STANDARD FIRST AID BY PDRRMO

CHAPTER 1
EMERGENCY: An unforeseen combination of circumstances or the resulting
state that call for immediate action. It is also a sudden bodily
alteration that is likely to require immediate medical attention. This
is usually distressing event or condition that can often be
anticipated or prepared for but seldom exactly foreseen.
In any emergency, it's essential to stay calm if you are to help the
individual involved. Here are the basic actions to take:
1. Ensure that the scene is safe.
2. Make sure there are no immediate dangers such as fallen power
lines, floodwaters, high tides, hazardous materials, or traffic.
3. Check the patient for life-threatening conditions. Common ones are
unconsciousness, difficulty breathing, or severe bleeding.
4. Activating the Emergency Medical Services System. Call EMS/9-1-
1/0932-6000-119 or another designated emergency phone number in your
localities and ask for instructions from the emergency dispatcher.

EMERGENCY MEDICAL SERVICES SYSTEM

The emergency medical services (EMS) system is a network of community
resources and trained personnel, organized to give emergency care in
cases of injury or sudden illness. The system begins when someone sees
an emergency and decides to take action by calling EMS/9-1-1/0932-
6000-119.

CHAIN OF SURVIVAL
The Chain of Survival Behaviours is a series of steps that helps
ensure a positive outcome for an ill/injured person. As a First Aider,
your role is to prepare, recognize emergencies, and provide first aid
and/or access help.

YOUR ROLES AS A FIRST AIDER

First aid is the immediate care that is given to an ill or injured
person until more advance care can be obtained.
First Aider includes four basic steps:
1. Recognize the emergency
2. Protect yourself, the ill/injured person, and bystanders
3. Access help
a. (e.g., Call EMS/9-1-1/0932-6000-119)
4. Act according to your skills, knowledge, and comfort level.

Responding to the scene of an emergency involves providing emotional

support as well as caring for injuries. When providing care, you
should:

 Speak in a calm and reassuring manner. Ask for the ill/injured

person’s name and use it often.

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  Communicate both verbally and nonverbally to reassure the person.
 Position yourself at eye level when you talk to the ill/injured
person. Avoid unnecessary physical contact and any body language
that could appear threatening.
 Actively listen to the ill/injured person. This involves four
behaviours:
o Making every effort to fully understand what the person is
trying to say.
o Repeating back to the person, in your own words, what the
person just said.
o Avoiding criticism, anger, or rejection of the person’s
statements.
o Using open-ended questions (i.e., avoid question that can be
answered with Yes or No).

YOUR ROLE IN THE EMS SYSTEM

1. Perceive that an emergency exist.

2. Decide to take action or help the person.
3. Activate EMS System appropriately
4. Give initial appropriate care until EMS personnel take over.

RISK FOR INFECTION

Giving first aid care is a hands-on activity that can put you in close
contact with another person’s bodily fluids (i.e., saliva, mucus,
vomitus and blood), which may contain harmful pathogens
(microorganisms that can cause disease or infection).

MODE DEFINITION EXAMPLE

DIRECT CONTACT HIV/AIDS, Hepatitis,
Herpes

INDIRECT CONTACT Meningitis, Influenza

AIRBORNE TRANSMISSION MEASLES, TUBERCULOSIS

VECTOR-BORNE DENGUE, MALARIA

TRANSMISSION

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PREVENTION OF DISEASES

1. Personal Precaution
a. Hand washing
b. Hand sanitizing
c. Immunization
2. Equipment Precaution
a. Gloves
b. CPR Barriers
c. Safety glasses/goggles
3. Equipment care
a. Cleaning and disinfecting
b. Managing exposure incident

CHAPTER 2
If you encounter an ill/injured person, there are three simple
steps that you must take:

CHECK
Once you recognize an emergency you must first check the scene,
and then check the person.

 CHECK THE SCENE

o Is the scene safe for you, the ill/injured person, and
any bystanders?
o What happened? How did it happen?
o How many ill/injured people are there?
o Is there someone to help?
o What is your initial impression of the ill/injured
person?
 CHECK THE PERSON (PRIMARY ASSESSMENT)
o Check the person to see if he/she is responsive (AVPU)
o Check the person’s ABC’s: Airway, Breathing, and
Circulation
 A = Check the Airway
 B = Check Breathing
 C = Check Circulation
An obvious sign of death includes:
 Torso transection (torso cut into 2 pieces)
 Decapitation (detached head)
 Decomposition

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ROLLING A PERSON FROM A FACE-DOWN TO FACE-UP POSITION
Move an ill/injured person only if:
1. The person’s position stops you from giving care for a
life-threatening injury/illness.
2. The person is blocking access to someone with a more
serious injury/illness.
3. The scene is becoming unsafe
To roll a person from face-down to face-up position:
1. Support the head while rolling the person
2. Try to roll the person as one unit (head, back, and legs
at one time)
3. Open the airway with a head-tilt/chin-lift once the
person is facing upward.
4. Check the person’s ABC.

CALL
If you identify an unresponsive individual or an individual with
life-threatening condition in your initial check, you must always
activate EMS.

If you are alone: Call first or Care first?

If you are alone without a phone and there is no one to send to call
EMS/9-1-1/0932-6000-119, you may need to decide whether to call first
or care first. Unless the situation specifically requires you to
provide care before calling EMS/9-1-1/0932-6000-119, you should always
activate EMS first so that help will arrive as soon as possible.

You should provide care first in the following situations:

 The person is choking or is experiencing anaphylaxis and carrying
epinephrine.
 The person has life-threatening bleeding
 The person is an unresponsive child or baby who is not breathing.

WHEN YOU CALL EMS/9-1-1/0932-6000-119

When you call, the EMS dispatcher who answer will likely ask:
 Where is the location of emergency? ( address, nearby
intersections, or landmarks)
 What is the nature of the emergency (police, fire or medical
assistance) needed?
 What has happened?
 How many people are involved and what is their condition?
 What is your name?
 What telephone number are you calling from? (Call back number)

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CARE
Care for any life-threatening conditions first. Give the care that is
needed, within the scope of your knowledge and training, and follow
these general guidelines:
 Monitor the person’s breathing and level of responsiveness.
 Help the person rest in the most comfortable position. If
necessary, roll the person into recovery position.
 Keep the person from getting chilled or overheated
 Reassure the person by repeating that you are there to help and
that EMS personnel have been called (if this is true).
 Continue to watch for changes in the person’s condition.

RECOVERY POSITION
A person who is unresponsive or has an altered level of responsiveness
should not be left in a face-up position, as the airway can become
blocked by the person’s tongue or the person’s saliva or other bodily
fluids. You can help protect the airway by rolling the person onto
his/her side and into the recovery position.

WHEN TO STOP GIVING CARE

Once you begin providing care to an injured/ill person, you must
continue to give the appropriate care until:
o Another trained First Aider or EMS personnel take over.
o You are too exhausted to continue.
o The scene becomes unsafe.

GUIDELINES FOR HELPING AN ILL/INJURED PERSON WITH MEDICATION

You should only help a person take his/her medication if:
 It is safe to do so.
 The person is responsive and has in some way expressed a need for
help with finding, preparing, and/or taking the medication.

1. Finding the Medication

2. Preparing the Medication
3. Guiding the Person in Taking the Medication
4. Giving Lifesaving Medication
5. Giving Ingested Medications

SECONDARY ASSESSMENT
After you have identified and cared for any life-threatening
conditions found in the primary assessment, you must check the person
for other injuries and conditions that may require care. This is
called the secondary assessment.

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If the person’s ABC seems normal, do a secondary assessment to look
for injuries or conditions that were not identified in your primary
assessment. The secondary assessment consists of three steps:
1. Ask the SAMPLE History
2. Check the quality of the person’s vital signs
a. Level of responsiveness
b. Breathing
c. Skin colour and integrity
3. Doing an injury check
a. Focused Examination
 Explain that the purpose of the examination is to
identify injuries.
 Ask the person if anything hurts or feels
uncomfortable.
 If the person indicates an area of pain, discomfort,
or concern, look at the area for signs of injury
including discoloration (bruises) or deformities (odd
shapes). For privacy reasons, do not remove any of the
person’s clothing unless it makes providing first aid
difficult.
 If there are no signs of any injury, ask focused
questions about how the person feels. The symptoms the
person describes might help to determine whether
EMS/911/0932600119 needs to be called and what kinds
of care should be provided.
 If you find a medical identification product, be sure
to read it carefully. It may indicate what is wrong,
who to call for help, and what care to give.
 If the person doesn’t complain of any pain or
tenderness, and there are no signs of injuries, ask
the person to rest for a few minutes in a comfortable
position. Check the quality of the person’s vital
signs and ensure ABC’s are still unaffected. If there
is no visible problem, help the person to stand up
slowly when he or she is ready.
 Based on your findings, decide whether you need to
call EMS/911/0932600119, and provide first aid care as
needed.
b. Hands-On Check
c. Continual care
 Have the person rest
 Help the person maintain a normal body temperature
 Monitor the person’s condition and ABC
 Move the person into the recovery position, if
necessary.
 Give comfort and reassurance to the person.

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TO HELP A PERSON CALM DOWN AND CONTROL HIS BREATHING:
1. Encourage the person to maintain eye contact with you.
2. Have the person breathe in through his/her nose while you
raise your arm and count to five. Breathe with the person.
3. Have the person breathe out through his/her mouth, making an
audible sound, while you slowly lower your arm and count to ten.
4. Repeat 3-5 times, providing encouragement in a calm voice.

SHOULD YOU TRANSPORT AN ILL/INJURED PERSON TO THE HOSPITAL?

 The person is a friend/family member.
 The person’s injuries are minor and non-life-threatening.
 There is no risk of the person’s condition getting worse.
 There is no risk of the person experiencing an altered level of
responsiveness.

