
as pine branches, heather, or bracken. If possible put them in a dry sleeping bag and/or cover them
with blankets. If available, wrap them in a foil survival blanket. You can use your body to shelter them
and keep them warm.
4. Call for emergency help.
• Do not leave the casualty alone. Somebody must be with them at all times. If you are in a remote
area and cannot call for emergency help, send two people to get help together.
5. If the casualty is fully alert, offer them warm drinks and high energy food such as chocolate.
6. Monitor their breathing, level of response and temperature while waiting for help to arrive.
Management: Treating Hypothermia Indoors

1. If you are indoors, cover the casualty with layers of blankets and warm the room to about 25°C (77°F).
• Do not place any direct heat such as hot water bottles or fires near a casualty as they may cause
burns.
2. Give them something warm to drink, like soup, and/or high-energy food, like chocolate.
• Do not give the casualty alcohol in an attempt to warm them, it will make hypothermia worse.
3. Seek medical advice. Hypothermia could be disguising a more serious illness such as a stroke, heart
attack or an underactive thyroid gland.
4. Monitor their breathing, level of response and temperature until they recover.
79
HYPOTHERMIA IN BABIES →
Signs & Symptoms:
1. be cold to touch,
2. be quiet and sleepy,
3. be limp,
4. refuse to feed.
Management:
1. If you suspect a baby has hypothermia, take them to a warm room and dress them in warm clothes.
2. Do not place any direct heat, such as hot water bottles, near a baby as they can cause burns.
• You can also wrap them in a blanket and hold them close to you to help to warm them up.
3. Call for emergency help. Keep trying to warm them until help arrives.
HEAT STROKE →
If someone has heatstroke, your priority is to cool the casualty down as quickly as possible and get them to
hospital. Heatstroke is caused by a failure of the ‘thermostat’ in the brain which regulates the body’s
temperature. This means the body is unable to cool down when it becomes too hot.
It could be caused by spending too much time in the sun, having a high fever, or from taking non-prescription
drugs such as Ecstasy. It can also occur after heat exhaustion when sweating ceases.
Your priority is to cool them down as quickly as possible and get them to hospital.
Signs & Symptoms:

1. headache, dizziness and discomfort ,
2. they may be restless and confused ,
3. hot, flushed and dry skin,
4. becoming less responsive quickly,
5. pulse that’s full and bounding,
6. body temperature above 40°C (104°F).
Management:
1. Quickly move the casualty to a cool place and remove as much of their outer clothing as you can. Call
for emergency help.
2. Help them to sit down in a comfortable, supported position. Wrap them in a cool, wet sheet and keep
pouring cold water over the sheet until their temperature falls to at least 37.5°C (measured under the
armpit).
3. If a sheet is not available, fan them or sponge them down with cold water.
4. Once their temperature has come down to normal, replace the wet sheet with a dry one.
5. While waiting for help to arrive, monitor their level of response and temperature.
• If their temperature starts to increase cool them down again using the same method.
• If they become unresponsive at any point, open their airway, check their breathing and prepare to
give CPR.
FROST BITE →
Frostbite can happen when exposed to freezing cold temperatures. Frostbite happens when part of the skin
and other tissues freeze due to low temperatures. It can lead to loss of sensation and eventually tis sue death
and gangrene. This usually happens when exposed to freezing cold temperatures and windy weather.
Signs & Symptoms:

1. ‘pins and needles’,
2. paleness of the area and numbness,
3. hardened and stiffened skin,
4. colour change to the skin. The skin may change from white to mottled and blue. On recovery, the skin
may be red, hot, painful and blistered. When gangrene occurs, the skin may become black due to the
loss of blood supply.
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Management:
1. Help move the casualty indoors or to somewhere warm.
2. Once inside, gently remove any constricting rings, gloves, boots or any other constricting items.
3. Next, warm the affected part with your hands, in your lap.
• Do not rub the area as this could damage their skin.
• Do not place the affected part of the body on to direct heat.
4. Place the affected part into warm but not hot water – around 40°C. Dry the area carefully and put on
a light dressing, ideally a gauze bandage from your first aid kit.
5. Once you’ve done that, help them to raise the affected part to reduce swelling. If the casualty is an
adult, you can suggest they take the recommended dose of paracetamol tablets. If the casualty is a
child, you can give them the recommended dose of paracetamol syrup.
• Do not give aspirin to anyone under the age of 16 or anyone who is known to be allergic.
6. Take or send them to hospital.
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UNIT 11
TRANSPORTATION OF INJURED PERSON
TRIAGE OF VICTIMS OF DISASTER →
It is important in the early stages of any accident to decide whether the casualty should be treated where
the accident occurred or whether he/she should be moved to hospital. It would be safer and easier to carry
out a complete examination and provide First aid. Anyhow, if advice of a doctor is required, victim must be
moved for medical help as early as possible.
RED YELLOW PRIME YELLOW GREEN BLACK
Transfer only after

Transfer immediately Transfer to a Transfer to an
evacuating all Red
to a referral Hospital referral Hospital appropriate Health
victims, with a Transfer to
Priority with a medical escort in in Ambulance Care Facility by
medical escort in an Morgue.
an equipped with First Aid available vehicles
equipped
Ambulance escort. without escort.
Ambulance
Urgent (IV, Line

Most urgent (fluids, Urgent (constant, Not Urgent
Urgency Drugs, immobilize Not Urgent
intubation, fascitomy) intensive care) (Splint/Dressing)
fractures)
No Pulse/
Shock/Hypoxia Deep shock, needs Stable for 1 hour, Stable till end of Respiration.
Condition
present/imminent available resources can wait at field response No BP/Heart
Beat.
Systematic
Injuries Life-threatening Catastrophic effects, not yet Localised Fatal
life threatening
Potential
High after immediate High after
for Very Poor Good None
care & transportation treatment
Survival
Massive Skull or Heart Attack,

Intra-Abdominal injury,
Chest injuries, Compound Minor fractures,
Examples Shock status from any Dead
Extensive and Fractures, Severe Burns, Wounds
cause
Severe Burns Burns
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2.0 TRANSPORTATION OF VICTIM → After appropriate First Aid has been given the following principles or
transport must be kept in mind.
1. The position assumed by the casualty or in which he has been placed, must not be disturbed unnecessarily.
2. Throughout the transport a careful watch must be kept on:

a) The general condition of the casualty,
b) Any dressing that may have been applied.
c) Any recurrence of haemorrhage.
d) The transport must be safe, steady and speed
REMOVALS & TRANSPORTATION →

