First Aid and Emergency Information

1 Fundamental Criteria for First Aid
2 Basic Measures for First Aid
3 First Aid for Special Wounds
4 First Aid for Fractures
5 First Aid for Climatic Injuries
6 First Aid for Bites and Stings
7 First Aid in Toxic Environments
8 First Aid for Psychological Reactions

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Chapter 2 - Basic Measures for First Aid

Introduction
Several conditions which require immediate attention are an inadequate airway, lack of breathing or lack of heartbeat, and excessive loss of blood. A casualty without a clear airway or who is not breathing may die from lack of oxygen. Excessive loss of blood may lead to shock, and shock can lead to death; therefore, you must act immediately to control the loss of blood. All wounds are considered to be contaminated, since infection-producing organisms (germs) are always present on the skin, on clothing, and in the air. Any missile or instrument causing the wound pushes or carries the germs into the wound. Infection results as these organisms multiply. That a wound is contaminated does not lessen the importance of protecting it from further contamination. You must dress and bandage a wound as soon as possible to prevent further contamination. It is also important that you attend to any airway, breathing, or bleeding problem IMMEDIATELY because these problems may become life-threatening.

Section I. OPEN THE AIRWAY AND RESTORE BREATHING
* 2-1. Breathing Process

All living things must have oxygen to live. Through the breathing process, the lungs draw oxygen from the air and put it into the blood. The heart pumps the blood through the body to be used by the living cells which require a constant supply of oxygen. Some cells are more dependent on a constant supply of oxygen than others. Cells of the brain may die within 4 to 6 minutes without oxygen. Once these cells die, they are lost forever since they DO NOT regenerate. This could result in permanent brain damage, paralysis, or death.

2-2. Assessment (Evaluation) Phase (081-831-1000 and 081-831-1042)
a. Check for responsiveness (Figure 2-1A)—establish whether the casualty is conscious by gently shaking him and asking, “Are you O.K.?”
b. Call for help (Figure 2-1B).
c. Position the unconscious casualty so that he is lying on his back and on a firm surface (Figure 2-1C) (081-831-1042).

WARNING (081-831-1042)
If the casualty is lying on his chest (prone position), cautiously roll the casualty as a unit so that his body does not twist (which may further complicate a neck, back or spinal injury).
Figure 2-1
(1) Straighten the casualty’s legs. Take the casualty’s arm that is nearest to you and move it so that it is straight and above his head. Repeat procedure for the other arm.
(2) Kneel beside the casualty with your knees near his shoulders (leave space to roll his body) (Figure 2-1B). Place one hand behind his head and neck for support. With your other hand, grasp the casualty under his far arm (Figure 2-1C).
(3) Roll the casualty toward you using a steady and even pull. His head and neck should stay in line with his back.
(4) Return the casualty’s arms to his sides. Straighten his legs. Reposition yourself so that you are now kneeling at the level of the casualty’s shoulders. However, if a neck injury is suspected, and the jaw-thrust will be used, kneel at the casualty’s head, looking toward his feet.

2-3. Opening the Airway—Unconscious and Not Breathing Casualty (081-831-1042)
*The tongue is the single most common cause of an airway obstruction (Figure 2-2). In most cases, the airway can be cleared by simply using the head-tilt/chin-lift technique. This action pulls the tongue away from the air passage in the throat (Figure 2-3).
Figure 2-2 Figure 2-3
a. Step ONE (081-331-1042). Call for help and then position the casualty. Move (roll) the casualty onto his back (Figure 2-1C above).

CAUTION
Take care in moving a casualty with a suspected neck or back injury. Moving an injured neck or back may permanently injure the spine.

NOTE (081-831-1042)
If foreign material or vomitus is visible in the mouth, it should be removed, but do not spend an excessive amount of time doing so.

b. Step TWO (081-831-1042). Open the airway using the jaw-thrust or head-tilt/chin-lift technique.

NOTE
The head-tilt/chin-lift is an important procedure in opening the airway; however, use extreme care because excess force in performing this maneuver may cause further spinal injury. In a casualty with a suspected neck injury or severe head trauma, the safest approach to opening the airway is the jaw-thrust
technique because in most cases it can be accomplished without extending the neck.¹

(1) Perform the jaw-thrust technique. The jaw-thrust may be accomplished by the rescuer grasping the angles of the casualty’s lower jaw and lifting with both hands, one on each side, displacing the jaw forward and up (Figure 2-4). The rescuer’s elbows should rest on the surface on which the casualty is lying. If the lips close, the lower lip can be retracted with the thumb. If mouth-to-mouth breathing is necessary, close the nostrils by placing your cheek tightly against them. The head should be carefully supported without tilting it backwards or turning it from side to side. If this is unsuccessful, the head should be tilted back very slightly.² The jaw-thrust is the safest first approach to opening the airway of a casualty who has a suspected neck injury because in most cases it can be accomplished without extending the neck.
Figure 2-4
(2) Perform the head-tilt/chin-lift technique (081-831-1042). Place one hand on the casualty’s forehead and apply firm, backward pressure with the palm to tilt the head back. Place the fingertips of the other hand under the bony part of the lower jaw and lift, bringing the chin forward. The thumb should not be used to lift the chin (Figure 2-5).