SHOCK
Life-threatening condition in which there is not enough blood/fluid
being delivered to all parts of the body. A person who is ill/injured
may go into shock. Shock is a life-threatening condition.
Causes of Shock:
1. Significant blood loss
2. Heart damage
3. Extensive burn
4. Infection
5. Anaphylaxis
6. Severe Infection

What you could see:

 Anxiety
 Cool, Clammy skin
 Pale skin
 Weakness
 Confusion
 Excessive Thirst
 Rapid Breathing
 Drowsiness/Loss of responsiveness
 Nausea or Vomiting

What to do on it:
The best thing you can do when a person is in shock is to Call
EMS/911/09326000119. While you are waiting for the EMS personnel to
arrive, provide care by:
1. Caring for the cause of the shock.
2. Having the person rest
3. Keeping the person warm
4. Monitor person’s ABC
5. Providing comfort reassurance.

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CHAPTER 3
CIRCULATION EMERGENCIES AND CPR

Circulatory Emergencies are sudden illnesses or injuries involving the

heart or the blood vessels. Because every minute counts when a person
is experiencing a circulation emergency, the person’s survival often
depends on First Aiders acting quickly and giving appropriate care
until EMS personnel arrive and take over.

CARDIOVASCULAR DISEASE
CVD is an abnormal condition that affects the heart and blood vessels.
It is one of the leading causes of deaths in the Philippines, and it
is the underlying cause of many circulation emergencies.

PREVENTIVE MEASURES:
CVD has both controllable and uncontrollable factors.
Uncontrollable Factors: age, sex, family history and ethnicity.
Fortunately, many risk factors of CVD are the result of lifestyle
choices and are therefore within a person’s control: Smoking,
Cholesterol, Blood Pressure, Weight, and Stress.

HEART ATTACK
It occurs when the heart muscle cannot get enough oxygen because of a
blockage in one of the arteries that feeds it.

What you could see:

The sign and symptoms may vary from person to person, and can be
different in men and women. Even a person who has had a heart attack
before may not experience the same signs and symptoms if he or she has
a second heart attack.

Signs and Symptoms of heart attack:

 Discomfort or pain that spreads to one or both arms, jaw,
shoulder, neck or (common in women) the back or upper part of the
stomach
 Problem on breathing
 Cold, sweaty skin
 Skin, lip, fingers that are bluish, ashen, or paler than normal.
 Feeling of anxiety, denial or impending doom.
“Soft signs” of a Heart attack
1. Mild, unfocused chest discomfort that:
• Come and goes
• Does not necessarily feel painful
• Gets better with rest and worst with activity, or gets
progressively worse
2. Extreme Fatigue
3. Gastric Discomfort, nausea, or vomiting
4. Flu-like symptoms
5. Dizziness or light-headedness

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 What to do on it:
If you suspect a person is having a heart attack, call
EMS/911/09326000119 and get an AED immediately (if available).
• Have the person rest comfortably
• If the patient has a prescribed medication to relieved chest
pain (i.e., nitroglycerin), offer to locate the medication and
help the person to take it.
• Reassure the person. Anxiety may increase the person’s
discomfort.

ANGINA
Occurs when the heart requires more oxygen than it is receiving. This
occurs when two factors are combined:
1. The arteries are narrowed by CVD, reducing blood flow;
2. The heart’s oxygen needs are elevated(e.g., during times of
physical activity or emotional stress).
Angina causes a painful squeezing, suffocating or burning feeling in
the chest.

STROKE
Happens when the blood flow to part of the brain is interrupted,
resulting in the death of brain cells. Stroke can cause permanent
brain damage, but with quick action, the damage can sometimes be
stopped or reversed.
Causes: Ruptured Aneurysm, Blood Clot, Brain Tumor
Prevention: Lifestyle changes

PREVENTIVE MEASURE
Because the risk factors for stroke are similar to those for heart
disease, the risk of a stroke can be reduced by following the same
lifestyle changes discussed for preventing cardiovascular disease.

What you could see:

A person who is having a stroke may suddenly develop one or more of
the following signs and symptoms:
• A sudden, severe headache
• Dizziness or confusion
• Unresponsiveness or temporary loss of responsiveness
• Sudden loss of bladder or bowel control

FAST
When trying to determine if a person is having a stroke, remember the
acronym:
(F) : Facial drooping
(A) : Arm deviate
(S) : Slugged Speech
(T) : Time to transport to the nearest hospital

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What to do on it:
Call EMS/911/09326000119 and get an AED immediately(if available).
 Have the person rest in comfortable position. If the person
prefers to lie down, or is unresponsive, drooling, or having
trouble swallowing, place the person in the recovery position.
 Note when the sign and symptoms first started(or, if you do not
know when the signs and symptoms started, note the last time the
person was known to be well).
 Monitor the person’s condition and provide reassurance until EMS
arrive; a stroke can be an extremely frightening experience

LIFE_THREATENING BLEEDING
Life-threatening bleeding refers to a situation where large amount of
blood loss occur either externally (outside the body) or internally
(within the body)

PREVENTION:
SAFETY FIRST!
 Be familiar with your surroundings
 Keep all sharp objects
 Get proper training on machinery in the workplace.
 Always follow the outlined safety procedures when operating
equipment.
 Wear and use appropriate safety equipment at work and at home
 Only use equipment for its intended purpose
 Stay alert when operating equipment.

Life-threatening External Bleeding

WHAT COULD YOU SEE?
EXTERNAL BLEEDING
Blood spurting or flowing freely from a wound
Blood that fails to clot after you have taken all measures to control
bleeding.
Large amounts of blood loss.
WHAT TO DO ON IT:
Call EMS/911/09326000119 and get an AED (if available)
Expose the wound
Apply firm and direct Pressure to the wound
While maintaining direct pressure, apply a dressing and bandage, and
then secure them in place.
Reassess the wound to see if the pressure has stopped the bleeding. If
not consider using tourniquet if the wound is on a limb.

Life-threatening Internal Bleeding

Internal bleeding is the escape of blood from arteries, veins, or
capillaries into spaces in the body. Life-threatening internal
bleeding usually occurs in injuries caused by a violent blunt force,

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such as when someone falls from a high place. You should suspect
internal bleeding after any injury that involved a forceful blow to
the body. Internal bleeding may also occur when a sharp object, such
as knife, penetrates the skin and damages internal structures.

WHAT WOULD YOU SEE

Signs and symptoms of the life-threatening internal bleeding include
the following:
 Bruising in the injured area
 Soft tissue (e.g., abdomen) that are tender, swollen, or hard
 Blood in saliva/vomit
 Pain
 Severe thirst, nausea, and vomiting
 Anxiety

WHAT TO DO
CALL EMS/911/09326000119 and get an AED. You cannot provide first aid
for life-threatening internal bleeding as a First Aider. Life-
threatening internal bleeding, especially if it results from damage to
an organ, requires i-hospital medical intervention. Help the injured
person rest in the most comfortable position and provide continual
care while waiting for EMS personal.

CPR or Cardiopulmonary Resuscitation is a skill that is used when a

person is in cardiac arrest. CPR involves giving sets of 30 chest
compressions followed by sets of 2 rescue breathes; it keep oxygenated
blood moving to the brain and other vital organs until advance medical
help arrives. Because we breathe in 21% oxygen and breathe out 16%,
even exhaled breathe has more than enough to sustain life.

CARDIAC ARREST
Cardiac arrest occurs when the heart stops beating or beats too
ineffectively to circulate blood to the brain and other vital organs.
Under normal circumstances, a network of special cells in the heart
muscle conducts electrical impulses that coordinate contractions,
causing the heart to beat rhythmically. In cardiac arrest, the
electrical impulses become abnormal and chaotic. This causes the heart
to lose the ability to beat rhythmically, or to stop beating
altogether.

SUDDEN CARDIAC ARREST

Cardiac arrest can happen suddenly and without any warning signs; this
is called sudden cardiac arrest. People who have a history of
cardiovascular disease or a congenital heart disorder are at higher
risk for sudden cardiac arrest. However, sudden cardiac arrest can
happen in people who appear healthy and have no known heart disease or
other risk factors for the condition. A person who experiences sudden
cardiac arrest is unlikely to survive without immediate care.

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Clinical and Biological Death
Clinical Death occurs when breathing stops and the heart stops
beating. A person without a heartbeat is clinically dead. Because
permanent brain damage does not begin for 4-6 minutes, clinical death
is reversible with immediate care and intervention.
Biological death occurs when the brain becomes irreversibly damaged,
which occurs after about 8-10minutes without oxygen. This is called
“brain death.”

Common Causes of Cardiac Arrest:

 Drowning
 Severe blood loss
 Suffocation or complete choking
 Electrocution
 Drug overdose
 Severe chest injuries
 Commotio Cordis
 Other heart disease and abnormalities

What you could see:

When a person experiences cardiac arrest, signs and symptoms may
include the following:
 The person suddenly collapses.
 The person is unresponsive and not breathing, or is unresponsive
with agonal breathe.

What to do on it:
 Have someone Call EMS/911/09326000119 and get an AED immediately
(if available). If you are alone with an adult, Call
EMS/911/09326000119, get an AED, and then return to care for the
person.

COMPRESSION ONLY CPR

Compression only CPR uses chest compressions (without rescue breathe)
to pump the heart and circulate oxygen that is already in the person’s
body. If you are unwilling or unable to give rescue breathes for any
reason (e.g., you do not have a barrier device or the ill or injured
person has facial trauma), compression only CPR is acceptable.

