First Aid.docx
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First Aid.docx
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FirstAid
Firstaid
FirstAidsymbol
Firstaidistheprovisionofinitialcareforanillnessorinjury.Itisusuallyperformedbyalaypersontoasickorinjuredcasualtyuntildefinitivemedicaltreatmentcanbeaccessed.Certainself-limitingillnessesorminorinjuriesmaynotrequirefurthermedicalcarepastthefirstaidintervention.Itgenerallyconsistsofaseriesofsimpleand,insomecases,potentiallylife-savingtechniquesthatanindividualcanbetrainedtoperformwithminimalequipment.
Whilefirstaidcanalsobeperformedonanimals,thetermgenerallyreferstocareofhumanpatients.
History
Theearliestinstancesofrecordedfirstaidwereprovidedbyreligiousknights,suchastheKnightsHospitaller,formedinthe11thcentury,providingcaretopilgrimsandknights,andtrainingotherknightsinhowtotreatcommonbattlefieldinjuries.[1]ThepracticeoffirstaidfelllargelyintodisuseduringtheHighMiddleAges,andorganizedsocietieswerenotseenagainuntilin1859HenryDunantorganizedlocalvillagerstohelpvictimsoftheBattleofSolferino,includingtheprovisionoffirstaid.Fouryearslater,fournationsmetinGenevaandformedtheorganizationwhichhasgrownintotheRedCross,withakeystatedaimof"aidtosickandwoundedsoldiersinthefield".[1]ThiswasfollowedbytheformationofSt.JohnAmbulancein1877,basedontheprinciplesoftheKnightsHospitaller,toteachfirstaid,andnumerousotherorganizationjoinedthem,withthetermfirstaidfirstcoinedin1878ascivilianambulanceservicesspreadasacombinationof'firsttreatment'and'nationalaid'[1]inlargerailwaycentresandminingdistrictsaswellaswithpoliceforces.FirstaidtrainingbegantospreadthroughtheempirethroughorganisationssuchasStJohn,oftenstarting,asintheUK,withhighriskactivitiessuchasportsandrailways.[2]
Manydevelopmentsinfirstaidandmanyothermedicaltechniqueshavebeendrivenbywars,suchasinthecaseoftheAmericanCivilWar,whichpromptedClaraBartontoorganizetheAmericanRedCross.[3]Today,thereareseveralgroupsthatpromotefirstaid,suchasthemilitaryandtheScoutingmovement.Newtechniquesandequipmenthavehelpedmaketoday’sfirstaidsimpleandeffective.
Aims
Thekeyaimsoffirstaidcanbesummarisedinthreekeypoints:
[4]
∙Preservelife-theoverridingaimofallmedicalcare,includingfirstaid,istosavelives
∙Preventfurtherharm-alsosometimescalledpreventtheconditionfromworsening,thiscoversbothexternalfactors,suchasmovingapatientawayfromanycauseofharm,andapplyingfirstaidtechniquestopreventworseningofthecondition,suchasapplyingpressuretostopableedbecomingdangerous.
∙Promoterecovery-firstaidalsoinvolvestryingtostarttherecoveryprocessfromtheillnessorinjury,andinsomecasesmightinvolvecompletingatreatment,suchasinthecaseofapplyingaplastertoasmallwound.
Firstaidtrainingalsoinvolvesthepreventionofinitialinjuryandrespondersafety,andthetreatmentphases.
Keyskills
Incaseoftonguefallenbackwards,blockingtheairway,itisnecessarytohyperextendtheheadandpullupthechin,sothatthetongueliftsandclearstheairway.
Certainskillsareconsideredessentialtotheprovisionoffirstaidandaretaughtubiquitously.Particularly,the"ABC"soffirstaid,whichfocusoncriticallife-savingintervention,mustberenderedbeforetreatmentoflessseriousinjuries.ABCstandsforAirway,Breathing,andCirculation.Thesamemnemonicisusedbyallemergencyhealthprofessionals.Attentionmustfirstbebroughttotheairwaytoensureitisclear.Obstruction(choking)isalife-threateningemergency.Followingevaluationoftheairway,afirstaidattendantwoulddetermineadequacyofbreathingandproviderescuebreathingifnecessary.Assessmentofcirculationisnownotusuallycarriedoutforpatientswhoarenotbreathing,withfirstaidersnowtrainedtogostraighttochestcompressions(andthusprovidingartificialcirculation)butpulsechecksmaybedoneonlessseriouspatients.
Someorganizationsaddafourthstepof"D"forDeadlybleedingorDefibrillation,whileothersconsiderthisaspartoftheCirculationstep.VariationsontechniquestoevaluateandmaintaintheABCsdependontheskilllevelofthefirstaider.OncetheABCsaresecured,firstaiderscanbeginadditionaltreatments,asrequired.Someorganizationsteachthesameorderofpriorityusingthe"3Bs":
Breathing,Bleeding,andBones(or"4Bs":
Breathing,Bleeding,Brain,andBones).WhiletheABCsand3Bsaretaughttobeperformedsequentially,certainconditionsmayrequiretheconsiderationoftwostepssimultaneously.Thisincludestheprovisionofbothartificialrespirationandchestcompressionstosomeonewhoisnotbreathingandhasnopulse,andtheconsiderationofcervicalspineinjurieswhenensuringanopenairway.
