An introduction to first aid

Imagine: Whilst feeding your child, they start to gag and appear unable to
breathe. You have tried slapping them on the back, with no success. They seem
close to losing consciousness, their lips are turning a definite shade of blue.

People rarely give first aid a thought, until the day they need it. The above
scenario is the sort of every day occurrence that can so easily lead to tragedy.

However, with the correct first aid training anyone could, in the short term (until
the arrival of the emergency services) save a life.

These notes have been designed to aid you with your first aid training. It is,
however, not a substitute for hands on training from a professional first aid
trainer, but a reference for you to look back on when you need to.

We hope the training you undertake with us will give you the knowledge and
confidence to, if the worst happens, help keep someone alive.

The Aims of first aid

Preserve life
This doesn’t just refer to the injured party, but yourself and anyone
helping you. Far too often, a helper will inadvertently put themselves in danger
and subsequently be another casualty for the emergency services to deal with.
Please take a moment to assess the situation, and make sure there are no threats
to you before you step in.

Prevent the situation from getting worse

If you are in no danger yourself, try to stop the situation from becoming
worse by removing any obvious dangers (such as stopping traffic, clearing
people away from the casualty, opening a window to clear any fumes, etc.).
Also, act as quickly as you can to stop the casualty’s condition from worsening.

Promote recovery
Your role as a first aider is, after ensuring that the situation can not get
worse, helping the casualty to recover from their injury or illness, or stop their
condition from getting worse. If the injury is severe, then the best you can do is
try to keep them alive until the emergency services arrive.

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 The priorities of treatment

This is the course of action you should try to follow, providing the situation
allows.

Primary survey (Airway → Breathing):

A. Make sure the casualty’s airway is clear. Do this by gently tipping their
head back so that the front of the throat is extended.

B. Check if they are breathing normally. You can do this by placing the back
of your hand near their nose and mouth. You are looking for about two breaths
every ten seconds. If the casualty is breathing, then their heart is working,
which means blood is being circulated around their body.

Secondary survey (Breathing → Bleeding → Bones):

Once you are satisfied that the casualty is breathing normally, the second thing
to do is make sure to treat any bleeding. This is to stem any blood loss and to
ensure there is a steady supply of oxygenated blood to the casualty’s vital
organs. If there is no bleeding, or you have dealt with any cuts, the next priority
is broken bones.

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An emergency action plan is important to have in place should you be faced
with a situation requiring first aid.

1. REMOVE DANGER: Make the scene safe, do not take risks.

2. DANGER: Look for any further danger. If yes, go back a step, if no go to

step 3.

3. RESPONSE: Shout and gently shake or tap the casualty. If the casualty
responds, find out what happened. Check their signs and symptoms (how
does the casualty feel or look? Try to work out what’s wrong), and determine
a treatment (remember - if you are unsure, always seek medical advice). If
there is no response, shout for help but don’t leave the casualty just yet, and
go to step 4.

4. AIRWAY: Open the casualty’s airway by lifting their chin and tilting their
head back.

5. BREATHING NORMAL?: Look, listen and feel for two breaths in a

maximum of ten seconds. If you can clearly determine the casualty is
breathing, perform a secondary survey (check for bleeding, injuries and
clues). Put the casualty into the recovery position, dial 999 if not already
done, monitor airway and breathing and keep the casualty warm. If you
cannot determine if the casualty is breathing, go to step 6.

6. DIAL 999 FOR AN AMBULANCE NOW IF YOU HAVEN’T DONE SO

ALREADY.

7. RESUSCITATION: Give 30 chest compressions followed by 2 rescue

breaths, continue giving cycles of 30 compressions to 2 breaths. If there is
more than one first aider on hand, change over every 2 minutes to prevent
fatigue. Continue until the ambulance arrives.

Resuscitation

To maintain life, we need our hearts to pump oxygenated blood to our vital
organs. To achieve this we need to be breathing and our hearts need to be
pumping. Should either of these functions stop, our brain and other vital organs
will start to deteriorate (brain cells usually die within 3-4 minutes due to lack of
oxygen) which will eventually lead to death.

‘Ventricular fibrillation’ is the most common result of cardiac arrest, caused by

heart attack. When this happens, the best chance of survival for the patient is to

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have their heart ‘restarted’ with a defibrillator. These are carried on all
ambulances, and can also be found in some public places (shopping centres,
etc.). These days’ defibrillators are very sophisticated, and will talk you through
the process, but you should be trained in the use of them before attempting to
use one. However, even if you are trained to use one, you must call an
ambulance first, as this will give the casualty the best chance of survival.