CPR SUMMARY HAND POSITION COMPRESS BREATH CYCLE COMPRESSION RATE

ADULT Two hands on At least Just enough 30 compression Rate:

100-120/min
the middle of 5cm(about 2in) volume to make and 2 breathes
the chest the chest start 30
compression/15-18
to rise (1 seconds
second/breathe)
CHILD Two hands on At least 1/3 Just enough 30 compression Rate:
100-120/min
the middle of of the chest’s volume to make and 2 breathes
the chest depth the chest start 30
compression/15-18
to rise (1 seconds
second/breathe)
BABY Two fingers on
the middle of
At least 1/3 Gently, with just
enough volume to
30 compression Rate:
100-120/min
of the chest’s and 2 breathes
the chest(just depth make the chest 30
below the nipple start to rise(1 compression/15-18
line) second/breathe) seconds

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CHAPTER IV
AUTOMATED EXTERNAL DEFIBRILLATION (AED)
USING AN AUTOMATED EXTERNAL DEFIBRILLATION (AED)
When a cardiac arrest in an adult occurs, EMS/911/09326000119 or local
emergency number and begin CPR immediately. Also, use an AED as soon
as it is available and ready to use. If CPR is in progress, do not
interrupt until AED is turned on and the defibrillation pads are
applied.

AED PRECAUTIONS
When operating an AED, follow these general precautions:
 Do not use alcohol to wipe the person’s chest. Alcohol is
flammable.
 Do not use an AED and/or pads designed for adult on a child
younger than 8 years or weighing less than 55 pounds unless
pediatric AED pads specific to the device are not available.
 Do not use paediatric AED pads on an adult or a child older
than 8years, or on a person weighing more than 55 pounds.
 Do not touch the person while the AED is analysing. Touching
or moving the person may affect analysis.
 Before shocking a person with AED, make sure that no one is
touching or is in contact with the person or any
resuscitation equipment.
 Do not touch the person while the device is defibrillating.
 Do not defibrillate someone when around flammable or
combustible materials, such as gasoline or free-flowing
oxygen.
 Do not use an AED in a moving vehicle. Movement may affect
the analysis.
 The person should not be in a pool or puddle of water when
the responder is operating an AED.
 Do not use an AED on a person wearing a nitroglycerin patch
or other medical patch on the chest.
 Do not use a mobile phone or radio within 6 feet of the AED.

How to use an AED-Adult

Most AEDs can be operated by following these simple steps:
1. Turn on the AED
2. Expose the person’s chest and wipe the bare chest dry with
small towel or gauze pads.
3. Apply the AED pads to the person’s bare, dry chest.
4. Plug the connector into the AED, if necessary.
5. Let the AED analyse the heart rhythm (or push the button
marked “analyse,” if indicated and prompted by the AED).

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 Advise all responders and bystanders to “Stand clear”. If
the AED advises that a shock is needed:
a. Make sure that no one, including you, is touching the
person.
b. Say, “EVERYONE, STAND CLEAR”.
c. Deliver the shock by pushing the “shock button”, if
necessary. (Some models can deliver the shock
automatically while others have a “Shock button” that
must be manually pushed to deliver the shock).
6. After delivering the shock, if no shock is advised:
a. Perform about 2 minutes (or 5 cycles) of CPR.
b. Continue to follow the prompts of the AED.
If at any time you notice an obvious signs of life, such as
breathing, stop performing CPR and monitor the person’s breathing
and any changes in the person’s condition.

HOW TO USE AN AED-CHILDREN AND INFANTS

Most cases of cardiac arrest in children and infants are not
sudden and maybe causes by:
 Airway and breathing problems.
 Traumatic injuries or accidents (e.g., motor-vehicle
collision, drowning, electrocution or poisoning).
 A hard blow to the chest.
 Congenital heart disease.
 Sudden infant death syndrome (SIDS).

Most AEDs can be operated by following these simple steps:

1. Turn on the AED
2. Expose the child/infant’s chest and wipe the bare chest dry
with small towel or gauze pads.
3. Apply the AED pads to the child/infant’s bare, dry chest.
4. Plug the connector into the AED, if necessary.
5. Let the AED analyse the heart rhythm (or push the button
marked “analyse,” if indicated and prompted by the AED).
Advise all responders and bystanders to “Stand clear”. If
the AED advises that a shock is needed:
a. Make sure that no one, including you, is touching the
child or infant.
b. Say, “EVERYONE, STAND CLEAR”.
c. Deliver the shock by pushing the “shock button”, if
necessary. (Some models can deliver the shock
automatically while others have a “Shock button” that
must be manually pushed to deliver the shock).
6. After delivering the shock, if no shock is advised:
a. Perform about 2 minutes (or 5 cycles) of CPR.
b. Continue to follow the prompts of the AED.

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If at any time you notice an obvious signs of life, such as
breathing, stop performing CPR and monitor the person’s breathing
and any changes in the person’s condition.

SPECIAL AED SITUATIONS

Some situations require you to pay special attention when using
an AED. These include using AEDs around water and on people with
implantable devices, transdermal patches, hypothermia, trauma and
jewellery or body piercings.

AEDS AROUND WATER

If the person is in water, remove him/her from the water before
defibrillation. A shock delivered in water could harm responders or
bystanders. Once you have removed the person from the water, be sure
there are no puddles of water around you, the person or the AED.
Remove wet clothing to place the pads properly, if necessary. Dry the
person’s chest and attach the AED pads.

PACEMAKERS AND IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS

Some people whose hearts are weak, beat too slowly, skip beats or beat
in a rhythm that is too fast may have a pacemaker implanted. These
small, implantable devices are usually located in the area below the
person’s left collar bone, although they can be placed elsewhere.
Typically, they feel like a small lump under the skin. Other people
may have an implantable cardio verter-defibrillator (ICD), a miniature
version of an AED. ICDs automatically recognize and restore abnormal
heart rhythms. Sometimes a person’s heart beats irregularly, even if
the person has a pacemaker or ICD.

TRANSDERMAL MEDICATION PATCHES

Some people have a patch on their skin that automatically delivers
medication through the skin is called a transdermal medication patch.
A common medication patch is the nitroglycerin patch, which is used by
people with a history of cardiac problems. Because a responder can
absorb medication through the skin, remove patches with a gloved hand
before defibrillation.

HYPOTHERMIA
Hypothermia is a life-threatening condition in which the entire body
cools because its ability to keep warm fails. Some people who have
experienced hypothermia have been resuscitated successfully, even
after prolonged exposure to the cold. If the person is not breathing,
begin CPR until an AED becomes readily available.

TRAUMA
If a person is in cardiac arrest as a result of traumatic injuries,
you still can use an AED.

CHEST HAIR

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Some men have excessive chest hair that may interfere with AED pad-to-
skin contact, although it’s rare occurrence. Since time is critical in
a cardiac arrest situation and chest hair rarely interferes with pad
adhesion, attach the pads and analyse the heart’s rhythm as soon as
possible.

METAL SURFACES
It is safe to deliver a shock to a person in cardiac arrest when
he/she is lying on a metal surface, such as bleachers, as long as
appropriate safety precautions are taken. Specifically, care should be
taken that defibrillation electrode pads do not contact the conductive
(metal) surface and that no one is touching the person when the shock
button is pressed.

JEWELLERY AND BODY PIERCINGS.

You do not need to remove jewellery and body piercings when using AED.
Leaving them on the person will do no harm. Taking time to remove them
will delay giving the first shock. Therefore, do not delay the use of
an AED to remove jewellery or body piercings.

AED MAINTENANCE
For defibrillators to perform properly, they must be maintained like
any other machine.
Although AEDs requires minimal maintenance, it is important to
remember the following:
 Follow the manufacturer’s specific recommendations and your
facility schedule for periodic equipment checks, including the
batteries and defibrillation pads.
 Make sure that the batteries have enough energy for one complete
rescue. (A fully charged backup battery should be readily
available.)
 Make sure that the correct defibrillation pads are in the package
and are properly sealed.
 Check any expiration dates on defibrillation pads and batteries
and replace as needed.
 After use, make sure that all accessories are replaced and that
the machine is in proper working order.
 If at any time the machine fails to work properly or warning
indicators are recognized, stop using it and contact the
manufacturer immediately. If the AED stops working during an
emergency continue performing CPR until EMS personnel take over.

CHAPTER V
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BREATHING EMERGENCIES
Is any respiratory problem that can threaten a person’s life.
Breathing emergencies happens when air cannot travel freely and easily
into the lungs. In a breathing emergency, seconds count so you must
react at once.

Respiratory Distress/Arrest
These are types of breathing emergencies.
Respi-Distress is a condition which breathing becomes difficult. It is
the most common breathing emergencies.
This is also can lead to Respi-Arrest occurs when breathing has
stopped.

Common Causes:
 Choking (partial or complete airway obstruction).
 Illness
 Hyperventilation
 Asthma or COPD
 Pneumonia or Bronchitis
 Allergic Reaction / Anaphylaxis
 Heart Attack/Failure
 Chest Trauma
 Poisoning/Drug Overdose
 Electrocution
 Drowning
 Certain Medical health condition (i.e,. Panic dso).

What you could see:

• Shortness of breath or gasping for breathe
• Trouble speaking in complete sentences
• Wheezing, gurgling, or high-pitch noises
• Breathing abnormally quickly or slowly
• Unusually deep shallow breathing
• Cool, moist skin
• Bluish/Ashen skin
• Flushed/Pale skin
• Feeling of fear
• Dizziness or light-headedness.

What to do on it:
Call EMS/911/09326000119.
 If the person carries medication for respi-distress, offer help
to take medication.
 Encourage to rest, sit down into comfortable position
 Provide reassurance, as this can help reduce anxiety and help the
person control breathing.

17 | P a g e
  Remember a person with breathing problems may find it hard to
talk. Make the question short and answerable by nod or shaking
his/her head to answer yes-no question.
 Monitor person’s condition and provide continual care until EMS
arrives.

If an adult is unconscious and not breathing, the cause is most likely

a cardiac emergency. Immediately begin CPR starting with chest
compressions.

