First aid is the immediate care given to a person who has been injured or suddenly taken ill. It includes self-help and home care if medical assistance is not available or is delayed. It also includes well-selected words of encouragement, evidence of willingness to help, and promotion of confidence by demonstration of competence.
The person giving first aid, the first-alder, deals with the whole situation, the injured person, and the injury or illness. He knows what not to do as well as what to do; he avoids errors that are frequently made by untrained persons through well-meant but misguided efforts. He knows, too, that his first aid knowledge and skill can mean the difference between life and death, between temporary and permanent disability, and between rapid recovery and long hospitalization.
NEED FOR FIRST AID TRAINING
Statistics show that accidents are the leading cause of death among persons from 1 year old to 38 years old; thereafter, accidents are one of the leading causes. The annual cost of medical attention, the loss of earning ability due to temporary or permanent impairment, the direct property damage, and the insurance costs amount to many billions of dollars each year, not to mention the toll in pain, suffering, disability, and personal tragedy.
Added to the grim accident statistics is the fact that the pattern of medical care has changed. Individuals today require, and should demand, the best possible care. Equipment for diagnosis and treatment, which is needed to provide such care, is usually at a hospital. Moreover, the growing population and expanding health needs have not been balanced by a proportional increase in numbers of doctors, nurses, and allied health workers. It is not enough to say, "Call the doctor"; a doctor may not be available to come to the scene of the emergency.
VALUE OF FIRST AID TRAINING
First aid training is of value in both preventing and treating sudden illness or accidental injury and in caring for large numbers of persons caught in a natural disaster.
If you, as a first-aider, are prepared to help others, you are better able to care for yourself in case of injury or sudden illness. Even if your own condition keeps you from caring for yourself, you can direct others in carrying out correct procedures to follow in your behalf.
Help for Others
Having studied first aid, you are prepared to give others some instruction in first aid, to promote among them a reasonable safety attitude, and to assist them wisely if they are stricken. There is always an obligation on a humanitarian basis to assist the stricken and the helpless. There is no greater satisfaction than that resulting from relieving suffering or saving a life.
Preparation for Disaster
First aid training is of particular importance in case of catastrophe, when medical and hospital services are limited or delayed. Catastrophe may take the form of a hurricane, a flood, an earth-quake, a tornado, an explosion, or a fire. It may also take the form of a single accidental death or a life-threatening illness. Knowing what to do in an emergency helps to avoid the panic and disorganized behavior that are characteristic of unprepared persons at such times. Knowledge of first aid is a civic responsibility. It not only helps to save lives and prevent complications from injuries but also helps in setting up an orderly method of handling emergency problems ac-cording to their priority for treatment, so that the greatest possible good may be accomplished for the greatest number of people.
First aid training not only provides you with knowledge and skill to give life support and other emergency care but also helps you to develop safety awareness and habits that promote safety at home, at work, during recreation, and on the streets and highways. In the promotion of safety awareness, it is important to closely relate three terms: cause, effect, and prevention.
As various types of injury and illness are studied, initially only the more likely causes are identified, mainly because of the diversity of circumstances that are present in most accident situations. Aside from the more likely and obvious causative conditions, there are related human and mechanical factors to consider, as well as factors beyond the control of man.
A primary consideration in determining the root cause of an accident is human failure: an act of thoughtless, careless, or unwise behavior. Human failure may involve an act of doing something—or perhaps not doing something. It can create danger to oneself as well as to others. A person may wantonly disobey some regulation or law that has been established for safety. People often fail to heed warnings and follow directions. Instruction in the safe use of an object or in safe conduct may be inadequate; supervision during the learning process may be ignored. Human failure can also involve such mental or physical conditions as fatigue, inattention, impatience, and structural or functional handicaps of the body.
The possibility of mechanical malfunctions or structural failures as contributing causes of accidents also requires consideration. Faulty design or engineering may create a built-in hidden hazard. Manufacturing or construction procedures could lack the quality control necessary to ensure safe performance or use. The raw material may contain some inordinate defect.
When the in-depth study of an actual or hypothetical accident situation identifies all the causative factors, it becomes possible to determine what can be done to eliminate, control, or avoid the hazards.
The immediate effects of an injury or sudden illness consist of changes in the body's structure and functions. These effects are dealt with in the material on first aid care, particularly in discussions of signs and symptoms. However, long-range—possibly permanent—effects are also involved in many situations. Permanent disability can make it difficult for a person to enjoy a fully active and productive life. The economic and social structure of the family unit is frequently disrupted. In an accident, mental anguish brought on by knowing that one may have contributed to another's death or disability can linger on through a lifetime.
When analysis carefully considers both immediate and long-range or permanent effects of injury or sudden illness, it becomes obvious why every possible effort should be taken to eliminate, control, or avoid a situation that is hazardous to oneself or to others.
A better understanding of the overall accident problem is developed if all the circumstances surrounding various types of accidents are carefully studied, including the broad range of first aid care that may be required. With such understanding, a person is likely to think and act more carefully, thoughtfully, and wisely. He tends to become more concerned for his own personal safety, as well as for that of others. He is likely to become genuinely interested in creating a safer environment on the highway, in the home, at work, in school, and at play. He will have a more responsible attitude toward accident prevention.
The causes of an accident indicate what accident-producing conditions and activities require attention. Accident effects indicate why such conditions and activities deserve concerted attention. Preventive measures should include a consideration of how these conditions and activities can be eliminated, controlled, or avoided.
