FIRST AID SERIES

PART 1: ELEMENTARY FIRST AID

 FIRST AID SERIES
PART 1: ELEMENTARY FIRST AID

A VIDEOTEL PRODUCTION
The Producers would like to acknowledge the assistance of:

International Maritime Organization (IMO)

Shell International Ltd
Warsash Maritime Academy
Casualties Union
St John Ambulance

CONSULTANT: SANDRA ROBERTS

FRASER BETTS
PRODUCER: KATHREIN GÜNTHER
DIRECTOR: STEPHEN SAUNDERS

WARNING
Any unauthorised copying, lending, exhibition diffusion, sale, public performance or other exploitation of this
workbook and accompanying video is strictly prohibited and may result in prosecution.

COPYRIGHT © VIDEOTEL 2009

This video and accompanying workbook training package is intended to reflect the best available techniques and
practices at the time of production. It is intended purely as comment. No responsibility is accepted by Videotel,
or by any firm, corporation or organisation who or which has been in any way concerned, with the production or
authorised translation, supply or sale of this video for accuracy of any information given hereon or for any
omission here from.
CONTENTS HOW TO USE THIS WORKBOOK
HOW TO USE THIS WORKBOOK 5 This workbook has been written to accompany the video First Aid Series Part 1 –
INTRODUCTION 6 Elementary First Aid (STCW Code Section A-VI/1-3).

OBJECTIVES AND PRIORITIES OF FIRST AID 6 The video and workbook training package will assist with the underpinning knowledge
MANAGING A FIRST AID SITUATION 7 of first aid but it is important to remember that first aid requires practical skills. This
► ASSESSING THE SCENE AND DANGERS 7 programme supports, but does not replace, statutory first aid training required by
► ASSESSING THE CASUALTY 7 seafarers under the STCW code.
► GETTING HELP 8
► TREATING THE CASUALTY 9
► DEALING WITH THE AFTERMATH 9 USER GUIDANCE
ANATOMY AND PHYSIOLOGY 9 ★ The programme may be used by individuals, or in small groups for training
RESUSCITATION 10
★ It is essential to work through the programme systematically and NOT to miss any
► INTRODUCTION 10
► BASIC LIFE SUPPORT (BLS) 10 section
► USE OF ADJUNCTS 13
★ Do not proceed to the next topic until everything watched and read has been
► DROWNING 14
► SUMMARY 14
understood

AUTOMATED EXTERNAL DEFIBRILLATION (AED) 15 ★ If something is not understood, replay the video section and read the relevant
THE UNCONSCIOUS CASUALTY 16 chapter in the book again
MONITORING THE CASUALTY 17
★ To fully understand the contents it will usually be necessary to watch the video more
SECONDARY SURVEY 18
than once, as well as re-reading the supporting workbook
CHOKING 19
★ At the end of the workbook there are questions to test your knowledge
SHOCK 20
WOUNDS AND BLEEDING 21
► EXTERNAL BLEEDING 22
► INTERNAL BLEEDING 24
BURNS 27
► HEAT BURNS 27
► COLD BURNS 28
MOVING A CASUALTY 29
FIRST AID KITS 31
BANDAGING 32
HEALTH AND HYGIENE 32
TEST QUESTIONS 34
TEST ANSWERS 36 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 5
 Think about the immediate space around
INTRODUCTION MANAGING A the casualty. When kneeling to manage a
FIRST AID SITUATION casualty look out for splinters, broken
Ships can be hazardous places, and even with good safety procedures and well trained
glass or spills which could cause harm to
crews accidents and illnesses may happen at any time. The life of a fellow mariner or a
The time it takes and the methods used the rescuer.
passenger could depend on the help given in just such an emergency. Knowledge and
may vary according to circumstances, but
practice of first aid could be the difference between life and death for a casualty. There will be possible dangers specific to
this process will always be carried out.
the area on board ship e.g. hot cooking oil
This workbook details the basic immediate first aid that all seafarers need to be familiar Management of a first aid situation includes:
in a galley, open hatches.
with, and will have undertaken training in, to satisfy their first aid training requirements in
★ Assessment of the scene and dangers
accordance with the STCW Code (Section A -VI/1-3). People can be a danger if they are getting
★ Assessment of the casualty in your way or panicking. It is important for
Officers on board will have received additional training and be more experienced in
★ Raising the alarm the first aider to take control of the
dealing with both first aid and medical care.
★ Treating the casualty situation and give instruction to others.

★ Dealing with the aftermath The casualty themselves could be a

OBJECTIVES AND PRIORITIES OF FIRST AID danger if they are uncooperative. If they
are bleeding there are possible infection
ASSESSING THE SCENE AND
risks to consider.
The objectives of first aid can be remembered by using the “3 P’s”. They are DANGERS
Are there clues in the scene you observe ASSESSING THE CASUALTY
Preserve life Prevent further harm Promote recovery that may tell you what happened to the
casualty? The initial assessment of the casualty is
called the Primary Survey. This is the
Do not approach the casualty until it is
priority in any first aid situation and is also
These objectives will be demonstrated at all times when managing a casualty and will safe to do so. Assess the dangers to the
known as the ABC.
be mentioned throughout the video. rescuer and the casualty that may be
The priorities of first aid can be remembered by using DR ABC: present and make them safe. On board Does the casualty have an open AIRWAY?
ship there are many possible hazards that
D – danger Are they able to BREATHE?
could be a danger.
R – response Do they have a CIRCULATION?
Here are some possible dangers to be
considered. They may not always be Try and establish what injuries a casualty
A – airway
obvious. may have. Look for evidence of injury and
B – breathing
listen carefully to what the casualty is
C – circulation Fire Electricity Toxic fumes Water saying.