CHOKING
The airway is the passage that connects the nose and mouth with the
lungs. Choking occurs when the airway becomes partially or completely
blocked by a foreign object.(eg,.small toy, piece of food), by
swallowing in the mouth or throat, or by fluids such as vomit or
blood. If it is blocked by a physical object, this is called
mechanical obstruction.

Partial Choking happens when the airway is partially blocked. Coughing

is the body’s way of clearing the airway, and so it may indicate a
partial airway obstruction.
Complete Choking happens when the airway is completely blocked. The
person is unable to breathe and is in life-threatening situation.

Common Causes:
 Any medical conditions that affects a person’s ability to
chew/swallow increases the risk of choking.
 Dental problem or poorly fitting dentures.
 Swallowing large pieces of food
 Eating while talking, laughing, walking or running
 Eating too quickly

PREVENTION:
For Adults:
o Chew food well before swallowing
o Eat slowly and calmly
o Avoid extra-curricular activities while eating.
For Child and Babies:
• Purees food for babies whose starting to eat
• Always supervise children and baby when eating
• Teach children to eat calmly, chew properly, and not to speak
with a mouthful of food.
• Encourage to sit while eating
• Make sure small object that can be swallowed is out of reach

PARTIAL CHOKING
WHAT YOU COULD SEE:
 A look of panic, with wide eyes
 Forceful or weak coughing
 One or both hands clutching the throat

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WHAT TO DO ON IT:
 Encourage the person to cough forcefully.
 Encourage/Assist to sit upright, if possible, as this will make
coughing easier and more effective.
 Continue to monitor person’s condition until either the
obstruction clears or the person’s condition worsens.

COMPLETE CHOKING
WHAT YOU COULD SEE:
 Inability to speak, cough and breathe
 High-pitched squeaking noises
 Flushed (red) skin that becomes bluish/paler.
 A look of panic with wide eyes
 One or both hands clutching the throat.
WHAT TO DO ON IT:
If possible, send someone to call EMS/911/09326000119 and get an AED
immediately (if available) while you care for the person.
If you are alone, immediately begin providing care for complete
choking. Shout for help to try attracting the attention of bystander,
but do not delay calling EMS/911/09326000119 yourself.

CARE:
Try to utilize the three options: Back blows, abdominal thrust and
chest thrust. Continue alternating between the two methods until the
object comes out, the person begins to breathe or the person becomes
unresponsive.

SPECIAL CHOKING SITUATIONS:

Larger or Pregnant Responsive Choking Adult:
1. If you cannot reach far enough around a person to perform
abdominal thrusts, or if you are aiding a woman who is obviously
pregnant, alternate between 5 firm back blows and 5 chest thrust.
2. Continue until object comes out, the person begins to breathe or
cough or becomes unresponsive.

Responsive Choking Toddler

1. If the child is short enough, kneel on the floor with one knee
raised.
2. Perform 5 back blows with the child leaning across your raised
leg, alternating with either 5 chest thrusts or 5 abdominal
thrust.
3. Continue until object comes out, the child begins to breathe or
cough or becomes unresponsive.

If you are by yourself and Choking:

 Dial EMS/911/09326000119 and leave the phone off the hook. This
will tell the dispatcher to send help.
 If there are people nearby, move to a place where you can be
noticed.

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  Attempt to dislodge the object by performing an abdominal thrust
against a safe object with no sharp edges or corners, such as the
back of a chair or the edge of a table.
Unresponsive Choking:
Lower the person on the ground as safely as possible and immediately
begin CPR, start with chest compressions.

Choking Baby (Less than 12 Months)

What to do on it:
 Shout for help
 If the baby is making high-pitched noises, is wheezing, can no
longer make a sound, or becomes too weak to cough, have someone
call EMS/911/09326000119 and get an AED while you care for the
baby.
 If you’re alone, immediately begin care for complete choking.
Shout for help to try to attract the attention of a bystander.

 Sit/kneel holding the baby.
 Position the baby face-down along your forearm, holding his/her
jaw in your hand.
 Rest your forearm on your leg so that the baby’s head is lower
than his/her body.
 Deliver 5 firm back blows between the shoulder blades with the
heel of your free hand.
 If the object has not been dislodged, turn the baby face-up,
ensuring you support the head.
 Place 2 fingers on the middle of the chest just below the nipple
line and quickly deliver 5 firm chest compression, pushing down
1/3 of the chest’s depth.
 Repeat the 5 firm back blows and 5 chest compressions until the
object is coughed up, the baby starts to cry, breathe, or cough,
or the baby becomes unresponsive.

AFTER THE OBJECT COMES OUT.

An object lodged in the airway can cause damage to the sensitive
tissues in the trachea and the back of the throat. This can cause
bleeding and swelling.
Any person who has suffered complete choking should always seek
medical attention, even if the object comes out. If you have done back
blows, abdominal thrusts, or chest thrusts, that procedure may have
cause damage (in addition to the damage cause by the choking itself),
so any person given this care should be assessed in a hospital.

Unresponsive Choking
If the choking person becomes unresponsive, lower him/her to the
ground as safely as possible and immediately begin CPR, starting with
chest compressions.

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HYPERVENTILATION
Is a condition in which a person is breathing much more quickly than
the usual. This upsets the body’s balance of oxygen and carbon
dioxide.

Common Causes:
 Strong emotions such as excitement, fear, or anxiety
 Asthma
 Injuries, esp. injuries of the head
 Exercise
 Life-Threatening bleeding.

PREVENTION:
 Relaxation technique when strong emotions start or currently
occurring.
 If you hyperventilate due to a diagnosed medical condition,
speaking to your doctor will help you learn how to treat or
control it.

WHAT YOU COULD SEE:

 Rapid , shallow breathing
 A feeling of suffocating or not getting enough air
 Fear, anxiety or confusion
 A feeling of dizziness
 Numbness or tingling of the fingers and toes
 Muscle contractions, usually in the hand, feet, arms and legs.

WHAT TO DO ON IT:
 It is not always necessary to call EMS/911/09326000119 for a
person who is hyperventilating. You should call
EMS/911/09326000119 and get an AED if the hyperventilating does
not stop after a few minutes, the person becomes unresponsive, or
you suspect that the person is hyperventilating because of an
injury or illness.
 Encourage the person to take controlled breathe by breathing
slowly, holding the breathe for few second, and the gradually
exhaling, or by Coach Breathing.

ASTHMA
a chronic illness in which certain substances or conditions(triggers)
causes inflammation and swelling of the bronchioles, making it harder
for air to move in and out of the lungs. It is usually controlled with
medication.

CAUSES:
 Air pollutions or poor air quality
 Allergies
 Temperature fluctuation ( extreme humidity/dryness)

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  Strong odors
 Colds/flu
 Physical activity
 Respiratory Infection
 Stress/Anxiety

PREVENTION
- Know what triggers your attacks and avoid them if possible.
- Ensure prescribed medication is always easily accessible in case
of an attack.

[CHILD]
Make sure that anyone who supervises the child knows about the asthma
and how to help give medication if necessary.

ASTHMA MEDICATION
Two main types of medication:
Long term controlled
Quick-relief (rescue) medication.

WHAT COULD YOU SEE:

 Wheezing or coughing, especially when exhaling
 Gasping for air
 Shortness of breath
 Rapid, shallow breathing
 Anxiety and Fear
 Tightness in the chest
 Tingling in the hands and feet
 Sweating
 Inability to say more than a few words without pausing to
breathe.

WHAT TO DO ON IT:
 Call EMS/911/09326000119 and get an AED If the person is
struggling to breathe, the person’s breathing does not improve
after taking medication, or the person become unresponsive.
 Eliminate any triggers if possible. If something in the
environment is causing the attack, move the person away from the
area if it safe to do so.
 Help the person get into a comfortable position and provide
reassurance
 Help the person to take any prescribed quick-relief asthma
medication that is available.

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CHAPTER VI

SUDDEN ILLNESS AND MEDICAL EMERGENCIES

Sudden Illness
It usually is obvious when someone is injured and needs care. The
person may be able to tell you what happened and what hurts. Checking
the person also gives you clues about what might be wrong. However,
when someone becomes suddenly ill, it is not easy to tell what is
physically wrong. At times, the signals only confirm that something is
wrong, without being clear as to what is wrong. In either case, the
signals of a sudden illness often confusing. You may find it difficult
to determine if the person’s condition is an emergency and whether to
call EMS/911/09326000119 or the local emergency number.

What would you see:

When a person becomes suddenly ill, he/she usually looks and feels
sick.
Common signals include:
 Rapid, shallow breathing
 Changes in level of consciousness, such as feeling lightheaded,
dizzy, drowsy or confused, or become unconscious.
 Breathing problems (i.e., trouble breathing or no breathing).
 Signal of a possible heart attack, including persistent chest
pain, discomfort or pressure lasting more than a few minutes that
goes away and come back or that spreads to the shoulder, arm,
neck, jaw, stomach or back.
 Signals of a stroke, including sudden weakness on one side of the
face (facial droop); sudden weakness, often on one side of the
body; sudden slurred speech or trouble forming words; or a
sudden, severe headache.
 Loss of vision or blurred vision.
 Signals of shock, including rapid breathing, changes in skin
appearance and cool, pale or ashen (grayish) skin.
 Sweating
 Persistent abdominal pain or pressure
 Nausea or vomiting
 Diarrhea
 Seizures

What to do on it
Call EMS/911/09326000119 or the local emergency for any of the
following conditions:
 Unconsciousness or altered level of consciousness
 Breathing problems
 No breathing

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  Chest pain, discomfort or pressure lasting more than 3-5 minutes
that goes away and comes back or that radiates to the shoulder,
arm, jaw, neck, stomach or back.
 Persistent abdominal pain or pressure.
 Severe external bleeding (bleeding that spurts or gushes steadily
from a wound).
 Vomiting blood or passing blood
 Severe (Critical) burns.
 Suspected poisoning
 Seizures
 Stroke
 Suspected or obvious injuries to the head, neck or spine
 Painful, swollen, deformed areas (indicates possible broken bone)
or an open fracture.

