Let’s start with the Cambridge Dictionary version of what First Aid actually means:

“Basic medical treatment that is given to someone as soon as possible after they have been hurt in an accident or suddenly becomes ill.”

The Highway Code has a similar take:

“Any First Aid given at the scene of an incident should be looked on as a temporary measure until the emergency services arrive.”

The words basic and temporary sum up first aid provision either at the scene or in the workplace so what defines both basic and temporary in first aid terms?

Let’s start with basic, basic being the basics of keeping someone alive which consist mainly of dealing with severe bleeds and breathing issues. If we lose 30% of our blood supply, we can go into Hypovolemic shock and if we are not breathing normally, then Hypoxia is our enemy. These two basics on preserving human life are easily recognisable, or are they?

What are the first steps to recognition of life-threatening conditions? Well, something many people don’t consider is, what has actually happened or to use technical speak, what was the event history. Looking for clues can give vital information when dealing with a severe bleed. So, what are the clues regarding a severe bleed? The obvious clue is blood, lots of it and bright red spurting blood, however, blood loss can also be internal, how can I recognise internal bleeding? The short answer is, that sometimes you can’t but, the event history may point you in the right direction.

Bright red spurting blood will usually indicate an arterial bleed which, if not stopped will end in the death of the injured person so, what can I do if I come across this type of injury? I need to stop the flow of blood, usually, this means applying direct pressure to the artery affected for a minimum of ten minutes until the bleeding stops. Once the bleeding has stopped, the casualty will need urgent medical attention in a hospital environment. Hopefully, the paramedics arrive quickly which will then mean they will take over and the casualty will now be receiving expert medical care. So, what you have done there is buy time for the casualty until the professionals arrive, you played a vital role in the casualty’s survival.

Arterial bleeds on the outside are fairly easy to recognise but, what about the internal bleed? Let’s go back to the event history. Which sort of incidents could cause an internal bleed? Road traffic collisions and severe or sudden stops in a motor vehicle, a fall from height, an act of aggression and even an existing medical condition. Hang on, you said basic, now you are talking about medical conditions! Yes, however, we are not diagnosing, just looking for clues, I’ll come to that later.

Internal bleeds, what are the signs and symptoms? Some obvious signs are blood in the mouth, ears, nose, eyes and any other orifice we have as human beings. The not-so-obvious could be bruising or swelling of the abdomen, blue (cyanosed) lips, loss of consciousness, pale cold clammy skin, all outward signs of internal bleeding that would become obvious if looked for! Head injuries can lead to internal bleeding in the brain, again look at the mechanisms of the injuries, and what happened, be inquisitive, and have a high index of suspicion.

The most life-threatening bleed is arterial, bright red and spurting then bleeds from veins followed by the least life-threatening bleed from capillaries. The thing to remember when dealing with bleeds is that they all stop eventually! We only have a certain amount of blood in our bodies (between 9 and 12 pints depending on size and age). A person will usually go into Hypovolaemic shock having lost around a third of their blood supply which would be three pints in a person with nine pints of blood. Bleeds from veins are easier to control as they generally ooze instead of spurting giving the first aider more time to stop the flow. Capillary bleeds could be classed as minor injuries such as a graze which, in all cases should be thoroughly cleaned and covered to prevent infection. Don’t forget, cold bleeders don’t clot so, keep them warm!

For bleeds that cannot be stopped by pressure alone then, a tourniquet would be a last resort or even haemostatic bandages or granules. Trying to keep things basic means dealing with tourniquets in my next blog which will be added in the coming months.

That brings us to breathing, something we as human beings do automatically when things are going well for us but, what happens when we don’t breathe normally, what are the signs and symptoms and what can we do in basic lifesaving first aid?

If someone is unconscious, in basic lifesaving first aid we look at normal breathing as 2 to 4 breaths in a 10-second period. Anything more or less than this is not normal and at that point, the first aider should call 999/112, shout or call for help, and then start CPR.

Determining normal breathing can be very difficult, especially in a stressful environment so, try to remain calm and count the breathing rate, look for the chest or stomach rising and falling, feel for breath on the back of your hand and if the casualty is unconscious then start CPR if you are unsure, best to do something than nothing at all.

When dealing with a conscious casualty, a health care professional would look to count breathing over one minute and look for a rate of between 50 to 90 breaths.

What are some of the outward signs of abnormal breathing? Fast, shallow breaths or deep breathing with a long pause between breaths. The skin colour may change, the skin may become pale and clammy to the touch, and blue tinges on lips and skin (cyanosis), for black people cyanosis will be sometimes present inside the bottom lip or on the inside of the bottom eyelid. The casualty may feel nauseous and may even vomit. As with blood loss, look for clues, what happened and how do I deal with the problem?

We mentioned unconsciousness so, how do we figure out if a person is unconscious or not? Let’s introduce you to the Primary Survey:

Danger – Always check for danger before you go any further.
Response – Try to get a response by talking to the casualty and gently pressing on their upper chest
Catastrophic Bleed Check – History dependent. Don’t waste valuable time looking for bleeds unless obvious catastrophic bleeding is evident, at that point if bleeding is found stop the bleed.
Airway – Ensure the airway is open by gently tilting the head back
Breathing – Check for normal breathing
Circulation/CPR – If the person is unconscious and not breathing normally, call 999/112, shout for help ask for an AED and start CPR

If the casualty is unconscious and breathing normally then, we would consider recovery position, should we have to leave the casualty to go and get help, when they are uninjured or if their airway becomes compromised and to ultimately keep the airway open and create an effective drain.

When dealing with a conscious casualty we have a much better chance of dealing with the issue they have as they may be able to answer our questions. We mentioned being inquisitive and having a high index of suspicion and using the mnemonic SAMPLE will be very useful. Whilst conscious, ask the casualty the following using SAMPLE:

Signs & symptoms
Allergies – ask if they have any allergies
Medications – ask if they are taking medication
Past medical history – ask if this type of illness has happened to them before
Last meal and last pee – Ask when they last ate and when they last urinated. Not urinating in a 12-hour period can indicate sepsis
Event History – ask them what they were doing prior to you dealing with them

The above is a very brief summary of our Emergency First Aid at Work session which lasts for six hours. We go into more detail in all of the above and more to include choking, bandaging, recovery position, CPR and using an AED (Automated External Defibrillator) as well as dealing with bleeding and if requested, training on the use of tourniquets and haemostatic bandages.

I hope this blog captured your interest and, if so, then why not give us a call to discuss the right course for you and your employees.