THE AIMS OF FIRST AID
First Aid treatment is given to a casualty:

1. To preserve life,
   
2. to prevent the worsening of the condition,
   
3. to promote recovery

THE RESPONSIBILITY OF THE FIRST AIDER
Because of the frequency and serious nature of many accidents, the role of the first Aider is very important.

In the management of a casualty, your immediate responsibility as a First Aider is to

This is the preferred method of artificial respiration in all cases where a casualty is not breathing if the mouth cannot be used, satisfactory respiration can be achieved through the nose (Mouth - to - nose) or through the mouth and nose in small children and infants (Mouth to Mouth and Nose).

1. Remove any obvious obstructions over the face or constrictions around the neck open the airway and remove any debris seen in the mouth and throat.
   
2. Open your mouth wide, take a deep breath, pinch the casualty's nostrils together with your fingers and seal your lips around his mouth.

DRESSING

• Prevent infection
• Absorb discharge
• Control bleeding
• Avoid further injury

An efficient dressing should be sterile (germ-free) and have a high degree of porosity to allow for oozing and sweating

• Patient shows signs of restlessness.
• Patient shows signs of restlessness.
• Rate of breathing increases
• Breath gets shorter
• Veins of the neck become swollen
• Face, Lips, Nails, Fingers and Toes turn blue.
• Pulse gets faster and feebler
  

NOTE: Even after breathing has stopped the heart may continue to beat for ten to twelve minutes. In such cases artificial respiration must be undertaken immediately, which can prevent death.

MANAGEMENT

1. Remove the cause, if possible or remove the casualty.
2. Loosening the tight clothing e.g., collar belt etc and expose the chest and neck.
3. Resuscitations:

• Opening the Airway
• Checking the breathing
• Clearing the Airways
• Artificial Respiration - mouth to mouth respiration
• Circulation - External Chest Compressions

TYPES OF WOUNDS::

1) Incised Wounds are caused by sharp instruments like knife, razor etc. The blood vessels are clean cut and so these wounds bleed very much.

2) Contused Wounds are caused by blows by blunt instruments or by crushing. The tissues are bruised.

3) Lacerated Wounds are caused by machinery, falls on rough surfaces places of shells, claw of animals etc. These wounds have torn and irregular edges and they torn and irregular edges and they bleed less.

4) Punctured Wounds are caused by stabs by any sharp instrument like a knife or a dagger. They have small openings but may be very deep.

MANAGEMENT

1. Stop bleeding. Apply direct pressure to the wound with a sterile dressing or a clean cloth piece. If necessary press the relevant arterial pressure-point.
2. Handle the injured part as gently as possible.
3. Make the patient sit or let him lie down. If the wound is in a limb, and there are no broken bones, raise the limb. This will lessen the bleeding
4. Wash your hands thoroughly or clean them with an antiseptic lotion.
5. Remove any foreign objects like glass, stones, etc. if you can easily get at them. This should not open up the wound again which will cause more bleeding. Do not disturb any blood clot already formed.
6. Place a clean dressing over the wound and bandage firmly.
7. Get a doctor. If you cannot get a doctor or nurse, you will have to transport him as early as possible to the hospital.

Shock is a symptom complex condition of collapse (depression of vital functions) which should be treated on top priority second only to attending to obstructed breathing, stoppage of heart, or severe bleeding. It may lead to death. If not treated on time.

TYPES AND CAUSES
Shock can be divided into two types: Nervous shock and True shock.
Nervous shock is due to strong emotional upset, e.g. fear, pain, or bad news and not necessarily due to a serious injury. Does not need treatment, as such, except for reassuring and sympathetic handling.
True shock is due to severe bleeding, severe burns, heart attacks, abdominal emergencies, crush injuries, loss of body fluid, bacterial infections.

MANAGEMENT

1. Reassure the casualty (when conscious)
2. Put him comfortably on his back. However, in cases of injury of the head, chest or of the abdomen, lower the head slightly and turn it to a side. in cases of vomiting place in the three-quarter prone position (Recovery position)
3. Loosen tight clothing, do not remove clothing.
4. Wrap in light bed sheet or thin rug
5. Never use hot water bottles or very warm rugs. Do not rub any part of the body with anything.
6. In cases of injuries to chest or abdomen, nothing should be given by mouth as he may later need an operation or blood transfusion.
7. Observe all the above quickly as even a minutes delayed may mean death. if there is no chest or abdominal injury and the patient is conscious, give sips of water, hot tea, coffee or coconut milk (Never give any alcoholic drinks),
8. Most important: Remove to hospital on top priority.

MANAGEMENT

The aims of first aid are:

• To prevent further damage,
• To reduce pain
• To make the patient comfortable and manage shock.
• To get medical aid as soon as possible.

