First Aid Level 1

Aligned with
SAQA: US119567

Presenter: Johan Ackerman

Auditor OHSAS 18001:2007
0832615576

HWSETA: HW591AR1101814
 INDEX

Module 1 Introduction

Module 2 Artificial Respiration

Module 3 CPR

Module 4 Choking

Module 5 Shock

Module 6 Unconsciousness

Module 7 Wounds

Module 8 Burns

Module 9 Electrical Injuries

Module 10 Bandages & Splints

Module 11 Head and Spinal injuries

Module 12 Injuries to Muscles and Limbs

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Own summary: All emergency first aid is conducted in the sequence as follow:

H: ..............................................................................................................................

H: .............................................................................................................................

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H: ................................................................................................................................

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A: ................................................................................................................................

B: ................................................................................................................................

C: .................................................................................................................................

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 MODULE 1

INTRODUCTION

LEARNING OBJECTIVES

After you have completed this module you should be able to:

Understand the principals of first aid

Take charge of an emergency situation
To activate the possible sources of help
Know the legal aspects regarding rendering of first aid
Perform a primary and secondary survey on a casualty
Know the various vital signs

Approach to an emergency situation

H: Hazards; Safety of yourself always comes first, Identify the hazards that
caused the accident or that may possess a risk for further injury.
H: Hello; (Take control of the situation), stating your name and qualifications
and request consent that you may assist the person.
H: Get assistance – send a bystander to call the emergency services.
A: Airway – ensure the airway is open if not, use the forehead and chin tilt, or jaw thrust
method to open the airway.
B: Breathing - When the airway is open, listen to ensure that the person is
breathing, while listening, look if the chest is rising.
C: If the patient is breathing, check the circulation by exercising the thumb
press and release and feeling the pulse, to ensure his heart is beating

Make area safe from hazards

* Identify amount of casualties, and their location

* Asses injuries.
* Identify life threatening injuries, e.g. no breathing, no pulse or severe bleeding.
* Get Assistant to phone for an Ambulance
* Treat life threatening injuries.
* Assist in transportation of casualties
* Keep detail records

Definition First Aid

This is the emergency care given to an injured or suddenly ill person, using readily available
materials. This may be given while awaiting the transportation of the casualty or while medical
aid is underway.

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The aim of the first aid is to:

a. PRESERVE life - Ventilate, CPR, stop bleeding, manage airways, etc.

b. PROMOTE healing - work as sterile as possible when attending to

wounds.

c. PREVENT injury or illness from becoming worse.

Get Assistance

 To phone for an Ambulance.

 Traffic Department - to regulate and direct the traffic, .to take down
details, etc.
 Other medically qualified persons. Can assist with the patient treatment, etc.
 Bystanders- they can organise the traffic, they can call the Ambulance, the can help
hold the casualty, etc.
 Fire Department - in case someone is trapped in a car, if there is a fire risk, etc. In case
there chemical spillages, etc
 Police / Security - making the scene safe - there might a crowd of people, etc.

Legal matters

Let us look at the LEGAL ASPECTS which a First Aider may face when offering Assistance to
someone ill or injured:

This all is based upon the "GOOD SAMARITAN ACT” Under normal circumstances a First
Aider is covered, except if he exceeds his qualifications or acts without consent.

Definition
CONSENT

Means: permission to actually treat someone. There are different forms of consent which we
will briefly discuss in this paragraph.

Consent regarding a minor

Permission to treat is required from parents or guardian of the child under 18 years of
age. This may be overruled in an emergency situation where the child's life depends on
immediate action.

Implied consent

(Consent in an emergency) Casualty is who unable to give consent due to e.g. a head
injury, or who is unconscious, would have given consent if he was able to understand the
situation.

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Consent of the mentally ill

(As with Consent for a minor) In a case of life and death, the First Aider can act without
actual consent.

Actual Consent

This is the permission for treatment given by the casualty himself.

Patient assessment

The procedures of patient assessment may bring you in contact with the patient's blood
or body fluids.

YOUR SAFETY FIRST: WEAR PROTECTIVE LATEX OR RUBBER GLOVES

Patient assessment is a systematic procedure, but it is not always done in the same
step-by-step order. Successful pre-hospital emergency care is quite dependent upon the
evaluation of the vital signs and overall injury. Interpreting vital signs correctly is basic
to distinguishing between life-threatening and non-life threatening conditions. Changes
in vital signs reflect not only alterations in the patient's condition with time, but also the
effectiveness of injury or illness management.

Assessment

1. Primary assessment - quick check to determine life threatening conditions,

such as no breathing, no heartbeat and severe bleeding, unconsciousness.