WHAT TO DO ON IT:
Although you may not know the exact cause of the sudden illness, you
should still give care. Initially you will care for the signals and
not for any specific condition. In the few cases in which you know
that the person has a medical condition, such as diabetes, epilepsy or
heart disease, the care you give may be slightly different. This care
may involve helping the person take medication for his/her specific
illness.

Care for sudden illness by following the same general guidelines as

you would for any emergency.
o Scene Safety
o Check the person
o First care for the life-threatening conditions such as
unconsciousness; trouble breathing; no breathing; severe
bleeding; severe chest pain; or signals of a stroke, such as
weakness, numbness or trouble with speech.
o Help the person rest comfortably.
o Keep the person from getting chilled or overheated.
o Reassure the person because he/she may be anxious or frightened.
o Watch for changes in consciousness and breathing.
o If the person is conscious, ask if he/she has any medical
conditions or is taking any medication.
o Do not give the person anything to eat or drink unless he/she is
fully conscious, is able to swallow and does not show any signals
of a stroke.
o If the person vomits and is unconscious and lying down, position
the person on his/her so that you can clear the mouth.
o If you know the person is having a severe allergic reaction or a
diabetic emergency, assist the person with his/her prescribed
medication, if asked.

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SPECIFIC SUDDEN ILLNESS

FAINTING
Fainting is a brief period of unresponsiveness that happens when there
is not enough blood flowing to the brain. If a person suddenly becomes
unresponsive and then “comes to” after about a minute, he/she may have
simply fainted.

Common Causes
Fainting is caused by sudden decrease in blood flow to the brain.
Usually the cause of fainting is not serious. The following are common
causes of fainting:
 Pregnancy
 Pain
 Heat
 Dehydration
 Decrease blood sugar (e.g., from missing a meal)
 Standing in one position for too long without moving
 Intense emotion
 Traumatic information (e.g., news of someone’s death)

PREVENTIVE MEASURE
The following tips help prevent fainting:
 Keep hydrated
 Eat at regular intervals to maintain a consistent blood sugar
level.
 Get up slowly from sitting or lying down.
Fainting may be preceded by paleness, dizziness, sweating, or nausea.
If you think that someone is about to faint, have the person sit or
lie down.

WHAT WOULD YOU DO

 Call EMS/911/09326000119 and get an AED if the person is
unresponsive for more than a few minute, the person is pregnant,
the person’s medical history is unknown, or you suspect that the
person fainted as a result of a serious injury or illness. If you
are unsure, call EMS/911/09326000119 and get an AED.

 Place the person in the recovery position

 Encourage the person to follow up with his/her healthcare
provider

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SEIZURE
A seizure is an episode of abdominal electrical signals in the brain
that result in temporary and involuntary disturbances in brain
function, shaking or contraction of limbs (convulsions), changes in
sensation, shifts in behavior, and altered level of responsiveness.

Common Causes
Seizures can have many different causes. One common cause is epilepsy,
a chronic seizure disorder that can often be controlled with
medication. Other causes of seizures include the following:
 Fevers or Infection
 Head Injuries
 Heat stroke
 Poisons (including drugs)
 Drug or alcohol
 Diabetic emergencies
 Audio-Visual stimulation (e.g., flashing lights)

WHAT WOULD YOU DO:

 Call EMS/911/09326000119 and get an AED if:
 You do not know the person or the medical history.
 The seizure lasts more than a few minutes.
 The person has several seizures in a row
 The person appears to be injured.
 The person is pregnant.
 The person is experiencing a diabetic emergency.
 The seizure takes place in the water.
 This is the person’s first seizure, or the cause of the seizure
is unknown.
 The person does not wake up after the seizure or is unresponsive
for an extended period.

Calling EMS/911/09326000119 for people with Seizure Disorders

Some people have multiple seizures during a day, and will likely have
a seizure treatment plan in place. The treatment plan will outline
when a seizure no longer follows the normal pattern or duration for
the person and when to Call EMS/911/09326000119. Follow the person’s
seizure plan if you are familiar and comfortable with it.

During Seizure:
Protect the person from injury by:
1. Moving the furniture and other objects that could cause
injury out of the way,
2. Protect the person’s head with a soft object (such as
blanket).
3. Roll the person onto his/her side, if you are able to do so
safely.

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After Seizure:
The person may be drowsy and disoriented for up to 20 minutes:
1. Check the person’s ABC
2. Place the person in the recovery position.

FEBRILE SEIZURE
Babies and young children may have seizures if their body temperatures
suddenly rise. These are called “febrile seizure” and are most
commonly associated with sudden high fevers, normally with
temperatures over 39’C (102’F). In most cases, these seizure are non-
life-threatening and do not last long.

To reduce the risk of febrile seizure in a child or baby with a high

fever, you must lower his/her body temperature:
1. Remove any excess clothing or blankets.
2. Give the child or baby a sponge bath with water that is room
temperature (not icy cold).
3. Give the child or baby plenty of fluids to drink to help prevent
dehydration. Consider giving the child or baby fever-reducing
medication such as Paracetamol.
If these steps do not reduce the child/baby’s temperature, seek
medical attention.

WHAT WOULD YOU DO:

Call EMS/911/09326000119 for a febrile seizure if:
 It is the first time that the child/baby has had a febrile
seizure.
 The seizure lasts longer than 5 minutes or is repeated.
 The seizure is followed by a quick increase in body temperature.

DIABETIC EMERGENCIES
Diabetes is a chronic condition characterized by the body’s inability
to process glucose (sugar) in the bloodstream. An organ called the
pancreas secretes insulin, a hormone that causes glucose to move from
the bloodstream into the cells, where it is used for energy.

HYPERGLYCEMIA is a condition in which lowered insulin levels result in

elevated blood sugar. Hyperglycemia can result if a person eats too
much food, takes too little medication, exercises less than usual, or
experiences physical or emotional stress.

HYPOGLYCEMIA occurs when the insulin level is too high relative to the
level of sugar in the blood. The small amount of sugar in the blood
gets used up quickly. Hypoglycemia can result if a person misses a
meal or snack, exercises more than usual, vomits, or takes too much
medication.

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COMMON CAUSES
A diabetic emergency occurs when there is an imbalance between two or
more of the following:
 Exercise
 Food intake
 Medication
 Insulin production

WHAT WOULD YOU SEE

The following are signs and symptoms of a diabetic emergency:
 Changes in the level of responsiveness
 Changes in behavior, such as confusion, irritability, or
aggression
 Rapid breathing
 Cool, sweaty skin
 Skin that is paler than normal
 Appearance of intoxication (e.g., slurred speech, difficulty
walking)
 Feeling and looking ill
 Seizures

Call EMS/911/09326000119 if:

You are unable to give the person sugar.
The person is not fully awake
The person has a seizure
The person’s condition does not improve within 10 minutes of
having sugar.

If the Person is unable to follow simple commands, unable to swallow

safely, or is unresponsive, ensure that EMS/911/09326000119 has been
called and place the person in the recovery position.
1. If the person is able to follow simple commands, answer
questions, and swallow safely, offer 15-20 grams of sugar. Check
the label on packaged products to determine how much of the
package’s contents to give. The following are the forms of sugar
to give, listed in order of preference:
 Oral glucose tablets
 Chewable candy
 Fruit juice
 Fruit strips
 Milk
 Other forms of sugar, such as a non-diet soft drink or a
spoonful of sugar mixed into a glass of water.
2. Monitor the person’s condition for 10 minutes:
 If the person’s condition deteriorates or does not improve
within 10 minutes, Call EMS/911/09326000119 and administer
more sugar if it is still safe to do so.
 If the person’s condition improves, recommend that he/she
eat a complete meal.

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ALLERGIC REACTION
Normally, our immune systems help to keep us healthy by fighting off
harmful pathogens that can cause disease. In a person with an allergy,
however, the immune system can react to normally harmless substances
to produce allergic reactions.

Preventing Allergic Reaction in a Child you are caring for

Discuss the allergy with the parent/guardian before you begin caring
for the child, and ask at least the following questions:
 What is your child allergic to?
 What signs will tell us that your child is having an allergic
reaction?
 What should we do if your child has a reaction?
 Has the doctor prescribed any allergy medication? For instance,
should you give us your child’s epinephrine auto-injector?

What would you see?

Signs and symptoms of an allergic reaction can range from mild to very
severe and include the following:
 Runny, itchy, or stuffy nose
 Sneezing
 Watery, itchy, red, or swollen eyes
 Nausea, vomiting, or diarrhea
 A rash or hive (raised, itchy areas of skin)
 Tingling of the mouth
 Swelling of the lips, tongue, face, or throat
 Coughing, chest tightness, wheezing, or shortness of breathe
 Weakness, dizziness, or confusion

WHAT TO DO
• Call EMS/911/09326000119 and get and AED if the reaction is
severe, the person is struggling to breathe, or the person loses
responsiveness.
• Calm and reassure the person
• Try to identify the allergen and have the person avoid further
contact with it.
• Watch the person for signs of increase distress.
• If the person uses a medication to control allergic reaction
(such as antihistamines), help him/her to take it.

ANAPHYLAXIS
Anaphylaxis is a severe allergic reaction. While mild allergic
reactions are localized, anaphylaxis is a body-wide reaction and it
can cause system-wide inflammation and swelling.

Common causes
Anything that causes other allergic reactions can also cause
anaphylaxis, and the causes vary from one person to another. The most
common allergens that trigger anaphylaxis include:
 Insect stings

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  Food
 Medication

Prevention
The following steps may help to prevent an anaphylactic incident:
 Avoid the substances, foods, or insect that causes reactions.
 Wear a medical identification product and carry the appropriate
medication at all times.