Enclosed spaces Unstable environment

Falling debris Trip hazards Infection

6 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 7
GETTING HELP bring with them useful items such as first their priority to 1 or 2. The first aider must death. A debrief on board will help, but
aid equipment, blankets or pillows. therefore constantly be assessing any some employers may provide additional
Help should be sought as quickly as casualties being cared for. help for seafarers in this situation by
possible. This may be as simple as When there is more than one casualty
offering to arrange counselling.
shouting “Help” as loudly as possible, they need to be prioritised. This is known
contacting the bridge or control room by as triage. TREATING THE CASUALTY
radio or telephone, or using a general Priority 1 Constantly be aware that dangers to ANATOMY AND
alarm call point. yourself or the casualty may be present.
► the casualty will die unless immediate
Remember the priorities of the 3 P’s in
PHYSIOLOGY
It is important that the bridge or control action is taken
room are given as much information as ► e.g. the casualty’s airway is blocked everything you do for the casualty and
possible so they have a full picture of what by the tongue falling back in constantly monitor the casualty’s ABC. To understand why first aid actions are
is happening and can pass on relevant unconsciousness, the first aider opens taken, it is necessary to have a basic
Remember some first aid situations
information to the first aid party when they the airway understanding of how the body works.
require urgent and instant action and
are detailed to assist. They should also be We all need oxygen to survive. We take
Priority 2 others may allow time to plan treatment.
kept informed of the progression of an oxygen in when we breathe. It is then
Never do something if not trained to do so.
incident as it is being dealt with. Good ► if action is not taken quickly the circulated around the body by the blood
communication is vital in any first aid casualty may die Treatments for specific injuries will be to the tissues. If breathing is affected by
incident. ► e.g. there is a major arterial bleed, the detailed in videos Part 1 and 2. illness or injury parts of the body may be
first aider raises the alarm while deprived of oxygen.
When calling for help the information that starting bleeding control DEALING WITH THE Brain cells start to die after only a few
will be required is:
minutes without oxygen and will not
Priority 3 AFTERMATH
★ The location of the incident recover. The heart stops working if it does
► minor injuries only
★ What has happened This element of first aid covers the not receive oxygen. In first aid, efforts are
► If the casualty is calling out for
practical things like re-stocking and made to ensure oxygen continues to
★ What help is required attention or is in pain they are
replacing first aid kits, cleaning up any reach vital organs.
★ How many casualties there are breathing! The first aider will put them
blood or body fluid spillages in a safe
in a safe position and return to treat Blood circulates around the body pumped
★ What injuries the casualties have manner, safe disposal of used dressings
their injuries later by the heart. The vessels that carry blood
and completion of accident reports.
The location should always be repeated at from the heart to all parts of the body are
Priority 4
the end of the message to ensure there is As well as dealing with practical issues, called arteries; those that bring it back to
no delay in help arriving. ► the casualty is dead or unsalvageable consideration needs to be given to the heart are called veins.
► there is nothing the first aider can do emotional needs. Attempting resuscitation
If someone is sent for help they should be for the casualty When a casualty is bleeding, it is
or involvement in a major incident can be
given this information to pass on and important to recognise the type of
very traumatic for all involved. Never be
should be told to return to the scene. This It should be remembered that a casualty’s bleeding as this will dictate the speed of
afraid to talk about what happened. A
allows them to relay any messages but condition may change. A casualty initially the action to be taken.
feeling of guilt is often experienced
also to assist with the incident. If possible assessed as a priority 3 with a broken arm
especially in cases of serious injury or Arterial blood is being pumped from the
they should not return empty-handed and may have hidden injuries which changes

8 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 9
 heart to the tissues and contains oxygen to respond to using an Automated R is for Response.
which makes the blood appear bright red External Defibrillator (AED). Key features of Shout at the casualty as you approach B is for Breathing
in colour. A cut artery will spurt blood. the chance of survival are known as the them. If they respond they should be told Keeping the chin supported, you
chain of survival. These are: to stay still. If there is no response to now need to check for breathing.
Venous blood is on its way back to the
shouting, you should kneel by the casualty With your head next to the face of
heart, having delivered oxygen to the ★ Early Access – finding the casualty
and place a hand on their forehead to stop the casualty, keep the chin supported
body. It is a darker red in colour as it no quickly
their head from moving. Shout again at the and look, listen and feel for evidence
longer contains oxygen, and blood from a ★ Early CPR – commencing effective
casualty while gently tapping and shaking of normal breathing for no longer
damaged vein flows, gushes or pools. CPR as soon as cardiac arrest is
their shoulders. If there is still no response, than 10 seconds. Can you feel
Capillary blood, which is from the smallest identified
turn the casualty onto their back if they breath on your cheek? Can you see
of the blood vessels, oozes out. ★ Early defibrillation – using an AED to are not already in that position. At this the chest rise and fall? Can you hear
shock the heart, preferably within 8 point, if you have not already done so, you
Major organs are sited in the chest and any sounds?
minutes of collapse should shout for help.
abdomen, and recognising when these
may have been injured is discussed later ★ Early advanced care – getting the
in this workbook. casualty to medical help quickly.
A is for Airway
If all links in this chain are in place the
chance of survival is between 20 - 40%. You need to make sure that the
RESUSCITATION However, research has shown that the casualty has an open airway.
survival of the casualty may depend on Keeping your hand on their forehead
the early commencement of CPR. gently tilt the head back. Place your
INTRODUCTION fingertips under the chin and lift the
In the majority of cases of cardiac arrest chin up. This action opens the
This section describes Cardio Pulmonary
the casualty has collapsed suddenly and airway by moving the tongue away
Resuscitation (CPR), also known as Basic
there will still be oxygen in their blood. The from the airway entrance.
Life Support (BLS). This is a technique
priority is to circulate this oxygen by
that attempts to maintain the provision of
commencing compressions as soon as Do not confuse irregular noisy gasps for
oxygen to the brain and to the heart when
possible. normal breathing. If you doubt that
the heart has stopped beating – i.e.
cardiac arrest. The section also includes breathing is normal act as if it is not and
information on resuscitation in specific BASIC LIFE SUPPORT (BLS) continue with resuscitation.
scenarios e.g. drowning, and the use of If the casualty is not breathing raise the
Use the initials DR ABC to remember the
equipment that may be available. alarm if you have not already done so.
sequence of events.
The likelihood of cardio pulmonary This may mean leaving the casualty.
D is for Danger.
resuscitation restarting the heart is
First make sure that you, the casualty and
remote. It buys time, helps keep the brain
any bystanders are safe.
alive and helps keep the heart more likely