GENERAL DIRECTIONS FOR FIRST AID
As a first-aider, you may encounter a variety of problem situations. Your decisions and actions will vary according to the circumstances that produced the accident or sudden illness, the number of persons involved, the immediate environment, and the availability of medical assistance, emergency dressings and equipment, and help from others. You will need to adapt what you have learned to the situation at hand or will need to improvise.
Sometimes, prompt action is needed to save a life. At other times, there is no need for haste. Efforts in the latter case will be directed toward preventing further injury, obtaining assistance, and reassuring the victim, who may be emotionally upset and apprehensive, as well as in pain.
First aid begins with action, which in itself has a calming effect. If there are multiple injuries or if several persons are hurt, priorities must be set. If you are the first-aider in charge you should enlist the help of bystanders to make telephone calls, to direct traffic, to keep others at a distance if necessary, to position safety flares in case of highway accidents, and so on. You should provide life support to victims with life-threatening injuries, attending first to those suffering from stoppage of breathing and then to those with severe hemorrhaging. You can then turn to those with less critical injuries.
Telephone or have someone else telephone the appropriate authorities regarding the accident. The police department or the high-way patrol is a good first contact, but the circumstances surrounding the accident should be a guide as to whom to call. You should always have a list of emergency telephone numbers available. If the numbers are not readily available, ask the operator for assistance. Describe the problem, indicate what is being done, and ask for whatever help you think is needed, such as an ambulance, the fire department, the rescue squad, or utility company personnel. Give your name, the location of the accident, the number of persons involved, and the telephone number where you can be reached. Do not hang up the receiver until after the other party hangs up, because he may wish to clarify some information.
In case of serious injury or sudden illness, and while help is being summoned, you must immediately—
Specific emergencies that require immediate first aid will be discussed in the appropriate chapters in the text.
Additional First Aid Directions
Unless it is necessary for safety to move a victim at once, keep him in the position best suited to his condition or injuries. Do not let him get up or walk around. Protect him from aggravation of existing injuries. If blankets or covers are available, keep him warm enough to overcome or avoid chilling. If he is exposed to cold or dampness, place blankets or additional clothing over and under him.
If haste is not imperative, or after immediate problems are under control, survey the situation and try to find out exactly what happened. The direction and extent of the examination should be determined by the kind of accident or sudden illness and the needs of the situation. Have a reason for what you do. Information may be obtained from the victim or from persons who were present and saw the accident or the onset of illness. If the victim is unconscious and has no sign of external injury, try to obtain identification either from papers carried in the victim's billfold or purse or from bystanders, so that relatives may be notified. (It is advisable to have a witness when you are looking for identification.)
Many people with chronic illness, such as heart disease, may carry medication with them, to be taken in the event of sudden illness; or they may have emergency medical identification, such as a card or bracelet, that gives a clue to their condition.
Examine the victim methodically. Loosen constricting clothing but do not pull on the victim's belt, in case spinal injuries are present. Remove or open clothing as necessary to examine the victim and give first aid (clothing may be cut away or ripped at the seams) but do not expose the victim unduly without protective cover. (Discretion must always be used in removing clothing.) Note the general appearance (including discoloration) of the victim's skin and other signs and symptoms that may give a clue to the injury or sudden illness. In the case of a victim with dark skin pigmentation, it may be difficult to interpret changes in skin color; look for changes in the color of the mucous membrane, which is the inner surface of the lips, mouth, and eyelids. Use all other available information concerning signs and symptoms, the history of the accident, and the like.
Check the victim's pulse; if you cannot feel it in the wrist, check for a pulse of the carotid artery at the side of his neck. Is the victim awake, stuporous, or unconscious? Does he respond to questions? Look at the expression of his eyes and the size of his pupils. Examine his trunk and limbs for open and closed wounds and for signs of fractures.
If the victim is unconscious, look for evidence of head injury. If he is conscious, look for paralysis of one side of his face or body. See whether he shows evidence of a recent convulsion. (He may have bitten his tongue, producing a laceration.) Check the front of the victim's neck to determine whether he is a laryngectomee. (Most laryngectomees carry a card or other identification stating that they cannot breathe through nose or mouth.) Do not inadvertently block the stoma of a laryngectomee when carrying out other first aid, because blockage could cause death from asphyxiation.
If poisoning is suspected, check for stains or burns about the victim's mouth and a source of poisoning nearby, such as pills, medicine bottles, household chemicals, or pesticides.
Apply emergency dressings, bandages, and splints as necessary, if they are available.
Decide whether it is absolutely necessary to move the victim before help arrives.
After you determine the nature of the victim's injuries or illness, your plan of action will be affected by the kind of accident or sudden illness and the needs of the situation. Another major factor influencing this plan is the availability of human and material resources.
The first aid worker is not expected to explain the victim's probable condition to bystanders or to reporters. He is expected, however, to remain in charge until the victim can be placed in the care of qualified persons (for example, a physician, an ambulance crew, a rescue squad, or a police officer) or until the victim can take care of himself or can be placed in the care of relatives. Meanwhile, proper first aid measures should include standard specific techniques that have been taught and that, in view of the circumstances, appear to be necessary.
Above all, as a first aid worker, you should know the limits of your capabilities and must make every effort to avoid further injury to the victim in your attempt to provide the best possible emergency first aid care.