25. 6 - Treating: Keep under observation Check breathing and pulse every few minutes Cover the victim with a blanket to keep him warm and avoid shock Stay with the victim until emergency services arrive
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Editor's Notes
According to the Red Cross, First Aid is the assistance or treatment given to a casualty for any injury or sudden illness before the arrival of an ambulance or qualified medical expert. It may involve improvising with facilities and materials available at the time. Within the oilfield, the situation may be even more time-critical than in civilian life due to the remoteness of the operations, the distances involved in travel and the quality of local communications and health facilities. Even though emergency response plans exist, as well as medics with infirmaries or doctors with clinics on or near the work site, any accident far from the base where communications and travel are difficult will increase the remoteness and severity of the situation. It is in these situations when you are isolated and where time is of the essence that having the skills and knowledge of a Certified First Aider is of value. First Aid treatment is given to a casualty in order: To preserve life To prevent the condition from worsening To promote recovery
Each one of us can be endangered by a serious accident or illness requiring rapid assistance. One day you may witness an accident and be the one called upon to provide that assistance to someone else. If you are the first person on the scene of an accident, the future survival of the victim may depend on what you do or don't do in the first few moments. Your role as that first person on the scene will be to assess, protect, examine, alert and assist. ASSESSING the situation. (THE VITAL SIGNS) PROTECT the casualty, yourself and any bystanders and prevent any further casualties or accidents. EXAMINE the victim rapidly for bleeding, consciousness, breathing and pulse. CALL FOR ASSISTANCE or HAVE SOMEONE ALERT the emergency medical service rapidly. But while awaiting their arrival, you must ASSIST the casualty and practice FIRST-AID.
The rescuer, the injured person(s) and the bystanders are often exposed to a second accident aggravating the first one. In order to assist an injured person, it is essential to make sure that there is no danger. PROTECT and OFFER PROTECTION. The prevention of a second accident is essential prior to any action. In most cases a rescuer can avoid danger either by eliminating the cause, cutting the electricity to equipment, having someone control traffic... - or by moving bystanders away from the scene of the accident.
We will review in details the vital checks which must be doneprior to call for help and the fiurst aid techniques associated with each situation.
When faced with the victim of an accident, it is important to make sure that there is no bleeding. First make sure that there is no external bleeding. L ook for any bloodstains on or around the victim. Bleeding may be hidden by heavy clothing . Slide your hand under the victim's clothing in order to check for bleeding If you note an important hemorrhage, it must be stop it immediately.
In order to determine the victim's level of consciousness, question him and give a simple order such as : "- Can you hear me? Press my hand!" If there is no reply and no response, the victim is unconscious. You must then assess his breathing
In order to determine whether an unconscious casualty is breathing, first open the victim's air way , (tilting the casualty's head backwards by lifting the chin with one hand and pressing on the forehead with the other.) Kneel beside the casualty, place your ear above his nose and mouth in order to look, listen and feel for signs of respiration. . Look to see if the chest and upper part of the abdomen are moving; listen to hear any respiratory noises; lean your cheek to feel if the air is blown out If these signs are missing it means that there is no spontaneous breathing It is necessary to transfer air from your own lungs into the casualty's by blowing into them through the mouth. Two inflations should immediately be administered before checking the victim's carotid pulse.
Check the pulse at the neck-this is the carotid pulse The diagram shows where the carotid artery is located in the neck. In the cross section of the neck you can see : the trachea which transports air from the mouth and nose to the lungs the esophagus which transports food from the mouth to the stomach the muscles of the neck. This pulse can be felt by placing three fingers gently on the mid line or voice box and sliding them down, towards you, into the hollow between the voice box and the adjoining muscles. Softly press downwards in order to feel the carotid pulse between the fingertips and the cervical vertebrae. If you do not feel a pulse, the heart is not beating. If there is no pulse, start an External Chest Compression For newborn babies and small infants , the pulse is taken at the inner and middle part of the upper arm.
We will review in details the vital checks which must be doneprior to call for help and the fiurst aid techniques associated with each situation.
In order to stop bleeding you should immediately apply direct pressure directly on the wound. If possible place a plastic bag, clean cloth or towel, or ideally use a glove to protect yourself from possible blood-borne pathogens (AIDS, hepatitis B and C. Lay the casualty down in a suitable and comfortable position and elevate the limb. Cover the wound with a sterile or clean dressing and apply direct pressure with your thumb and or fingers Secure the dressing with a bandage tied firmly enough to control bleeding, but do not cut off circulation. (This is not a tourniquet). Direct pressure is sufficient to stop most external bleeding
The application of pressure to compress an artery must be viewed as a drastic measure. If application of indirect pressure is stopped, bleeding will resume, therefore, pressure on a pressure point should continue until either emergency medical assistance arrives and takes over or a tourniquet is placed on the limb. When two rescuers are present, they can alternate in maintaining the pressure point.