10 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 11
 If rescue breaths did not make the chest
C is for Circulation Compression Mouth-to-mouth rise and fall, check the mouth for visible
It’s time to start chest compressions Positioned vertically over the After 30 compressions, open the obstructions and ensure that head tilt and
to restore circulation and make sure casualty, and with arms locked airway using the head tilt chin lift chin lift are adequate before the next
the brain continues to receive oxygen straight, i.e. hand, elbow and method. Pinch the soft part of the attempt at breaths. Do not attempt more
while you wait for help. Kneeling by the shoulder in line, press down on the nose using your thumb and index than two breaths before returning to
side of the casualty, place the heel of breastbone to a depth of 4 - 5 cm. finger of one hand. Maintain chin lift compressions.
one hand in the centre of their chest. After each compression release all with the other hand keeping the Do not interrupt resuscitation. Only stop
Place the heel of the other hand on the pressure on the chest, letting it mouth open. Take a normal breath CPR if you are in danger, exhausted, or if
top of the heel of the first. Interlock return to its original position, but do and place your lips around the help arrives to take over from you.
fingers and raise them off the chest not remove hands from the chest. casualty’s mouth making sure there is
The rescuer becomes tired after only a
ensuring no pressure is applied on a good seal. Blow steadily in the
Repeat this at a rate of 100 per minute of CPR. Where two rescuers are
the ribs. No pressure should be put mouth and watch for the chest to
minute - a little less than 2 present they should take turns, swapping
on the lower end of the breast bone rise as in normal breathing. This
compressions per second. over every two minutes, attempting to do
or the upper abdomen. takes about 1 second. Take your
Compression and release should so without any break in the CPR.
mouth away and watch for the chest
take an equal amount of time.
to fall as the air comes out. Repeat If you are unable to do ventilations
Complete 30 compressions.
this once more. This completes two because of infection risk, presence of
effective rescue breaths. blood or vomit, or suspicion of poisoning
it is important to still do compressions.
Continue compressions without any break
until help arrives.

CPR can only be undertaken in an

environment in which it is safe to breathe.
A casualty may need to be rescued and
moved to a safe environment before CPR
can commence, for example from an
enclosed space.

USE OF ADJUNCTS
A face shield is simple to use and may be
used by a first aider. It offers protection by
Return to the chest without delay and give
providing a barrier which prevents direct
30 more compressions. Continue with a
contact with the casualty’s face and their
ratio of 30 compressions to 2 breaths.
body fluids. Several types are available.

12 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 13
 Be aware that using a face shield may not electrode pads to the chest, following the
AUTOMATED
protect the rescuer from any poison that is A SUMMARY OF ADULT voice prompts.
on the casualty’s face or has been inhaled. BASIC LIFE SUPPORT EXTERNAL Place one AED pad to the right of the
DEFIBRILLATORS sternum, below the clavicle. Place the
DROWNING other pad in the mid-axillary line. This
(AED) position should be clear of any breast
UNRESPONSIVE
Where a casualty has been rescued from
tissue. It is important that this electrode is
drowning, they have not been breathing The heart beat is controlled by electrical placed sufficiently laterally. In order to
and do not have oxygen in their blood to activity generated from within the heart. improve efficiency, place the mid-axillary
be circulated. If the casualty is not SHOUT FOR HELP When the heart is damaged for any reason, pad with its long axis vertical.
breathing, give 5 rescue breaths first and usually after a heart attack, the normal
then continue with compressions and electrical impulses may be affected and in
ventilations at a ratio of 30:2. their place there is wild, uncoordinated
OPEN AIRWAY electrical activity. When this happens the
RESUSCITATION SUMMARY heart is unable to beat and circulate blood
around the body.
On board ship there is additional
IS BREATHING NORMAL? An Automated External Defibrillator (AED)
equipment available to aid resuscitation
but it should only be used by those who is a computerised device that delivers a
have had advanced medical training and controlled shock to the heart to stop this
are familiar with its use. wild electrical activity and allow normal
RAISE THE ALARM WITH THE function to return.
The initial priority of the first aider is to BRIDGE / CONTROL ROOM
raise the alarm and commence basic life AED are simple to use and have audio
support. They should not use equipment and visual prompts for the user. There are
unless they have been trained to do so. two types of AED. Most are semi
30 COMPRESSIONS automatic, but a few fully automatic AED
are also available. All AED analyse the
casualty’s heart rhythm, determine the
need for a shock, and then deliver the
2 RESCUE BREATHS shock. Be aware that the chance of
success declines by more than 10% with Although most AED pads are labelled left
each minute that passes. Although simple and right, or carry a picture of their correct
to use, training is required, and not all placement, it does not matter if they are
30 COMPRESSIONS
ships carry AED. reversed. When this has happened, the
2 BREATHS
pads should not be removed and replaced
Start CPR without delay. When the AED
as this wastes time and they may well not
arrives, switch it on and attach the