2. Secondary assessment - done when all life threatening injuries have been
treated and the casualty has been stabilised

Important
Be observant as you approach the patient. Early observations can be critical factors in
how soon you can initiate care. Bear in mind that for every obvious injury, there may be
a number of hidden ones. Knowing what an accident can do, and being able to
recognise the mechanisms of injury is important.

THE PATIENT ASSESSMENT

The Conscious Injured

1. Check safety.
2. Position yourself close to the patient and make eye contact.
3. Introduce yourself, state that you are trained in first aid and ask for his/her name
and primary complaint.
4. Get consent to render assistance.

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5. Calmly reassure the patient with a gentle touch on his shoulder or hand.
6. Begin the patient survey.

Primary assessment

When the patient is breathing and has circulation, Check the patient’s vital signs every 2-
3 minutes.

Airway Check for obstructed airway

Breathing Is the patient breathing

Circulation Pulse, bleeding, shock

The primary survey is always the first step in patient assessment. It takes precedence
over all other aspects of history taking and physical examination. In many instances,
the primary survey will be completed at a glance. However, when the patient is
unconscious or has a major injury, close examination will be required.
If, while doing the primary survey, an obstructed airway, cardiac arrest or serve
bleeding is found, you will have to attend to the problem ASAP.

Secondary assessment (Head to toe examination)

This includes the following:

Pulse

Feel for the carotid (neck) or radial (wrist) pulses and determine the strength, rate & rhythm.
Record beats over 30 seconds and times by two, and that will fix’s you rate per minute.

Respiration

Determine rate, character, depth and sound record breaths for 30 seconds and times by
two, that will give you rate per minute

Skin

The skin is responsible for maintaining normal body temperature. Normal temperature is
37 C.
Skin condition can be hot, cool, moist, clammy or dry.
Skin colour: Can be white, pale, ashen grey, red, flushed or blue.

Eyes

Size of pupils, and reaction to light

Ears, Nose and Mouth

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Note any fluid leakage

Neck and Spine

Look for obstruction or bleeding Spine: Feel for deformity and bleeding

Chest

Press on the rib cage and chest wall ask the casualty if he feels pain

Abdominal and pelvic area

Check for rigidity and bleeding by observing if blood could be noticed

Medic - alert Device

This is in the form of a bracelet or a necklace. It contains life saying Info on the patient's
allergies and/or illnesses

Legs

Press in the legs feel for fractures asking the casualty if he could feel pain

Level of consciousness

 Speak to the casualty - determine his LEVEL OF CONSCIOUSNESS

 Are his eyes open, or does he opens them to sound?
 Does he answer back?
 Do his words make sense?
 Can he remember what happened?
 Can he give personal details, date and time?
 Does he move upon touch or pain?
 Place the unconscious casualty on the survival position - demonstrated later (on his
side) and remember to take care with his neck and spine!

History

To complete the picture, you need the details of what happened prior to your arrival. This
can be found out while treating the casualty
etc.

Signs

Things that you can see yourself, bleeding, etc

Symptoms

Things that the casualty MUST tell you, e.g. nausea, headache, pain,
.
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 Things to remember

* Your safety always comes FIRST

* Arrange for an ambulance ASAP.
* Never leave the casualty alone!
* Monitor vital signs between 2-10min intervals
* Stay with your casualty until the ambulance or assistance arrives
* Hand over the casualty to the emergency personnel.
* Keep records for yourself for each person treated.

MODULE 2

Artificial Respiration

At the end of this module, the student will be able to:

 Recognise breathing emergencies

 Apply the method of artificial respiration
 Apply the survival position

Causes of Breathing Emergencies

 Obstruction of the airway either by medical conditions or injury.

 Lack of oxygen in the air inhaled
 The Heart - lung action is interrupted

Direct Method of Artificial Respiration

This is the most effective first aid means to ventilate someone who is not
breathing

* Identify any hazard why the “potential patient is lying on the floor.
 Shake and shout: Hello, hello my name is …….. may I help you (Shake the shoulder
Lightly).
* Call for help : Attract someone's attention to assist you to call the emergency services
* If no response, open airway, (remember neck and possible spinal injuries).
* Look, listen and feel for breathing, (practical demo)
* Check carotid pulse; or brachial pulse for babies
* If no breathing and pulse, get someone to phone for an Ambulance - Tel.
* If pulse but no breathing, then Ventilate twice - make sure the chest rises with each
breath
* Continue, one ventilation every 5th second to ensure 12 ventilations per minute
* Continue until casualty starts to breathe by himself, or assistance arrives to take over.
 Check circulation after every 2 to 3 blows.

