ESSENTIAL FIRST AID PRINCIPLES FOR EMERGENCIES

First aid is the immediate assistance given to a person suffering from an injury or illness, with the aim of preserving life, preventing the condition from worsening, and promoting recovery. It is a critical skill that empowers individuals to provide vital support in emergency situations, bridging the gap between the incident and the arrival of professional medical help.

The Aims of First Aid

The primary objectives of first aid are encapsulated by the “3 Ps” and are fundamental to understanding its purpose:

1. Preserve Life: This is the paramount aim. It involves taking immediate steps to prevent death, such as opening an airway, stopping severe bleeding, or initiating cardiopulmonary resuscitation (CPR). The focus is on addressing life-threatening conditions without delay.
2. Prevent Worsening (Prevent Further Harm): Once life-threatening situations are addressed, the next aim is to prevent the casualty’s condition from deteriorating. This includes immobilizing fractures to prevent further injury, covering wounds to prevent infection, or keeping a casualty warm to prevent shock. It also encompasses protecting the casualty from environmental hazards or further injury at the scene.
3. Promote Recovery: The ultimate long-term aim is to aid the casualty’s recovery. This involves making the casualty as comfortable as possible, providing reassurance, and managing conditions until professional medical help arrives. Effective first aid can significantly reduce the duration and complexity of recovery.

Beyond the “3 Ps,” first aid also aims to:

• Alleviate Pain and Suffering: Providing comfort and support can significantly reduce distress.
• Provide Reassurance: A calm and confident first aider can help reduce panic and anxiety in the casualty and bystanders.
• Facilitate Professional Medical Care: By stabilizing the casualty and gathering relevant information, the first aider assists emergency services in providing more effective and timely treatment upon arrival.

The Responsibility of the First Aider

Being a first aider carries significant responsibilities, demanding a blend of practical skills, ethical considerations, and sound judgment. These responsibilities include:

1. Duty of Care (Where Applicable): In certain contexts (e.g., workplace first aiders, designated volunteers), there may be a legal or moral duty of care to provide assistance. Even without a formal duty, many jurisdictions offer “Good Samaritan” laws protecting those who render aid in good faith.
2. Safety First: The first aider’s own safety, and the safety of bystanders, must always be the priority. Never put yourself in danger to help someone else. This involves assessing the scene for hazards before approaching the casualty.
3. Act Within Competence: A first aider must only provide care for which they are trained and confident. Attempting procedures beyond one’s skill level can cause more harm. If unsure, it is better to call for professional help and provide basic support.
4. Respect and Privacy: Treat the casualty with dignity and respect. Maintain privacy regarding their condition and personal information.
5. Obtain Consent (Where Possible): Always ask for permission before providing first aid, if the casualty is conscious and able to respond. In cases of unconsciousness or severe injury where life is at risk, “implied consent” is generally assumed.
6. Maintain Communication: Communicate clearly and calmly with the casualty, bystanders, and emergency services. Provide accurate information to responders.
7. Record Keeping (Where Applicable): In professional settings (e.g., workplaces), it is often a requirement to record details of incidents and the first aid provided. This aids in ongoing care and incident analysis.
8. Continual Learning: First aid knowledge and techniques evolve. A responsible first aider seeks to refresh their training regularly and stay updated.

Initial Actions of the First Aider

Upon encountering an emergency, the first aider’s initial actions are critical and follow a systematic approach, often remembered by the acronym DRSABCD:

