3.1 First aid procedures

First aid is the immediate, practical care given to an ill or injured person before professional medical help takes over. Its aims are to preserve life, prevent the condition from worsening and promote recovery. In a hospital kitchen, for example, a cook whose apron catches fire at a gas burner needs the right action within seconds, long before an ambulance can arrive. A first aider who follows a fixed sequence (make the scene safe, assess, call for help, treat the most life-threatening problem first) acts calmly and avoids harming both the casualty and themselves.

Scene safety and personal protection

Before touching any casualty, the first aider must check that the area is safe for themselves, the casualty and bystanders. A first aider who becomes a second casualty cannot help anyone. In a food store attached to a hospital kitchen, for instance, a worker who has fallen beside an unstable stack of crates must not be approached until the stack is secured or the casualty can be moved safely.

Have the first aid kit and protective equipment (covered under tools, equipment, materials and supplies) at hand before starting.

Hazards to look for and the protective measures to take:

• Fire and smoke: Do not enter a smoke-filled room without training and equipment. Raise the alarm and let the fire team make the area safe.
• Electricity: Switch off the supply at the mains before approaching. Never touch a casualty who is still in contact with a live source, for example a faulty blender or food mixer.
• Traffic and machinery: Stop or isolate machines such as slicers and mixers, and warn or divert traffic before attending to a casualty near a road or delivery bay.
• Unstable structures: Keep clear of leaning shelves, loose racking or falling objects until the risk has been removed.
• Body fluids: Wear disposable gloves and, where possible, eye protection to reduce the risk of infection from blood or vomit.
• Chemicals and gases: Ventilate the area if it is safe to do so, and do not enter if fumes from cleaning chemicals or leaking gas are present and you have no protection.

Primary assessment of the casualty

The primary assessment identifies life-threatening conditions quickly so they can be treated first. It follows the order of danger, response, airway, breathing and circulation (DRABC). On a hospital ward, a patient who slumps at the bedside during a meal is assessed in this order, and the first aider does not waste time on minor injuries until the basics are secure.

Steps of the primary assessment:

1. Danger: Confirm that the scene is safe, as described under scene safety and personal protection.
2. Response: Kneel beside the casualty, speak loudly and ask, "Can you hear me? Open your eyes." Tap the shoulders firmly. Do not shake a casualty with a suspected neck injury.
3. Send for help: If there is no response, shout for assistance and ask a bystander to call for an ambulance and bring a first aid kit.
4. Airway: Open the mouth and check for obstruction such as food, vomit or a loose denture. Remove only what you can see and reach easily. Gently tilt the head back and lift the chin to open the airway.
5. Breathing: Look for chest movement, listen for breath sounds and feel for air on your cheek for no more than 10 seconds.
6. Circulation: Look for severe bleeding and control it at once. Note the colour and temperature of the skin as a sign of circulation.
7. Secondary survey: Once life threats are under control, examine the casualty from head to toe for other injuries and ask about pain, allergies and medication.

Calling for emergency help

Early calling for help shortens the time before skilled treatment begins and can decide whether a casualty survives. A clear, calm message allows the dispatcher to send the right resources. In a nutrition clinic, one staff member should be named to make the call while the first aider stays with the casualty.

Information to give when calling:

• Your number: Give the telephone number you are calling from so that the service can call back.
• Exact location: State the building, street, floor, landmarks and the easiest entrance for the ambulance.
• Nature of the emergency: Say briefly what happened, for example a fall, burn, collapse or choking.
• Number and condition of casualties: State how many people are hurt and whether they are conscious and breathing.
• Hazards present: Mention fire, gas, live wires or traffic so crews arrive prepared.
• Instructions: Stay on the line and follow advice from the dispatcher until they end the call. The national emergency numbers (999 or 112) or the nearest hospital's ambulance line may be used.

Cardiopulmonary resuscitation (CPR) for an unresponsive casualty who is not breathing normally

When the heart stops, blood no longer carries oxygen to the brain, and brain damage can begin within minutes. Chest compressions keep blood moving, and rescue breaths supply oxygen. For example, if a client collapses in the waiting area of a nutrition clinic and is not breathing normally, a staff member who starts CPR immediately greatly improves the chance of survival until the ambulance arrives.