What would you see?

The signs and symptoms of anaphylaxis may be similar to the signs and
symptoms of mild allergic reaction, but they are more pronounced.
Anaphylaxis can affect a variety of body systems and can present in
various ways. If a person exhibits signs and symptoms from two or more
of these categories – especially after contact with an allergen – you
should provide care for anaphylaxis:
 Skin (e.g., swelling of the lips, face, neck, ears, and/or hands,
a raised, itchy, blotchy rash, flushing, or hives)
 Breathing (e.g., a feeling of tightness in the chest or throat,
coughing, wheezing, or high-pitched noises)
 Alertness (e.g., weakness, dizziness, or unresponsiveness
 Stomach (e.g., stomach cramps, nausea, vomiting, or diarrhea)

1. If the person has an epinephrine auto-injector, help him/her to

use it,
2. Provide reassurance and encourage the person to breathe normally.
3. Help the person get into a comfortable position.

POISON
A poison is a substance that has a harmful effect within the body if
it is inhaled, swallowed (ingested), absorbed, or injected. Poisons
are immediately life-threatening if they affect breathing or
circulation.

Types of Poisons
SWALLOWED Enters the body through the mouth, lips, esophagus, or
POISON stomach. Drinking bleach is an example of swallowed
poisoning.
ABSORBED Enters the body through the skin. Plants and chemicals
POISON can cause absorbed poisoning.
INJECTED Enters the body through bites or stings or as drugs
POISON injected with a needle.
INHALED POISON Is breathed into the body. Breathing in carbon
monoxide from a car’s exhaust is an example of inhaled
poisoning.

INTERNATIONAL HAZARD SYMBOLS

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 FLAMMABLE
These materials catch fire easily and burn quickly
when exposed to any form of ignition (such as fire or
heat).
TOXIC
These materials can harm the respiratory (breathing)
system, nervous system, and other systems if they are
absorbed through the skin, inhaled, or ingested.
EXPLOSIVE
These materials can explode when exposed to heat,
flame, or pressure
CORROSIVE
These materials can burn the skin and cause permanent
blindness.

Call EMS/911/09326000119 or a Poison Control Center (02) 542-1078 is

the most important thing you do if a poisoning of any type is
suspected. Other general first aid care tips for poisoning include the
following:
 Limit further exposure by moving either the person or the source
of the poison.
 If the poison’s container is found nearby, give the information
from the label to the Poison Control Centre or Call
EMS/911/09326000119 dispatcher.
 Do not give the person anything to eat or drink unless an EMS
dispatcher or Poison Control Center staff member tells you to do
so.
 If you do not know what the poison was and the person vomits,
save a sample to give to EMS personnel.

SWALLOWED POISON
What would you see?
The following may indicate that a poisonous substance has been
swallowed.
 An open container of poison nearby
 Burns around the mouth
 Increased production of saliva or discoloration of it.
 Abdominal cramps, vomiting, or diarrhea
 Seizures
 Dizziness or drowsiness
 Unresponsiveness
 A burning sensation in the mouth, throat, or stomach

WHAT WOULD YOU DO

 If the person is responsive and alert and his/her ABC’s are
unaffected, call the local Poison Control Center. Call
EMS/911/09326000119 and get an AED if the person has an altered
level of responsiveness or has difficulty breathing.

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  If the person is not breathing, start CPR. Use a barrier device
so that you don’t contaminate yourself with the poison.
 Check the packaging of the poison, if possible, so that you know
what it is.
 Induce vomiting only if told you to do so by the EMS dispatcher
or the Poison Control Center.
 If the person needs to go to the hospital, bring a sample of the
poison (or its original container).

INHALED POISONS
WHAT WOULD YOU SEE
The following may indicate that a poisonous substance has been
inhaled:
 Breathing difficulties
 Irritated eyes, nose, or throat
 Dizziness
 Vomiting
 Seizures
 Bluish color around the mouth
 Unresponsive
 An unusual smell in the air

WHAT WOULD YOU DO

 If the person is responsive and alert and his/her ABC’s are
unaffected, call the local Poison Control Center. Call
EMS/911/09326000119 and get an AED if the person has an altered
level of responsiveness or has difficulty breathing.
 If the person is not breathing, start CPR. Use a barrier device
so that you don’t contaminate yourself with the poison.
 Get the person into fresh air but do not enter into a hazardous
atmosphere in order to do so.
Inhaled poisons can affect everyone in an area. Stay out of the area
if you suspect that the poison may still be in the air.

CARBON MONOXIDE POISONING

Carbon monoxide (CO) is a gas that has no smell, color, or taste. CO
poisoning is often called a “silent killer” because it is not
detectable to any of the body’s senses. CO bonds to red blood cells
200 times better than oxygen, preventing oxygen from attaching and
therefore starving the body of oxygen.

PREVENTION
The Following tips help prevent carbon monoxide (CO) poisoning:
 Have all fuel-based appliances and equipment installed and
repaired by a qualified technician.
 Have all fuel-based appliances and equipment serviced annually by
a qualified professional.
 Use fuel-based appliances and materials as intended (e.g., do not
use generators or portable flameless chemical heaters indoors, do

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 not use a gas stove or oven for heating, and do not burn charcoal
indoors).
 Never run a car or truck inside an attached garage. For detached
garages, always leave the garage door open when running a car or
truck inside.
WHAT WOULD YOU SEE
The signs and symptoms of acute carbon monoxide (CO) poisoning are
commonly mistaken for a stomach virus, the flu, or food poisoning.
Signs and symptoms include the following:
 Headache
 Dizziness or light-headedness
 Confusion
 Impaired hearing and vision
 Weakness or fatigue
 Muscle cramps
 Nausea and vomiting
 Chest pain
 Altered level of responsiveness

WHAT WOULD YOU DO

 Treat the person as you would for any other type of inhaled
poison.

ABSORBED POISONS
WHAT WOULD YOU SEE
The following signs and symptoms can indicate that a poisonous
substance has been absorbed:
 Rash or hives (raised, itchy areas of skin)
 Burning or itching skin
 Swelling
 Blisters
 Burns
 Unresponsiveness

WHAT WOULD YOU DO

 If the person is responsive and alert and his/her ABC’s are
unaffected, call the local Poison Control Center. Call
EMS/911/09326000119 and get an AED if the person has an altered
level of responsiveness or has difficulty breathing.
 If the person is not breathing, start CPR.
 If the poison is a dry powder, brush if off the person’s skin. Be
careful to avoid contaminating yourself.
 Remove any clothing or items covered in the poison.
 Flush the skin with running water for at least 15 minutes. To
prevent any further injury, make sure the water flushes away from
any unaffected areas of the body.

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INJECTED POISONS
WHAT WOULD YOU SEE
Needles found nearby are a common sign that an injected poisoning has
occurred. The following are other signs and symptoms that indicate a
poisonous substance has been injected:
 One or more puncture wounds on the person’s skin
 Problems breathing
 Redness and swelling at the entry point on the person’s skin.

WHAT WOULD YOU DO

 If the person is responsive and alert and his/her ABC’s are
unaffected, call the local Poison Control Center. Call
EMS/911/09326000119 and get an AED if the person has an altered
level of responsiveness or has difficulty breathing.
 Clean the puncture site with clean running water.
 Keep the person as still as possible.

BITES AND STINGS

Bites and stings can range in severity from mildly irritating to life-
threatening. When a person is bitten or stung, proper first aid care
can help to limit complications and speed healing, and it may even be
lifesaving.

ANIMAL BITE
Any animal that has teeth, whether domesticated (e.g., pets or
livestock) or wild, can be the source of a bite wound. If the person
does not know the animal, rabies may be a concern. Most animal bites
carry a high risk of infection, so they should be monitored closely in
the hours and days after the incident.

WHAT WOULD YOU DO

 Call EMS/911/09326000119 if bleeding is life-threatening. Call
your local animal control department if the animal is wild or
stray.
 Try to get the person safely away from the animal without putting
yourself in danger
 Do not try to capture the animal.
 If the wound is bleeding heavily, provide care for external
bleeding.
 If the wound is minor:
o Wash the wound thoroughly with clean water, ideally by
running it under a tap, as the pressure from the running
water lets it penetrate more deeply into the wound.
o Control any bleeding
o Encourage the person to apply antibiotic ointment or cream
to the wound, if they have no known allergies or
sensitivities.
o Cover the wound with a dressing or bandage.
o Seek medical attention if the animal is wild, stray, or
unknown to you, or if you suspect the animal might have
rabies.

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 o Watch for signs and symptoms of infection and ensure that
the person continues to monitor the wound over the next
several days.
RABIES
Rabies is a serious infection that attacks the brain and spinal cord.
It is fatal if it is not treated. The virus that causes rabies is
spread when an animal that has the disease bites another or a person.
Wild animal can carry rabies, as can pets and livestock that have not
been vaccinated against it. Only mammals can be infected with rabbies.

INSECT STINGS
Most of the time, insect stings are merely uncomfortable. However,
allergic reactions and anaphylaxis are always a concern. Some insects,
such as bees, leave their stingers embedded in the person’s skin.
Others, such as wasps, can sting multiple times, but leave no stinger
behind.

PREVENTION
To reduce the risk of insect stings:
 Wear a long-sleeved shirt, long pants, and closed-toe shoes.
 Don’t wear perfume, cologne, or other products with strong
scents.
 Remove or cover items that will attract insects, such as garbage
or food.