1. D – Danger:
   • Assess the Scene: Before approaching, quickly scan for any immediate dangers to yourself, the casualty, or bystanders (e.g., traffic, falling objects, electricity, chemicals, aggressive individuals).
   • Make the Scene Safe: If possible and safe to do so, eliminate or minimize dangers (e.g., switch off a power source, move a hazard). If the scene cannot be made safe, do not approach; call for professional help immediately (e.g., fire department, police).
   • Wear PPE (Personal Protective Equipment): If available and appropriate (e.g., gloves, face shield) to protect against bodily fluids.
2. R – Response:
   • Check for Response: Gently tap the casualty’s shoulders and ask loudly, “Are you alright? Can you hear me?”
   • Observe Reactions: Look for any movement, sounds, or opening of eyes.
   • If Responsive: Ask what happened, where they are injured, and reassure them. Continue with assessment and management based on their condition.
   • If Unresponsive: Proceed immediately to summon help.
3. S – Send for Help:
   • Call Emergency Services (e.g., 999, 111, 911, 112): Immediately call for an ambulance or designated emergency services. Provide clear, concise information: your location, nature of the emergency, number of casualties, and any known hazards.
   • Request Assistance: If other people are present, delegate tasks (e.g., “You, call an ambulance,” “You, find an AED,” “You, help me control the crowd”).
4. A – Airway:
   • Open the Airway: If the casualty is unresponsive, open their airway to ensure clear passage for breathing. This is typically done using the head tilt/chin lift maneuver (place one hand on their forehead, two fingers under their chin, gently tilt the head back and lift the chin). This moves the tongue away from the back of the throat.
   • Check for Obstructions: Look inside the mouth for any visible obstructions (e.g., vomit, foreign objects) and remove them carefully if safe to do so.
5. B – Breathing:
   • Check for Normal Breathing: With the airway open, look, listen, and feel for normal breathing for no more than 10 seconds.
     • Look: For chest rise and fall.
     • Listen: For breath sounds.
     • Feel: For breath on your cheek.
   • Normal vs. Agonal Breathing: Distinguish between normal breathing and “agonal breathing” (gasping, irregular, or noisy breaths), which is a sign of cardiac arrest.
   • If Not Breathing Normally: Commence CPR immediately.
   • If Breathing Normally: Place the casualty in the recovery position (on their side) to protect their airway, continually monitor their breathing, and await professional help.
6. C – CPR (Cardiopulmonary Resuscitation):
   • If No Normal Breathing: Begin chest compressions and rescue breaths (if trained and willing).
   • Compressions: 30 compressions at a rate of 100-120 per minute, to a depth of 5-6 cm, in the center of the chest.
   • Breaths: 2 rescue breaths after every 30 compressions (pinch nose, make a tight seal over the mouth, breathe until chest rises).
   • Continue CPR: Until professional help arrives, an AED becomes available, or the casualty shows signs of life.
7. D – Defibrillation (AED – Automated External Defibrillator):
   • Apply AED if Available: If an AED is present, follow its voice prompts immediately. Early defibrillation significantly increases the chances of survival for someone in cardiac arrest.
   • Continue CPR while AED is Prepared: Do not interrupt CPR until instructed by the AED or emergency services.

Essential Principles of First Aid

Beyond the initial actions, several guiding principles underpin effective first aid:

1. Prioritization: Always address life-threatening conditions first (e.g., severe bleeding before a minor fracture). The “ABC” (Airway, Breathing, Circulation/CPR) approach is a key prioritization tool.
2. Improvise and Adapt: Be prepared to use available resources creatively if a formal first aid kit is not present (e.g., a clean cloth for a bandage, a jacket for warmth).
3. Maintain Communication and Reassurance: Keep the casualty informed about what you are doing, explain the steps, and offer calm reassurance. This helps reduce anxiety and pain.
4. Prevent Cross-Contamination: Use personal protective equipment (PPE) like gloves. If not available, use barriers like plastic bags. Avoid touching open wounds directly.
5. Record Information: Note down key details such as the time of the incident, what happened, the casualty’s condition, and the first aid provided. This information is invaluable for paramedics.
6. Do No Further Harm: This ethical principle means that any intervention should aim to improve the situation and avoid causing additional injury or distress. If unsure, err on the side of caution and call for professional help.
7. Stay with the Casualty: Do not leave the casualty unattended unless absolutely necessary to ensure your safety or to call for help.

Assessment, Management, and Disposal of the Casualty Case

Once the initial DRSABCD actions are complete and immediate life threats are managed, a more detailed assessment and ongoing management are required until professional medical help takes over. “Disposal” in this context refers to handing over care and the subsequent clean-up and reporting.