Practical Demonstration

 Establishing breathlessness
 Establishing presence or absence of pulse
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 Apply a cervical collar if necessary
 Mouth to mouth artificial ventilation
 Opening the airway: Jaw thrust and head tilt/ chin lift.
 Cardio Pulmonary Resuscitation
 Place into the Recovery Position
 Monitor vital signs waiting for the emergency services

Establishing Breathlessness:

Look: Look at chest for movement

Listen: With your ear near the casualty's mouth and nose

Feel: With your cheek, at the victim's mouth, you will fee! the breath when the casualty
exhales.

Establishing presence or absence of pulse

Determine if there is circulation by feeling for a pulse in the patient's neck. Place the
tips of your index and middle fingers directly over the midline of the "Adam's apple" and
slide your fingertips to the side of the patient's neck closest to you.

Recovery position:

Casualty positioned and supported on his side

(All unconscious casualties MUST be placed in this position to maintain an open airway)

Artificial Respiration

Mouth - to - mouth ventilation when breathing is inadequate or absent

• Open the airway:

• (head tilt-chin lift or jaw thrust)
• Make a good seal with your mouth around casualty's mouth,
• Pinch the nose, or seal with your cheek
• Ventilate twice, making sure the chest rises. (Look at chest in between each breath)

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Methods to open the airway: Jaw Thrust for trauma casualties

The idea of this method is to open the airway without moving, the casualty's
neck!
Grasp the casualty's jaw firmly with your fingers hooked behind the angle
of the jaw.
Move the jaw forward as if the casualty has an "overbite" With the thumbs, open the mouth.

Non trauma casualties

Use head-tilt-chin-lift method.

This method is the easiest, but you must be sure that there is no chance
for neck injuries!

MODULE THREE

Cardio Pulmonary Resuscitation – CPR

At the end of this module, the student will:

• Understand the principals of Cardio Pulmonary Resuscitation

• Be able to demonstrate on a manikin, the correct method cardio of pulmonary resuscitation

Each year, hundreds of people are saved from brain damage due to the effective
application of CPR in time!
When CPR is done correctly, it still only simulates the effectiveness of the heart by 60%!
So make sure you know this skill before you complete this course!

This session is a practical learning experience and the student MUST pass this
section successfully in order to pass the Course.

Correct hand position is important

CPR
a. The patient must lie flat on his back on a firm surface.
b. Open the airway and check for breathing, if no breathing:
c. Blow two slow, full breaths into the patient's lungs and make sure that the chest lifts
d. Position the hands in the middle of the sternum (breastbone)
e. Place the other hand on top of the hand on the sternum.
f. Interlock the fingers of both hands with the fingers raised off the chest.
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 g. Apply pressure on the sternum only with the heels of the hands for
compressions.
h. Keep your arms straight, elbows locked and your shoulders vertical above your
hands.
i. Use the weight of your body to apply the pressure.
j. Apply pressure directly downwards.
k. Keep the compressions smooth, rhythmical and at a constant depth.
l. Do not lift your hands off the chest during compressions.
m. Do not rock onto your heels. Keep the body in a vertical line.
n. Compress the sternum to a depth of 4-5 cm every time.
o. Count "one-and-two-and-three-and-four-and-five-and".

Count up to 20-30 compressions: a compression rate of between 80-100 per minute

which is equal to the normal pulse rate.

MODULE FOUR

Choking

At the end of this module, the student will be able to

Recognise choking
Be able to treat conscious as well as unconscious choking in adults
Be able to treat partial as well as complete obstruction

How to recognise choking

Learn to recognise choking quickly in order to render treatment before

The obstruction causes the casualty to become unconscious.
Signs and symptoms

Partially obstructed Airway (Casualty can still make sounds)

 Casualty is still able to cough

 Casualty will have great difficulty to breathe
 He will clutch his throat
 He will be red in the face
 He will be very anxious.
 His breath will make whistling sounds
 The veins in his neck will stand out.

Complete Airway Obstruction: This is a true emergency!

 Casualty cannot make any sounds or cough!

 He will clutch throat.
 He will also be red in the face initially.
 The neck veins will also stand out.
 With a complete obstruction, casualty cannot breathe at all!
 After four to six minutes brain damage will to start.
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 Remember casualty will lose consciousness and go into cardiac arrest if
 you are unable to dislodge the object

Treatment

 Partial obstruction
 Do not panic! (The casualty is panicking)
 Calm and reassure the casualty
 Get someone to assist you and phone for an ambulance
 Ask him if he can cough, If he can, encourage him to cough and dislodge the obstruction.
 DO NOT intervene while he can still cough.
 Be ready to take over if the obstruction becomes complete.