Even so, we need to keep the heart and brain oxygenated as best we can while
help is on the way; this is when we start Cardio Pulmonary Resuscitation
(CPR).

Cardio Pulmonary Resuscitation (CPR) – Primary Survey:

D Danger – ensure the area is safe and find out what has happened
 Make sure that it is safe for you to approach the casualty. Do not put yourself
in any danger, because if you get injured you won’t be able to help the
casualty.
 Remove any danger from the casualty, or if that is not possible, and it is safe to
do so, try to move the casualty away from the danger area.
 Try to find out what happened, making sure that you are safe doing so. DO
NOT PUT YOURSELF IN ANY DANGER.
 How many casualties are there? Can you cope with the situation?

R Response – is the casualty conscious?

 Try to get a response from the casualty. Gently shake their shoulders, shout
and clap your hands in front of them, pinch their underarm or fingernail to get
a pain response.
 If they do not respond, immediately shout for help, or call 999 if you have a
mobile phone on you. Whatever you do, do not leave the casualty alone.

A Airway – clear the airway

 Clear the airway by placing your fingertips under the casualty’s chin and
lifting, so the front of the neck is extended. Simultaneously placing your
other hand on their forehead to gently tilt the head back.

B Breathing – is the casualty breathing normally?

 When their airway is cleared, check if they are breathing normally. You are
looking for two breaths in ten seconds. Take no longer than this to assess
their breathing, as every second counts.
 Check whether their chest and abdomen are rising and falling.
 Listen for breath (more than a sporadic gasp).
 Use the back of your hand (lick the back of your hand if that will help) or your
cheek to feel for any breath from the casualty.

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 This will all determine if the casualty is breathing normally. If they are, you
will need to place them in the recovery position, which will be covered later in
the notes.

If the casualty is not breathing normally:

The first thing to do in this situation is call 999 for an ambulance. If someone
is with you, get them to do this so you don’t have to leave the casualty. If you
are alone, and do not have a mobile with you, you may need to leave the
casualty to do this. However, it is vital that an ambulance is called, as the
casualty will stand a much better chance of survival with help on the way. Once
the ambulance is called, start CPR:

 Place the heel of one hand in the centre of the casualty’s chest. Place the other
hand on top and interlink your fingers.
 Take a position next to the casualty’s chest, kneeling at whichever side feels
more comfortable for you.
 Press down firmly on the casualty’s breastbone current guidelines suggest
pushing down to a depth of 6cm) then release the pressure, but try not to lose
contact with the casualty. This is known as a chest compression. When
applying pressure, avoid doing so on the ribs, upper abdomen or the end of
the casualty’s breastbone.
 Each compression should take the same amount of time.
 Carry out 30 chest compressions at a speed of 100-120 compressions per
minute.
 After 30 chest compressions, you must administer two rescue breaths (see
images below).

In an ideal situation, the casualty will be on a flat hard surface to be able to

administer CPR. However, this isn’t always the case, and you may find that you

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need to perform CPR on a casualty who is, for example, in bed. If this situation
arises, try to get the casualty onto the floor without hurting yourself or the
casualty. If it is not possible, remove any pillows or cushions so the casualty is
lying flat and attempt CPR. This is still better than doing nothing.

Combining chest compressions with rescue breaths:

 After chest compressions, make sure the casualty’s airway is clear by tilting
their head back.
 Pinch the casualty’s nose closed; this will make sure the breath you give them
does not escape.
 Take a breath and place your mouth over the casualty’s, forming a seal.
 Steadily blow into the casualty’s mouth, making sure their head is tilted back
and the airway is open. Keep your eyes down on the casualty’s chest to make
sure it rises (this should take about a second). This is known as a rescue
breath.
 Remove your mouth from the casualty’s and leave enough room for you to
take a fresh breath of air. Keep the casualty’s airway open and watch for the
chest deflating, as the air is expelled.
 Place your mouth over the casualty’s forming the seal again and give another
rescue breath. You need to do this twice.
 Replace your hands on the casualty’s chest immediately and perform another
30 chest compressions, followed by 2 more rescue breaths.

Continue swapping between 30 chest compressions and 2 rescue breaths.