An injured or sick person may be removed to shelter or hospital by:
1. Support of single helper.
2. Hand seats and the 'Kitchen-chair carry.
3. Blanket lift.
4. Stretcher.
5. Wheeled transport (ambulance).
6. Air and sea travel.
The method to be adopted and it may be necessary to use more than one, will depend upon:
1. The nature and severity of the injury.
2. The number of helpers and facilities available.
3. The distance to shelter/hospital.
4. The nature of route to be covered.
METHOD OF CARRYING →
IF ONLY ONE PERSON IS AVAILABLE:-
CRADLE – (To be used only in the case of light casualty or children) Lift
1. the other casualty by passing one of your arms well beneath his two knees
and the other round his back
HUMAN CRUTCH – Standing at his injured side except where there is injury
to an upper limb, assist the casualty by putting your arm round his waist,
grasping the clothing at him and placing his arm round your neck, holding
2. his hand with your free hand.
If his upper limbs are injured and his other hand is free, the casualty may
gain additional help from a staff or walking stick.
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3. PICK-A-BACK – If the casualty is conscious and able to hold, he may be
carried in the ordinary Pick-a-back fashion.
FIREMAN’S LIFT CARRY – (To be used only when the casualty is not
heavy for the bearer). Help the casualty to rise to upright position. Grasp
his right wrist with your left hand. Bend down with your head under his
extended right arm so that your right shoulder is level with the lower part of
his abdomen and place your right arm between or around his legs.
4.
Taking his weight on your right shoulder rise the position. Pull the casualty
across both shoulder and transfer his right wrist to your right hand, so
leaving your left hand free.
IF TWO OR MORE BEARERS ARE AVAILABLE:-
1. THE FOUR HANDED SEAT – This seat is used when the casualty can assist the bearer by using one or
both arms.
Two bearers face each other behind the casualty and grasp their left wrists with their right
STEP 1
hands and each other's right wrist their left hands.
The casualty is instructed to place one arm around the neck of each bearer so that he may
STEP 2
raise himself to sit on their hands and steady himself during transport.
The bearers rise together and step off, the bearer on the right hand side of the casualty with
STEP 3
the right foot and the left hand bearer with the left foot.
2. THE TWO HANDED SEAT – This seat is mostly used to carry a casualty who is unable to assist the bearers
by using his arms.
Two Volunteers face each other and stoop down - (not kneel) one on each side of the
STEP 1 casualty. Each bearer passes his forearm nearest the casualty's head under his back just
below the shoulders and if possible takes hold of his clothing.
They slightly raise the casualty's back and then pass their other forearms under the middle
of his thighs and grasp their hands the bearer on the left of the casualty with his palm
STEP 2
upwards and holding a folded handkerchief to prevent hurting by the finger nails; the bearer
on the right of the casualty with his palm downwards, as shown in (Hook Grip).
The bearers rise together and stop off, the right- hand bearer with the right foot and the
STEP 3
left-hand bearer with the left foot.
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1 2
3 4
3. THE FORE AND AFT METHOD – This method of carrying should

be used only when space does not permit a hand seat. One bearer
stands between the casualty's legs, facing the feet with hands
down and grasps the casualty under his knees. The other bearer
takes a position behind the casualty and after raising his trunk
passes his hands under the casualty’s armpits and grasps his own
wrists on the casualty’s chest. The casualty is then lifted. The
bearers walk in step.
4. THE KITCHEN CHAIR CARRY – The bearers walk in step by

carrying the patient in a chair. Use this method when the casualty
is light weight and the distance is small.
5. BLANKET LIFT → The placing of a casualty on to a blanket is

described earlier when lifting by a blanket the edges are role up
close to the casualty's sides and lifted by two persons on either
side.
85
STRETCHERS →
➢ Stretchers are of two patterns viz. "Ordinary" and "Telescopic-handled". In general Principle they are alike,
the component parts being designated the poles, handles, jointed traverses, runners, bed, pillow -sack and
slings. The 'head‘ and 'foot' of a stretcher correspond to the head and feet of the casualty.
➢ At the head of the stretcher there may be a canvas overlay (the pillow sack) which can be filled with straw,
hay, clothing etc. to form a pillow. The pillow sack opens at the head and its contents can therefore be
adjusted without due disturbance of the casualty. The traverses are provided with joints for opening or
closing the stretcher. The telescopic-handled pattern is similar but its length can be reduced to 6 feet by
sliding the handles underneath the poles. This is of a great value when working in confined space, or when
a casualty has to be taken up or down a narrow stair-case with sharp turns.
➢ When closed, the poles of the stretcher lie close together, the transverse bars being bent inwards, the canvas
bed neatly folded on top of the poles and held in position by the slings, which are laid along with canvas and
secured by strap which is placed transversely at the end of each sling and passed through the large loop of
the other, and round the poles and bed.
➢ Carrying a loaded Stretcher: Depending on the availability of manpower one can decide whether the
stretcher is to be carried by four or two persons.
➢ Lowering a loaded Stretcher:

1. "Lower Stretcher“ – the four bearers will stoop, gently lower the stretcher to the ground and rise
together.
2. Hand Carriage by Two Bearers – "Lift Stretcher" will take a side pace over the handles of the stretcher
and if they decide to use sling will pick them up, Place them over their shoulders and on the handles of
the stretcher. They will then rise steadily together keeping the stretcher level.
➢ To load into an Ambulance:
1. The stretcher is lowered with its head one pace from the door of the ambulance. The casualty will be
loaded head first.
2. While loading, take side pace to the ambulance raising the stretcher evenly to the level of the berth to
be loaded. The front bearers place the runners in the grooves and then assist the rear bearers to slide
the stretcher into its place and secure it. If sling have been used they should be kept with their stretcher.
SPINAL INJURY TRANSPORT →

➢ Injuries to the spine can involve one or more parts of the back and/or neck, the bones (vertebrae), the discs
of tissue that separate the vertebrae, the surrounding muscles and ligaments, or the spinal cord and the
nerves that branch off from it.
➢ The most serious risk associated with spinal injury is damage to the spinal cord. Such damage can cause
loss of power and/or sensation below the injured area. The spinal cord or nerve roots can suffer temporary
damage it they are pinched by displaced or dislocated discs or by fragments of broken bone. If the cord is
partly or completely severed, the damage may be permanent.
➢ The Spinal Cord is protected by the vertebrae (back bones). Injury to a vertebra or to an inter-vertebral disc
may damage nerve roots that emerge from the Spinal Cord or damage the cord itself.
CAUSES OF SPINAL INJURY:-

1. Falling from a motor bike or horse,
2. a heavy object falling across their back,
3. a collapsed rugby scrum,
4. falling awkwardly, for example, while doing gymnastics,
5. falling from a height, for example, from a ladder,
6. an injury to the head or face,
7. sudden deceleration in a vehicle,
8. diving into a shallow pool and hitting the bottom.
SIGNS & SYMPTOMS:-

1. Pain in the neck or back at the site of injury.
2. Irregular shape or twist in the normal curve of the spine.
3. Tenderness and/or bruising in the skin over the spine.
4. Movement of limbs may be weak or absent.
5. Loss of sensation, or abnormal sensations, e.g. burning or tingling.
86
6. Loss of bladder and/or bowel control.
7. Breathing difficulties.
→ NOTE 
When the vertebrae are damaged, there may be:
❖ Pain in the neck or back at the injury site; this may be masked by other, more painful injuries.
❖ Take step to avoid twisting of the normal curve of the spine.
❖ When the spinal cord is damaged, there may be:
▪ Loss of control over limbs; movement may be weak or absent.
▪ Loss of sensation, or abnormal sensations such as burning or tingling. The casualty may say that limbs
feel stiff, heavy, or clumsy.
▪ Loss of bladder and/or bowel control.
▪ Breathing difficulties.
ASSESSMENT OF CONDITION OF THE CASUALTY:- The Casualty could be either conscious or may be
unconscious. To assess gently tap the shoulder and observe by gently asking the question to see the
response, if casualty response indicates consciousness.
A. FOR A CONSCIOUS CASUALTY –

