ASSESSMENT OF VICTIM AT
THE ACCIDENT SITE
WHAT IS FIRST AID?
First
aid is the temporary and immediate
treatment given to a person who is injured
or suddenly becomes ill using the facilities
or materials available at the time before
regular medical help is imparted.
PRINCIPLES OF FIRST AID
1.RESTORATION OF RESPIRATION
2.CONTROL OF BLEEDING
3.TREATMENT OF SHOCK
4.CARE FOR THE UNCONCIOUS
5.ASSESSMENT OF ASSOCIATED
INJURIES.
6.TRANSPORTATION.
OBJECTIVES
1.To preserve life.
2.To prevent further injury and deterioration
of the condition.
3.To make the victim as comfortable as
possible.
4. To put the injured person under
professional medical care at the earliest
time possible.
QUALIFICATIONS
1.BE A GOOD OBSERVER
2.BE ABLE TO ACT QUICKLY
3.SHOULD NOT GET PANICKY OR EXCITED.
4.BE ABLE TO LEAD, CONTROL CROWDS,
AND TAKE HELP FROM ONLOOKERS.
5.ABLE TO JUDGE THE INJURIES TO BE
HANDLED FIRST.
6.ABLE TO REASSURE THE APPREHENSIVE
VICTIM, RELATIVES, AND PROVIDE GOOD
COUNSELLING.
FIRST AID PRIORITIES
Assess a situation
Protect yourself
Prevent cross infection
Comfort & reassure
Assess the casualty
Give early treatment
Arrange for appropriate help
PRIMARY SURVEY/ BASIC LIFE
SUPPORT
The approach to any incident requires a
Common Sense Planning
The basic priority step of approaching an
incident is called Primary Survey
It is the initial rapid assessment of a
casualty to establish & treat immediate life
threatening conditions
It is an easily remembered practice by using the
letters – D R A B C D
PRIMARY SURVEY
Remember …
DR A B CD
D = Danger
R = Response
A =Airway
B = Breathing
C = Circulation/ chest compression
D= Defibrillation
D- DANGER
Most accident scenes are uncontrolled and
potentially dangerous
Do not become a casualty yourself
CALLING FOR ASSISTANCE
Ask the bystanders to call for assistance
R
Is the victim conscious… ?
RESPONSE
SHOUT !!! and SHAKE
No response??
ACTIVATE THE EMERGENCY
RESPONSE SYSTEM & GET
AED/defibrillator
Give painful stimuli
AIRWAY
Tongue is the most common of airway
obstruction in an unconscious victim
AIRWAY
Head tilt , chin lift
techniques
JAW THRUST
USED WHEN THERE IS SUSPECTED INJURY ON
THE CERVICAL SPINE INSTEAD OF HEAD TILT &
CHIN LIFT
B
Look , Listen, and Feel
Is he breathing
BREATHING
Observe for breathing
Watch and feel the chest rise and fall
Check breathing for 5 seconds
Ifbreathing move to next step
If not breathing start mouth to mouth
ventillation/ breathing
ADULTS: aim at 10- 12 breathes/min
CHILDREN: aim at 12-20 breathes/ min
NOTE: if pulse is below 60 in children
START CPR( sign of poor perfusion)
CHEST COMPRESION/
CIRCULATION
CHECK FOR PULSE IN 5- 10 SECONDS
• CAROTID PULSE FOR ADULTS (30:2)
• FEMORAL PULSE – 1YR- PUBERTY (30:2)
• BRACHIAL PULSE- 0-1YR 30: 2 (1 RESCUER)
15:2 (2 RESCUERS)
NO PULSE-BEGIN CHEST COMPRESIONS
30 : 2 UPTO 100/MIN
IF PULSE IS PRESENT, MOVE TO AIRWAY THEN
BREATHING.
DEFIBRILLATION
USE OF AUTOMATED EXTERNAL
DEFIBRILLATOR
AED: ARE COMPUTERIZED DEVICES THAT CAN
IDENTIFY CARDIAC RHYTHMS THAT NEED A
SHOCK ,THEN DELIVERS THE SHOCK. (Ventricular
fibrillations)
SIMPLE AND SAFE TO USE, ALLOWS A LAY
PERSON & HEALTH CARE WORKERS TO
ATTEMPT DEFIBRILLATION SAFELY
PROCEDURE FOR AED USE
TURN ON AED
ATTACH AED PADS ON VICTIM(ADULT/CHILD)
AED OPERATOR CLEARS THE VICTIM BEFORE
RHYTHM ANALYSES
ACTIVATE ANALYSE FEATURE OF AED
CLEAR VICTIM & EVERYONE BY SHOUTING
COMMAND
PRESS SHOCK BUTTON
START/ CONTINUE CPR
NOTE; IF THE PATIENT IS UNCONSCIOUS, THE
RESCUER SHOULD ADDRESS CIRCULATION
FIRST.
