First aid

First aid is a series of simple, life-saving medical procedures that laymen can be trained to perform in emergency situations, before the intervention of emergency medical technicians or doctors. It is best to obtain training in first aid before a medical emergency occurs.

Training in first aid is often available through community organizations such as the American Red Cross or the American Heart Association and is a standard part of military basic training. (In many British Commonwealth countries the Order of St. John provides first aid training and operates Ambulance services.)

The following are basic guidelines for how to perform first aid.

The most important rule is not to panic. Many people learn first aid and are then too frightened to use it when it becomes necessary. STOP (Stop, Think, Observe and Plan) is a helpful acronym that can be easily used to start first aid. It is important that the first aider calmly takes in what he or she sees and forms a plan based on the available information. Most importantly, the first aider must check for possible dangers so as not to increase the number of victims. (See also Good Samaritan law)

FIRST: Check, Call, Care

The American Red Cross suggests "Check, Call, Care" as the sequence of events. First, the scene must be checked for safety, and then the victim must be checked for signs and symptoms. Next, professionals must be called to help, and then first aid is given as much as it is practical.

The first step, if at all possible, is to contact professional aid by calling for help. Ideally, the first aider sends someone else to call for help; this may not always be possible. Some interventions can be done reasonably simply before leaving a patient to call for help; other times, it can be a difficult choice. It is important to rationally decide if the victim has a chance of survival without medical attention. Sometimes, the victim must be left somewhere in order to obtain treatment.

If there is more than one person injured, it may be necessary to perform triage. In triage the victims must be categorized according to the degree of emergency, and treated accordingly.

Consent

If the patient is conscious, it is important to ask for permission before proceeding. Touching another person under any circumstances without that person's permission is considered assault in most jurisdictions. Consent for treatment is implied if the patient is:

• Unconscious
• Intoxicated
• Irrational (i.e. delusional, insane or confused due to the injuries)
• Not an adult (parent or guardian must give consent if present and able, otherwise consent is implied)

Since the victim will likely be frightened, explaining your actions and talking in a calm, reassuring voice will have a beneficial effect in reducing stress and increasing the probability of survival.

ABCs: Airway, Breathing, Circulation

Once care of a victim begins, the first three steps are ABC -- airway, breathing and circulation. First, the patient should be breathing and have a pulse; if this is not true, artificial respiration or cardiopulmonary resuscitation (CPR), respectively, is begun.

1. If the first step, "airway" fails and the patient is incapable of breathing due to an obstruction of the trachea (i.e. choking), begin abdominal thrusts.

1. Breathing can be determined with "Look, Listen, Feel"; the responder places his or her head over the patient's face, ear pointing towards the patient. The responder looks at the chest, to see if it rises and falls,listens for the sound of breathing and feels for breath on the cheek.

1. The third step, circulation, has two parts. First, the responder feels for a pulse (generally at the carotid artery). Next, the first aider should check for severe bleeding as well, generally by patting down the body.

Diagnosis and First Aid

If the patient is breathing and has a pulse with no severe bleeding, the next step is to decide what the injury or illness is and form a plan of treatment. The "nature of illness" or "method of injury" is determined.

First Aid For Bleeding

Severe bleeding can be stopped with one of four steps. In order, they are

• Direct pressure on the wound
• Elevation of the wound above the heart (depending on the location of the wound)
• Pressure point (pressing down on an artery above the wound to keep blood from flowing to the wound)
• Tourniquet (a bandage tied tightly to cut off all circulation to the area of the wound; used only as a last resort because it often results in the limb affected being amputated later)

First Aid and Possible Spinal Injury

Most importantly, the possibility of a spinal injury must be investigated. The spinal cord is a thick nerve that runs down the neck and back; it is protected by bones called vertebrae. If the spinal cord is injured, this can lead to paralysis. Since the vertebrae protect the spinal cord, it is generally difficult to cause such an injury. Note that only an x-ray can conclusively determine if a spinal injury exists. If a spinal injury is suspected, the patient must be treated as though one does exist.