Aims of the First Aider –
➢ To prevent further injury.
If you suspect neck injury place rolled-up blankets, towels, or items of clothing on either side of the
casualty's head and neck, while you keep her head in the neutral position. Continue to support the
casualty's head and neck throughout until emergency medical services take over.
Management –
➢ Reassure the casualty and advise him/her not to move.
➢ Kneel behind the casualty's head. Grasp the sides of the casualty's head firmly, with your hands over
the ears. Do not completely cover her ears he/she should still be able to hear you. Steady and support
her head in the neutral head position, in which the head, neck, and spine are aligned. This is the least
harmful head position for a casualty with a suspected spinal injury.
➢ Continue to support the casualty's head in the neutral position until emergency medical services take
over, no matter how long this may be. Get help to monitor and record vital signs -level of response,
pulse, and breathing.
➢ Examining for any other injury on the body.
➢ lf casualty is moving limbs because of pain before preparing to transport the casualty suitably put
bandages on the legs so that it becomes easy to apply Log- Roll technique.
87
B. FOR A UNCONSCIOUS CASUALTY –
Aims of the First Aider –
➢ To maintain an open airway.
➢ To resuscitate the Casualty if necessary.
➢ To prevent further spinal damage.
Management –
➢ Kneel behind the casualty's head. Grasp the sides of her head firmly with your hands over the ears.
Steady and support her head in the neutral head position, in which the head, neck, and spine are
aligned.
➢ If necessary, open the casualty's airway using the jaw thrust method. Place your hands on each side of
her face with your fingertips at the angles of her jaw. Gently lift the jaw to open the airway. Take care
not to tilt the casualty's neck.
➢ Transport the casualty with spinal injury with special care to neck, head and spine from hard plank or
stretcher as stated above to the ambulance.
Transportation –
➢ Prepare the stretcher, the soft bed of the canvas type of stretcher must be stiffened, preferably by
placing short boards across the stretchers, or long ones lengthwise on the canvas if only these are
available. If no stretcher is available, a narrow shutter, door or board of at least the same width and
length as the patient may be used.
➢ Cover the stretcher with a folded blanket and then "blanket the stretcher“ by one of the methods.
➢ Place pillows or pads in readiness on the stretcher in a position to support the neck, and small part of
the back. Those should be sufficiently large, but not too large, to preserve the normal curves of the
spine.
➢ Whenever the casualty is to be moved or lifted he must not be bent, twisted or over extended. One
bearer must apply firm but gentle support to the head and face, so as to prevent neck movement and
another bearer must steady and support the lower limbs to prevent trunk movement. This must be
continued until the casualty has been placed on the stretcher.
➢ When the casualty is not already laying on a blanket or rug.
a) Place the blanket or rug on the ground in line with the casualty, and rolled lengthwise for half its
width.
b) While the two bearers maintain control of the head and lower limbs, other bearers very carefully
turn the casualty on to his side every precaution being taken against movement at the site of the
fracture. Place the roller portion of the blanket or rug close to the casualty's back and gently rolls
him over the roll until he is lying on his opposite side. Unroll the rolled portion of the blanket or
rug gently lowering the casualty on his back so that he lies on the centre of the open blanket or
rug. The bearers at the head and at the lower limbs conform to the rolling of the casualty
throughout.
➢ Loading the stretcher. There are two methods of loading a stretcher, a standard method (when there
is a blanket under the casualty) and an Emergency Method (When there is no blanket under the
casualty) in which case the stretcher can be pushed under the casualty it will be necessary for the
bearer at the feet to keep his legs wide apart to allow the stretcher to be placed between them.
• "Blanket lift" is the standard method for loading fractures of the spine when there is blanket
under the casualty.
• Roll the two edges of the blanket up against the casualty's side. If poles of sufficient length
and rigidity are available the edges of the blanket should be rolled around them. This will
make the lifting of the casualty very much easier.
• While two bearers maintain support of the head and lower limbs, the remaining bearers
distribute themselves as required on each side of the casualty facing one another. On the
word of command they raise him by grasping the rolled edges of the blanket and, acting
together, carefully and evenly lift him to a sufficient height to enable the stretcher to be
pushed underneath him. If this is for any reason impossible the stretcher should be brought
as near to the casualty as circumstances permit and the bearers should move short even side
88
paces until the casualty is directly over the stretcher, when he should be gently and cautiously
lowered onto it.
• Ensure that the pads are in the correct position.
b) Emergency method for loading fractures of the spine when there is no blanket under the Casualty
and none is available –
• Open out the casualty jacket and roll it firmly so that the rolls are close to each side.
• Place the casualty on the stretcher adopting the same procedure as described for the standard
Method except that the bearers grasp the rolled up jacket and/or the clothing and /or bandage
round the casualty's thighs instead of the rolled edges of the blanket. When the clothing is
insecure, a broad bandage must be placed round the body just below the shoulder for the
bearers to grasp.
➢ In the case of cervical injuries, place firm supports such as rolled-up blankets or sandbags on each side
of the head to steady it.
➢ Place a folded blanket in the hollow above the heels so as to relieve pressure on them.
➢ Wrap the casualty.
➢ If he is to be carried over rough ground, reduce his body movements to a minimum by binding him
firmly but not too tightly to the stretcher, with broad bandages. These should be applied round the
pelvis, thighs and calves, and round the body and arms, just above the elbows.
On reaching shelter, do nothing further until the arrival of medical aid. The above method of
transportation of spinal injury case is to be used only if hard board is not available.
RESCUE OF UNCONSCIOUS VICTIMS →

After giving emergency First Aid, the victim is to be placed on a large hard or inverted "charpoy'. Secure
him on the board and strap him.
The head of the victim is to be secured tightly.
If due to certain conditions it is not possible to rescue in horizontal position the vertical position is to be used
in case of removal from a "Cave" in accident or the First Aider must ensure his own safety as more mud or
earth or building material may give way. Immediately after the casualty is spotted out you must uncover his
face and chest and start artificial respiration if it is necessary.
If you have a portable oxygen apparatus with you, give oxygen at the spot and then place him on board
ensuring that he is properly strapped before lifting
8.0 LABELLING OF CASUALTIES→
X
Requires priority of removal from the incident and examination when reaching hospital. This
is used mainly, but not exclusively, for wounds of the chest and abdomen for internal
haemorrhage, and for all unconscious casualties
H Severe haemorrhage has occurred
S Sedative has been given.

The time of administration and dosage should be written on the label.
C Contaminated or suspected of having been contaminated
89
UNIT 12
AMBULANCE & EQUIPMENT
AMBULANCE →
An Ambulance is a vehicle for transportation of sick or injured persons to, from or between places of
treatment for an illness or injury and in some instances will also provide out of hospital medical care to the
patient.
The word is often associated with road going emergency ambulances which form part of an emergency
medical service, administering emergency care to those with acute medical problems.
The term Ambulance comes from the latin word ambulare meaning “to walk or move about which is a
reference to early medical care where patients were moved by lifting or wheeling”.
TYPES OF AMBULANCE →
Emergency Ambulance:- The most common type of Ambulance, which provide care to patients with an
acute illness or injury. These can be road-going vans, boats, helicopters, Air Ambulances.
Patient Transport Ambulance:- A Vehicle, which has the job of transporting patients to, from or between
places of medical treatment.
Response Unit:- Also known as a Fly-Car which is a vehicle which is used to reach an acutely ill patient
quickly, and provide On-scene Care.
Bariatric Ambulance:- A special type of patient transport Ambulance designed extremely for obese
patients equipped with the appropriate tools to move and manage these patients.
3.0 EQUIPMENT IN AMBULANCE →

1. Two-Way Radio: It allows for the issuing of jobs to the Ambulance and can allow the crew to pass
information back to control or to the Hospital.
2. Trauma Lights: In addition to the normal working lights, Ambulances can be fitted with special lighting.
3. Air Conditioning: Ambulances are often fitted with a separate Air Condition System to serve the working
area from that which serves the cab. This helps to maintain an appropriate temperature for any patients
being treated, but may also feature additional features such as filtering against airborne pathogens.
4. Data Recorders: These are often placed in Ambulances to record such information as Speed, Braking Power
& Time, Activation of Active emergence warnings such as lights & sirens, as well as seat belt usage.
5. Active Visual Warnings.
6. Audible Warnings.
4.0 SERVICE PROVIDERS →