Complete obstruction

Conscious casualty: Abdominal Thrusts: (practical demonstration)

 Casualty will be panicking!

 Stand behind the casualty
 Find your landmark (Xhipoid process) with index finger of one hand.
 Place the other hand on the naval.
 Make a fist and roll the fist upward towards the Xhipoid process.
 Place the first hand on top of your fist.
 Do five to ten abdominal thrust - inward and upward jerks.
 Reassess the casualty.
 If unsuccessful, repeat the exercise.
 Remember, soon the casualty will become unconscious Be ready to
 let him down
 to the floor softly
 Then carry on with the treatment as below.

Choking Unconscious Casualty

The Unconscious Patient Abdominal Thrusts:

1. Place the patient on his back.
2. Attempt to open the airway ~ finger sweeps ~ head-tilt-chin-lift method
3. Try to ventilate the patient.
4. Kneel close to the patient's hips or straddle the thighs of the patient.
5. Place the heel of one hand just above the patient's naval in the mid-line.
6. Place the second hand on top of the first, interlocking your fingers.
7. Administer up to 5 quick upward thrusts.
8. Check in the mouth if the object has become dislodged and remove gently if it can be
seen.
9. This treatment must be maintained until: Object has been dislodged.
10. You can hand over your casualty to a person with the same or higher qualifications as
yourself who can maintain the treatment to Hospital.
11. Advise a casualty, who received abdominal thrusts to be checked over by a doctor.

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Demonstrate the full treatment required for an obese person, or pregnant lady, or someone
with ‘suspected abdominal injuries, chest thrusts instead of abdominal thrusts must be used.
The hand position in such a case, will be the same as for CPR - bad choice for hand
position, but nothing else you can do!!

MODULE FOUR

Shock
At the end of this module, the student will be able to:

 Recognise shock
 Determine degree of shock present
 Prevent shock from worsening
 Treat shock

Definition SHOCK

Inadequate blood circulation to the body organs and tissue, Vital organs are deprived
of oxygen and this can lead to unconsciousness and death.

Recognise the conditions that can lead to shock so that treatment can be started in
order to prevent severe shock developing.

Condition which can lead to shock

 Injuries such as wounds, fractures, etc

 Bleeding
 Pain
 Heart attacks
 Stroke
 Poisoning
 Diabetes
 Epilepsy
 Bad news

Signs & Symptoms

The severity depends upon the severity of the illness or injury

 Casualty is restless and anxious

 Breathing is rapid, shallow and sometimes gasping.
 Weak and rapid (fast) pulse rate.
 Thirst, is severe if blood loss is the cause of the shock.
 Casualty is disorientated
 Skin becomes cold, pale and clammy (sweaty)
 Cyanosis occurs: Blueness of fingernails, lips, nostrils and earlobes.
 Nausea and vomiting may occur
 A decreasing level of consciousness, gradually resulting in unconsciousness and
eventually death.
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Treatment for shock

 Safety of yourself and your casualty.

 Identify yourself.
 Calm and reassure casualty.
 Remove cause of shock if possible, or remove casualty from cause
 Place on the back with legs raised if the injuries permit.
 Monitor vital signs and record every five to ten minutes.
 Be gentle.
 Treat all life threatening injuries.
 Maintain body temperature - cover with a blanket or jacket, etc.
 Loosen tight clothing around neck and waist.
 Arrange for transport by ambulance ASAP.
 Remember persons in shock do not act normal.

Casualties with chest injuries, or heart problems, will be more comfortable if they are
placed in a semi-seated position.

When a casualty is nauseous, he is best off on his side for good drainage.

In case of shock the casualty is best off on his back, but remembers if he is having
difficulty to breathe, or if he is unconscious, you MUST place him in the recovery
position!

MODULE SIX

UNCONSCIOUSNESS

At the end of this module, the student will be able to:

 Understand unconsciousness
 Determine the Level Of Consciousness (LOG)
 Know the reasons for unconsciousness
 Turn the casualty in the survival position
 Treat unconsciousness

Unconsciousness can be the result of many different situations:

1 Heart Attack

The heart cannot maintain its function and causes a decrease in oxygen rich blood to the
vital organs e.g. the brain.

2 Asphyxia

A shortage of oxygen to the vital organs caused by the inability to inhale enough oxygen
to maintain a high enough level in the blood, e.g.:

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a. Too little oxygen in the air breathed in
b. inhalation of smoke
c. Inhalation of poisonous gasses
d. Airway obstruction with e.g. foreign body
e. High altitudes with a too low oxygen content
f. Strangling / choking / etc.
g. Drowning

3. Diabetes

Too much or too little "sugar" in the blood, both conditions can cause unconsciousness.