1. Fractures often occur in major accidents. Therefore it is common to find other injuries also. The First Aider must decide which is more urgent. Heavy bleeding and severely wounded parts are more urgent and should be treated first.
2. There may be more than one fracture in the same patient or even in the same limb
3. If there is no immediate danger to life, temporary attention to fracture is enough.
4. Treat the fracture on the spot, so that the fractured ends are established and patient is ready for transport.
5. Handle very gently, avoid all unnecessary movements of the injured parts.
6. Send for medical aid or send the patient to hospital as quickly as possible. Also inform party's relatives.
7. Treat for shock.
8. If the broken ends of the bones show out, do not wash the wound or apply antiseptics to the ends of the bone.
9. Do not handle the fracture unnecessarily; the simpler the first aid the better.
10. Never attempt to bring the bones to normal position or reduce the fracture.
11. Do not give anything by mouth as this might delay treatment under anesthesia.
12. Arrange, without delay, for the disposal of a casualty to a doctor, hospital or home, according to the seriousness of the casualty's condition.

INJURIES TO MUSCLES AND JOINTS MUSCLES AND TENDONS

Muscles are the fleshy part of the body. They give the body its shape. All movements of the body are done with the help of muscles. There are two types of muscles voluntary and involuntary.

Voluntary muscles are found in the head, the neck, the limbs and the walls of trunk. They are attached to the bones either directly or by white fibrous bands called tendons. Voluntary muscles are under the control of the Will. Movements of the body take place by the contraction and relaxation of these muscles.

Involuntary muscles are found on the walls of the stomach and intestines, in the air passages, the blood vessels and the heart. They are not controlled by the Will. They work under the influence of the autonomous nervous system.

MUSCLE STRAINS AND RUPTURES

A muscle stain is caused by overstretching of muscles. It generally happens as a result of a twist or a sudden effort such as lifting a heavy weight. A few muscles or tendon fibers will be torn.

A rupture (or tear) is a more serious injury in which a muscle bundle or tendon is torn across. The sudden pulling of the calf muscle is a common example of a rupture.

SIGNS AND SYMPTOMS

1. There is a sudden sharp pain at the muscle
2. The muscles may swell and feel stiff
3. In a rupture there is sever pain and the casualty cannot move the injured part.

THE AIMS OF FIRST AID

1. To reduce pain
   
2. To give rest and support to the part
   
3. To get medical aid.

MANAGEMENT

1. Place the casualty in the position most comfortable to him/her.
2. Support the injured part. Use a sling in case of an upper limb and a crutch or a stick for a lower limb.
3. Apply a cold compress (a handkerchief, towel, or a piece of cloth soaked in cold water and squeezed).
4. Get a doctor or take the casualty to a hospital. If he/she has to travel a long distance, immobilize the limb as in fracture.

FIRE ACCIDENTS

DANGERS DUE TO FIRE HELPING A PERSON WHOSE CLOTHES HAVE CAUGHT FIRE.

The person administering First Aid should know how to deal with a person whose clothes have caught fire.

1. Put out the flames by whatever means available. Most of the causes of burns occur in homes and water is readily available to quench the flames, water also cools the burnt area causing less damage to occur
2. Do not allow the person to run about. This only fans the fire and makes the flame spread.
3. Hold a rug, blanket, coat or table cover in front of you, while approaching a man whose clothing have caught fire
4. Lay him down quickly on the ground and wrap tightly with any thick piece of cloth, rug or coat. Smoother the flame by gentle pats over the covering but do not roll the casualty.
5. If the clothes in front of the body have caught fire, lay him on his back and vice versa, till suitable material is brought to smother the flame.

MANAGEMENT OF SERIOUS BURNS AND SCALDS
Immediate attention that is required in serious burns are:

1. Keep the casualty quiet and reassure him.
2. Wrap him in clean cloth.
3. Do not remove adhering particles of charred clothing.
4. Cover burnt area with sterile or clean dressing and bandages. In case of burns covering a large part of the body. It is sufficient to cover the area with a clean sheet or towel/
5. Keep him but do not overheat him.
6. If the hands are involved, keep them above the level of the victim's heart.
7. Keep burnt feet or legs elevated.
8. If victim's face is burnt, sit up or prop him up and keep/under continuous observation for breathing difficulty. If respiration problems develop, an open airway must be maintained.
9. Do not immerse the extensive burnt area or apply ice water over it because cold may intensify the shock reaction. However a cold pack may be applied to the face or to the hands or feet.
10. Shift the casualty to the nearest hospital if he is fit to be moved.
11. If you cannot take him to a hospital, wait for the doctor to arrive.
12. do not open blisters.
13. Keep him wrapped up in clean cloth.
14. Treat for shock.
15. Remove quickly from the body anything of a constricting nature like rings, bangles, belts and boots. If this is not done early, it would be difficult to remove them later as the limb begins to swell.
16. If medical help or trained ambulance personnel can not reach the scene for an hour or more and the victim is conscious and not vomiting, give him a weak solution of salt and soda at home and enroute one level teaspoonful of salt and half level teaspoonful of baking soda to each glass of water, neither hot nor cold. Allow the casualty to sip slowly. Discontinue fluid if vomiting occurs. Do not apply ointment or any form of grease or other home remedy.

