Safety First

First aid is the immediate care that is given to an injured or an ill person before treatment by a medically trained personnel so as to ensure saving a life, a better chance at recovery and to prevent complications.

It can be classified into:

• First aid on the spot/site
• First aid at a medical set-up.

Another classification could be on the basis of clinical conditions that require immediate attention to avert death.

The aim of first aid

The aims of first aid can be summarised in three key points:

• Preserve life: the main aim of all medical care, including first aid, is to save life.
• Prevent further harm: this covers external factors, such as moving a patient away from harm, and applying first aid techniques to prevent worsening of the condition.
• Promote recovery: first aid tries to start recovery process and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound.

Emergency conditions which require immediate first aid

• Common surgical conditions like external trauma/injury/severe bleeding/bites and stings, fractures/dislocation, burns, shock, and frostbite.
• Medical conditions like asphyxia and emergency respiratory conditions, emergency cardiac conditions, stroke/aneurysm, epilepsy, and hyperpyrexia
• Immediate management of unconscious/collapsed patient
• Emergency obstetric condition.

First aid in surgical conditions

• External trauma/head injury/chest trauma/abdominal trauma, road traffic accident, fall, gun shot injury, fights and quarrels. These injuries may lead to severe internal haemorrhage [bleeding in the intravascular compartment or organs], external bleeding, fractures or dislocations. If the victim is immediately resuscitated within the “golden hour” [the first one hour from the time of injury], s/he stands a greater chance of survival and a reduction in the adverse consequences of the injuries, especially if followed by quality health care assistance.
• Immediate on-the scene rescue and assistance is vital, especially if healthcare emergency response is absent or significantly delayed. Such rescue measures include pplication of pressure on the bleeding site by any available resources like a cotton bandage/clean cloth/ice application to stop bleeding. Thereafter, arrange to shift the victim to a nearby medical/trauma centre.
• In case of suspected fracture, the least that can be done is to immobilise the affected part by firmly strapping it to any rigid material [even a bundle of newspapers will do].
• In case of animal/human bite, cleanse the wound thoroughly with soap and clean water, then apply iodine-containing antiseptic to prevent infection.
• For snake bite, wash the area thoroughly, do not move the affected part too much and apply a tourniquet above the site of bite to slow down absorption of poisons. Anti-venom treatment should be administered in a medical setting only for a small percentage of reptile bites.
• For insect stings, apply cortisone ointments, soothing lotions, or cold compress.

In case of burns

Symptoms of a burn injury include redness [first-degree burns], blistering [second-degree burns], charring of skin [third-degree burns]. Treatment includes applying running tepid/cool water to first and second degree burns. All burns should be covered with sterile non-adherent dressings.

Chemical burns should be washed with large quantity of water; vinegar may be added to the water for alkali burns, and sodium bicarbonate may be added in case of acid burns.

Electric burn may lead to sudden death. Switch off the supply before handling the victim. If this is not possible, then at least try to separate the victim from the live wire by using dry wood or rubber. Wrap the victim with warm blankets to prevent hypothermia [abnormally low body temperature], administer CPR [Cardio Pulmonary Resuscitation] and rush him/her to an hospital.

In case of shock

In case of hypovolaemic shocks [severe blood loss], the extra cellular fluid volume is lost due to burns/bleeding/excessive vomiting and/or loose motions. The immediate aid would be to give lots of water and oral fluids like ORS, lime juice and coconut water to replenish the loss. This may prevent mortality due to dehydration a common cause of death especially in the paediatric age groups.

In case of cardiogenic shock, basic life support measures like the CPR should be immediately given. Shift the patient to a nearby intensive cardiac set-up.

For frostbite

The common symptoms of frostbite include numbness, pale and glossy skin, and possible blistering. Keep the victim warm by placing him/her indoors, remove clothing from frostbitten areas of skin and immerse it in warm water; do not massage. For cold exposure, give artificial respiration. Placing blankets over a person, who has a reduced bodycore temperature will do no good; heat must be applied to the victim to bring the temperature up to normal. If conscious, give the victim some warm liquids to drink.

First aid in medical emergencies

Asphyxia and respiratory emergencies include choking, drowning, hanging, burning, and suffocation, wherein there is death due to hypoxia/anoxia [severely reduced/absent oxygen saturation in blood.

In case of choking due to food/foreign body in trachea, thump the back with patient in forward bending position so that the cause of obstruction may be vomited out.

In case of drowning, remove the victim from water, put him/her in recovery position. Then give him chest compressions so as to remove water from lungs. CPR can also be given before transferring the victim to an emergency medical set-up.

In case of suicide attempt/homicide, the injury occurs due to sudden obstruction of trachea and upper cervical vertebra fracture. If the victim is still alive, remove the cause of obstruction around the neck, give CPR and immediately transfer the victim to an emergency set-up.

In case of a severe asthma attack, give the victim the emergency inhalers prescribed to him/her.

In cardiac emergencies like heart attack, immediate specific medications like Sorbitrate/anti-platelets should be given. Give the victim immediate CPR and transfer him/her to a cardiac care unit via cardiac ambulance or any earliest vehicle available. In case of cardiac emergencies, the initial treatment given during the golden hour period, leads to lesser complications and mortality, and a better survival rate.

In neurological emergencies like stroke [paralysis], unconsciousness, convulsions [fits], immediately transfer the victim to a medical/neurological centre as specific management needs to be given at the earliest.

In case of convulsions, the patient should be made to lie laterally [on one side] to prevent aspiration. In order to avoid tongue bite, a mouth gag should be used.

First aid for an unconscious patient

The cause of unconsciousness or the sudden collapse needs to be assessed. A common cause could be hypoglycaemia [sudden lowering of blood sugar level in brain] which can be treated by giving a glass of glucose water or a little sugar dissolved in a glass of water. This can prevent neuronal damage in the brain.

An unconsciousness patient should be assessed for proper breathing and circulation. If all is well the patient is to be placed in recovery position. In case the individual requires resuscitation, CPR is to be started and a patient not responding to initial resuscitation like CPR needs immediate hospitalisation.