14 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 15
 adhere adequately when re-attached. Kneel next to the casualty and straighten
THE UNCONSCIOUS both their legs. Remove any glasses or
MONITORING THE
If two people are present CPR should be
continued while the AED is being set
CASUALTY goggles. Quickly check there are no items CASUALTY
in the pockets that may cause harm to the
up. Make sure that nobody touches the
The immediate threat to life in an casualty when they are turned onto their All casualties will need to be carefully
casualty while the AED is analysing the
unconscious casualty is an airway side. Place the nearest arm out at right monitored. Check their breathing and
heart rhythm.
obstructed by the tongue preventing angles to the body with the elbow bent pulse regularly. Assessment of the skin is
If a shock is advised, the equipment will and the palm uppermost. Bring the
breathing. This section describes the important as it can indicate, for example,
give warning to stand clear of the patient. casualty’s opposite arm across the chest
causes of unconsciousness, how to shock. An unconscious casualty will also
Instruct everyone in the area to stand clear, and hold the back of the casualty’s hand
position an unconscious casualty and have their level of consciousness
then push the shock button as directed. against their cheek with your own palm.
why, and how to assess levels of monitored as well as their pupils.
Continue to follow the voice prompts. Do not let go. This hand supports the
consciousness.
head as the casualty is turned. These observations are listed here. Initially
If no shock is indicated, immediately
The causes of unconsciousness are the first aider may be carrying out these
resume CPR using a ratio of 30 With your other hand grasp the leg
numerous, and may be related to injury or checks every 10 minutes, so it is
compressions to 2 rescue breaths. furthest away from you just above the
trauma, medical conditions or important to record findings. Breathing is
Continue to follow the voice prompts. It is knee and pull it up keeping the foot on the
environmental conditions. The role of the checked every 1 – 2 minutes. Remember
important to follow the voice prompts ground. Pull this leg towards you to roll the
rescuer is to position the casualty to that brain cells start to die off after a few
exactly. casualty on their side. Tilt the head back
secure the airway and to identify possible minutes without oxygen.
The AED machine on board will be causes of the unconsciousness. to make sure the airway remains open.
maintained by the person in charge of The casualty’s hand may be adjusted
Check the casualty is actually under the cheek to support the head or a LEVEL OF CONSCIOUSNESS
medical care on board. Although AED are
unconscious by using the ABC approach pillow may be used. Adjust the upper leg
simple to use, all users need to be This is assessed by using “AVPU”.
as in resuscitation. Once breathing is so the hip and knee are at right angles.
adequately trained, with periodic refresher
confirmed, the casualty must be placed in A is for Alert.
training. Both the initial and the refresher Breathing must be checked frequently –
a safe position to ensure the airway Is the casualty alert? Can they state their
training must be provided by qualified every 1 to 2 minutes. If the casualty is not
remains open, and to prevent the name and ship?
individuals. breathing roll them onto their back and
inhalation of vomit.
commence the resuscitation routine. V is for Voice.
Do they respond to voice commands? To
If the casualty has to be kept in the
THE RECOVERY POSITION what extent do they respond?
recovery position for more than 30
minutes turn them to the opposite side to P is for Physical Stimulus.
relieve pressure on the lower arm. Do they respond to physical stimuli? Will a tap
and shake get a response or is pain needed?
Any injury the casualty has suffered may
Check for pain response by applying
determine which side they should be laid
pressure to the nail bed of the finger.
on in the recovery position.
U is for the casualty being unresponsive.

16 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 17
 PUPILS SKIN doing this as a protection against blood or the upper part of their abdomen. Clench a
other body fluids that may be present. fist and place it midway between the belly
The pupil is the black hole in the centre of The colour of the skin can be a good button and the bottom end of the breast
the coloured part of the eye. Pupil size indicator of the casualty’s condition. What bone. Grasp this hand with the other and
and reactions can indicate a problem colour is it? Pale skin may indicate shock.
within the brain itself. Blue tinged skin indicates a severe lack of
CHOKING pull sharply upwards and inwards. Repeat
up to five times checking after each thrust
oxygen. Is the skin hot or cold? Is it wet or to see if the object has dislodged.
Are they the same size? - Estimate the
dry? Are any marks or wounds visible? One threat to the supply of oxygen to the
diameter in millimetres of each pupil.
brain is choking. Foreign bodies may
Do they constrict when a light is shone in partially or wholly block the airway.
the eye? Normal response is to do so OTHER OBSERVATIONS
Choking commonly occurs when eating.
immediately. Test each eye in turn. The first signs are that the person will
Check in the pockets for additional
How quickly do they respond? information like medicines. Smell the have difficulty breathing and speaking,
breath for evidence of alcohol or other they may also point to their throat.
If pupils are not equal in size and do not
odours that may indicate possible medical It’s important not to confuse this
both respond immediately to light, this
conditions. The breath of a diabetic may emergency with other conditions that may
needs to be reported at once to the person
smell like acetone. cause severe respiratory distress such as
in charge of medical care on board ship.
heart attack or seizure. Always ask the
casualty ‘Are you choking?’ If the casualty
PULSE SECONDARY SURVEY answers ‘yes’ and is able to speak, cough Abdominal thrusts may cause serious
and breathe, encourage them to continue internal injury. Radio Medical Advice (RMA)
Feel for the pulse in the neck. It is found at should be obtained if they have been
coughing, but do nothing else.
the side of the voice box. This is the carotid The secondary survey is sometimes called carried out and the casualty observed for
artery, a major artery close to the heart. If the the “head to toe” or “top to toe” as it If the casualty is unable to speak, or evidence of internal injury.
casualty’s pulse is weak it may still be felt here. describes what the first aider does – unable to breathe but is still conscious,
looking for evidence of other injuries, attempt to dislodge the foreign body. Please also see ‘Summary of adult
The pulse may also be taken at the wrist. choking’ table on page 20.
working down the body from the head. Stand beside the casualty and lean them
How many beats per minute? Is it strong
The secondary survey establishes the forward supporting them with an arm.
or weak? Is it regular or irregular?
presence of other injuries which may not Give up to five sharp blows between the
have been apparent initially. The casualty shoulder blades with the heel of the other
BREATHING may be able to give information about hand. Check after each slap to see if the
pain they are experiencing, but the survey object has dislodged.
Every 1 – 2 minutes check to ensure the should always be fully carried out by the
casualty is still breathing. Is the breathing If this does not relieve the situation, the
first aider, whether the casualty is
noisy? Fast or slow? How many breaths next technique to try is the abdominal
conscious or unconscious.
per minute? Is the chest moving evenly? thrust. Stand behind the casualty and lean
It is sensible to be wearing gloves when them forward, putting both arms around
Does it hurt to breathe?

