Treatment and Disposal

Carry out the appropriate treatment gently and quickly in a confident manner. Reassurance and encouragement of the casualty is most important – calmness and efficiency on the part of the First Aider will inspire greater confidence than mere words. Common sense is essential on every occasion.

Pay attention to the casualty’s requests and any remarks he may make – remember the casualty may overhear remarks not intended for him.

When the appropriate treatment has been given, keep a careful watch on the casualty until he has been sent to hospital or is no longer the responsibility of the First Aider.

Do not pester the casualty by asking repeatedly how he is feeling. This is most annoying and a sign of nervousness on the part of the First Aider.

After the First Aider has carried out his treatment the casualty may be:

  • sent to hospital by ambulance, or in appropriate cases, by car;
  • handed over to the care of a doctor, a nurse or other responsible person;
  • taken into a nearby house or shelter to await the arrival of ambulance or doctor;
  • allowed to go home and told to seek medical advice, if necessary.

Do not send anyone home unaccompanied who has been unconscious, if only for a short period, or ibadly shocked.

Conscious and Unconscious Casualties

Use all your senses to obtain maximum information and diagnose the casualty – look, speak, listen, feel and smell.
If the casualty is conscious:

  • look and size up the problem as you approach;
  • ask him if he has pain and where it is;
  • examine that part first;
  • ask him if he thinks there is anything else wrong;
  • examine the casualty carefully in a regular and methodical manner by running your hands gently but firmly over all parts of the body. Start at the head and neck, then check the spine and trunk; the upper limbs, the lower limbs.
  • handle injured parts gently but firmly;
  • make sure there are no other injuries present, which may be masked by pain, by checking for tenderness and bleeding;

Always compare abnormal parts with the normal side. The First Aider need only remove enough of the casualty’s clothing to expose the injuries and treat them. Then check:

  • count the pulse – noting its strength and rhythm;
  • colour of skin, the nail beds and the inside of the eyelids;
  • the nature of the breathing – listen to it: smell the breath;
  • the temperature of the body – whether hot or cold to the touch.

If the casualty is unconscious the task is much more difficult and a thorough detailed examination is necessary. So you must:

  • note if breathing is present: if absent, immediately commence artificial respiration;
  • examine over and under the casualty for dampness which might indicate bleeding. Stop any serious bleeding before proceeding further with the examination;
  • bear in mind the possibility of internal bleeding;
  • establish the cause of unconsciousness by examining the:
    • breathing – rate and depth;
    • pulse — rate and character;
    • face and skin – colour, temperature and condition;
    • pupils of the eyes;
    • head for injury;
    • ears, eyes, nose and mouth for blood and other signs;
    • whole body for signs of injury.

Urgent Needs and Priority Taking

The First Aider must first reduce to a minimum any danger to the casualty or to himself (take care to avoid becoming a second casualty), e.g. in the case of:

  • fire and collapsing buildings: move the casualty to
  • safety;
  • road accidents: instruct someone to control the traffic;
  • electrocution: switch off the current; take necessary precautions against electric shock;
  • gas and poisonous fumes: turn off at source, remove casualty to fresh air.

As for breathing, check that his airway is clear and that he is breathing; if not, commence artificial respiration. When the casualty is unconscious, place him in the recovery position.

Also check for serious bleeding and control it; raise the part if possible and if no fracture is suspected.

When these urgent matters have received attention, time can be taken to obtain the history of the accident, to weigh up the situation, and to decide in which order action should be taken. Establish the level of consciousness; immobilize all serious fractures and large wounds before moving the casualty, unless there is immediate danger to life from the surroundings; give appropriate treatment to the condition found.

Immediately it is decided that an ambulance is required. Call for it, stating:

  • the exact place of the accident (if necessary with directions of how to get there);
  • the number, and approximate age of the casualties;
  • some indication of the type and seriousness of the accident, e.g. car crash, fall from building, the nature of the injury or injuries.

In all cases of suspected fracture of the spine, or heart attack, obtain medical aid, if readily available, or transport to hospital immediately. In country districts a doctor may be obtained more quickly than an ambulance.

First Aiding Multiple Casualties

So, what are the main things that we must know in case of a real emergency? Well, firs of all, the first aider must be prepared to take responsibility. This includes:

  • an appreciation of the situation;
  • diagnosis;
  • treatment and disposal;
  • taking charge until someone more experienced is available.

Where there is more than one casualty (the case of multiple casualties), the First Aider must decide by rapid assessment, which one should receive priority of treatment. Consideration must be given to:

  • the immediate placing of any unconscious casualties in the recovery position (previously known as the coma position and, earlier, as the three quarters prone position);
  • temporary control of continuous severe bleeding with the assistance of the casualty, or by a bystander, if available;
  • restoration of breathing, if necessary.

Recovery Position

A First Aider working alone must quickly place all unconscious casualties in the recovery position before attending to any others. It is important to note that the noisiest casualty need not be the most severely injured.

Make use of any bystanders; keep them occupied — the more they are given to do, the less they will interfere. They should be used to telephone for the ambulance, police or any other service, to keep back any crowds which may gather, to assist with the control of traffic at a road accident, and, if necessary, to assist with the actual treatment of the casualty.

When sending bystanders to telephone, make sure that they understand the message to be sent; write it down if possible, but in any case ask them to repeat the message (before actually sending it).