Procedure for an adult:

1. Check that the scene is safe and confirm that the casualty does not respond.
2. Shout for help, and send someone to call an ambulance and to fetch an automated external defibrillator (AED) if one is available.
3. Open the airway with head tilt and chin lift, then check breathing for up to 10 seconds. Occasional gasps are not normal breathing.
4. Place the casualty on their back on a firm surface. Place the heel of one hand on the centre of the chest, put the other hand on top and interlock the fingers.
5. With straight arms and shoulders directly above your hands, press down 5 to 6 cm at a rate of 100 to 120 compressions per minute, allowing the chest to rise fully between compressions.
6. After 30 compressions, give 2 rescue breaths: pinch the nose, seal your mouth over theirs, and blow steadily for about one second each, watching the chest rise.
7. Continue cycles of 30 compressions to 2 breaths without long pauses. If you are untrained or unwilling to give breaths, continue compressions alone.
8. If an AED arrives, switch it on, follow its voice prompts and apply the pads as shown. Continue until the casualty shows signs of life, trained help takes over, or you are too exhausted to continue.

For a child, use one or two hands and press about one third of the depth of the chest. For an infant, use two fingers on the lower half of the breastbone and press about one third of the chest depth. For children and infants, begin with 5 rescue breaths if you are trained.

The recovery position

An unconscious casualty who is breathing normally is at risk of choking on the tongue, vomit or blood. The recovery position keeps the airway open and allows fluids to drain from the mouth. In a school feeding programme, a learner who has fainted in the dining hall queue and is slow to wake can be placed in this position while an ambulance is awaited, provided there is no suspected spinal injury.

Procedure:

1. Kneel beside the casualty and straighten their legs. Remove bulky objects such as spectacles from the face.
2. Place the arm nearest you at a right angle to the body with the palm facing up.
3. Bring the far arm across the chest and hold the back of that hand against the cheek nearest you.
4. With your other hand, grasp the far knee, lift it and keep the foot flat on the ground.
5. Pull on the bent knee to roll the casualty towards you onto their side, keeping their hand pressed against the cheek.
6. Adjust the upper leg so that the hip and knee are bent at right angles, which stops the casualty rolling forward.
7. Tilt the head back gently to keep the airway open, and make sure the mouth faces downwards so that fluids can drain.
8. Stay with the casualty and be ready to begin CPR if breathing stops.

Choking

Choking occurs when a foreign object blocks the airway partly or completely. A casualty with a mild blockage can cough, speak and breathe, while one with a severe blockage cannot speak, cough or breathe and may clutch the throat. In a hospital dining room, a patient who suddenly stops talking in the middle of a meal, grips their neck and turns blue needs immediate help.

Procedure for a conscious adult or child with a severe blockage:

1. Ask, "Are you choking?" If the casualty can cough, encourage them to keep coughing and do not slap their back.
2. If they cannot cough, speak or breathe, lean them forward and support the upper body with one hand.
3. Give up to 5 sharp back blows between the shoulder blades with the heel of your other hand, checking after each blow whether the object has come out.
4. If this fails, give up to 5 abdominal thrusts: stand behind the casualty, place a clenched fist just above the navel, grasp it with your other hand and pull sharply inwards and upwards.
5. Alternate 5 back blows with 5 abdominal thrusts until the object is expelled or the casualty becomes unresponsive.
6. If the casualty becomes unresponsive, call an ambulance and start CPR.
7. Any casualty who has received abdominal thrusts should be seen by a doctor afterwards, because internal injury can occur.

For an infant, give 5 back blows with the infant face down along your forearm and head lower than the body, then 5 chest thrusts with two fingers on the lower breastbone. Do not use abdominal thrusts on infants.

Controlling severe bleeding

Severe bleeding can lead to shock and death within minutes if it is not controlled. The main method is firm direct pressure on the wound. In a hospital kitchen, a cook whose forearm is deeply cut by a boning knife needs the bleeding stopped before any cleaning or further care.

Procedure:

1. Put on gloves, or use a plastic bag or clean cloth as a barrier if none are available.
2. Expose the wound by removing or cutting away clothing, but do not remove objects embedded in the wound.
3. Apply firm direct pressure over the wound with a clean pad or dressing, using your hand.
4. If there is an embedded object, press on either side of it and build up padding around it.
5. Lay the casualty down and keep the injured part still while you keep firm pressure on the wound.
6. Secure the pad with a firm bandage that controls bleeding without stopping circulation to the limb.
7. If blood soaks through, do not remove the first dressing. Add another pad on top and bandage more firmly. If blood seeps through the second pad as well, remove both and apply a new pad with firm pressure directly on the bleeding point.
8. Call an ambulance for severe bleeding. A tourniquet is a last resort for life-threatening limb bleeding that cannot be controlled by pressure, and should only be applied by someone trained to do so.