The placing of a tourniquet must be considered as an extreme measure. It is a last resort when: - bleeding is profuse and the pressure point is ineffective or impossible to achieve, - you are alone and cannot apply a pressure point and perform CPR at the same time -there is no other choice as in the case of an amputated limb. The tourniquet should be placed between the wound and the patient's heart, over the artery. It should not be applied below the elbow or the knee.A tourniquet is ineffective on the leg or forearm. If you do not have a commercially made tourniquet use a flat belt, necktie, stocking or long dressing material. Flat materials are best. The band should be at least half an inch wide. Carefully slip the tourniquet and tie a knot with the ends of the tourniquet. A wooden stick or metal rod should be inserted into the knot and the device turned until bleeding has been stopped. The tourniquet must be visible. Indicate on the victim, in a very apparent manner, the time at which the tourniquet was placed. Once a tourniquet is in place it should never be loosened. Deliver care for shock, cover the victim with a blanket but do not cover the tourniquet.
If a casualty is unconscious, the airway may be narrowed or blocked by the tongue which sags back and blocks the air passage particularly if the head is flexed forward. In order to open the airway it is necessary to use the head-tilt, chin-lift maneuver. Place one hand on the patient's forehead while placing the fingertips of the other hand under the chin, over its bony part. Without compressing the tissues under the lower jaw, lift the patient's chin and move it to a point where the lower teeth are almost touching the upper teeth. Do not close the patient's mouth. While the lower jaw is being lifted, you should apply gentle pressure to the patient's forehead. This simple process of opening the airway will often relieve many problems of partial airway obstruction. If the patient is breathing spontaneously he should be placed in the recovery position.
For the unconscious casualty, who is not breathing, and who has a heart beat and pulse, artificial ventilation should be performed. The air that the rescuer delivers or blows into the victim's lungs contains 16% of oxygen which is more than is needed to keep the casualty alive. If the technique is adequately performed, the casualty maintains a correct concentration of oxygen in his blood. Open and maintain the airway free by removing any obvious obstructions or debris in the mouth, nose or throat. The first aider pinches the casualty’s nostrils with the hand placed on the casualty’s forehead, opens his mouth wide, takes a deep breath, and applies his mouth around the casualty’s making sure that there is a tight seal between his lips and the patient's face. He delivers into the casualty’s lungs a sufficient volume of air until he sees the victim’s chest rise to maximum expansion. ONLY PRACTICE THIS ON A MANNEQUIN. Training on a mannequin will give you the feel for how much air must be blown into the victim’s lungs. For an adult, this volume is between 0.8 liters and 1.2 liters. For an efficient artificial ventilation, it is necessary to inflate at a rate of 12 to 15 times per minute. The duration of each inflation is approximately 2 seconds; After each inflation, sit up, take a deep breath, and check to see if the victim’s chest falls, indicating that he is correctly exhaling the air. The fact that the victim has regained or maintains normal skin coloration indicates that artificial ventilation is performed correctly.
CPR is an emergency procedure applied when the heart and lungs have stopped. EXTERNAL CHEST COMPRESSION simulates contractions of the heart muscle causing blood to be pushed out of the heart. External Chest Compression should only be performed on a victim who is in an apparent state of death: The victim is unconscious, and is not breathing There is no carotid pulse, therefore the heart is not beating. By compressing the chest blood is driven out of the heart and into the arteries where it can be oxygenated by artificial ventilation. Artificial ventilation is essential so that the external chest compression sends oxygenated blood to the brain: -> ventilation ->oxygenation of blood ->chest compression External Chest Compression and CPR is very dangerous when performed on a person who has a normal heart beat. For this reason DO NOT PRACTICE CPR compressions on any person. PRACTICE ONLY ON A MANNEQUIN.
Lay the casualty on his back on a firm surface. The first aider places the victim's arm perpendicular to the body and kneels astride the arm. Both of the first aider's knees are touching the victims chest. This position will allow easy alternation of external chest compression and artificial ventilation. The compression site is found in the following manner: The index and middle finger of the first aider's hand closest to the victim's waist locates the lower margin of the patient's rib cage. The fingers are then run along the patient's rib cage until they find the notch where the ribs meet the breastbone. This is in the lower center of the patient's chest. The middle finger of the other hand locates the notch above the breastbone Using his thumbs, the first aider will determine where the center of the breastbone is located. The compression site is located just under this spot.
The first aider places the HEEL of his hand on this compression site. The other hand is placed atop the first one, with the heels of both hands parallel to one another. The fingers of both hands should be pointing away from the body. The fingers can be extended or interlaced, but the fingers must be kept off the patient's chest. The first aider's elbows must be straightened and locked. Elbows should not be bent when delivering or releasing compression. Shoulders should be positioned directly over the hands so that they will deliver all compressions straight down, perpendicular to the chest and the ground, onto the compression site. There should be no swinging back and forth of the first aider's body. Enough force should be applied to the compression site so that the breast bone is depressed 1 1/2 to 2 inches or 3 to 5 centimeters. The sequence on the mannequin demonstrates correct compression amplitude. CPR should only be practiced on a mannequin.