4. Trauma

a. Injuries to the brain, egg: A fall on the head

b. Motorcar and motorbike accidents
c. Diving accidents
d. Gunshots (head)
e. Blunt trauma to the head causing brain injury

5. Extremes of temperatures:

a. Excessive heat

i. Heat stroke
ii. Heat exhaustion

b. Excessive cold: This can occur In the following ways:

i. Inadequate warm clothing in the winter

ii. Falling into ice-cold water
iii. Illness causing a poor resistance
iv. A poor diet can also contribute
v. Poor living surroundings, e.g. hobos sleeping in parks, etc.

6. Poisoning

Any substance taken in excessive quantities, can be harmful, and sometimes

causes unconsciousness and death

7. Cerebro Vascular Accident (CVA) - Stroke

When an artery bursts in the brain, causing pressure (depending where in the brain, what
signs and symptoms there will be) When a blood clot enters the brain and "gets stuck" it
cuts off the blood supply to the area beyond that point.

8. Overdose of medication: For example

a. Aspirin
b. Paracetamol
c. Sleeping tablets or anti-depressants, and many more.....
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 9. Severe allergic reaction

When a person is allergic to a certain substance, it causes a severe reaction within his
body, called ANAPH'YLAXIS

a. This is a true emergency with which no time should be wasted.

b. Such a casualty should be moved to a doctor / medical facility / Hospital without
delay.

NB: To maintain an open airway, an unconscious casualty, must airways be

turned into the lateral position - to lie on his side if any neck or spinal injuries are
suspected, immobilise casualty on a spine board, with a cervical collar to support
his neck.

MODULE SEVEN

WOUNDS & BLEEDING

At the end of this module, the student will be able to:

a. Know the dangers of a wound

b. Different types of bleeding
c. Recognise the different types of wounds
d. Apply direct pressure to stop bleeding
e. Apply indirect pressure to stop bleeding
f. Protruding foreign objects
g. Assist with a bleeding nose and ear
h. Recognise internal bleeding
i. Treat internal bleeding

Definition A wound

A break in the continuation of the soft tissue of the body

Dangers of a wound

1. Bleeding which can be life threatening

2. Infection caused by dirt & grime
3. Scar tissue can form
4. Shock developing from blood loss

Types of bleeding

Arterial: Oxygenated blood

Colour: Bright red

Squirts out rhythmically
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Venous: De-oxygenated blood
Colour: Dark red
Flows out

Capillary: A mixture of venous and arterial bleeding-ooze from wound

Methods to stop bleeding: Direct Pressure indirect pressure

Different types of wounds

Lacerated wound: (Tear wound)

This can be caused by e.g. barbed wire. It is not a clean cut wound, the edges are
usually jiggered and it heals difficulty

Contused wound

Usually caused by a blunt object

There is usually bruising of the surrounding areas
Possible underlying fractures

Incised wound

This type of wound can be caused by e.g. a knife. Usually bleeds profusely.

Puncture wound

a. Caused by e.g: nails, needles, bullets, etc.

b. Can cause severe bleeding.
c. This type of wound can be easily overlooked.
d. When a puncture wound was caused by e.g. a bicycle spoke, it can easily be
overlooked.

Amputations

a. This usually has a very traumatic effect on the casualty

b. Severe bleeding is usually the main concern
c. Indirect pressure may have to be used to control bleeding
d. Remember to take amputated part with you to hospital
e. Cover part with sterile (if possible) dressing, cover with ice if available.
f. Rush casualty to a medical facility where such a situation can be handled

Protruding foreign bodies

A ring pad (which will be demonstrated) is used to prevent pressure on the object itself.

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Treatment

a. Wear gloves!
b. Bleeding can be stopped by using direct pressure on the wound itself.
c. in severe cases, indirect pressure can be used to stop bleeding.
d. Demonstrate direct pressure points during practical sessions
e. Casualty needs to be calmed and reassured constantly.
f. if casualty shows signs of shock, and injuries permit, lay him on his back and raise
the legs about 30 cm. to facilitate blood flow to the vital organs.
g. If bleeding continues through first bandages, do not remove, simply ADD more
bandages on top.
h. Monitor vital signs
i. Keep warm
j. Arrange for removal ASAP!