1. Government Ambulance Service: Operating separately from the Fire & Police service of the area, these
Ambulances are funded by local or national Governments.
2. Volunteer Ambulance Service: Charities or Non-Profit Companies operate Ambulances, both in

emergency and patient transport function.
3. Private Ambulance Service: Normal commercial companies with paid employees, but often on contract
to the local or national government. Private companies may provide only the patient transport elements of
Ambulance care.
90
4. Charity Ambulance: This special type of Ambulance is provided by a Charity for the purpose of taking sick
children or adults to other hospital.
5. Cardiac Ambulance: It is a fully equipped Life Support Ambulance. They are equipped with international
quality instruments for international standards of service & care. It contains a Doctor, Trained Nurse, ECG,
Defibrillator, Suction Machine, Oxygen, Resuscitation Kit, Syringe Pump, Pace Maker, Cardiac Monitor,
Portable Ventilator, Pulse Oxymeter, Emergency Medicines, Nebuliser, Bipap, Spine Board.
108 EMERGENCY SERVICE →

How it works?
1. When an emergency is reported through 108, the Call taker gathers the needed basic information and
dispatches appropriate services.
2. Emergency help dispatched through this process is expected to reach the site of emergency in an average
of 18 minutes.
3. Pre-hospital care is given to the patients being transported to the nearest hospital. This is a free service.
4. 108 is management by the EMRI (Emergency Management and Research Institute) across more than
10 States in India.
91
UNIT 13
MISCELLANEOUS
(Drowning, Poisoning, Bites & Stings,
Convulsion & Epilepsy, Diabetes)
A. DROWNING
➢ This is another consequence of disaster especially during flooding. Drowning causes asphyxia by water weeds
and mud entering into the lungs. It may also cause the throat to go into spasm (constricting the air passage
dry drowning). Congestion of the lungs can occur very quickly but it may be several hours before it is
apparent.
➢ All casualties rescued from drowning should be sent to a hospital. If a casualty has been immersed
in cold water there is also a danger of hypothermia. It is important that the casualty is kept warm.
➢ Symptoms & Signs →

➢ Aims → Get air into the casualty's lungs as fast as possible, even in water. If necessary arrange removal to
hospital.
➢ Management →
1. Quickly remove any obstruction such as weed from the casualty's mouth and begin artificial respiration
immediately.
5. Keep him warm. If possible, remove wet clothing and dry him off. Cover with spare clothes and or
towels to keep the body warm.
:: NOTE ::
B. POISONING
➢ Some substances when taken in fairly large quantities can be dangerous to health or can cause death, such
substances are called POISONS. They may be taken with a view to committing suicide, or may be given to
persons by enemies deliberately, or taken by mistake.
➢ Poisons get into the body by swallowing, by breathing poisonous gases, and by injections.
➢ Recognizing and treating the effects of poisoning:
ENTRY
POISON SIDE EFFECTS ACTION
POINT
• Drugs and Alcohol Nausea and Vomiting, • Monitor Casualty.

• Cleaning products Abdominal Pain, Seizures, • Seek medical help.
Swallowed • Gardening products Irregular or fast or slow • Resuscitate if necessary
• Plants poisons heartbeat, impaired
• Food poisoning consciousness
92
ENTRY
POISON SIDE EFFECTS ACTION
POINT
• Remove contaminated
• Cleaning products clothing.
Absorbed
• Gardening products Pain, swelling, rash, • Wash area for at least 10
through the
• Industrial poisons redness, itching minutes.
Skin
• Plant poisons • Seek medical help.
• Resuscitate if necessary
• Fumes from cleaning

Difficulty in breathing, • Help Casualty into fresh air.
and DIY products
Inhaled Hypxia, Cyanosis (grey- • Seek medical help.
• Industrial poisons
blue skin coloration) • Resuscitate if necessary.
• Plant poisons
• Cleaning products
• DIY and Gardening • Irrigate the Eye.
Splashed in Pain and watering of the
products • Seek medical help.
the Eye eye, blurred vision.
• Industrial poisons • Resuscitate if necessary.
• Plant poisons
Pain, redness and • For Sting/Venom:

swelling at injection site, • Remove sting, if possible.
Injected • Venom from stings and blurred vision, nausea • Seek medical help.
through the bites. and vomiting, difficulty in • Resuscitate if necessary.
Skin • Drugs breathing, seizures, • For Injected Drugs:
impaired consciousness, • Seek medical help.
anaphylactic shock • Resuscitate if necessary.
➢ TYPES OF POISONING & MANAGEMENT:-

A. POISONING BY SWALLOWING→
Sometimes acids, alkalies, disinfectants etc; are swallowed by mistake. They burn the lips, tongues, throat,
food passages and stomach and cause great pain. Other swallowed poisons cause vomiting, pain and later
on diarrhoea. Poisonous fungi, berries, metallic poisons and stale food belonging to the latter group. Some
swallowed poisons affect the nervous system. To this group belong:
o Alcoholic drink (Methylated spirit, wine, whisky etc.) when taken in large quantities.
o Sleeping pills, tranquilizers, and pain killers taken in overdoses.
All these victims must be considered as seriously ill. The symptoms are either delirium or fits or coma.
B. POISONING BY SWALLOWING→
Fumes or gases from charcoal stoves, household gas, motor exhausts and smoke from explosions etc., cause
choking (asphyxia) which may result in unconsciousness in addition to difficulty in breathing.
C. POISONING BY INJECTION→
Poisons get into the body through injection, bites of poisonous snakes and rabid dogs, or stings by scorpions
and poisonous insects. Danger to life is again by choking and coma.
➢ FIRST AID IN POISONING→

• Poisoning is a serious matter. Patient must be removed to a hospital or a doctor be sent for at once with a
note of the findings and if possible the name of the poison.
• Preserve packets or bottles which you suspect contained the poison and also any vomits, sputum etc. for
the doctor to deal with.
• If Unconscious:-
1. Do not induce vomiting.
2. Make the casualty lie on his back on a hard, flat bed without any pillow and turn the head to one side.
As there is no pressure on the stomach and the gullet is horizontal, the vomited matter will not get
93
into the voice box and the tongue will not close the air passage. This is also the best posture for
giving artificial respiration, if needed.
3. Sometimes when there is excess of vomiting the three-quarter prone posture (i.e., the Casualty is
made to lie on his sides with one leg stretched, the other bent at knee and thigh) will make things
easier for the Casualty.
4. If breathing is very slow or stopped, start artificial respiration and keep it up till the doctor comes.
• If Conscious:-
1. Ask the person as to what has he/she consumed and quantity.
2. Ask person’s name and address.
3. When the poison is a corrosive, do not induce vomiting.
• The poison must be diluted by giving large, quantities of cold water iced, if possible. This will dilute the
irritant and delay absorption and will replace fluid lost by vomiting. Tender coconut water will be even better
as this will be a food and also a diuretic.
• Soothing drinks can be given. Like Milk, beaten egg mixed with water or any other soothing drinks are good
for the purpose.
SIGNS OF CORROSIVES
• Lips, mouth and skin show grey, white or yellow patches which are to be looked for, acids, alkalies etc.
cause such burns.
• Factories which use certain chemicals shall have the respective antidotes ready and displayed in an easily
available place. The personnel should be taught about the use of antidotes-so-that anyone can render
assistance in case of emergency.
NOTE
• For children between two and eight years of age one half or the quantity mentioned should be given.
• For infants less than two years one quarter of the quantity is sufficient.
➢ POISON – SOURCE – FIRST AID →
POISON SOURCE FIRST AID
Induce Vomiting
Arsenic Rat Poisons and Arsenic itself
Give Soothing Drinks
Charcoal Stove, Gas Stoves, Apply artificial respiration.