18 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 19
 them when dealing with a casualty. In the Prevent heat loss by covering the casualty
SUMMARY OF ADULT CHOKING early stages of an emergency these signs and if possible lying them on something
are easily missed. rather than directly onto a cold steel deck.
Constantly reassure the casualty and try
ASSESS SEVERITY Lack of oxygen reaching the brain may
to keep them comfortable.
cause drowsiness, confusion, agitation or
dizziness. Pale, cold, clammy skin occurs Remember that shock can happen at any
as the body withdraws the blood supply time during an emergency. It’s important
SEVERE AIRWAY MILD AIRWAY
from the skin and diverts it to vital organs. to keep monitoring the casualty even if
OBSTRUCTION OBSTRUCTION
(Ineffective cough) Thirst, nausea and vomiting, rapid shallow their condition appears to have been
(Effective cough)
breathing and a fast weak pulse can also stabilised.
be found in a shocked casualty.

Always remember ABC and ensure the

Unconscious Conscious Encourage cough casualty is breathing. Deal with the cause WOUNDS AND
Start CPR 5 back blows Continue to check
5 abdominal for deterioration to
of the shock. Unless they are in danger do BLEEDING
not move the casualty as this may worsen
thrusts ineffective cough or
relief of obstruction the shock, but protect them from the
elements if they are outside. In many casualty situations, dealing with
minor or life threatening bleeding will be
required. It is important to recognise
TREATMENT different types of bleeding and to know
★ Severe pain
SHOCK Lay the casualty down flat on their back
how to deal with them quickly and
★ Injury effectively. At sea, where medical help is
and raise their legs if the injury allows this
★ Allergy not readily available, it is vital that all
Shock is a lessening of the vital activities of (see diagram). This helps blood flow to the
★ Infection seafarers know how to stop bleeding that
the body, caused by injury or illness. It is a core body organs. Loosen tight clothing at
is potentially life threatening.
physical condition and should not be ★ Fluid loss the neck and waist to aid breathing. Moisten
confused with emotional shock. It may ★ Medical conditions their lips but do not allow them to eat or Bleeding may be external with blood easily
result in unconsciousness and death if not drink. This is likely to cause vomiting and seen. Internal bleeding may not be visible
managed immediately. The speed of onset Fluid loss may be caused by bleeding, the airway may then be compromised. unless it is able to exit from the body.
of shock will vary and may not depend on diarrhoea and vomiting, or burns. Shock Cover the casualty to prevent them losing
the severity of the injury. can be also brought on by medical heat but do not over warm them.
conditions such as a heart attack.

CAUSES THE SHOCK POSITION

SIGNS AND SYMPTOMS
Shock can have many different causes. It
may be the result of: There are many different symptoms of
shock, and it is important to be aware of

20 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 21
 EXTERNAL BLEEDING bleeding wound. dressing has been secured, as the the first aider will need assistance. If
dressing by itself will not stop severe alone, they should maintain the indirect
Identifying Type of Bleeding If a foreign body is present, pressure
bleeding. Do not remove any dressings pressure.
It is important to identify the type of visible should be applied to the wound at the
applied. If blood soaks through, add
bleeding. This will determine the severity base of the penetrating object. Try and Indirect pressure must only be maintained
another dressing on top, up to a
of the bleeding and the speed of response elevate the wound as high above the level for a maximum of ten minutes. Blood
maximum of two.
required. The appearance of blood will of the heart as possible. This helps to supply is being cut off from the whole
vary depending on whether the blood is slow the flow of blood and allow clotting Where there is a penetrating object, limb, not just the wound, and tissue is
going to or from the heart. Arterial blood is to take place. padding should be applied at the base of being deprived of oxygen. If pressure is
being pumped from the heart and the object and held in place. No pressure maintained for longer than ten minutes
Make sure the casualty is in a safe
contains oxygen. It is bright red and must be put on the object, nor any healthy tissue will start to die and the limb
position. Sitting on the floor is safest but if
spurting. Arterial bleeding is life attempt made to remove it. is being put at risk.
the bleed is severe, shock will happen set
threatening and requires urgent action. in quickly and the casualty should be laid Indirect Pressure At the end of ten minutes, very slowly
Venous blood is on its way back to the down in the shock position. Remember In an arterial bleed, direct pressure to the release the indirect pressure while
heart, having delivered oxygen to the that the casualty will be unable to maintain wound may not be sufficient to stop maintaining pressure over the wound itself
body. It is dark red, and flows, gushes or adequate pressure and elevation for long bleeding. If the bleeding continues and together with elevation. Indirect pressure
pools. Capillary blood, which is from the as they become weaker and more dressings applied are soaked in blood, the may be reapplied once the limb has
smallest of the blood vessels, oozes out. shocked. flow of blood must be controlled by returned to normal colour.
Control of Bleeding restricting it at a point distant to the
If the bleed is arterial, a casualty should
To control external bleeding two things are wound. This is known as a pressure point.
not be left alone. Rather than leaving them INDIRECT PRESSURE POINTS
needed – pressure and elevation. It can be found where an artery is lying
to raise the alarm, hit the nearest general
close enough to the surface to be felt and
Where there is visible bleeding, identify the alarm button or shout out to colleagues
where it can be compressed against an
type of bleeding, and the exact location of and apply direct pressure by any means
adjacent bone. This compression will
the wound. Check whether there are any until help arrives. Remember a first aid kit
restrict the blood flow through the artery.
penetrating objects, and if there are, do is not required to control bleeding. It is
not remove them as this could worsen the pressure and elevation that control If bleeding is in the leg, there is a pressure
situation. bleeding. point in the groin (femoral artery). In the
arm there is a pressure point in the upper
Apply direct pressure to the wound. This Apply a dressing directly over the wound.
arm (brachial artery). These pressure
needs to be firm and constant. It does not matter if the dressing looks
points are labelled on the diagram.
bulky or unsightly as long as it helps to
If possible, the rescuer should get the
stop the bleeding. A neatly secured It is important to maintain elevation while
casualty to apply initial pressure
dressing pad and bandage may not do indirect pressure is being applied. Direct
themselves, whilst the rescuer protects
this. Any pad may be used if first aid pressure should also be maintained while
themselves from blood contact. This may
dressings are not immediately to hand. indirect pressure is being carried out. A
be by putting on gloves or just using any
single first aider is able to do this if the
barrier preventing direct contact with the Continue to apply pressure even when the
bleed is in the arm but for a leg bleed,