Bleeding from the ear

A ruptured eardrum usually causes bleeding

Bleeding from the ear can also be a sign of base of skull fracture

Treatment

Place a dressing lightly over the ear - do not plug! Place casualty in a semi-seated position
leaning over towards the injured side, (for drainage) if injuries permit. Seek medical assistance
ASAP

Bleeding from the nose is a common occurrence

Treatment

a. Sit down and lean forward

b. Pinch soft part of the nostrils for at least 10 minutes
c. Breathe through mouth
d. Spit out all blood entering mouth
e. If bleeding has stopped, advise casualty not to blow his nose.
f. if bleeding has not stopped, instruct the casualty pinch to his nose for another 10
minutes.
g. if the bleeding has not stopped after 30 minutes, casualty must be seen by a Doctor

Internal Bleeding

Possible causes of internal bleeding

a. Ruptured liver, spleen or pancreas

b. Fractured rib protruding into another organ like the lungs or heart
c. Burst peptic ulcer in stomach or intestines
d. Ectopic pregnancy - pregnancy in the fallopian tubes
e. Ruptured aneurism - weakening of an artery wall which eventually bursts

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 f. Because this type of bleeding cannot be seen it Is the most dangerous of all bleeding It
may occur following an injury or illness.
g. There is no method of determining how much blood has been lost.
h. Always suspect internal bleeding when the casualty shows severe signs and symptoms
of shock without any external evidence.
i. If the bleeding is inside the chest cavity, it will cause difficult breathing, and frothy blood
may be coughed up.

Signs & Symptoms of internal Bleeding

a. Signs & symptoms of shock (perhaps without evidence of injury)

b. Correct cause of injury..
c. History of a medical condition which may cause internal bleeding.
d. Pain & tenderness around affected area
e. Shallow breathing which may be accompanied by yawning.
f. Thirst and restlessness is a late sign.
g. Blood may appear from one of the body orifices (openings) in various forms,

Example

a. Pink frothy sputum / blood coming from the lung and is mixed with air.
b. Black coffee-grounds-like vomeius is bleeding within the stomach when the blood is
mixed with the digestive juices.
c. Tarry-like stools are evident of bleeding in the small & large intestines.

Treatment

a. Your safety comes first!

b. Calm & Reassure casualty.
c. Check vital signs
d. Arrange for urgent transport to hospital.
e. Place casualty in the most comfortable position provided he doesn't have other
injuries which contra-indicate the chosen position.
f. DO NOT give him anything to eat or drink - as he may have to have surgery for the
bleeding.
g. Monitor his vital signs at least every 10 minutes
h. Keep him warm and never leave the casualty unattended
i.

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 MODULE EIGHT

BURNS

At the end of this module, the student will be able to:

a. Take the correct steps for safety

b. Correctly recognise the different severities of a burn
c. Give the correct treatment for a burn
d. Give the correct support to the burn victim

Classification of burns

Superficial burns

Only the outer layer of the skin is damaged

A good example of this is sunburn.
Superficial burns usually heal without medical help,

Intermediate Burns

This involves more than the outer layer of the skin Blisters form which is a sign of deeper
damage The skin is very red around the blisters. This needs medical attention to heal properly

Deep burns (Full thickness)

The entire thickness of the skin (all the layers) have been damaged
Often bone and muscles are also involved
This definitely needs medical attention
The skin appears wax like and is often also black charred to the bone

Burns can occur through the following:

a. Chemical contact
b. Contact with e.g. steam, hot liquid, etc.
c. Lightning
d. Electricity (discussed separately)

Treatment

a. SAFETY is important!
b. Remove the source of heat from the casualty or remove the casualty from the heat
c. Reassure the patient
d. COOL DOWN is the most important Use water to cool down the affected areas
for at least 10 minutes.
e. Rinse off all chemicals, after brushing off all loose powder
f. Cover all burnt areas with wet sterile dressings
g. DO NOT puncture blisters!
h. Wash out the eyes with water to clear away all foreign matter.

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 i. Watch out for burns around mouth - then suspect burns to the airways give cool liquids
to drink and monitor closely
j. Cut out a "mask" from a bandage, or clean cloth, for a badly burnt face and keep wet.
k. Jewellery must be removed ASAP as swelling will make removal impossible at a later
stage!
l. Do not apply lotions or ointments to the affected area
m. Get casualty transported to a hospital which can handle a burned victim, without
delay- keep wet throughout journey Burn shieid is a good choice to apply to a burn.

Complications of burns

Severe infection

Especially when blisters are broken

Casualties do not necessarily die from the actual burn, but from the infection which sets in
afterwards.

Shock

Shock will always be present.

Severe shock can develop due to the fluid loss out of the burnt area, as well as the severe
pain accompanying most burns.

Formation of scar tissue

This can be greatly reduced by stopping the burning action by cooling the affected area, or
by using Burn shield, a product specially developed for the treatment of burns in the
emergency situation.