Carbon-Monoxide
Exhaust Gases of Cars Give oxygen
Induce Vomiting
Sleeping Tablets Chemists Give Mag. Sulph (2 Tea Spoons)
Give Hot Coffee. Keep him awake.
Put a few crystals of Potassium Permanganate in

Opium and Hospitals, Some Mixtures,
a tumbler of Water, give as a drink.
Morphia Opium Eaters
Give Hot Coffee. Keep him awake.
Induce vomiting
Petrol, Kerosene, Give a large quantity of water of tender coconut.
Houses, Garages, Industry
Oil, etc. Liquid paraffin if available is preferable to water in
cases of Kerosene oil poisoning.
Induce vomiting
Give a large quantity of water of tender coconut.
Phosphorus Rat Poison, Match Heads Note: Never give oils as they will dissolve
phosphorous and increase the effect of the
poison.
Used in photography and - It is an emergency act at once. Induce
Prussic Acid
electroplating and in oil of vomiting.
94
bitter almonds. Tender - Begin artificial respiration.
bamboo shoots.
Some vermin killers and also - Induce vomiting if there is no spasm. If

Strychnine
to kill stray dogs. breathing stops, give artificial respiration.
- Used for bug and - Induces vomiting.

Follidol cockroach. - Give water of tender coconut.
- Destruction - Start artificial respiration, if needed.
- Symptoms: Giddiness, blurred vision, chocking

Insecticides and in Chest (slow pulse, contracted pupils,
Agriculture
Weed killers sweating, blue lips, convulsions)
- Give artificial respiration till doctor comes.
- Must not be made to vomit

Hospitals, Laboratories, - Dilute the acid with large quantities of water of
Acids (Strong)
Garages, Industries tender coconut. Better add soda bicarb, chalk
or milk of magnesia to water.
Hospitals, Laboratories, - Must not induce vomiting.

Alkalis (Strong) Industries, Ammonia slaked - Give water of tender coconut in plenty. Better
Lime (Chunam) add orange or lime juice to it.
Disinfectants
- Do not induce vomiting.
Carbolic Acid,
Hospitals and Homes - Give four spoons of Mag. Sulp. in a litre of
Phenyle, Lysol,
water.
Dettol
C. BITES & STINGS →

1. SNAKE BITE:- There is more than 2,500 different kinds of snakes. Only about 200 of them are poisonous.
All snakebites are not fatal. Most people die not because of the venom, but from fear. However, all snake
bite cases are to be treated as if bitten by poisonous ones and should be referred to nearest health care
provider.
AIMS OF FIRST AID→

1. To reassure the person.
2. To stop spreading of the venom.
3. To obtain medical aid.
MANAGEMENT→
1. Lay the patient down, give him complete rest. Calm and reassure him, never make him walk or sleep.
2. Wash the wound with soap and water. Flush the wound with lot of water.
3. Cover the wound with a sterilized dressing.
4. Get medical aid or send the person on a stretcher to the hospital as quickly as possible. If the snake
has been killed, carry it to the hospital for identification. If breathing fails, commence artificial
respiration.
5. Be on the lookout for signs of poisoning such as drooping eyelids, bleeding gums, unusual bruises,
drowsiness, swelling, as well as difficulty in speaking.
2. DOG BITE:- Dog bites are sometimes very serious. They may cause infection the animal is suffering from
rabies it will be transmitted to the person. The condition is known as Hydrophobia.
AIMS OF FIRST AID→

1. To prevent rabies or other infections.
2. To get medical aid.
MANAGEMENT→
1. Wash the wound thoroughly with plenty of soap and water.
2. Cover the wound with a dry, sterile light dressing.
3. Get medical aid or send the patient to the hospital for proper treatment.
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The dog should not be killed. It must be chained if it is a pet animal and not risky to do so, and must be
kept under observation for ten days. Rabies is also caused by infected cats, monkey and jackals. If animal
cannot be observed or dies /runs away from observation, bitten person should be referred to nearest
health care provider. Immediate washing the bitten area with soap and water is useful.
In case of animals that are stray and cannot be observed, the treatment with vaccine becomes essential.
Animals suffering from rabies have short life, if the animal is kept under observation and survives; the
possibility of rabies is much less where testing facilities are not available.
3. STINGS OF MITES, TICKS AND LEECHES:- Mites, Ticks and Leeches are found in marshes and jungles.
They attach themselves firmly to the skin. Mites and Ticks may carry typhus and may transmit it to the
person. Leeches are normally harmless, but they suck blood from the victim.
MANAGEMENT→
1. Don’t try to remove the insects manually, their mouth part may remain in the skin and may cause
inflammation and infection.
2. Put the burning of a cigarette to the body of the ticks and leeches. They will fall off.
3. Application of common salt results in leech dropping off.
4. Mites are so small that they can’t easily be seen to be removed by hand.
5. Clean the area with mentholated spirit.
6. Apply weak ammonia or bicarbonate of soda or antihistamine ointment. This will relieve irritation.
4. STINGS OF BEES, WASPS, FLEAS AND HORNETS:- The stings of bees, wasps, etc., can cause a lot of
pain. The area may swell. Sometimes the person may suffer from shock.
MANAGEMENT→
1. A sting should be removed with forceps, or with the tip of a sterilized needle.
2. Apply weak ammonia or bicarbonate of soda or antihistamine ointment to the area. This will relieve the
pain.
D. CONVULSIONS →
There are convulsions that occur in children. The usual cause is high temperature caused by infective disease
or infection of lung, throat or ear.
SIGNS & SYMPTOMS→

1. Twitches of the limbs, head and body.
2. Paleness of the face (later blueness).
3. Upturned eyes.
4. Holding of breath with foaming at the mouth.
MANAGEMENT→
1. Follow the general steps laid down.
2. Remember to keep child warm.
3. Consult the doctor for treatment and further management.
E. EPILEPSY →
Epilepsy is a disease of the young. Usually in the beginning the attacks of convulsions are rare, but they
become more and more frequent later. The casualty hurts himself when he falls down.
Epilepsy May Be Minor or Major

(a) In minor Epilepsy, the casualty becomes pale, his eyes become fixed and staring and he becomes
unconscious for few seconds. He resumes his work soon as though nothing had happened. Watch the
casualty for development of a major attack, if any. Treat as for fainting.
(b) Major Epilepsy is a serious matter. The attack always follows headache, restlessness or a feeling of
dullness. The casualty is aware that immediately he is going to get an attack of an epileptic fit.
96
The fit itself has the following four phases:
1. Sudden loss of consciousness which makes him falls to the ground. He may cry or scream.
2. The body becomes rigid for a few seconds. The face is flushed.
3. The fits begin in full force; the casualty may injure himself by striking against hard or sharp objects.
There is frothing at the mouth and he may bite his tongue. He may pass urine and motion as these get
out of control.
4. The attack lasts for a few minutes, the convulsion stops. The casualty is dazed and confused. He may
act in a strange manner without knowing what he is doing. After some time, he becomes normal again.
MANAGEMENT→
1. Just keep the casualty under control, do not use force to stop the convulsions. Remove objects that
may cause injuries.
2. Prevent biting of tongue by inserting a spoon wrapped in a handkerchief near the back teeth, when the
jaws are relaxed.
3. Wipe froth from the mouth.
4. Follow the general rules for treating unconsciousness.
5. Watch for recurrence, if any. Leave the casualty after making sure he is aware of his surroundings.
Advise him to see a doctor.
Generally →
1. Sudden unconsciousness.
2. Rigidity and arching of the back.
3. Convulsive movements.
In Epilepsy, the following sequence is common→