DRCABD
SECONDARY SURVEY
SECONDARY SURVEY
This is the methodical process of checking for
other injuries or illnesses.
Involveshistory taking and a head to toe
examination.
It should take 1 to 2 minutes.
It is not necessary to be sequential
HISTORY
Use mnemonic AMPLE as a reminder.
A- allergy
M-medications
P- previous medical history
L- last meal
E- event history
HEAD TO TOE EXAMINATION
HEAD
Observe skin color, lacerations, contusions, and
facial asymmetry.
Assess the level of consciousness. (AVPU)
Check pupil’s size.
Check ears and nose for blood.
Check mouth for foreign objects and bleeding
NECK AND ARMS
observe and palpate areas of tenderness.
ARMS;
Palpate the entire length for pain, wounds,
deformity, and sensations.
Ask about pain and tingling sensations
CHEST
Observewhether the chest expands
normally upon inspiration.
Palpate clavicles and shoulders
Pressgently on the ribs, checking for
integrity of the chest wall .
ABDOMEN, PELVIS.
Check for distention or for wounds.
Palpate the four quadrants for tenderness
and rigidity.
PELVIS
Palpate the iliac crests and pubis for pain.
Observe for incontinence
SPINE AND LEGS
SPINE
Palpate for tenderness, wounds, and deformity
from the shoulders to the buttocks.
NOTE : LOG ROLL VICTIM WITH
SUSPECTED C- SPINE INJURY TO PREVENT
FURTHER INJURY
LEGS
Palpate the entire length for pain, deformity,
wounds.
Ask about pain, numbness, and movement
TREATMENT
AIM : To preserve life
Maintain an open airway by positioning
the casualty correctly.
Begin resuscitation if the casualty is not
breathing and the heart is not beating and
continue treatment until skilled help
arrives
Control bleeding.
TO PREVENT THE CONDITION FROM
WORSENING
Dress the wounds.
Immobilize any fractures./ SPLINTING
Place the casualty in a comfortable
position consistent with the requirements
of treatment.
Keep the casualty warm.
MONITOR VITAL SIGNS
LEVEL OF RESPONSE (AVPU)
A- alertness /eye opening
V-response to VOICE
P- response to PAIN
U- unresponsiveness to any stimuli
REMOVING CLOTHING
COAT, JACKET,SHIRT, VEST:
Raise the casualty and slip the garment
over the shoulders.
Bend the arm on the sound side and
remove garment from that side first.
Slip the injured arm out of its sleeve while
keeping it straight.
If necessary slit up the seam on injured
side
REMOVING TROUSERS
pull them down from the waist to reveal
the thigh, knee and calf.
if necessary, slit up the inside seam .
SHOES, AND SOCKS
Support the ankle, undo or cut the laces.
If socks are difficult to remove, insert your
first two fingers between the sock and the
leg and cut between your fingers.
DISPOSAL OF THE CASUALTY
Arrange transport to hospital by ambulance or
any other vehicle nearby.
Hand over the casualty to a medical worker at
the scene .
Take the casualty to a nearby shelter or home to
await the arrival of an ambulance.
If the injury is minor , allow patient to go home
and ask them to get medical advice.
EMERGENCY MEDICAL SERVICE
SYSTEM/ RESCUE SERVICE
EFFICIENT TRANSPORT & COMMUNICATION
SERVICES
TRAINED PERSONNEL
EQUIPED HOSPITAL
AVAILABLE RESOURCES
RECOMMENDED PROCEDURE FOR
VERY INJURED
Position the victim on his back on a hard
flat surface.
Check for pulse
Open the victim’s airway by head tilt-chin
lift or jaw thrust method.
Take five seconds to look, listen and feel
for breathing.
Deliver four successive breaths by mouth
to mouth ventilation.
RESUSCITATION TECHNIQUES
Use the A.B.C’s of basic life support.
AIRWAY:
Position the casualty on their back.
Find out if the patient is unconscious.
Check whether there is any debris in the mouth
or throat .
Check for breathing:
See movement of the chest and abdomen.
Listen for breath sounds.
METHODS OF RELIEVING AIRWAY
OBSTRUCTION
HEAD TILT:
Place your palm on the patient’s
forehead.