22 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 23
 A tourniquet should only be used when been from an arm wound the limb may be
bleeding cannot be controlled by direct or immobilised in a sling to keep it still or to EXTERNAL BLEEDING SUMMARY TABLE
indirect pressure, and blood loss has maintain elevation.
become life threatening. It is a tight,
Dressings should be checked for evidence What How and why
encircling dressing which completely
of renewed bleeding. The circulation to a
restricts all blood flow to a limb. It should Sit them or lie them down. Place directly in the
limb below the wound should be Casualty safety
be placed as close to the wound as shock position if the bleed is major.
monitored. If the limb below the dressing
possible to limit tissue loss and be tied as
is cold to touch, looks pale or blue and Identify the type of To determine the urgency and seriousness of the
tightly as possible. Once in place the
the casualty complains of numbness or bleeding situation.
tourniquet stays there and should not be
tingling the circulation may be restricted. It
released. Radio Medical Advice should To ensure direct pressure is placed in the correct
may have been damaged by the injury or Identify the wound
always be sought if a tourniquet is used or place.
is restricted by a dressing which is too
being considered for use. Record the time
tight. It may be necessary to release the
the tourniquet was applied. Identify penetrating To ensure pressure is placed at the base of the
pressure on an encircling dressing if it is object and not on top of it.
objects
too tight.
MANAGING THE CASUALTY Must be placed directly over the bleeding wound to
The key things to consider when dealing Apply direct pressure
restrict blood flow and encourage blood clotting.
Manage any shock and if the casualty with an external bleed are shown in the
becomes unconscious place them in the ‘External Bleeding Summary Table’. This restricts blood flow, reduces blood loss and
Elevate the wound
recovery position while continuing to stop allows clotting to take place at the wound.
the bleeding. Try to keep the wound
INTERNAL BLEEDING To restrict the blood flow when it is not possible to
elevated as high as possible. For example
Apply indirect pressure control bleeding by direct pressure. Maximum time
if a wound is on the right arm the If blood cannot escape from the body,
is 10 minutes. Release slowly. May be reapplied.
unconscious casualty should be placed internal bleeding can only be recognised
on their left side. This will allow the arm to by the symptoms of shock that the A last resort in life threatening bleeding only. Goes
be raised as high as possible, as well as casualty will be displaying. History of an Apply tourniquet on and stays on. Place as close to the wound as
allow easy access to the upper arm if injury having occurred, or illness of the possible.
indirect pressure is needed. Although a casualty, will also offer clues. The casualty
Check the circulation beyond the wound and
wound may be obvious, damage to may also be in pain.
bandaging. If necessary release pressure slightly
underlying structures may also have taken Monitor injury
In some situations evidence of internal from an encircling dressing.
place and the casualty should be bleeding may be seen, for example Check for renewed bleeding.
monitored closely. coughing up blood after a chest injury or
Check for shock and manage immediately if
Keeping the casualty still will help slow passing blood in urine after a back injury.
Monitor casualty recognised.
down the blood flow so, unless in danger, The blood is escaping from the body
Check pulse and breathing.
a casualty should not be moved until the through an orifice, or opening. The
bleeding is under control. If the bleed has appearance of the blood will depend on

24 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 25
 the cause of the bleeding and its location. before attempting to give first aid. This is
INTERNAL BLEEDING SUMMARY TABLE Some examples of this are shown in the particularly important in cases of chemical
Internal Bleeding Summary Table. When it or electrical burn.
Internal Bleeding Recognition is seen as obvious red blood it is called
The severity of a burn depends on both
frank blood. When it has been altered
the depth and area of the skin that has
Orifice Revealed in Description Possible cause and is not an obvious red it is called
been affected.
occult blood.
Nose anything from (i) frank blood (i) damage to blood vessels The depth of a burn is described as
a slight trickle (ii) straw coloured in the nasal passages – a The first aider should manage any shock
superficial, partial or deep. A superficial
to a profuse fluid simple nose bleed and monitor the casualty, but the overall
burn is red and tender with no blisters. A
flow (ii) leakage of cerebrospinal care will be managed by the person in
fluid after a head injury partial thickness burn is red and tender
charge of medical care on board who will
with the formation of blisters. The most
Ear trickle or (i) frank blood (i) damage to eardrum or get Radio Medical Advice.
serious category, deep burns, are those
steady flow (ii) straw coloured ear canal involving most layers of the skin. Deep
fluid (ii) leakage of cerebrospinal
burns may appear white or charred
fluid after a head injury
BURNS depending on the cause and there may
Mouth (i) vomit (i) frank blood or (i) evidence of bleeding in be no pain as nerves have been
(ii) coughed brown specks the upper gastrointestinal destroyed.
Burns may be caused by heat or cold.
up resembling coffee tract
grounds (iia) chest or facial trauma. Both may result in serious extensive tissue A further categorisation is made by assessing
(iia) frank blood Could be active bleed in damage that requires skin grafting. As well the area, or percentage of skin involved in
(iib) blood streaked stomach as treating the burn itself the first aider relation to the whole body. The casualty’s
sputum (iib) possible chest infection must always treat any shock. palm is used as a measuring template; it
or upper respiratory tract
trauma represents 1% of the body surface.