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Should your rescue breaths not be effective, follow the steps below:
 Give a further 30 chest compressions.
 Remove any visible obstructions in the casualty’s mouth.
 Make certain their airway is clear by tilting their head back and lifting the
chin. If the airway is not clear, the breath you give will not fill their lungs.

Do not give the casualty more than two rescue breaths before continuing
with chest compressions.

If you have someone with you, take it in turns to administer chest compressions.
Every 1-2 minutes, change over so one person administers chest compressions
while the other gives the rescue breaths. Ensure there is as little delay in
swapping as possible, so the casualty is constantly receiving CPR.

Continue CPR until:

The emergency services arrive to take over.
You become too fatigued to continue.

Resuscitation for babies and children:

Understandably, some people are reluctant to perform CPR on a child or baby
for fear of causing further harm to them. However, a child in this state is likely
to suffer far worse consequences if CPR is not administered. Please keep that in
mind should the situation ever arise.

CPR on a child is very similar to CPR on an adult. There are only a few minor
modifications to the process, which are detailed below:

 Give the child 5 rescue breaths before starting CPR, then switch back to 30
chest compressions to 2 rescue breaths.
 If you are alone, perform CPR for about a minute before going for help.

Chest compressions on a child should be about one-third of the depth of the

chest. For a baby under 1 year old, only use two fingers to administer CPR.
For a child over 1 year use either one or two hands to compress the chest, again
one third of the depth of the chest.

Full details on child CPR is covered later in the notes.

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Resuscitation with chest compressions only
An adult cardiac arrest casualty will probably still have oxygen in their blood
stream. If there is any reason you cannot give the casualty rescue breaths, you
can still help the casualty by giving them ‘chest compression only’ resuscitation.
Although not ideal, it will still circulate the residual oxygen in their blood to
their vital organs, so it is better than no CPR.

If you are only giving chest compressions, the continuous rate should be 100-
120 compressions per minute.

If you have someone with you, take it in turns to administer chest compressions.
Every 1-2 minutes, change over so one person administers chest compressions
while the other rests and maintains the casualty’s airway. Ensure there is as
little delay in swapping as possible, so the casualty is constantly receiving chest
compressions.

Vomiting during CPR:

It is not uncommon for an unconscious casualty who has stopped breathing to
vomit. This is an autonomic reaction from the unconscious casualty which you
may not notice until you come to give a rescue breath, or their breath comes out
with a gurgling noise.
 If this happens, turn their head to the side and allow the vomit to drain.
 Before continuing resuscitation, clean the casualty’s face, and if you have a
face shield handy use it.

Points of hygiene during resuscitation:

 Use a cloth, or whatever you have to hand to wipe the casualty’s mouth clean.
 Face shields are useful to have on you, as they protect you from any serious
infections such as TB, Hepatitis, etc. Always use one if you have it with you.
 If you do not have a face shield to hand, a piece of plastic with a hole cut or
torn into it will suffice, as will a handkerchief or any piece of material which
will help to prevent direct contact.
 If you are in any doubt about the safety of giving rescue breaths, you can
perform ‘chest compression only’ resuscitation as a last means (this is
described above).
 If you have protective gloves, use these. Always wash your hands afterwards
to prevent any contamination.

Main causes of unconsciousness in a casualty:

Unconsciousness is an interruption to normal brain activity. Unconsciousness
disrupts the body’s autonomic reflexes such as coughing. The worst position for
an unconscious casualty is lying on their back, as they may ‘swallow’ their
tongue (the tongue slides back in the throat blocking the airway) which will

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suffocate them, or they may asphyxiate on their vomit.

If a casualty is unconscious, you need to take immediate action: clear the

airway, call for an ambulance by dialling 999 and if you can, treat the cause of
their condition.

To help you remember the main causes of unconsciousness in a casualty, try to

remember FISH SHAPED. These points are dealt with more fully elsewhere in
these notes.

F Fainting S Stroke
I Imbalance of heat H Heart attack
S Shock A Asphyxia (choking)
H Head injury P Poisoning
E Epilepsy
D Diabetes

Responses in casualties:
To correctly ascertain the level of consciousness in a casualty, you can use the
AVPU scale:

A Alert
The casualty is fully alert
The casualty is awake and fully aware of their surroundings (they will usually
know the answer to general questions like the date, their name, where they are,
etc.)

V Voice
Confused
The casualty may not be fully aware of their surroundings, but will ask and
answer questions.