NOTE
The fingers should not press deeply into the soft tissue under the chin because the airway may be obstructed.
Figure 2-5
c. Step THREE. Check for breathing (while maintaining an airway). After establishing an open airway, it is important to maintain that airway in an open position. Often the act of just opening and maintaining the airway will allow the casualty to breathe properly. Once the rescuer uses one of the techniques to open the airway (jaw-thrust or head-tilt/chin-lift), he should maintain that head position to keep the airway open. Failure to maintain the open airway will prevent the casualty from receiving an adequate supply of oxygen. Therefore, while maintaining an open airway, the rescuer should check for breathing by observing the casualty’s chest and performing the following actions within 3 to 5 seconds:
(1) LOOK for the chest to rise and fall.
(2) LISTEN for air escaping during exhalation by placing your ear near the casualty’s mouth.
(3) FEEL for the flow of air on your cheek (see Figure 2-6),
(4) If the casualty does not resume breathing, give mouth-to-mouth resuscitation.

NOTE
If the casualty resumes breathing, monitor and maintain the open airway. If he continues to breathe, he should be transported to a medical treatment facility.

2-4. Rescue Breathing (Artificial Respiration)
a. If the casualty does not promptly resume adequate spontaneous breathing after the airway is open, rescue breathing (artificial respiration) must be started. Be calm! Think and act quickly! The sooner you begin rescue breathing, the more likely you are to restore the casualty’s breathing. If you are in doubt whether the casualty is breathing, give artificial respiration, since it can do no harm to a person who is breathing. If the casualty is breathing, you can feel and see his chest move. Also, if the casualty is breathing, you can feel and hear air being expelled by putting your hand or ear close to his mouth and nose.
b. There are several methods of administering rescue breathing. The mouth-to-mouth method is preferred; however, it cannot be used in all situations. If the casualty has a severe jaw fracture or mouth wound or his jaws are tightly closed by spasms, use the mouth-to-nose method.

2-5. Preliminary Steps—All Rescue Breathing Methods (081-831-1042)
a. Step ONE. Establish unresponsiveness. Call for help. Turn or position the casualty.
b. Step TWO. Open the airway.
c. Step THREE. Check for breathing by placing your ear over the casualty’s mouth and nose, and looking toward his chest:
(1) Look for rise and fall of the casualty’s chest (Figure 2-6).
(2) Listen for sounds of breathing.
(3) Feel for breath on the side of your face. If the chest does not rise and fall and no air is exhaled, then the casualty is breathless (not breathing). (This evaluation procedure should take only 3 to 5 seconds. Perform rescue breathing if the casualty is not breathing.

NOTE
Although the rescuer may notice that the casualty is making respiratory efforts, the airway may still be obstructed and opening the airway may be all that is needed. If the casualty resumes breathing, the rescuer should continue to help maintain an open airway.
Figure 2-6

2-6. Mouth-to-Mouth Method (081-831-1042)
In this method of rescue breathing, you inflate the casualty’s lungs with air from your lungs. This can be accomplished by blowing air into the person’s mouth. The mouth-to-mouth rescue breathing method is performed as follows:
a. Preliminary Steps.
(1) Step ONE (081-831-1042). If the casualty is not breathing, place your hand on his forehead, and pinch his nostrils together with the thumb and index finger of this same hand. Let this same hand exert pressure on his forehead to maintain the backward head-tilt and maintain an open airway. With your other hand, keep your fingertips on the bony part of the lower jaw near the chin and lift (Figure 2-7).
Figure 2-7
NOTE
If you suspect the casualty has a neck injury and you are using the jaw-thrust technique, close the nostrils by placing your cheek tightly against them.³

(2) Step TWO (081-831-1042). Take a deep breath and place your mouth (in an airtight seal) around the casualty’s mouth (Figure 2-8). (If the injured person is small, cover both his nose and mouth with your mouth, sealing your lips against the skin of his face.)
Figure 2-8
(3) Step THREE (081-831-1042). Blow two full breaths into the casualty’s mouth (1 to 1 1/2 seconds per breath), taking a breath of fresh air each time before you blow. Watch out of the corner of your eye for the casualty’s chest to rise. If the chest rises, sufficient air is getting into the casualty’s lungs. Therefore, proceed as described in step FOUR below. If the chest does not rise, do the following (a, b, and c below) and then attempt to ventilate again.
(a) Take corrective action immediately by reestablishing the airway. Make sure that air is not leaking from around your mouth or out of the casualty’s pinched nose.
(b) Reattempt to ventilate.
(c) If chest still does not rise, take the necessary action to open an obstructed airway (paragraph 2-14).