Anus (i) only blood (i) frank blood (i) piles (haemorrhoids)
HEAT BURNS Areas of the body where a burn is
(ii) faeces (iia) dark, tarry faeces (iia) bleeding in upper gastro considered complex are the face and
Causes
(iib) streaks of blood in intestinal tract neck, joints, hands, feet, genital area,
faeces (iib) bleeding in lower gastro Heat burns may be caused by dry heat
buttocks. This may be because of
intestinal tract such as touching something hot, wet
concerns about the airway as in facial
heat, such as steam or scalds from hot
Urethra (i) in urine (i) frank clotted blood bleeding may be from burns, because of the risk of infection,
liquids, or radiation such as sunburn.
(ii) urine stained pink / anywhere in the urinary tract loss of function, the emotional impact or
red Electrical, chemical and friction burns are
simply because they are in an awkward
(iii) not visible found also heat burns.
spot. Remember – if facial hair is singed
only on urine
Assessing a Burn the casualty should be monitored carefully
testing
When approaching a casualty who has for signs that the airway is swelling. Their
Vagina moderate to dark or bright red menstruation, miscarriage, been burned, make sure there is no breathing will become noisy and difficult.
severe flow injury, pregnancy complication further danger to you or to the casualty This is an emergency situation.

26 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 27
 Treatment charge of medical care on board ship. If The damaged tissue is pale, cold and takes careful planning. The person in
The first and most important action is to used before then, the cream or lotion will possibly hard to touch. There may be charge of medical care on board ship will
remove the casualty from the source of need to be cleaned off the burn for numbness, pins and needles or no oversee any movement of the casualty.
heat and cool the burn, preferably under accurate assessment of the wound. This sensation at all.
Consideration needs to be given to many
gently running cool water. If a burn is may cause further harm to the casualty as
Treatment different factors. These are:
immersed in water, the water will well as considerably increase their pain.
The treatment for a cold burn is slow and
eventually heat up so will need to be ★ the type of injury
Ongoing Care gentle re-warming. Limbs can be
changed frequently. Cooling should take ★ the condition of the injured person
After the initial first aid, the burn will be immersed in warm water at 40º C. Never
place for a minimum of 10 minutes. Ice ★ does the casualty need to be moved?
assessed by the person in charge of rub cold skin or use hot water bottles. As
should never be used to cool a burn as
medical care on board. When a burn is a temporary measure cold burns to the ★ availability of manpower
this causes further tissue damage. Special
over 10-15% Radio Medical Advice hands can be warmed by the casualty ★ availability of equipment
burns dressings may be used to cool a
should always be sought. Any burn 20% placing their hands in their armpits. Rings,
burn but where cool water is available it ★ what route is to be taken if the
or over is considered to be critical. In watches and other constricting items
should be used. casualty is moved?
children these percentages are should be removed as soon as possible.
Remove all constricting items such as considerably reduced. ★ safety of the casualty and the
It is important to remember that while the rescuers
rings, jewellery, watches, belts etc. as
A casualty with extensive burns is in casualty may appear to have no pain at
soon as possible. Swelling can happen ★ principles of moving and handling
danger of fluid loss and infection, and will the time of injury, when the cold tissue
very quickly. Do not attempt to remove ★ is evacuation imminent?
be severely shocked. The first aider can warms up sensation will return and may
fabric which is burnt onto the skin as this
assist in managing the shock and cause excruciating pain. Pain relief given
will cause further harm, but where hot fluid If a casualty is in danger they may need to
monitoring the casualty. by the person in charge of medical care
has been spilt onto clothing and the be moved at once, but it should only be to
on board may be required.
clothing can easily be removed this should Although the casualty is suffering from the closest place of safety.
be done. fluid loss no drinks should be given to
All unnecessary moves should be
them (see ‘Shock’) until Radio Medical
After cooling cover the burn with a light,
Advice has been sought. As well as MOVING A CASUALTY avoided. A casualty should not be moved
sterile, non-fluffy dressing. Cling film is also to one location e.g. the hospital on board,
information about the burn itself they will
useful as a temporary dressing. Special if it is known they are to be evacuated
want to know the time the burn occurred Unless the casualty is in immediate
burns dressings may also be used. Burnt soon from another. Move them directly
in order to calculate the specific fluid danger they should not be moved initially
hands may be placed in sterile plastic from the place of injury to the evacuation
requirements. other than to place them in an appropriate
bags found in burns first aid kits. point. This is particularly important if the
position according to their injury or illness. movement involves a stretcher and
Do not burst blisters as this will increase Moving a casualty inappropriately may
COLD BURNS considerable manpower. A walking
fluid loss from the casualty and put them worsen bleeding, deepen shock and can casualty with a minor injury may safely be
at greater risk of infection. Do not apply Cause and Recognition potentially be life threatening. moved to the hospital once their injury is
any creams or lotions at the first aid stage. Cold burns can be caused by environmental
Once the casualty is stable it may be under control, but a casualty in shock
These should only be used once the burn conditions, contact with something cold,
necessary to move them to a more should never be moved as it will worsen
has been fully assessed by the person in ice for instance, or by chemicals.
convenient place on board ship. This their shock.

28 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 29
 METHODS OF MOVING AND Three Hand Grip Two Handed Seat STRETCHERS
HANDLING (i) Arm injury Stretchers are available on board and it is
If a casualty is able to walk, the rescuer important that they are used correctly for
should walk on their injured side. If the both the safety of the casualty and the
casualty falls they will then fall onto the rescuer. Stretchers should only be used
support of the rescuer. by the first aiders if they have been trained
to use them.
There are various types of lifting methods
that can be used by two people to carry a There are many types of stretcher for use
third injured person, but remember that on board ship. One of the most common
manual carrying of a casualty could put is the Neil Robertson. It can be used to
the rescuer at risk of injury. Some of these rescue a casualty in a vertical lift as well as
manual two person lifts are pictured, help with immobilisation.
together with the hand grip that should be The Paraguard stretcher is a compact and
used. Two Handed Seat versatile rescue stretcher, designed for a
Two rescuers may link hands as shown in variety of emergencies. It is ideal for
these diagrams to create a seat. If the search and rescue operations and can be
three handed grip is used it leaves one used to rescue casualties from confined
rescuer with a free hand either to support spaces.
an injured leg or to give support behind Both of these stretchers feature in the video.
Two Handed Seat
the casualty.
(i) Leg injury

FIRST AID KITS

Four Hand Grip

The number and location of first aid kits

on board will vary according to the size
and type of vessel and the number of
crew. As well as in the hospital or on the
bridge, kits are usually found in the engine
room and the galley as these are high risk
workplaces. As well as standard kits
containing basic dressings there may also
be burns first aid kits available.