Inappropriate words
This refers to casualties who are conscious, but may not be able to string a
coherent sentence together. Words may be in the wrong place or missing

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altogether from responses.

Making sounds
The casualty is not able to respond verbally, but may make grunts or moans in
response to painful stimuli.

No sounds
In this case the casualty will make no vocal sounds.

P Pain
Locating pain
The casualty will be able to locate painful stimuli, and tell you where it is being
applied (pinch on the underside of the arm, pressing firmly on a finger nail,
etc.).

Pain response (but not able to locate the pain)

The casualty will respond to painful stimuli, but not be able to locate where the
pain is.

U Unresponsive
The casualty is not able to respond to pain or vocal stimuli. They will remain
unresponsive.

You can perform primary and secondary surveys of the casualty, which will help
you to decide in which order to treat the casualty, the most urgent first. You can
then go on to assess the casualty further, which may help with diagnosis and
treatment. The more information you can give the ambulance crew the better.

Primary survey:
When you perform the DRAB check, this is usually the primary survey. This
has been covered previously (page 4). Primary surveys are to assess whether
the casualty is breathing. Once you have established this, you can move onto
the secondary survey.

Secondary survey:
If a casualty is unconscious, but breathing, you must protect the airway. As
detailed before, risks are swallowing the tongue, vomiting, etc. Place the
casualty in the recovery position immediately, as described here (see page 12).
The secondary survey needs to be done quickly in the following order of
importance:

Bleeding
 Check the casualty from head to toe for bleeding.

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 Make sure to check any covered areas, such as the back.
 Stop or control any bleeding you find (see page 36).

Head and neck

 Check for any signs of bruising, swelling or bleeding, particularly from the
ears.
 Make sure to examine the whole of the head and face.
 Feel the back of the neck, as this is a hidden area.
 Try to ascertain if the casualty has been in an accident that is likely to damage
the neck (for spinal injuries, see page 55).

Shoulders and chest

 Check both shoulders by placing your hands on them to see if there are any
irregularities.
 Run your fingers across the collarbones to check for any damage.
 Run your hands over the ribcage, squeezing and rocking gently, to make sure
there are no breaks, as a broken rib could easily puncture a lung.

Abdomen and pelvis

 Press the abdomen gently with the palm of your hand to see if there are any
irregularities or pain response.
 Gently put pressure on the pelvis to check for any fractures.
 Check if the casualty is bleeding or is incontinent.

Legs and arms

 Run your hands down the legs gently, checking for any fractures or breaks.
 Repeat the action with the arms.
 Check the casualty for any clues to their condition (medic alert jewellery,
needle marks, smell of alcohol, etc.).

Check the pockets

 Check there is nothing in the pockets that will injure the casualty further when
you roll them into the recovery position.
 Try to have a witness present if you need to remove any items from the
casualty who can vouch for you.
 Be wary, there may be sharp objects in the casualty’s pockets such as needles
or a knife.
 Be sure to loosen any restrictive clothing, such as ties and belts.

Recovery
 Gently place the casualty in the recovery position (see page 12).
 If you have any suspicion that the casualty may have an injured neck, try to get
someone to hold the head in line with the body while you turn the casualty

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 (see spinal injuries, page 55) to lessen the risk of further damage.
 Be careful not to cause further injury to the casualty or exacerbate suspected
injuries.

Mechanics of injury

Before attempting to move a casualty, it is important to think about the

‘mechanics of injury’. This is the process of figuring out what has happened,
and what injuries are likely to have been sustained by the casualty. If you
suspect there is a neck injury involved, you must try to get someone to help you
by keeping the casualty’s head in line with their body at all times, even when
the casualty is lying still. Any movement can cause serious, irreparable
damage. See page 55 for how to do this, under treatment of spinal injury.

The recovery position

When an unconscious casualty is lying on their back, their breathing can be

hampered by them ‘swallowing their tongue’ (the tongue slides back in their
throat, cutting off the airway). Or, the person can vomit while unconscious, and
are not able to reflexively heave or expel the vomit, which can suffocate them.
By placing the casualty on their side (the recovery position), this ensures the
airway is clear by stopping the tongue sliding back in the throat and allowing
vomit to drain from the mouth.

Try, if possible, to move the casualty onto their left, as this will keep any
contents in the stomach from escaping. However, always place breathing first,
so if a casualty has any damage to their right lung for example, place them on
their right to protect the one working lung.

