• 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.

• 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.