Deformity

Deformity of face and body is caused by severe burns,, which is difficult to repair and very
expensive. Often a burn victim spends years having the damage repaired by having
operations, skin grafts and treatment.
To burn is the most horrific of all injuries, and those victims need the most moral
support as well.

MODULE NINE

Electrical Injuries

At the end of this module, the student will be able to:

a. Aware of the dangers of electricity

b. Able to take appropriate safety measures
c. Understand electrical current injuries
d. Know the type of injuries which can occur from electricity
e. Able to treat electrical injuries.

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The severity of electrical injuries is determined by various factors

a. The power of the current

b. Resistance to the current
c. Type of circuit
d. Duration of contact
e. Pathway of current

Power of the current

High voltage injuries

a. More than 1000 volts

b. Extensive tissue charring
c. Often no survivors

Low voltage injuries

a. Less than 1000 volts

b. Less extensive tissue charring
c. NB in lowered skin resistance household current (220 volts) can be fatal

2. Type of circuit

Alternating current is more dangerous that direct current. It stimulates the muscle fibres
repeatedly causing victim to "freeze" to the circuit Direct current causes a single muscle
contraction which forces the victim away from the current

3 Duration

The longer the contact the more severe the Injury

4 Pathways

a. Once the skin has been destroyed, the Electrical Current travels through nerves,
blood vessels and muscles.
b. Tissue damage tends to be "spotting" and may appear at distant sites, away from
the point of contact.

Damage in other areas of the body

a. Brain - Intracranial haemorrhage (Bleeding in the brain)

b. Thorax - causes respiratory arrest
c. Heart - Ventricular fibrillation (Heart muscle quivers)
d. Arrhythmias (Irregular heart: beat)
e. Cardiac arrest (No heart beat.)

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Management

SAFETY: It is only safe when current is switched off!!

When breathing and heartbeat has stopped - begin CPR immediately
If casualty is unconscious - treat as described in module 6
Get help fast!
Monitor vital signs carefully - breathing and heartbeat may stop at any moment!
Treat and cover all wounds - remember there will be an entrance and exit wound.
Treat for shock and keep warm

REMEMBER: the most damage is caused INTERNALLY!

.MODULE TEN

Bandaging & Splinting

At the end of this module, the student will be able to:

a. Recognise the various types of bandages and splints

b. Know how to apply a sling
c. Know how to dress a wound
d. To make a ring-pad
e. Apply the various dressings, bandages and splints practically
f. To improvise

Dressings

A dressing is placed directly onto the wound - therefore it should be as clean as possible.
Never remove a dressing from a wound - only add more if bleeding persists.
Fibrous materials such as cotton wool, cannot be used as dressings.
A dressing should extend well beyond the edges of the wound.
A dressing should be kept in place with a bandage that must extend beyond the edges of the
dressing.

Bandages

The triangular bandage is the most widely used

bandage in first aid. Folded twice, it becomes a
BROAD bandage. Folded three times, it becomes a NARROW bandage.

Uses of a bandage

a. To make a ring pad

b. To cover a dressing
c. To make a sling
d. To immobilise a fractured limb
e. To pad and cover a splint before use
f. To support and fill natural hollows of the body
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Splints

a. There are many types of splints on the market.

b. Any rigid object such as a broomstick, ruler, etc can be used
c. The uninjured side of the body can also act as a splint, it should
d. always extend beyond the nearest joint to the fracture
e. A splint must always be padded or covered before it can be used.

MODULE ELEVEN

Head and spinal injuries

At the end of this module the student will be able to:

a. Recognise head and spinal injuries

b. Realise the importance of quick action
c. Know the importance in immobilisation
d. Able to give first aid to casualties with head and spinal injuries

The brain consists of two lobes-left and right-which fits snugly into the bony "box" called the
scull. It is bathed in a fluid called cerebro spinal fluid. There is no "extra" space in the scull in
case of swelling or bleeding. The brain continues to form the spinal cord. It exits through a
small opening in the scull bone, and is one continuous organ, right down to its end.

When can it occur?

Head and spinal injuries can occur almost with any accident, fall or sports injury.
Head and spinal injuries cannot be detected easily.
The aim of a First Aider is to be able to recognise such an injury.
Treatment should always be as if head and spinal injuries are present, until otherwise proven.

Head Injury

Signs and symptoms

a. Pupils may not be even in size or not react well to light (Or not at all)
b. Discoloration around the eyes, and behind the ear
c. Dropping level of consciousness or unconsciousness
d. May have convulsions after trauma to the head.
e. Projectile vomiting (a strong "squirt" of vomits)
f. Swelling where e.g. the blunt object is still stuck in the scalp. e.g. a knife.
g. Evidence of a gunshot through the head with an entrance and exit wound, there may
NOT be an exit wound!
h. Clear fluid or blood oozing from the ears.