Step 1
 Remove any dangers from the casualty (remove glasses, check pockets for
anything that will cause further injury) and straighten the legs.
 Preferably move the left arm out, with their elbow bent and palm face up.

Step 2
 Now bring the far side leg into a bent position, with the foot on the floor, tuck
their foot under the near side leg to keep it up.

Step 3
 Bring the far side arm across the chest, with the back of the hand against the
casualty’s cheek, and hold it there.
 Now using the bent knee as leverage and holding the back of the hand against
the cheek, pull the knee towards you, rolling the casualty onto their side.

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 Make sure their knee is touching the ground so that they don’t roll back.

Step 4
 Make sure that the upper leg is bent at both the hip and the knee, as though the
casualty is in a ‘running’ position. Keep their hand under their cheek and tilt
their head back to clear the airway.
 Check the casualty’s back for any hidden injuries, and if you have anything to
hand, cover them for warmth and their dignity.
 Call 999 and request an ambulance.
 Monitor the casualty’s breathing every 30 seconds while awaiting the
ambulance. If the casualty stops breathing, return them to their backs and
commence CPR.

Things not to do:

 Never put anything into an unconscious casualty’s mouth.
 Never move a casualty without performing the checks mentioned first.
 Never place anything under the head of a casualty who is on their back. This
could obstruct the airway.
 Never unnecessarily move a casualty as this could cause further injury.

Head injuries

Treat any suspected head injury with the utmost caution, as they have the
potential to be very serious. Head injuries often lead to unconsciousness and all
the attendant problems. Also, head injuries can cause permanent damage to the
brain.

Head injuries may also be associated with neck and spinal injuries, so they
must be treated with the utmost caution (see spinal injuries, page 55).

The three main areas of concern with head injuries are concussion, compression
and a fractured skull.

Concussion
Concussion occurs when the brain is violently shaken. Our brains are
cushioned within our skulls by ‘cerebro-spinal fluid’ (CSF), so any blow to the
head can cause the brain to bang against the skull which disrupts its usual
functions. A casualty may pass out briefly (no more than 2-3 minutes), and
when they come round their level of response should return to normal.
Concussion casualties should return to normal if no complications arise.
However, a concussed casualty should not be left on their own and should
ideally be monitored for 24 hours. No sporting activity should be undertaken
for at least three weeks after a concussion.

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Compression
Compression injuries are very serious, as the brain is under extreme pressure
which is caused by bleeding or swelling in the cranial cavity. Compression can
arise from a skull fracture or head injury, but can also be brought on by illness
(type of stroke, brain tumour, meningitis, etc.).

Fractured skull
Fractures to the skull are very serious as the broken bone of the skull can cause
direct damage to the brain which can cause bleeding and therefore compression.
Treat any casualty who has had a head injury, and whose response level is low,
as having a fractured skull.

Possible signs and symptoms of head injury

Concussion Compression Fractured Skull
Casualty is unconscious for short Possible history of recent head trauma Casualty may suffer from concussion
period, after which response levels are with recovery, followed by or compression also, so symptoms of
back to normal, recovery is usually deterioration. these may be present.
quick.
Short term memory loss, groggy, Response level deteriorates as the Bleeding, swelling or bruising of the
confused irritable. condition develops. head.

Mild headache. Severe headache. Soft, egg shell feeling of the scalp.

Pale, clammy to the touch. Flushed, dry skin. Bruising apparent around the eyes.
‘Panda eyes’.
Shallow to normal breathing. Deep, slow and noisy breathing (due to Bruising or swelling behind one or
pressure on brain). both ears.
Rapid, weak pulse. Slow, strong pulse caused by raised Blood or fluid coming from an ear or
blood pressure. the nose.
Pupils are normal and react to light. One or both pupils may dilate as Deformity or lack of symmetry of the
pressure on the brain increases. head.

Nausea and vomiting can occur on As condition worsens, fits may occur, Blood visible in the white of the eye.
recovery. with no recovery.

Treatment of head injuries

Keep in mind that a casualty with any head injury may well be suffering from
neck and spine injuries also. Treat the casualty with the utmost care, and call
for an ambulance immediately.

 Ifthe casualty is or has been unconscious, you suspect a fractured skull, or

their responses deteriorate CALL AN AMBULANCE IMMEDIATELY.
 Keep their airway clear and monitor their breathing.