NOTE
If the initial attempt to ventilate the casualty is unsuccessful, reposition the casualty’s head and repeat rescue breathing. Improper chin and head positioning is the most, common cause of difficulty with ventilation. If the casualty cannot be ventilated after repositioning the head, proceed with foreign-body airway obstruction maneuvers (see Open an Obstructed Airway, paragraph 2-14).

(4) Step FOUR (081-831-1042). After giving two breaths which cause the chest to rise, attempt to locate a pulse on the casualty. Feel for a pulse on the side of the casualty’s neck closest to you by placing the first two fingers (index and middle fingers) of your hand on the groove beside the casualty’s Adam’s apple (carotid pulse) (Figure 2-9). (Your thumb should not be used for pulse taking because you may confuse your pulse beat with that of the casualty.) Maintain the airway by keeping your other hand on the casualty’s forehead. Allow 5 to 10 seconds to determine if there is a pulse.
Figure 2-9
(a) If a pulse is found and the casualty is breathing—STOP allow the casualty to breathe on his own. If possible, keep him warm and comfortable.
(b) If a pulse is found and the casualty is not breathing, continue rescue breathing.
*(c) If a pulse is not found, seek medically trained personnel for help.
b. Rescue Breathing (mouth-to-mouth resuscitation) (081-831-1042). Rescue breathing (mouth-to-mouth or mouth-to-nose resuscitation) is performed at the rate of about one breath every 5 seconds (12 breaths per minute) with rechecks for pulse and breathing after every 12 breaths. Rechecks can be accomplished in 3 to 5 seconds. See steps ONE through SEVEN (below) for specifics.

NOTE
Seek help (medical aid), if not done previously.

(1) Step ONE. If the casualty is not breathing, pinch his nostrils together with the thumb and index finger of the hand on his forehead and let this same hand exert pressure on the forehead to maintain the backward head-tilt (Figure 2-7).
(2) Step TWO. Take a deep breath and place your mouth (in an airtight seal) around the casualty’s mouth (Figure 2-8).
(3) Step THREE. Blow a quick breath into the casualty’s mouth forcefully to cause his chest to rise. If the casualty’s chest rises, sufficient air is getting into his lungs.
(4) Step FOUR. When the casualty’s chest rises, remove your mouth from his mouth and listen for the return of air from his lungs (exhalation).
(5) Step FIVE. Repeat this procedure (mouth-to-mouth resuscitation) at a rate of one breath every 5 seconds to achieve 12 breaths per minute. Use the following count: “one, one-thousand; two, one-thousand; three, one-thousand; four, one-thousand; BREATH; one, one-thousand;” and so forth. To achieve a rate of one breath every 5 seconds, the breath must be given on the fifth count.
(6) Step SIX. Feel for a pulse after every 12th breath. This check should take about 3 to 5 seconds. If a pulse beat is not found, seek medically trained personnel for help.
(7) Step SEVEN. Continue rescue breathing until the casualty starts to breathe on his own, until you are relieved by another person, or until you are too tired to continue. Monitor pulse and return of spontaneous breathing after every few minutes of rescue breathing. If spontaneous breathing returns, monitor the casualty closely. The casualty should then be transported to a medical treatment facility. Maintain an open airway and be prepared to resume rescue breathing, if necessary.

2-7. Mouth-to-Nose Method
Use this method if you cannot perform mouth-to-mouth rescue breathing because the casualty has a severe jaw fracture or mouth wound or his jaws are tightly closed by spasms. The mouth-to-nose method is performed in the same way as the mouth-to-mouth method except that you blow into the nose while you hold the lips closed with one hand at the chin. You then remove your mouth to allow the casualty to exhale passively. It may be necessary to separate the casualty’s lips to allow the air to escape during exhalation.

* 2-8. Heartbeat
If a casualty’s heart stops beating, you must immediately seek medically trained personnel for help. SECONDS COUNT! Stoppage of the heart is soon followed by cessation of respiration unless it has occurred first. Be calm! Think and act! When a casualty’s heart has stopped, there is no pulse at all; the person is unconscious and limp, and the pupils of his eyes are open wide. When evaluating a casualty or when performing the preliminary steps of rescue breathing, feel for a pulse. If you DO NOT detect a pulse, immediately seek medically trained personnel.

Paragraphs 2-9, 2-10, and 2-11 have been deleted. No text is provided for pages 2-15 through 2-20.

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