WHAT WOULD YOU SEE

The following can indicate an insect sting, especially if you see
insects nearby:
 Quick, sharp pain at the site of the sting
 Pain, redness or swelling at the site of the sting.
 A stinger embedded in the skin

WHAT WOULD YOU DO

 Call EMS/911/09326000119 and get an AED if there are any signs of
a severe allergic reaction.
 If the stinger is still in the person’s skin, remove it by
scraping it away from the skin. Use a plastic card (such as debit
card) to do this.
 Wash the area with clean water.
 Cover the site with an adhesive bandage.
 Apply ice or cold pack to help control swelling. Put a thin cloth
between the cold source and the person’s skin to avoid freezing
the skin.
 Continue to watch for signs of infection, an allergic reaction,
or anaphylaxis.

SNAKEBITES
In the wild, snakes like to occupy rock outcrops, swamps, undergrowth,
and abandoned human structures. When disturbed, some snakes can inject
venom as they bite.

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Most deaths from venomous snakebites occur because:
 Too much time passed before the person received medical care.
 The person had an allergic reaction to the venom.
 The snake bite compounded an existing health condition in the
person.

PREVENTION
The following steps will help prevent snakebites:
 Do not aggravate a snake.
 Wear proper footwear and watch where you put your feet when
trekking/hiking.

A SNAKE’S STRIKING RANGE

A snake’s striking range is about two-thirds of its length forward and
one-third upward. (In water, snakes have a shorter striking range). If
you are within striking distance, slowly back out of range.

WHAT WOULD YOU SEE

Signs and symptoms of a possibly venomous snakebite include:
 A pair of puncture wounds in the skin.
 Localized redness of the skin
 Pain and swelling in the area of the bite.

WHAT WOULD YOU DO

 Call EMS/911/09326000119 and get an AED. If you are not sure
whether the snakebite was caused by a venomous snake, call
EMS/911/09326000119 anyway. Do not wait for life-threatening
signs and symptoms of poisoning to appear.
 Before providing care, ensure that the snake is no longer
present. If you see the snake, remember what it looks like so
that you can describe it to EMS personnel. This information will
help them provide the most appropriate treatment. Never attempt
to capture or handle a potentially venomous snake.
o Keep the injured site still and level with the heart, if
possible.
o If the bite is on a limb, remove any jewellery or tight
clothing from the limb and watch for swelling
o Wash the wound with water.
o Cover the bite with a clean, dry dressing.

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CHAPTER VII

ENVIRONMENTAL ILLNESS
HOW BODY TEMPERATURE IS CONTROLLED
The human body’s core temperature (i.e., the temperature of the heart,
lungs, and brain) is normally around 37*C (98.6*F) and is maintained
by balancing heat loss with heat gain.
The body generates heat by either converting food into energy or by
contracting muscles (e.g., shivering, exercising). The heat produced
by routine activities such as walking is usually enough to balance
normal heat loss.

The Four Mechanisms of Heating and Cooling the Body

Heat moves from warmer areas to cooler ones through four mechanisms:
1. Radiation: (Warming or cooling) involves the direct loss or
absorption of heat energy through electromagnetic waves.
2. Conduction: (Warming or cooling) Occurs through direct contact
with a solid or liquid.
3. Convection: (Warming or cooling) Occurs when air or liquid moves
across the skin. (wind chill factor)
4. Evaporation: (Cooling only) Occurs when a liquid change to a
vapour.

HEAT-RELATED ILLNESSES
Hyperthermia occurs when the body’s core temperature rises above the
normal range. It results when at least one of the four mechanism that
cool the body is impaired by clothing, drug, or disease, or is
overwhelmed by internal heat production and/or external heat exposure.
Heat-related illnesses will get worse without treatment and can change
from one level to another very quickly.

PREVENTION
One of the most important actions a person can take to prevent heat-
related illnesses is to drink plenty of fluids. You should drink eight
250 ml (8oz.) glasses of fluid a day for low-exertion, routine
activities and more as exertion level increases.
It is important to rehydrate regularly during longer events. If you
feel thirsty, you are already dehydrated, so develop the habit of
drinking fluids regularly rather than waiting for the warning signs of
dehydration to appear.

The following tips will also help to prevent heat-related illness:

 Maintain a healthy level of cardiovascular fitness.
 Prior to a major event in the heat, let the body gradually
acclimatize by being exposed to 1-2 hours of heat exertion for at
least 8 days.
 Avoid being outdoors during the hottest part of the day.

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  Reduce the intensity of activities as it gets hotter and don’t
work or exercise for too long at a time.
 Take frequent breaks in a cool or shaded area to cool off. This
will help the body cope with short period of extreme heat.
 Dress for the heat and for the intended activity.
 Make adjustment to exertion levels and work/rest cycles on hot
days (e.g., schedule soccer practices for cooler parts of the
day).
 Wear a light hat when under the sun. Wear loose-fitting light
clothing that allows liquid and vapour to escape.
 Choose hydrating drinks, such as water or juice, over dehydrating
ones like alcohol.

HEAT CRAMPS
Heat cramps are painful muscle spasms, usually in the legs and
abdomen, caused by loss of fluid and electrolytes as a result of
sweating. While they are usually not serious, they are often the first
sign that the body is beginning to overheat.

WHAT WOULD YOU SEE

The following signs and symptoms can indicate heat cramps:
 Mild muscle contractions that can become severe, usually in the
legs and abdomen
 Moist skin
A person with heat cramps will typically have a normal or slightly
elevated core temperature (37*C or 98.6* F).

WHAT WOULD YOU DO

 Reduce heat exposure (e.g., get into shade) and, if possible,
move the person to a cooler environment.
 Have the person slowly sip a cool electrolyte-replacement
beverage (e.g., commercial sports drink, coconut water, fruit
juice, or milk). If a drink containing electrolytes is not
available, have the person drink water.
 Gently stretch and massage the cramped muscles.
When the cramps stop, the person can usually resume his/her activity
as long as there are no other signs of symptoms of illness.

HEAT EXHAUSTION
Heat exhaustion occurs when the body begins to overheat, especially
when it loses more fluids and electrolytes through sweating than it
gains through rehydration. It usually happens after long periods of
strenuous activity in a hot environment, especially if it is humid or
lacking in air circulation, as these conditions make it difficult for
sweat to evaporate.

WHAT WOULD YOU SEE

The following signs and symptoms can indicate heat exhaustion:
 Normal or slightly raised core temperature (37-39*C, or 98.6 to
102.2*F).

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  Moist skin that is flushed (red) immediately after exertion, and
then turns pale or ashen (grey)
 Dehydration or intense thirst
 Headache, nausea, dizziness or fainting
 Weakness or exhaustion

WHAT WOULD YOU DO

 Call EMS/911/09326000119 if the person is vomiting, has an
altered level of responsiveness, or is unable to drink fluids.
 Reduce heat exposure (e.g., get into the shade) and if possible,
move the person to a cooler environment.
 Pour cool water on the person’s clothing and/or on towels or
cloths and place them on the person’s chest. Fan the person to
increase evaporation.
 Apply ice or cold packs to the armpits and chest.
 If the person is responsive and able to swallow, have him/her
slowly sip a cool electrolyte-replacement beverage (e.g.,
commercial sports drink, coconut water, fruit juice, or milk). If
a drink with electrolytes is not available, have the person drink
water.
 Advise the person not to do any more activities in the heat that
day.

HEAT STROKE
Heat stroke is the least common but most severe heat-related illness.
It is a life-threatening emergency that occurs when the body’s cooling
system is completely overwhelmed and stops working.

WHAT WOULD YOU SEE

 High core temperature, above 40*C (104*F)
 Hot, dry skin
 Flushed (RED) or pale skin
 Headache
 Altered mental status (e.g., confusion)
 Irritable, bizarre, or aggressive behaviour
 Progressive loss of responsiveness
 Rapid, weak pulse that becomes irregular
 Rapid, Shallow breathing
 Vision problems
 Seizures or coma

WHAT WOULD YOU DO

 Call EMS/911/09326000119 and get an AED

 Move the person to a cooler environment
 Quickly lower the person’s core temperature with one of the
following methods:
o Immerse the person in cool water from the neck below down.
Do not remove the person’s clothing.
o Immerse the person’s forearms and hands in a cool water.

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 o
Pour cool water on the person’s clothing and/or on towels or
cloths and place them on the person’s chest. Fan the person
to increase evaporation.
o Apply ice or cold packs to the person’s armpits and chest.
 Continue to use the rapid cooling methods listed above until
either the person’s condition improves or EMS personnel arrive.
 If the person is responsive and able to swallow, have him/her
slowly sip a cool electrolyte-replacement beverage (e.g.,
commercial sports drink, coconut water, fruit juice or milk). If
a drink with electrolytes is not available, give the person
water.

COLD-RELATED ILLNESS
Cold related illnesses are any conditions that are caused by exposure
to colder temperatures.

HYPOTHERMIA
Hypothermia occurs when the body’s core temperature (i.e., the
temperature of the heart, lungs, and brain) drops to 35*C (95*F) or
lower. Hypothermia becomes a life-threatening condition when the core
temperature drops below 28*C (82.4*F). People with smaller body types,
lower overall body weights, and lower body-fat content are much more
likely to experience hypothermia. Hypothermia can occur at any time of
the year, with young children and the elderly being most at risk.

COMMON CAUSES
The Following may lead to hypothermia:
 Sweating while outdoors in cold weather
 Cold, wet, windy conditions
 Cold-water immersion, especially in water below 10*C (50*F)
 Dehydration
 Taking medications to eliminate water from the body.

PREVENTION
The following tips will help to prevent hypothermia:
 Prepare for activities in cold environments by wearing
appropriate clothing:
o Wear a hat and clothing made of tightly woven fibers (e.g.,
wool, fleece), which provide insulation and allow moisture
transmission from the skin to the external environment.
o Avoid cotton because it soaks up water and stays wet.
o Wear clothing in layers so that they can be added or removed
according to the weather conditions and exercise intensity.
Remove some clothing before working to reduce the amount of
sweat and keep clothing dry.
 Keep clothing dry. If clothing gets wet, change into dry clothing
as soon as possible.
 Carry and consume high-energy foods that have a lot of sugar.
 Drink plenty of warm, high-calorie drinks to help fuel heat
production. If high-calorie drinks are not available, drink
plenty of water to at least keep from becoming dehydrated.