Preservinglife
Inordertopreservelife,allpersonsrequiretohaveanopenairway-aclearpassagewhereaircanmoveinthroughthemouthornosethroughthepharynxanddownintothelungs,withoutobstruction.Consciouspeoplewillmaintaintheirownairwayautomatically,butthosewhoareunconscious(withaGCSoflessthan8)maybeunabletomaintainapatentairway,asthepartofthebrainwhichautonomouslycontrolsinnormalsituationsmaynotbefunctioning.
Ifthepatientwasbreathing,afirstaiderwouldnormallythenplacethemintherecoveryposition,withthepatientleantoverontheirside,whichalsohastheeffectofclearingthetonguefromthepharynx.Italsoavoidsacommoncauseofdeathinunconsciouspatients,whichischokingonregurgitatedstomachcontents.
Theairwaycanalsobecomeblockedthroughaforeignobjectbecominglodgedinthepharynxorlarynx,commonlycalledchoking.Thefirstaiderwillbetaughttodealwiththisthroughacombinationof‘backslaps’and‘abdominalthrusts’.
Oncetheairwayhasbeenopened,thefirstaiderwouldassesstoseeifthepatientisbreathing.Ifthereisnobreathing,orthepatientisnotbreathingnormally,suchasagonalbreathing,thefirstaiderwouldundertakewhatisprobablythemostrecognizedfirstaidprocedure-CardiopulmonaryresuscitationorCPR,whichinvolvesbreathingforthepatient,andmanuallymassagingthehearttopromotebloodflowaroundthebody.
Promotingrecovery
Thefirstaiderisalsolikelytobetrainedindealingwithinjuriessuchascuts,grazesorbrokenbones.Theymaybeabletodealwiththesituationinitsentirety(asmalladhesivebandageonapapercut),ormayberequiredtomaintaintheconditionofsomethinglikeabrokenbone,untilthenextstageofdefinitivecare(usuallyanambulance)arrives.
Training
Firstaidscenariotraininginprogress
Muchoffirstaidiscommonsense.Basicprinciples,suchasknowingtouseanadhesivebandageorapplyingdirectpressureonableed,areoftenacquiredpassivelythroughlifeexperiences.However,toprovideeffective,life-savingfirstaidinterventionsrequiresinstructionandpracticaltraining.Thisisespeciallytruewhereitrelatestopotentiallyfatalillnessesandinjuries,suchasthosethatrequirecardiopulmonaryresuscitation(CPR);theseproceduresmaybeinvasive,andcarryariskoffurtherinjurytothepatientandtheprovider.Aswithanytraining,itismoreusefulifitoccursbeforeanactualemergency,andinmanycountries,emergencyambulancedispatchersmaygivebasicfirstaidinstructionsoverthephonewhiletheambulanceisontheway.
Trainingisgenerallyprovidedbyattendingacourse,typicallyleadingtocertification.Duetoregularchangesinproceduresandprotocols,basedonupdatedclinicalknowledge,andtomaintainskill,attendanceatregularrefreshercoursesorre-certificationisoftennecessary.FirstaidtrainingisoftenavailablethroughcommunityorganizationssuchastheRedCrossandSt.JohnAmbulance,orthroughcommercialproviders,whowilltrainpeopleforafee.Thiscommercialtrainingismostcommonfortrainingofemployeestoperformfirstaidintheirworkplace.Manycommunityorganizationsalsoprovideacommercialservice,whichcomplementstheircommunityprogrammes.
Australia
InAustralia,NationallyrecognizedFirstAidcertificatesmayonlybeissuedbyRegisteredtrainingorganisationswhoareaccreditedontheNationalTrainingInformationSystem(NTIS).MostFirstAidcertificatesareissuedatoneof3levels:
∙Level1(or“BasicFirstAid”,or“BasicLifeSupport”):
isa1-daycoursecoveringprimarilylife-threateningemergencies:
CPR,bleeding,chokingandotherlife-threateningmedicalemergencies.
∙Level2(“SeniorFirstAid”)isa2daycoursethatcoversalltheaspectsoftraininginLevel1,aswellasspecializedtrainingfortreatmentofburns,bites,stings,electricshockandpoisons.Level2reaccreditationisa1daycoursewhichmustbetakenevery3years,butCPRreaccrediationmayberequiredmorefrequently(typicallyyearly).
∙Level3(“OccupationalFirstAid”)isa4-daycoursecoveringadvancedfirstaid,useofoxygenandAutomatedexternaldefibrillatorsanddocumentation.ItissuitableforworkplaceFirstAidersandthosewhomanageFirstAidfacilities.
Othercoursesoutsidetheselevelsarecommonlytaught,includingCPR-onlycourses,AdvancedResuscitation,RemoteAreaorWildernessFirstAid,AdministeringMedications(suchassalbutamolortheEpi-Pen)andspecializedcoursesforparents,schoolteachers,communityfirstrespondersorhazardousworkplacefirstaiders.CPRRe-accredidationcoursesaresometimesrequiredyearly,regardlessofthelengthoftheoverallcertification.
Canada
InCanada,firstaidcertificatesareawardedbyoneofseveral
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