Apply firm backward pressure
pushing the forehead as far back as
possible.
Additional assistance is gained by
placing your other palm under the
patient’s neck.
JAW THRUST:
Is used when a cervical or spinal injury is suspected.
The mandible is displaced forwards by placing the
fingers of both hands at the angles of the jaws.
Support the head carefully without tilting it backwards or
turning it side to side.
AIRWAY
Tongue is the most common of airway
obstruction in an unconscious victim
AIRWAY
Head tilt chin lift
B
Look , Listen, and Feel
Is he breathing?
BREATHING
Observe for breathing
Watch and feel the chest rise and fall
Check breathing for 5 seconds
BREATHING
If
patient is breathing
Leave the patient on their side with the
jaw supported
BREATHING
If
patient is not breathing
Turn on to their back
Breathe for the patient
Give two (2) initial breaths
RESTORATION OF BREATHING
MOUTH TO MOUTH VENTILLATION.
Principles:
Exhaled air contains 16% of oxygen which is
enough to sustain life.
You blow air from your lungs into the casualty’s
mouth and or nose to fill the casualty ‘s lungs.
Avoid this in case of poisoning, serious facial
injuries, recurrent vomiting.
PROCEDURE
Remove any obvious obstructions over the face
or any constrictions around the neck.
Open the airway and remove any debri from the
mouth and throat.
Open your mouth wide, take a deep breath
pinch the nostrils together with your fingers.
Seal your lips around the mouth and blow into
the casualty’s lung.
Do this until you see the chest rise to maximum
expansion.
TROUBLESHOOTING
Failure of chest expansion:
Check if the airway is fully open:
adjust the position of the jaw and the
head.
If there is still no chest movement,
the airway may be blocked therefore
first treat for chocking.
PROCEDURE
Remove your mouth well away from the
casualty and breath out any excess air.
Watch the chest fall and take in fresh air.
Repeat the inflation.
Give the first four inflations as quickly as
possible without waiting for complete deflation
of the lungs between breaths.
Check the casualty’s pulse to ascertain that the
heart is beating.
If the heart rate is normal give inflations at 16
breaths /min.
PROCEDURE
When the casualty is breathing normally, place
them in the recovery position.
Assessment of effective ventilation:
Observe the rising and falling of the chest
Hearing and feeling the escape of air during
pressure
Feeling resistance in your airway as the victims
chest starts expanding.
CARDIO PULMONARY RESCUCITATION
(CPR)
This is the use of artificial ventilation with
external heart compression.
Itshould be commenced in all cases of cardiac
arrest (sudden death).
Sudden death Is defined as the immediate and
unexpected cessation of respiration and
functional circulation.
HOW C.P.R WORKS
During C.P.R , the heart is squeezed
between the breast bone ( sternum) and
the spine and the lungs are ventillated.
CPR
When??
If
No danger
No response
Airway clear and open
No breathing
No pulse
CPR
Hand location
Locate the lower end of the breastbone
Place two fingers below where the ribs meet the
breastbone
Place the heel of one hand on the breastbone
Place your other hand securely on top of the first
hand
CPR
Technique /push hard, push fast
Compression technique uses the heel of
the hand with the fingers locked and
clear of the chest
Keep your shoulder vertically over the
victim’s chest
Depth of compression: 4-5 cm
Rate 100 compressions / minute
CPR
Procedure
One rescuer
2:3O
2 ventilations : 30 compressions
Rate 100 compressions / minute or 6-7
cycles/ minute
CPR
Procedure
Two rescuers
First use one person CPR whilst the 2nd
person gets help
Then with 2 persons
2 :30
2 ventilation : 30 compressions
Rate 100 compressions/ minute or 16-18
cycles/minute
CAUSES OF CARDIAC ARREST
Heart attack
Electric shock
Asphyxia
Suffocation
Drowning
Chocking
Allergic reactions
Severe injuries
SIGNS OF CARDIAC ARREST
Unconsciousness
No pulse in the neck ,wrist, or groin.
Absence of breathing
Dilated and fixed pupils
No heart beat
Bluish colour of the skin ,lips, and the nail
beds.
BASIC LIFE SUPPORT (BLS)
CPR CRITICAL CONCEPTS
Start chest compressions in the first 10 seconds of cardiac
arrest
Push hard , push fast .
Rate of 100/min depth of 2 inches or 5cm(adults),
5cm (children) and 4cm (infants)
Allow complete chest recoil
Minimize interruptions
give effective breathes to make sure chest rises
Avoid excessive ventillation