1. Assessment (Secondary Survey if time allows):

After addressing immediate life threats (primary survey), if the casualty is stable and professional help is en route but not yet present, perform a more thorough secondary assessment:

• Head-to-Toe Check: Systematically examine the casualty for any other injuries or medical conditions.
  • Head: Check for lumps, depressions, bleeding, fluid from ears/nose.
  • Neck: Check for tenderness, deformity.
  • Chest: Check for tenderness, instability, difficulty breathing.
  • Abdomen: Check for tenderness, distension.
  • Pelvis: Check for stability (if pelvic injury is suspected, do not move).
  • Limbs: Check for deformities, swelling, pain, inability to move.
  • Back: If practical and safe to do so.
• SAMPLE History: Gather relevant information from the casualty (if conscious) or bystanders:
  • S: Signs and Symptoms (what you observe, what they report).
  • A: Allergies (medications, food, environmental).
  • M: Medications (current prescriptions, over-the-counter).
  • P: Past Medical History (any relevant conditions, surgeries).
  • L: Last Oral Intake (when did they last eat or drink).
  • E: Events leading to the injury/illness.
• Monitor Vital Signs: Continuously monitor their level of consciousness, breathing, pulse, and skin color/temperature. Note any changes.

2. Management:

Based on the assessment findings, provide appropriate first aid management:

• Wound Care:
  • Bleeding: Apply direct pressure, elevate the limb if possible, apply a bandage. If severe, consider a tourniquet as a last resort if trained.
  • Minor Wounds: Clean gently with water or antiseptic wipes, cover with a sterile dressing.
• Fractures/Sprains:
  • Immobilize: Support the injured limb in a comfortable position, prevent movement using bandages, slings, or splints (if trained).
  • Ice/Cold Pack: Apply a cold pack to reduce swelling and pain.
• Burns:
  • Cool the Burn: Immediately cool the burn under cool running water (not ice) for at least 10-20 minutes.
  • Cover: Cover with loose, non-stick dressing (e.g., cling film). Do not remove clothing stuck to the burn.
• Fainting/Shock:
  • Fainting: Lay the casualty down on their back and elevate their legs.
  • Shock: Lay the casualty down, elevate their legs, keep them warm, loosen tight clothing, and reassure them.
• Unconsciousness (Breathing Normally): Place in the recovery position, ensure airway remains clear, and monitor closely.
• Medical Emergencies (e.g., Asthma Attack, Diabetic Emergency, Seizure):
  • Asthma: Help them use their reliever inhaler.
  • Diabetic: If conscious and low blood sugar suspected, give sugary food/drink.
  • Seizure: Protect from injury, do not restrain, time the seizure, place in recovery position once it stops.
• Reassurance and Comfort: Maintain a calm presence, speak reassuringly, and make the casualty as comfortable as possible. Keep them warm.

3. Disposal of the Casualty Case (Handover and Aftercare):

“Disposal” refers to the effective completion of the first aid incident.

• Handover to Professionals:
  • When emergency medical services arrive, provide a clear, concise, and accurate handover.
  • Include: Your name, what happened, the casualty’s condition (conscious/unconscious, breathing, pulse, injuries), first aid provided, and any changes observed.
  • Share the SAMPLE history and vital signs you monitored.
  • Answer any questions they may have.
• Post-Incident Care and Debriefing:
  • Clean-up: Dispose of contaminated materials (gloves, dressings) safely and appropriately (e.g., in a biohazard bag).
  • Decontamination: Clean any equipment used and wash hands thoroughly.
  • Replenish First Aid Kit: Ensure the kit is fully stocked for future use.
  • Incident Report: If in a formal setting (e.g., workplace), complete an incident report outlining what happened, the first aid given, and the outcome.
  • Self-Care: Being a first aider can be stressful. Take time to debrief, talk about the incident if you feel the need, and seek support if you are distressed by what you witnessed.

In conclusion, first aid is a vital skill built upon a foundation of clear aims, responsible conduct, systematic action, and adherence to core principles. From the initial scene assessment to the handover of care, a first aider’s actions can profoundly impact the outcome for a casualty. Continuous training and a commitment to these guidelines ensure that first aid remains an effective, life-saving intervention.