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 If the casualty is unconscious, and you don’t wish to move them as you suspect
a neck injury, you can use the jaw thrust method of keeping the airway clear
(see page 58).
 If you are unable to use the jaw thrust method, and you cannot keep the airway
clear, put the casualty in the recovery position but make sure the head, neck
and body are in line as you turn them to avoid any further damage to a
neck or spinal injury.
 If the casualty is conscious, you can help them lie down, making sure to keep
the head and neck in line with the body. You can help stop any movement of
their head by placing your hands on either side of the head and keeping it still.
 If there is bleeding, help to control it by applying pressure directly to or around
the wound. However, if there is blood or fluid coming from an ear, do not try
to stop the flow, as the fluid must be allowed to drain.
 If there are any other injuries on the casualty, attempt to treat these.
Some tips for treating head injuries:
 Monitor the casualty’s breathing, pulse and response levels. If the casualty
appears to recover, monitor them closely as they may well deteriorate and their
response levels drop.
 If a casualty has been concussed, try to make sure they are not left alone for
the next 24 hours. Advise them to seek medical help as soon as possible.
 If a casualty suffers any of the following in the few days after concussion, they
should go to A&E immediately: worsening headache, nausea or vomiting,
drowsiness, weakness in a limb, problems speaking, dizzy spells, blood or
fluid from an ear or the nose, problems seeing, seizures or confusion.
 If the concussion is received playing sports, do not allow the concussed player
to continue until they have seen a doctor. Usually, concussed players are not
allowed to participate for up to three weeks after being concussed.

Stroke

Strokes must always be treated as a medical emergency, and an ambulance

called immediately. Any delay in the treatment of a stroke can have a dramatic
effect on the casualty’s recovery. If you suspect a stroke, CALL AN
AMBULANCE IMMEDIATELY.

There are two types of stroke:

1. A blood clot blocks a blood vessel that supplies part of the brain. This is the
most common.
2. A ruptured blood vessel in the brain. The build-up of blood ‘squashes’ an
area of the brain.

With either type of stroke the signs are similar, with the result that a part of the
brain dies. There is no age definition of a stroke casualty; anyone of any age

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can have a stroke.

Signs and symptoms of a stroke:

A stroke must be treated immediately. If you suspect a stroke, carry out the
following FAST test:

F Facial weakness
Can the casualty smile? Has their mouth or eye drooped?
A Arm weakness
Can the casualty raise both arms?
S Speech problems
Can the casualty speak clearly? Do they have problems understanding
you?
T Time to call 999
If the casualty fails any of these tests, call 999 immediately as a stroke is
a medical emergency.

There may be other signs to look for, but the FAST check is the quickest and
may save time. However, please note the following may occur:

 One side of the face or body becomes suddenly numb.

 Loss of balance.
 Lack of co-ordination.
 Suddenly developing a severe headache.
 Sudden confusion.
 Problems seeing with one or both eyes.
 Pupil size becomes unequal

Treatment of stroke:
 Clear the airway and maintain breathing.
 DIAL 999 FOR AN AMBULANCE IMMEDIATELY.
 If the casualty is unconscious, place in the recovery position.
 If conscious, lay the casualty down with their head and shoulders raised.
 Be sure to talk to and reassure the casualty. Just because they may not be able
to speak, they still may be able to understand and react to you.
 Monitor their breathing, pulse and response levels. Keep a record if possible
for when the ambulance arrives.

Hypoxia

Hypoxia means low oxygen in the blood stream. This condition has the
potential to be fatal, so it is vital for a first aider to recognise the signs and know
how to treat the casualty.

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There are five categories for the causes of hypoxia. These are:

External causes
There is not enough oxygen in the air surrounding the casualty, such as:
 Suffocation by smoke or gas.
 Drowning.
 Suffocation by earth, sand or a pillow/cushion, etc.
 High altitude (lower oxygen levels)

Airway causes
These can be swelling or narrowing of the airway caused by:
 Swallowing or swelling of the tongue.
 Vomit.
 Choking.
 Burns.
 Strangulation.
 Hanging.
 Anaphylactic shock.

Breathing causes
The lungs are unable to function properly, caused by:
 Crushing of the chest.
 A collapsed lung.
 Injury to the chest.
 Poisoning.
 Asthma attack.
 Disease or illness.

Circulation causes
Oxygenated blood is unable to circulate around the body, falling blood pressure,
or oxygen is not absorbed by the blood, caused by:
 Heart attack.
 Cardiac arrest.
 Angina.
 Severe bleeding.
 Poisoning.
 Anaemia.