For a nosebleed, sit the casualty upright, lean them forward and pinch the soft part of the nose for 10 minutes. Do not tilt the head back.

Treating burns and scalds

Burns are caused by dry heat, hot liquids (scalds), chemicals, electricity or friction. Prompt cooling reduces pain and limits the depth of the injury. In a catering unit, a cook splashed with hot oil from a fryer must be treated quickly, because clothing soaked with hot liquid keeps burning the skin.

Procedure:

1. Remove the casualty and yourself from the source of danger. Switch off the power first in an electrical burn.
2. Cool the burn under cool running water for 20 minutes. Do not use ice.
3. Gently remove rings, watches and loose clothing from near the burn before swelling starts, but do not pull off anything stuck to the skin.
4. For chemical burns, remove contaminated clothing and flush with large amounts of clean water for at least 20 minutes.
5. Cover the burn loosely with clean cling film laid lengthways, or with a clean, dry, non-fluffy dressing.
6. Do not burst blisters, and do not apply butter, oil, toothpaste or other home remedies.
7. Keep the casualty warm and reassure them while waiting for help, taking care not to chill them while the burn is being cooled.
8. Call for medical help for burns to the face, hands, feet, genitals or airway, for large or deep burns, for all chemical and electrical burns, and for any burn in a young child.

Fractures, dislocations, sprains and strains

A fracture is a broken or cracked bone, while a sprain is damage to a ligament at a joint and a strain is damage to a muscle or tendon. Signs include pain, swelling, bruising, deformity, loss of movement and tenderness. In a food store, a worker who falls from a step stool and cannot bear weight on a swollen ankle should be treated as having a fracture until proven otherwise.

Procedure for a suspected fracture:

1. Keep the casualty still and do not move them unless there is immediate danger.
2. Support the injured part in the position found, using your hands or padding such as folded clothing.
3. Cover any open wound with a clean dressing and control bleeding without pressing on exposed bone.
4. Immobilise the injury by fixing it to a sling, a splint or the uninjured part of the body, with padding in the gaps. Tie bandages above and below the fracture, away from the break itself.
5. Check that the circulation beyond the bandage is still adequate by looking at skin colour and warmth.
6. Give nothing to eat or drink in case an operation is needed.
7. Arrange transport to hospital or call an ambulance. Suspected neck or back injuries must not be moved at all, and the head should be held steady until trained help arrives.

For a sprain or strain, use the RICE method:

• Rest: Stop activity and avoid putting weight on the injured part.
• Ice: Apply a cold pack wrapped in a cloth for up to 20 minutes at a time. Never place ice directly on the skin.
• Compression: Wrap a firm but comfortable bandage over the area to limit swelling.
• Elevation: Raise the injured part above heart level to reduce swelling.

Managing shock

Shock is a life-threatening condition in which the circulatory system fails to deliver enough blood and oxygen to the body's organs. It can follow severe bleeding, burns, serious infection, allergic reaction or heart problems. In a hospital ward, a patient who has lost a lot of blood may appear pale, cold and clammy, with a fast weak pulse and rapid breathing.

Procedure:

1. Treat the cause of shock first, for example by controlling bleeding.
2. Call an ambulance, because shock needs urgent medical care.
3. Lay the casualty down on a blanket or coat on the floor. If there is no suspected head, spinal or leg injury, raise and support the legs about 30 cm.
4. Loosen tight clothing around the neck, chest and waist.
5. Cover the casualty with a coat or blanket to keep them warm, but do not use direct heat such as a hot water bottle.
6. Do not give food or drink, because an anaesthetic may be needed. Moisten the lips with water if they are very dry.
7. Stay with the casualty and be ready to start CPR if they lose consciousness and stop breathing normally.

Chapter Summary

This chapter covered essential first aid procedures that guide the initial care provided to a casualty. It emphasized the importance of monitoring the casualty's condition by categorizing it into mild, moderate, severe, acute, and chronic states to determine the appropriate response. The chapter also detailed how to document and disseminate a casualty progress report, ensuring accurate communication among healthcare providers and responders. In concluding the first aid intervention, it highlighted the need to remove any hazardous materials to maintain safety, secure all equipment and supplies used during treatment, and clear away unnecessary items from the scene. Additionally, the chapter underscored the significance of reassuring the casualty throughout the process to support their psychological well-being. These steps collectively ensure that first aid is administered effectively, safely, and with proper follow-up.