The first aid kit will contain wound

dressings in various sizes, and triangular

30 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 31
 bandages. These can be used in a ★ select the right bandage for the job ★ wear gloves
number of different ways to aid a casualty. ★ keep injured part supported ★ wash hands
As a minimum, the kit should include the ★ work from the front or injured side ★ avoid blood contact
following items in a portable waterproof of the casualty ★ cover cuts on own hands with
container. Medication and creams or ★ pass bandages under natural adhesive dressings
lotions should not be kept in the first aid hollows and slide into position ★ avoid injuring self
kit.
★ apply firmly ★ immunisation
★ 4 Triangular bandages ★ leave fingers or toes exposed if ★ correct cleaning up and disposal of
★ 6 Medium sterile unmedicated possible waste
dressings ★ ensure knots don’t cause
★ 2 Large sterile unmedicated dressings discomfort
★ 2 Extra large sterile unmedicated ★ secure loose ends
dressing ★ check circulation beyond bandage
★ 6 Medium safety pins, rustless
★ 20 Assorted elastic adhesive
Some tips to make bandaging easier are: TEST YOUR KNOWLEDGE
medicated dressings ★ keep the bandage tightly rolled AND UNDERSTANDING BY COMPLETING
★ hold bandage roll uppermost in
★ 2 Sterile eye pads with attachments
palm of hand
THE TEST QUESTIONS FOR PART 1.
★ 2 Packages containing sterile gauze
swabs ★ keep roll close to the part being
bandaged
★ 5 Pairs large disposable latex free
examination gloves ★ remember triangular bandages are
very versatile
★ Sterile eye wash in eye wash bottle

BANDAGING HEALTH AND

HYGIENE
Bandages may be used to secure dressings,
control bleeding, support and immobilise Preventing cross infection is part of the
limbs and reduce swelling. They may be role of the first aider. Just as the casualty
improvised from everyday items. The needs to be protected from infection so
basic principles of bandaging are: does the first aider.

★ explanation to casualty Protective measures that may be taken are:

★ make casualty comfortable

32 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 33
 9. A casualty is placed in the recovery
PART 1 - TEST Put the casualty in the recovery
position:
10% of the total body surface area
position 2% of the total body surface area
QUESTIONS Apply a tourniquet When they are in shock 5% of the total body surface area
Press directly on the wound To aid breathing
To maintain the airway 15. A chemical burn should be cooled
1. A casualty with a severe bleed at
5. When checking a casualty’s ABC To make them more comfortable for a minimum of:
the right wrist is unconscious. What
position would you place them in? how long do you allow in order to 10 minutes
check their breathing? 10. During resuscitation the rate of 15 minutes
In the recovery position on the right
5 seconds compression should be: 20 minutes
side
10 seconds 60 per minute 30 minutes
In the shock position with right arm
15 seconds 80 per minute
elevated
1 minute 100 per minute 16. A casualty is found collapsed in an
In the recovery position on the left
120 per minute enclosed space. What would the
side rescuer do first?
6. What is the ratio of ventilations to
Laid down flat on the deck chest compressions in 11. If you think a casualty is choking Carry the casualty to safety
resuscitation? you should first: Assess the casualty’s breathing
2. You are in a safe environment.
What is the first action you take on 2:30 Ask them if they are choking Raise the alarm
encountering a casualty who 2:15 Do 5 back slaps Stop any major bleeding
appears to be unconscious? 30:2 Do 5 abdominal thrusts
15:2 Open their mouth to check for any 17. Cold burns to the hands may be
Place the casualty in the recovery
warmed up by being rubbed.
position blockage
7. Indirect pressure should be:
Shout at the casualty to provoke a TRUE or FALSE?
response Kept in place for 10 minutes and 12. A casualty in shock has:
Feel for a pulse at the neck released quickly Pale clammy skin and slow pulse 18. A shocked casualty who is thirsty
Kept in place for 10 minutes and Pale dry skin and fast pulse may be given a drink of water.
Check breathing
released slowly Pale clammy skin and fast pulse TRUE or FALSE?
3. The immediate treatment for a hot Kept in place for 15 minutes and Pale dry skin and slow pulse
burn is to: released quickly 19. It is OK to just do chest compressions
Cool the area with water Kept in place for 15 minutes and 13. The severity of a burn is assessed by: during resuscitation rather than
Remove charred clothing released slowly Its depth and its cause compressions and ventilations?
Apply antiseptic cream Its area and its cause TRUE or FALSE?
8. Arterial blood is:
Apply a sterile dressing Its cause and its complexity
Bright red and gushing Its depth and its area 20. The casualty may be a danger to the
4. Your casualty has an arterial bleed Bright red and spurting rescuer.
at the wrist. The first aid treatment Dark red and spurting 14. The casualty’s palm is considered
is to: to be: TRUE or FALSE?
Dark red and gushing
Apply a wound dressing and sling 1% of the total body surface area

34 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID 35
 PART 1 – TEST
ANSWERS
1. c

2. b

3. a

4. d

5. b

6. a

7. b

8. b

9. c

10. c

11. a

12. c

13. d

14. a

15. c

16. c

17. False see page 29

18. False see page 19

19. True

20. True

36 FIRST AID SERIES » PART 1: ELEMENTARY FIRST AID

NOTES
 84 NEWMAN STREET, LONDON, W1T 3EU, UK
T: +44 (0) 20 7299 1800 | F: +44 (0) 20 7299 1818 | E: mail@[Link] | W: [Link]