Control centre causes

The respiratory control centre in the brain, or the nerves connecting it to the
lungs, fails, caused by:
 Stroke.
 Head injury.

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 Drug overdose.
 Poisoning.
 Spinal injury.
 Electric shock.

Signs and symptoms of hypoxia

 Skin appears pale and feels clammy to the touch. For dark skinned casualties,
check the skin inside the lips and eyelids.
 A bluish tinge to the casualty’s skin and lips (cyanosis).
 Increased pulse.
 Weakening pulse.
 Nausea or vomiting.
 An increase to the casualty’s breathing rate (caused by lack of oxygen).
 A decrease to the casualty’s breathing rate (check for control centre causes).
 Distressed breathing, or gasping.
 Confused or dizzy.
 Decreasing levels of consciousness.
 Look for clues from the cause of the hypoxia (bleeding, injury, chest pain,
etc.).

Treatment of hypoxia
 Clear the airway and maintain breathing.
 Try to remove or treat the cause of hypoxia (stop bleeds, open windows to
clear smoke or gas, etc.).
 Do not allow the casualty to eat, drink or smoke.

How the body responds to hypoxia

Adrenalin is released if the body detects that there are low levels of oxygen in
the blood. The effect this has on a body is:
 Increases the heart rate.
 Increases the strength of the heartbeat, and therefore blood pressure.
 Diverts blood away from the skin, stomach and intestines.
 Diverts the blood towards the brain, heart and lungs.
 Dilates the air passages (bronchioles) in the lungs.

Adrenaline being released into the body has a dramatic effect on the signs and
symptoms that it is vital you as the first aider recognise.

The respiratory system

Air is taken in through the nose and mouth where it is warmed, filtered and
moistened. It then travels through the throat and past the epiglottis (the flap of

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skin at the back of the throat that closes over the airway when we swallow),
where it enters the larynx (the voice box or ‘Adam’s apple’). It then continues
between the vocal cords in the larynx and on into the trachea (windpipe). The
trachea is protected by cartilage rings that surround it and stop it from kinking.
The trachea then splits into two ‘bronchi’, each supplying oxygen to a lung.

The bronchi are divided into ‘bronchioles’, or smaller air passages. Right at the
end of the bronchioles are ‘alveoli’, microscopic air sacks. The walls of the
alveoli are one cell thick, which allows oxygen to pass through them and into
the blood, which is carried in capillaries around the alveoli. The waste gas from
our body is carbon dioxide, which passes from the blood through the alveoli and
is breathed out.

The ‘thoracic cavity’ is in the chest, and is where the trachea, bronchi and lungs
are all situated. To enable us to draw air into the thoracic cavity, the diaphragm
flattens and the chest walls expand, which increases the size of the thoracic
cavity creating a void which draws in air.

Each lung is encased in a two layered membrane known as the ‘pleura’.

Between these two layers is a thin layer of fluid called ‘serous fluid’. This
allows the chest walls to move without friction.

The ribs curl around from the spine, connecting to the sternum (breast bone),

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and protects the thoracic cavity.

‘Normal’ respiratory rates Breaths per minute

Adult 12 - 20

Child 20 - 40

Baby 30 - 60

Choking

Choking is a very common occurrence, and is probably one of the most useful
skills you can have as a first aider. Choking can lead to tragedy if not dealt with
properly.

Signs and symptoms

 Casualty is unable to talk, breath or cough.
 They may be gasping and clutching their throat.
 They may appear distressed.
 They may become pale and show signs of cyanosis in later stages.
 Becoming unconscious.

Treatment of an adult or child over 1 year:

Ask the casualty if they are choking firstly to establish this is the case. If they
are not doing so already, ask them to cough as this will usually dislodge minor
obstructions. However, if this doesn’t work, follow the steps below:

1 – Back slaps
 If there is no help around, shout for help. Do not leave the casualty alone.
 Bend the casualty forward at the waist so their head is lower than the chest. If
the casualty is a young child, you can place them over the knee to help with
this.
 Find the hollow spot between the shoulder blades and administer five firm
slaps with your open hand. Make sure to check between blows if the
obstruction has dislodged.
 If this does not work, go to step 2.

2 – Abdominal thrusts (Heimlich Manoeuvre)

 Stand (or kneel if it is a child) behind the casualty and place both your arms
around their waist.
 Make a fist and place it just below the casualty’s ribs with your thumb facing
inwards (as if you’re looking at a watch).

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