1. The Casualty suddenly falls unconscious, often letting out a cry.
2. He becomes rigid, arching his back.
3. Breathing may cease. The lips may show a grey-blue tinge (Cyanosis) and the face and neck may
become red and puffy.
4. Convulsive movements begin. The jaw may be clenched and breathing may be noisy.
Saliva may appear at the mouth and may be blood-stained if the lips or tongue have been
bitten.
1. There may be loss of bladder or bowel control.
2. Muscles relax and breathing becomes normal; the casualty recovers consciousness, usually within a
few minutes. He may feel dazed, or act strangely. He may be unaware of his actions.
3. After a seizure, the casualty may feel tired and fall into a deep sleep.
F. DIABETES →
➢ Diabetes is a long-term medical condition where the body cannot produce enough insulin. Sometimes those
who have diabetes may have a diabetic emergency, where their blood sugar level becomes too high or too
low. Both conditions could be serious and may need treatment in hospital.
➢ Insulin is a chemical produced by the pancreas (that lies behind the stomach). It regulates the blood sugar
(glucose) levels in the body. When someone has diabetes, their body cannot keep the blood sugar level
within the normal range. Their level can be higher or lower than normal blood sugar.
➢ There are two types of diabetes:

- Type 1, known as insulin dependent diabetes
- Type 2, non-insulin dependent diabetes.
➢ Someone with diabetes may have items with them which could lead you to suspect that they have diabetes:
- they may be wearing a medical warning bracelet or necklace
- they may be carrying glucose gel or glucose tablets
- they could have medication, such as an insulin pen, a special pump or tablets and a glucose testing kit.
97
➢ HYPERGLYCEMIA:- This is where the blood sugar level is higher than normal. It may be caus ed by a
person with diabetes who has not had the correct dose of medication. They may have eaten too much sugary
or starchy food or, they may be unwell with an infection.
Signs & Symptoms –

• warm, dry skin
• rapid pulse and breathing
• fruity, sweet breath
• excessive thirst
• drowsiness, leading them to become unresponsive if not treated (also known as a diabetic coma)
• medical warning jewellery or medication.
Management –
1. If you suspect hyperglycaemia (high blood sugar), they need urgent treatment. Call 999 or 112
for emergency help and say that you suspect hyperglycaemia.
o They may be wearing a medical bracelet or medallion, or have a card on them which can alert
you to their condition.
2. While you wait for help to arrive, keep checking their breathing, pulse and whether they respond
to you.
o If they become unresponsive at any point, open their airway, check their breathing and
prepare to start CPR.
➢ HYPOGLYCEMIA:- This is where the blood sugar level is lower than normal. It can be caused by an
imbalance between the level of insulin and the level of glucose in the blood. Someone with diabetes may
recognise the onset of a hypoglycaemic episode.
Signs & Symptoms –

• weakness, faintness or hunger,
• confusion and irrational behaviour,
• sweating with cold, clammy skin,
• rapid pulse,
• palpitations,
• trembling or shaking,
• deteriorating level of response,
• medical warning jewellery or medication.
Management –
1. If you suspect hypoglycaemia (low blood sugar), help the person to sit down. If they have their
own glucose gel or glucose tablets, help them take it. If not, you need to give them something
sugary, such as an 150ml glass of fruit juice or non-diet fizzy drink; three teaspoons of sugar or
sugar lumps; or three sweets such as jelly babies.
2. If they improve quickly, give them more of the sugary food or drink and let them rest. If they have
their blood glucose testing kit with them, help them use it to check their blood sugar level. Stay
with them until they feel completely better.
3. If they do not improve quickly, look for any other reason why they could be unwell and call for
emergency help.
4. Keep monitoring their breathing and level of response while waiting for help to arrive
o If they are not fully alert, don’t try to give them something to eat or drink as they may choke.
o If they become unresponsive at any point, open their airway, check their breathing and
prepare to give CPR.
98
UNIT 14
FIRST AID IN LEGISLATION
A. THE MINES ACT, 1952
Sl. No. SECTION STIPULA TION

In every mine there shall be provided and maintained so as to be readily
1. Section 21(1) accessible during all working hours such number of first-aid boxes or
cupboards equipped with such contents as may be prescribed
Nothing except the prescribed contents shall be kept in a first-aid box or
2. Section 21(2)
cupboard or room.
Every first-aid box or cupboard shall be kept in the charge of a responsible
3. Section 21(3) person who is trained in such first-aid treatment as may be prescribed and
who shall always be readily available during the working hours of the mines.
In every mine there shall be made to as to be readily available such
arrangements as may be prescribed for the conveyance to hospitals or
4. Section 21(4)
dispensaries of persons who, while employed in the mine suffer bodily injury
or become ill.
In every mine wherein more than 150 persons are employed there shall be
5. Section 21(5) provided and maintained a first-aid room of such size with such equipment
and in the charge of such medical and nursing staff as may be prescribed.
The Central Government may, by notification in the Official Gazette, make
rule consistent with this Act for providing for the supply and maintenance
of medical appliances and comforts and for prescribing the contents and
6. Section 58(ff) number of first-aid boxes and cupboards, the training in first-aid work, the
size and equipment of first-aid rooms and staff in charge thereof and the
arrangements for conveyance of injured persons to hospitals or
dispensaries;
B. THE COAL MINES REGULATIONS, 2017
Sl. No. REGULA TION STIPULA TION

Duties of the Safety Officer: It shall be the duty of the Safety Officer
to provide assistance in the formulation of programme for training at the
1. Regulation 44(i)
mine level, including vocational training, training in gas testing, and
training in first aid, etc.;
Whitewashing: The roof and sides of every first aid station
2. Regulation 174(e)
belowground shall be kept effectively whitewashed.
Regulation General Lighting: Adequate general lighting arrangements shall be
3.
175(1)(b)(viii) provided during working hours at every first aid station belowground.
Use and supply of Helmet: No person shall go into, or work, or be
allowed to go into, or work in a mine, other than the precincts of a mine
occupied by an office building, canteen, crèche, rest shelter, first aid
4. Regulation 241(1)
room or any other building of a similar type, unless he wears a helmet
of such type as may be approved by the Chief Inspector by a general or
special order in writing.
Emergency Response and Evacuation Plan: The Owner, Agent and
Manager of every mine shall have a comprehensive programme in place
to respond to an injury, illness or emergency that may occur at each
mine including foreseeable industrial and natural disasters which shall
5. Regulation 252(1)
include immediate first-aid treatment, medical treatment, transportation
and evacuation of injured persons procedures to respond to
emergencies that arise at the mine and make arrangements for the
rescue of persons incapacitated or trapped in coal mines.
99
Conventions for preparing Plans and Sections - Symbol of Underground First Aid Station
in a Plan as required under the Coal Mines Regulations, 2017
C. THE METALLIFEROUS MINES REGULATIONS, 1961
Sl. No. REGULA TION STIPULA TION