FIRST AID IN POISONING

1. Poisoning is a serious matter. Patient must be removed to a hospital or a doctor be sent for at once with a note of the findings and if possible the name of the poison.
2. Preserve packets or bottles which you suspect contained the poison and also any vomits, sputum etc. for the doctor to deal with.
3. If unconscious
   • Do not induce vomiting
   • Make the casualty lie on his back on a hard, flat bed without any pillow and turn the head to one side. As there is no pressure on the stomach and the gullet is horizontal, the vomited matter will not get into the voice box and the tongue will not close the air passage. This is also the best posture for giving artificial respiration, if needed.
   • Sometimes when there is excess of vomiting the three-quarter-prone posture (i.e. the casualty is made to lie on his sides with one leg stretched, the other bent at knee and thigh) will make things easier for the casualty.
   • If breathing is very slow or stopped, start artificial respiration and keep it up till the doctor comes.
4. If conscious
   • Aid vomiting by tickling the back of throat or make him drink tepid water mixed with 2 tablespoons of common salt for a tumbler of water.
   • Even if conscious, when the poison is a corrosive do not induce vomiting.

ROAD ACCIDENTS

FIRST AID TO VICTIMS OF ROAD ACCIDENTS

On many occasions the victims of road side accidents remain lying on the spot without medical aid or an help form the members of public till the arrival of police at the spot which in some cases may take time. The members of public do not basically have an indifferent attitude in such situation but they have a feeling that instead of any credit for helping the injured by way of removing him to the hospital, they will have to bear the expenditure on transportation of the victims to the hospital. They also feel that there will be harassment by the police who may look to them with suspicion. Such thinking is not correct. A person who is lying helpless can be relieved from sufferings if some one provides timely relief and if needed remove to nearest hospital. Even little knowledge of first aid which may rendered by public men or first aiders can provide skilled assistance and save lives.

To overcome this difficulty and to make the public aware of their moral duty, the police has been issuing instructions from time to time through press, posters, radio and even T.V. that members of public should give a positive response in the noble takes of removing the injured at the earliest for medical aid to the hospital. Instructions have also been given to police staff to ensure that such persons who bring an injured to the hospital for medical aid may not be detained. It would suffice if the following question are asked to the person who brings the injured to the hospital:-

1. Where have you brought this person from?
   
2. Do you know anything about the cause of the injury of the person?
   
3. May I have your particulars?

It is likely that the person would answer the first question, but may not have an answer for the second and hesitates to reply the third in which case it should not be insisted upon. The escorters should, under no circumstances be detained in the hospital for interrogation. On the other hand, he should be treated with courtesy.

However rendering aid to the injured is the Moral and Civic duty of each and every one of us.

INJURIES LIKELY TO BE MET IN  FACTORIES

In workshops, factories and industries the types of injuries sustained by workers generally, are as below:-

The victim may be pinned down under the machinery. There may be lacerations: a part of a limb ma be avulsed twisted there may be multiple fractures or severe traumatic shock. In some cases it is not possible to extricate or release the victim. In such cases, the machinery should be stopped immediately, power cut off and services of senior foreman or the persons who is familiar with the machine, requisitioned. Modern machines have automatic releasing devices or you may have to dismantle the parts. The first aider is to attend the victim, control the bleeding, treat shock, reassure and cover any burnt or injured part. If this victim is unconscious ensure that the air way is clear. Arrange for immediate medical aid at the spot and remove to the hospital.

In the air crash or railway accidents, comprehensive skilled medical facilities are available from the concerned authority. The instructions issued by them have to be followed.

In case of accidents in deep mines such as coal mines, besides first aid treatment rescue work is very important and is to be urgently provided. This is only possible by special safety devices and trained staff, the facilities for which must be available at all mines and at all times. Any delay or ill equipped services may lead to heavy causalities.

PRESERVE ANY CUT FINGER OR LIMB AND SEND IT ALONG WITH THE PATIENT IN A CLEAN PLASTIC BAG TO PREVENT DRYING OUT; AVOID USE OF LIQUID/ANTISEPTIC WHILE CARRYING THE SEVERED PART. DO NOT REMOVE OR CUT ANY HANGING PORTION OF SKIN, FINGER OR LIMB.