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Spinal Injury

The spinal cord is a continuation of the brain. It is therefore affected when injuries to the
brain occur, and vice versa.

Always suspect head injuries with evidence of spinal injuries

Signs and symptoms

a. Casualty may suffer a loss of feeling or sensation or both below the site of injury.
b. Severe pain and swelling at the site of injury.
c. Casualty says he feels “ cut in half “
d. Body temperature differs above and below injury.
e. The casualty may lose control over his bladder and bowel because of the damage
to the nerves.

Treatment for head and spinal injuries

Always remember SAFETY first with any treatment!

a. Introduce yourself
b. Do not move casualty unless it is absolutely necessary
c. Immobilise the head and spinal cord totally
d. Do allow the casualty to move
e. Apply a cervical collar immediately
f. Cairn and reassure the casualty continuously
g. Explain to him why you are strapping him onto a board for example
h. Ask bystanders to assist you
i. STAY with the casualty
j. Watch out for convulsions
k. Watch out for projectile vomiting
l. Monitor the vital signs every ten minutes and record if possible
m. This casualty needs URGENT medical attention

Circumstances in which casualties with suspected spinal injuries may be

moved

a. A casualty in cardiac arrest

b. Casualty lying in the road and traffic cannot be warned.
c. Building or vehicle is on fir
d. Danger e.g. shooting,
e. Bombs, etc in the area
f. Building collapsing

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Moving an injured person with a spine board and helpers:

Module twelve

Injuries to bone, muscles and ligaments

At the end of this module the student will be able to:

a. list the types of fractures

b. know the causes of fractures
c. Successfully treat a fracture
d. Improvise bandages and splint if necessary

Fracture

A crack or break in the continuity of hard tissue.

Types of fractures:

Greenstick The bone does not break right through (Usually in children)
Oblique Bone breaks at an angle
Crush Bone is crushed under a heavy weight
In driven Where the two bone ends are driven into each other.
Spiral The bone breaks in a spiral type pattern.
Horizontal A simple 90' break in the bone.

Causes of an injury

a. Casualty falls from a height

b. Diving accidents
c. Gunshots (High and low velocity)
d. Muscle spasms (as in epileptic fits)
e. Sports injuries.
f. Motor vehicle and motorbike accidents.

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Signs & symptoms

a. Pain at site if injury.

b. Loss of movement/sensation of limb.
c. Swelling.
d. Deformity at site of injury.
e. Irregularity at site of injury
f. Unnatural movement of limb.
g. Tenderness at site of injury.
h. Crepetus - the two broken bone grating against each other -extremely painful.
i. Signs of shock will be present.
j. Shortening of the limb may be noticed.

Treatment injuries:

a. Asses safety of the scene

b. Ascertain level of consciousness.
c. Confirm open airway, breathing and circulation.
d. Reassure the casualty.
e. Instruct casualty not move, and explain to him why
f. Arrange for an Ambulance .
g. Look for life threatening bleeding and treat.
h. Check pulse below the injury.
i. Immobilise fracture splinting limb with bandages and splints.
j. Reassess pulse BELOW the fracture once bandages and splints have been applied.
k. Raise limb.
l. Reassure casualty all the time.
m. Monitor vital signs and record.
n. After transportation, ensure that you keep records of the incident.

Improvise bandages and splints if no proper splints are available

a. The body method: Use the good limb to act as a splint

b. Magazines and newspapers can be used for splinting e.g.. an arm.
c. Plastic bags, nappies, dishcloths, ties, belts, scarves.
d. T-shirts etc., Make good bandages
e. Jackets, shirts and blouses with buttons can be used to support an arm by slipping the
limb in between the buttons of the garment.

Classification

Sprains

Ligaments are stretched or torn at a joint bones may not move out of position.

Torn muscle

The muscles tear loose from their points of attachment.

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Dislocation

The bones which form a joint, are pushed out of position.

Without proper X Rays, no one can tell! the difference between a fracture,
sprain or dislocation! So rather treat for the worst – a fracture

Signs and symptoms

a. Casualty may present the same signs and symptoms as that of a fracture
b. Shock will be present- treat!
c. Discoloration may be noticed at the affected area
d. Severe pain will be present
e. May swell up severely
f. Treat as for a fracture if you are not sure!
g. Ice can help to reduce the swelling - ice should be wrapped in a piece of cloth
before
h. placing it onto the skin.
i. Multiple Injuries can be expected when there is an accident involving i.e.: a
motorbike.

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