Duties of persons employed in mines: Every person receiving an
injury in the course of his duty shall, as soon as possible report the same
1. Regulation 41(6)
to an official who shall arrange for the necessary first-aid to the injured
person.
Lighting and Safety Lamps: Adequate general lighting arrangements
Regulation
2. shall be provided during working hours at every first aid station
175(1)(b)(vii)
belowground.
Use and supply of Helmet: No person shall go into, or work, or be
allowed to go into, or work in a mine, other than the precincts of a mine
Regulation occupied by an office building, canteen, crèche, rest shelter, first aid
3.
182(A)(1) room or any other building of a similar type, unless he wears a helmet
of such type as may be approved by the Chief Inspector by a general or
special order in writing.
D. THE MINES RULES, 1955

Chapter VI of the Mines Rules, 1955 termed “First Aid and Medical Appliances” deals with the First Aid
Qualifications, Persons, etc., which are portrayed below:
Sl. No. RULE STIPULA TION

It shall be the duty of the owner, agent or manager of a mine to see that
1. Rule 40(1) adequate and suitable arrangements are made for the training of persons in
first-aid and the provision of such equipment as is prescribed in these rules.
It shall be the duty of the owner, agent or manager to see that adequate and
suitable arrangements are made for the speedy removal from the mine to a
2. Rule 40(2)(a)
dispensary or hospital, of persons employed in the mine who while on duty
suffers from serious bodily injury or illness of a serious nature.
Unless otherwise approved by an order in writing of the Chief Inspector or
an Inspector and subject to such conditions as may be specified therein, the
arrangements for the purpose of clause(a) shall be by means of a proper
3. Rule 40(2)(b)
ambulance van, and in case such ambulance van is not readily available in
spite of proper and timely requisition, it may be by other suitable motor
vehicle in which the person can be taken in a supine condition on a stretcher.)
First Aid Qualifications: No person other than qualified nurse, dresser,
compounder-cum-dresser or medical practitioner shall be appointed to
4. Rule 41 render first-aid, or to be in charge of a first-aid station referred to in rule
44,unless he is the holder of a valid first-aid certificate of the standard of St.
John’s Ambulance Association (India).
The owner, agent or manager of a mine shall see that every first-aid station
provided under rule 44 is placed, during every working shift, in charge of a
5. Rule 42(1)
person holding qualifications specified in rule 41. The persons in charge of a
first aid station in any shift should be readily available throughout the shift.
The name and designation of every person appointed to be in charge of a
6. Rule 42(2)
first -aid station shall be prominently, displayed at every first-aid station.
An up-to-date list of persons appointed to be in charge of first-aid stations in
7. Rule 42(3) the mine shall be kept in the office of the mine and also displayed prominently
at the first-aid room.
100
At every mine employing more than 150 persons on any one day of the
8. Rule 43(1) preceding calendar year, there shall be provided and maintained in good
order a suitable first-aid room.
The first-aid room shall be situated at a convenient place on the surface of
9. Rule 43(2)
the mine and shall be used only for first-aid work.
The first-aid room shall have a floor space of not less than 10 square metres
10. Rule 43(3)
and shall contain at least the equipment specified in the Second Schedule.
The first-aid room shall be in charge of a qualified medical practitioner, where
11. Rule 43(4)(a) the number of persons ordinarily employed in a mine is more than 1000, such
medical practitioner shall be a whole time employee at the mine.
The medical practitioner referred to in clause (a) shall be assisted by a nurse
and a dresser or a compounder and a dresser who are qualified in the
Allopathic system of medicine. Whenever the Chief Inspector feels it
12. Rule 43(4)(b)
necessary, he may require by an order in writing that such number of
additional nurse or compounders or dressers shall be appointed to assist the
medical practitioner as may be specified by him.
The nurse, compounder or dresser referred to in clause (b) shall be whole
time employee of the mine and shall be readily available at the first-aid room
throughout the period when persons work at the mine :
Provided that wherein conformity with any other law in force, or otherwise
13. Rule 43(4)(c)
an adequately equipped hospital or dispensary belonging to the owner of the
mine or to any Mines Welfare Organisation is provided and maintained at or
in the immediate vicinity of the mine, the Chief Inspector or an Inspector
authorized by him in this behalf may grant exemption from the provision of
this sub-rule subject to such conditions as he may specify in writing.
Every person who suffers an injury during the course of work shall report for
examination or treatment at the first aid room, hospital or dispensary, as the
14. Rule 43(5)
case may be, before leaving the mine, irrespective of first-aid having been
rendered at or near the place of work.
At every mine there shall be provided and maintained first-aid equipment as
prescribed in the Third Schedule, at conveniently accessible stations where
injured persons may receive first-aid treatment, as follows:
(a) above ground, a first- aid station –
(i) at the top of every shaft or incline where men or material are
normally wound or hauled;
(ii) in every workshop;
(iii) at every screening plant and loading place; and
(iv) at every other place where more than 50 persons are employed at
any one time.
15. Rule 44(1)
(b) In every opencast working, one first-aid station for every 50 persons or
part thereof, employed at any one time; and
(c) below ground, one first-aid station -
(i) at the bottom of every shaft where men or material are normally
wound, and at or near every plant;
(ii) near the drive end of every haulage;
(iii) in or at the entrance to every district or section of the mine;
Provided that nothing in this sub-rule shall be construed to require the

provision of a first aid station within 300 metres of another first-aid station.
Not with standing anything contained in rule 42, every Overman, Foreman,
Sirdar, Mate, Shot-firer, Blaster, Electrician and Mechanic in a mine shall hold
the first aid qualifications specified in rule 41 and shall carry, while on duty,
16. Rule 45
a first-aid outfit consisting of one large sterilised dressing, one small sterilised
dressing and an ampoule of tincture of iodine or other suitable antiseptic,
and such outfit shall be securely packed to protect it against dirt and water.
Every person receiving an injury in the course of his duty shall, as soon as
possible, report the same to an official. Where the person receiving an injury
17. Rule 45A(1) is not in a position to report the same to an official, it shall be the duty of the
person who first comes to know of it to report the same to an official. The
official shall make such arrangements for rendering first aid to the injured as
101
may be required. If in the opinion of the official the injury is of such a nature
as to require immediate attention by the medical practitioner he shall arrange
for the medical practitioner to be called.
If an official who is required to carry a first-aid outfit under Rule 45 receives
18. Rule 45A(2) information about injury to a work person, he shall himself attend to the
injured person.
It shall be the duty of the person in charge of the nearest first-aid station
19. Rule 45A(3) provided under Rule 44 to render such first-aid to the injured person as may
be necessary.
E. THE FACTORIES ACT, 1948
Sl. No. RULE STIPULA TION

First Aid Appliances: There shall in every factory be provided and maintained
so as to be readily accessible during all working hours first-aid boxes or cupboards
1. Rule 45(1) equipped with the prescribed contents, and the number of such boxes or
cupboards to be provided and maintained shall not be less than one for every one
hundred and fifty workers ordinarily employed at any one time in the factory.
First Aid Appliances: There shall in every factory be provided and maintained
so as to be readily accessible during all working hours first-aid boxes or cupboards
2. Rule 45(2) equipped with the prescribed contents, and the number of such boxes or
cupboards to be provided and maintained shall not be less than one for every one
hundred and fifty workers ordinarily employed at any one time in the factory.
Each first-aid box or cupboard shall be kept in the charge of a separate responsible
person, who holds a certificate in first-aid treatment recognized by the State
3. Rule 45(3)
Government and who shall always be readily available during the working hours
of the factory.
In every factory wherein more than five hundred workers are ordinarily employed
there shall be provided and maintained an ambulance room of the prescribed size,
4. Rule 45(4) containing the prescribed equipment and in the charge of such medical and
nursing staff as may be prescribed and those facilities shall always be made readily
available during the working hours of the factory.
F. THE OCCUPATIONAL SAFETY, HEALTH & WORK CONDITIONS CODE, 2020
Sl. No. SECTION STIPULA TION