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  Do not drink alcohol
 Take frequent breaks from the cold to let the body warm up.
 Increase your activity level, add insulation, add a heat source,
or get out of the cold if shivering occurs.
 Be careful around cold water and always wear a personal flotation
device (PFD)

WHAT WOULD YOU SEE

LEVEL OF COLD STRESS

Cold stress (Not hypothermic)
 Shivering
 Normal Mental Status
 Able to care for self
Mild Hypothermia
 Vigorous shivering; complaining of the cold
 Decreased physical function
 Difficulty taking care of self
Moderate Hypothermia
 Weak and intermittent shivering or shivering that later stops
 Sometimes complaining of the cold
 Lack of coordination or speech; confused or unusual behaviour
 Impaired judgment
 Possible unresponsiveness
Severe Hypothermia
 Shivering has stopped
 Unresponsiveness; breathing has slowed down or stopped
 Body feels stiff
 No pulse

WHAT WOULD YOU DO

 Hypothermia can slow a person’s breathing, so you may need to
spend longer than usual checking of the person’s ABC’s. If the
person is unresponsive and you suspect hypothermia, check for
signs of breathing for 60 seconds.
 Call EMS/911/09326000119 and get an AED if the person has
moderate to severe hypothermia.
 Insulate the person (e.g., by applying a hypothermia wrap) to
protect him/her against further cold exposure.
 Warm the person by applying warm water bottles, heating pads, or
electric blankets to the person’s upper torso (i.e., the armpits,
chest, and upper back). Body heat from yourself or a bystander
can also work in an emergency. Never put the person in a warm
bath or shower or try to warm the person with a fire, a stove, or
hot rocks.
 If the person is responsive, provide warm, sugary, non-alcoholic
liquids to drink.

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DROWNING
Drowning occurs when a person’s airway is submerged in water, cutting
off the oxygen supply to body. Drowning is a leading cause of death
for children and babies. Young children aged 1-4 and men aged 15-44
are at the greatest risk.

PREVENTION
The following tips will reduce the risk of drowning:
 Always wear a personal flotation device (PFD) when in a boat or
other mode of marine transportation.
 Supervise children in, on, and around any body of water.
 Those who do not swim or are weak swimmers should wear a PFD when
in, on, and around any body of water.
 Check water depth before swimming or diving.
 Have appropriate safety equipment available when in or on the
water.
 Take PDRRMO Swimming and Water Safety Lesson.

FIRST AIDER RESCUE

To help rescue a person from water:
1. Talk – Instruct the person on self-rescue
2. Throw – Throw a rope or buoyant object to the person.
3. Reach – Reach out to the person with a rigid object like a
ladder, paddle, or tree branch.

RESPONSIVE DROWING PERSON

WHAT WOULD YOU SEE

These common warning signs can indicate that someone is drowning:

 The person is vertical in the water, and is not using his/her
legs to move forward or tread water.
 The person may have an expression of fear.
 The person’s arms may be flailing up and down as he/she tries to
rise out of the water to breathe, rather than trying to swim
forward.
 The person’s movements are uncontrolled

WHAT WOULD YOU DO

 Call for a lifeguard or other trained person (if one is nearby),

or Call EMS/911/09326000119.
 Remove the person quickly and safely from the water, but do not
put yourself in danger. Follow the same steps you use to perform
a First Aider Rescue for should be treated for hypothermia.

UNRESPONSIVE DROWNING PERSON

WHAT WOULD YOU DO
 Call EMS/911/09326000119 and get an AED
 If the person is not breathing and has no signs of life, begin
CPR.

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CHAPTER VIII
SOFT TISSUE INJURIES
WOUND
Soft tissues are the layers of skin and the fat and muscle beneath the
skin’s outer layer. An injury to the soft tissue commonly is called a
wound.

PREVENTION
The following general tips will help you to avoid both serious and
minor wounds:
 Develop safe habit, such as never running with sharp object.
 Use proper safety equipment when playing sports or engaging in
recreational activities.
 Wear proper safety equipment in the workplace, and request
training before using any potentially dangerous tools or
equipment.
 Stay alert and focused when engaged in any potentially risky
activity.

BANDAGING GUIDELINES
 Use clean, preferably sterile, dressings.
 Check circulation below the injury before and after applying a
bandage. If circulation is reduced, loosen the bandage.
 If blood socks through the bandage, place more dressings and
another bandage on top. The dressing that is in contact with the
wound should remain in place and not be removed.
 Dressings and bandages should be kept clean and dry to decrease
the risk of infection. Once bleeding is under control and the
wound has begun to heal, dressings that become wet should be
replaced with dry dressings.

TRIANGULAR BANDAGE
Triangular bandages are used in your first aid kit because they can be
used both to make slings and to make broad bandages to hold splints in
place.

FOLDING A TRIANGULAR BANDAGE INTO A BROAD OR NARROW BANDAGE

1. Fold the tip of the triangle down to touch the base
2. Fold the bandage in half lengthwise to make a broad bandage
3. Fold it in half again to make a narrow bandage.

CLOSED WOUNDS
The simplest closed wound is a bruise. A bruise develops when the body
is bumped or hit, such as when you bump your leg on a table or chair.
The force of the blow to the body damages the soft tissue layer
beneath the skin.

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WHAT WOULD YOU SEE
Signals of internal bleeding include:
 Tender, swollen, bruised or hard areas of the body, such as the
abdomen.
 Rapid, weak pulse.
 Skin that feels cool or moist or looks pale or bluish.
 Vomiting blood or coughing up blood.
 Excessive thirst
 An injured extremity that is blue or extremely pale.
 Altered metal state, such as the person becoming confused, faint,
drowsy or unconscious.

WHAT WOULD YOU DO

 Call EMS/911/09326000119 or the local emergency number if:

 A person complains of severe pain or cannot move a body part
without pain.
 You think the force that caused the injury was great enough
to cause serious damage.
 An injured extremity is blue or extremely pale.
 The person’s abdomen is tender and distended.
 The person is vomiting blood or coughing up blood.
 The person shows signals of shock or becomes confused,
drowsy or unconscious.
 Apply an ice pack to the area to decrease bleeding beneath the
skin. Applying cold can also be effective in helping to control
both pain and swelling.
 Do not assume that all closed wounds are minor injuries.
Take the time to find out whether more serious injuries
could be present.
 Help the person to rest in the most comfortable position
possible.
 Keep the person from getting chilled or overheated.
 Comfort and reassure the person.
 Be sure that a person with an injured lower extremity does
not bear weight on it until advised to do so by a medical
professional.

OPEN WOUND.
In an open wound, the break in the skin can be as minor as a scrape of
the surface layers or as severe as a deep penetration. The amount of
bleeding depends on the location and severity of the injury.

ABRASION
Abrasions are most common type of open wound. They usually are caused
by something rubbing roughly against the skin. Abrasions do not bleed
much. Any bleeding that occurs comes from capillaries (tiny blood
vessels).

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LACERATION
A laceration is a cut in the skin, which commonly is caused by a sharp
object, such as a knife, scissors or broken glass. A laceration also
can occur when a blunt force splits the skin. Deep laceration may cut
layers of fat and muscle, damaging both nerves and blood vessels.

AVULSIONS
An avulsion is a serious soft tissue injury. It happens when a portion
of the skin, and sometimes other soft tissue, is partially or
completely torn away. This type of injury often damages tissues,
causing significant bleeding.

PUNCTURES
Punctures usually occur when a pointed object, such as a nail, pierces
the skin. A gunshot wound is a puncture wound. Puncture wounds do not
bled much unless a blood vessel has been injured.

WHAT WOULD YOU DO

 Call EMS/911/09326000119 or the local emergency number
immediately for any major open wound.
 General care for open wounds includes controlling bleeding,
preventing infection and using dressings and bandages. Specific
care depends on whether the person has a minor or major open
wound.

INFECTION
An infection occurs when dirt, foreign bodies, or other materials
carrying germs get into a wound. Infection can be localized (e.g., in
a cut) or systemic (throughout the body). Infections accompanied by
nausea, fever, or general malaise are typically systemic, and can be
life-threatening.

PREVENTION
The following general tips help to minimize the risk of infection:
 Always wash your hands before and after giving first aid.
 Wear gloves whenever possible if you will be coming into contact
with someone’s bodily fluids.
 Keep your immunizations up to date. If you have been wounded and
do not know when your last tetanus shot was, seek medical
attention.
 Keep any wound clean and wash it regularly. Change the dressing
and bandages if they become dirty or wet.
 Use sterile dressings whenever possible. If sterile dressings are
unavailable, use the cleanest option possible.

USING DRESSINGS AND BANDAGES

All open wounds need some type of covering to help control bleeding
and prevent infection.

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DRESSINGS are pads placed directly on the wound to absorb blood and
other fluids and to prevent infection. To minimize the chance of
infection, dressings should be sterile.

An occlusive dressing is a bandage or dressing that closes a wound or

damaged area of the body and prevents it from being exposed to the air
or water.

A bandage is any material that is used to wrap or cover any part of

the body.
Bandages are used to hold dressings in place, to apply pressure to
control bleeding, to protect a wound from dirt and infection, and to
provide support to an injured limb or body part. Any bandage applied
snugly to create pressure on a wound or an injury is called a pressure
bandage.

Elastic roller bandages, sometimes called elastic wraps, are designed

to keep continuous pressure on a body part.

SPECIFIC CARE GUIDELINES FOR MINOR OPEN WOUNDS

In minor open wounds, such as abrasions, there is only a small amount

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