Signs of a spinal injury

• Mental confusion (such as paranoia or euphoria)
• Dizziness
• Head, neck or back pain
• Paralysis
• Any fall of more than three times the patient's height

If a spinal injury may exist, the victim must be kept in the position he or she was found in, if at all possible and safe, and told to move as little as possible. A minor crack in the vertebrae can result in paralysis if the patient moves in the wrong way, so all movement must be minimized. If possible, one caregiver should hold c-spine stabilization. "C-spine" refers to the part of the spine which is in the neck, called the cervical spine. One person places his or her palms on the victim's ears, with fingers spread open towards the chin. The person holding c-spine's job is to ensure that the neck does not move and may not let go of the c-spine unless someone else takes over or advanced equipment is used in place.

First Aid and Mental Status

Next, it is important to gain an adequate understanding of what is wrong with the patient. A level of mental responsiveness must be determined, generally by asking three questions:

• What is your name?
• Where are you?
• What day of the week is it? (note: stressed patients, even totally coherent, tend to respond that it is the day during which they last woke up)

Patients' mental coherence will fall into one of four categories (the AVPU system)

• A = alert, responds correctly to all three questions above
• V = responds to verbal stimuli inappropriately
• P = responds to painful stimuli only (such as rubbing the sternum with gusto)
• U = unresponsive to any stimuli

Shock

In most injuries, hypovolemic shock is often an issue. Symptoms include rapid breathing (a normal adult rate is 12-20 respirations per minute) and cold, clammy skin. The patient's body temperature must be maintained (it will tend to go down, even in warm weather) and the patient's feet must be elevated approximately six inches off the ground. The object is to raise the blood pressure to their inner organs to prevent oxygen starvation of major tissues- which is one way that shock kills.

In the short term, injured or ill persons should not be given water or anything by mouth. A notable exception is diabetic coma when other injuries are absent. There are multiple reasons for nothing by mouth (gastrointestinal lacerations or bleeding, lacerated esophagus, etc). The main reason though, is that the victim (especially a trauma patient]] may have to undergo surgery, and any substances by mouth can be vomited under anaesthesia, and aspirated (inhaled into lungs). This can severely damage lungs and cause massive infections.

Again in the short term, do not remove clotted dressings to put on new ones. This will disturb the wound and may start additional and unnecessary bleeding. Put new dressings over the existing dressings.

Long-Term and Wilderness First Aid

In some emergencies, such as earthquakes or an isolated accident, emergency services may be unable to arrive for several days or longer. In this case, responders may need to perform longer-term care. For long term treatment in disasters, wound-care and cleanliness is the most important issue.

Proper bedding and dressings are preferable in order to prevent infection, but fresh, unopened newspapers are sterile, and can be used to improvise dressings, blankets and clean areas. Broken limbs should be splinted in an effort to immobilize the bone (which should not be straightened due to the possibility of a splintered bone cutting an artery). Antibiotics, if available, should be used to prevent infection. Administer splints to broken limbs with the intent to immobilize broken limbs. This can sometimes prevent later amputation of infected limbs.

Do not remove existing bandages to put on new ones in the prehospital environment, even if care is delayed several days, unless complete wound cleaning and debridement is possible. A "bound-up" wound is less likely to be infected and more likely to heal than one that is opened repeatedly and inadequately cleaned each time. This is derived from World War II prehospital military experience.

If medical care is likely to be delayed by more than a day, small amounts of water may be given to patients unlikely to require surgery or to vomit. Fluids other than water and foods should not be given unless injuries are obviously minor. If there is any likelihood that surgery may be needed or that the gastrointestinal system may have been damaged, only give small sips of water that are entirely absorbed by the mucous membrane of the mouth.

Patients should be kept in a reasonably warm place. The stress of excessive heat or cold can stress an injured or ill body further, increasing the danger. Temperatures as high as 55F or as low as 95F can injure by exposure for an hour -- this is a major hazard in longer term care.

See also: triage, medical emergency, emergency medical service, hypothermia, heat stroke, hypoglycemia, hyperglycemia, diabetic coma, occlusive dressing, tourniquet, sub-abdominal thrust, Cardiopulmonary resuscitation (CPR), strain, sprain, fracture, laceration, avulsion, abdominal pain, gastro-intestinal bleeding, Good Samaritan law, childbirth

---

The rock and roll band Live used the name First Aid for a time before achieving much success in the music world. For more information, see Live.