The employer shall be responsible to provide and maintain in his
establishment such welfare facilities for the employees as may be
1. Section 24(1)(viii) prescribed by the Central Government, including, adequate first-aid
boxes or cupboards with contents readily accessible during all working
hours;
The Central Government may, by notification, make regulations
consistent with this Code requiring protective works to be constructed
by the owner, agent or manager of a mine before the mine is closed,
and in the event of non-compliance, for getting such works executed
2. Section 136(zzi)(ii) by any other agency and for recovering the expenses thereof from
such owner in the same manner as an arrear of land revenue;
providing for the ambulance rooms, first aid and rescue facilities and
arrangements for the removal of dock workers to the nearest place of
treatment;
102
CONTENTS OF A FIRST AID BOX
FIRST AID BOX – SMALL
Sl. No. ITEM QUANTITY

1. Silver Sulfadiazine Ointment 01 Tube
2. Band Aid 10 Strips
3. Roller Bandage (5cm x 5m) 01
4. Sterilized Cotton Wool (Absorbent) 01 Packet
5. Scissors 7cm (Sharp/Blunt) 01
6. Sterilized Dressings (Assorted Sizes) 02
7. Paracetamol Tablets 01 Strip
8. Mouth-to-Mouth Resuscitator (Plastic) 01
9. Triangular Bandage 01
10. Safety Pins 10
FIRST AID BOX – MEDIUM

DRESSING MATERIAL
1. Sterilized Finger Dressing 10
2. Sterilized Foot and Hand Dressings 10
3. Sterilized Dressing – Large 10
4. Sterilized Dressing – Extra Large 01
5. Sterilized Field Dressing – Army Pattern 02
6. Sterilized Shell Dressing 02
7. Sterilized Burn Dressing – Small 04
8. Sterilized Burn Dressing – Large 02
9. Adhesive Dressing Strips 50
10. Roller Bandage – 5cm x 5m 04
11. Roller Bandage – 7.5cm x 5m 02
12. Triangular Bandage – 90cm Broader Size 06
13. Gauze – 7.5m x 75cm Compressed 01
14. Sterilized Cotton – Absorbent 04
15. Sterilized Eye Pads 06
16. Adhesive Plaster – 2.5cm x 5m 01
17. Silver Sulphadizine Skin Ointment 01
18. Savlon/Dettol 01
19. Paracetamol Tablet 50
20. Chloromycetin Eye Applicaps 50
EQUIPMENT
21. Surgical Scissors – 12.5cm Sharp/Blunt 01 Pair
23. Split – Inflatable (3 Arms/3 Leg) – Set of 6 01 Set
MISCELLA NEOUS
24. Torch 01
25. Safety Pins 01
26. Scribbling Pad 01
27. Record Card in Plastic Cover 01
28. First Aid Leaflet Form 01
103
FIRST AID BOX – LARGE

DRESSING MATERIAL
1. Sterilized Finger Dressing 18
2. Sterilized Foot and Hand Dressings 24
3. Sterilized Dressing – Large 20
4. Sterilized Dressing – Extra Large 02
5. Sterilized Field Dressing – Army Pattern 04
6. Sterilized Shell Dressing 02
7. Sterilized Burn Dressing – Small 06
8. Sterilized Burn Dressing – Large 04
9. Adhesive Dressing Strips 100
10. Roller Bandage – 5cm x 5m 06
11. Roller Bandage – 7.5cm x 5m 06
12. Triangular Bandage – 90cm Broader Size 12
13. Gauze – 7.5m x 75cm Compressed 01
14. Sterilized Cotton – Absorbent 08
15. Sterilized Eye Pads 06
16. Adhesive Plaster – 2.5cm x 5m 02 Spools
17. Silver Sulphadizine Skin Ointment 01
18. Savlon/Dettol 01
19. Paracetamol Tablet 50
20. Chloromycetin Eye Applicaps 50
EQUIPMENT
21. Surgical Scissors – 12.5cm Sharp/Blunt 01 Pair
23. Split – Inflatable (3 Arms/3 Leg) – Set of 6 01 Set
MISCELLA NEOUS
24. Torch 01
25. Safety Pins 01
26. Scribbling Pad 01
27. Record Card in Plastic Cover 01
28. First Aid Leaflet Form 01
29. Ambu Bag 01
104
Ashritha Mines & Minerals Association
First Aid Training Institute
3rd Floor, Divyaansh Hospital, Dubai Building Opposite Line, Dammaiguda,
Keesara Mandal, Medchal-Malkajigiri District, Telangana State
Contact No.: 9948339202; Email Id: dftc.hyd@gmail.com
First Edition - 2022

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MINING MINE PREVIOUS

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UNIT NAME PAGE

Unit-1 Introduction to the First Aid 02-14

Unit-2 Dressing & Bandages 15-21

Unit-3 Introduction to Basic Anatomy 22-32

Unit-4 Fractures 33-41

Unit-5 Shock & Sprains 42-47

Unit-6 Wounds & Bleeding 48-55

Unit-7 Cardiovascular System 56-59

Unit-8 Respiratory System 60-67

Unit-9 Head & Spinal Injuries 68-71

Unit-10 Burn, Electrocution, Effects of Heat & Cold Management 72-81

Unit-11 Transportation of Injured Person 82-89

Unit-12 Ambulance & Equipment 90-91

Contents of First Aid Box 103-104

2.0 AIMS OF FIRST AID:

GOLDEN RULES OF FIRST AID:

5.0 INSTRUCTIONS TO THE FIRST AIDER:

RESPONSIBILITIES OF THE FIRST AIDER:

7.0 A-B-C RULE:

A – An Open Breathing Airway

Opening the Airway Checking the Breathing Clearing the Airway

1. Opening the Airway:

2. Checking the Breathing:

3. Clearing the Airway:

Ashritha Mines & Minerals First Aid Training Institute

ASSESSING THE CONDITION:

Assessing the Symptoms – These are what a Victim can convey –

Assessing the Signs – Signs are to be observed by the First-Aider –

PROCEDURE AFTER FIRST AID:

RULES OF FIRST AID:

(a) Is there failure of breathing?

11.0 D-R-S-A-B-C-D TECHNIQUE:

D DANGER Check for Danger. Ensure safety.

R RESPONSE Check for Response. Ask name, squeeze shoulders.

S SEND Send for help. Call an Ambulance or ask a bystander to call.

A AIRWAY Open Mouth-look for foreign material. Maintain Airway.

B BREATHING Check for Breathing. Look-Listen-Feel

C CPR Start CPR – 30 Compressions, 2 Breaths. Perform Chest Compressions only

ESM has four steps:

The Human Body Frame:-

The Skull is made of the following bones:

➢ In between each pair of vertebra there is a thick piece

• THE RIBS & BREAST BONE (STERNUM) –

➢ Last two pairs of ribs i.e. eleventh and twelfth

➢ The ribs and breast bone are liable to be fractured in

• THE UPPER LIMBS & SHOULDER –

• THE PELVIS & LOWER LIMBS –

➢ Femur, the thigh bone is the longest and strongest bone in

➢ The average adult has a Pulse Rate of 72 per minute.

Before assessing the patient, it is vital to check that the area

ASSESSMENT OF THE AREA –