The rate of compressions for an adult victim, is approximately 80 per minute. A metronome can be useful when training. After compression, the first aider must fully release the pressure on the victim's chest. This allows the heart to refill. The release of pressure should take the same amount of time as the time required for compression (50% compression/ 50% release). Lets see the correct compression rate with the metronome and the voice "one and two and three and four and five Blow in and one and two and three and four and five Blow in and so on” pronouncing: "one aaand two aaand three aaand Fooor aaand fiiive" etc. with a drawl in the voice !! and not "One! and two! and three! and four!" abruptly After each compression of the chest, the pressure must be fully released. The first aider's hands should remain in contact with the chest.
When there is only one first aider, he will successively complete 15 compressions followed by 2 full ventilations. Every 8 cycles, or about every two minutes, the first aider must perform a circulation check by looking for a carotid pulse. - if the pulse is absent, external chest compression must be continued along with ventilation - if the pulse is present, compressions must be stopped and only artificial ventilation must be continued. For a child , use only the heel of one hand, and compress at a rate of 100 per minute. Alternate 15 compressions / 2 ventilations. (note in USA and UK= 5 compressions/1ventilation for children) For babies and small infants : - check the pulse at middle and inner part of the upper arm (brachial pulse) - tilt the head slightly backwards to ventilate, compress the middle of the sternum with three fingers, at a rate of 120 per minute, alternating 15 compressions / 2 ventilations. (note in USA and UK= 5 compressions/1ventilation for children) Two-rescuer cardiopulmonary resuscitation, if performed correctly, is a much more efficient procedure than one-rescuer CPR. To guarantee good quality of ventilation, the rescuer delivering the compressions should, after each series of 5 compressions, completely release his pressure to allow time for adequate ventilation by the second rescuer. The succession of movements is identical for the resuscitation of a child or a baby with two rescuers.
When there is only one first aider, he will successively complete 15 compressions followed by 2 full ventilations. Every 8 cycles, or about every two minutes, the first aider must perform a circulation check by looking for a carotid pulse. - if the pulse is absent, external chest compression must be continued along with ventilation - if the pulse is present, compressions must be stopped and only artificial ventilation must be continued. For a child , use only the heel of one hand, and compress at a rate of 100 per minute. Alternate 15 compressions / 2 ventilations. (note in USA and UK= 5 compressions/1ventilation for children) For babies and small infants : - check the pulse at middle and inner part of the upper arm (brachial pulse) - tilt the head slightly backwards to ventilate, compress the middle of the sternum with three fingers, at a rate of 120 per minute, alternating 15 compressions / 2 ventilations. (note in USA and UK= 5 compressions/1ventilation for children) Two-rescuer cardiopulmonary resuscitation, if performed correctly, is a much more efficient procedure than one-rescuer CPR. To guarantee good quality of ventilation, the rescuer delivering the compressions should, after each series of 5 compressions, completely release his pressure to allow time for adequate ventilation by the second rescuer. The succession of movements is identical for the resuscitation of a child or a baby with two rescuers.
Unconscious casualties who are breathing and whose hearts are beating should be placed in the recovery position. This position will ensure that an open airway is maintained since: the tongue cannot fall to the back of the throat, the head and neck remain in an extended position so that the air passage is widened, and vomit or other fluid can drain freely from the casualty's mouth.
Unconscious casualties who are breathing and whose hearts are beating should be placed in the recovery position. This position will ensure that an open airway is maintained since: the tongue cannot fall to the back of the throat, the head and neck remain in an extended position so that the air passage is widened, and vomit or other fluid can drain freely from the casualty's mouth.
If two more inflations remain ineffective, in spite of desobstructing maneuvers, it is necessary to apply manual abdominal thrusts, known as the Heimlich maneuver in order to unblock an eventual foreign body in the upper airway. This abdominal thrust provokes a rapid increase of pressure in the chest, which can force the foreign body up into the mouth where it can then be removed by the finger sweep. If you are present when a person is choking and that person is still conscious apply the Heimlich maneuver. STANDING Stand behind the casualty and place your arms around the victim's waist. Place the fist of one hand horizontally above the victim's navel (thumb inwards), Grasp your fist with the other hand. Pull both hands towards you with a quick inward (toward yourself) and upward thrust from the elbows so that you compress the upper abdomen. The thrust must be hard enough to dislodge the obstruction. If it fails, repeat the pressure until you note that breathing has restarted. SITTING The technique is the same when the victim is sitting.
Burns are produced by extremes in temperature. Burns can be categorized according to cause of the injury: heat (thermal) include fire, steam,and hot objects. electrical burns, chemical burns. A first or a second degree burn involving a small portion of the patient's body. Signs are: Reddening of the skin and some swelling or a blister having an area half the size of the victim's palm. Use cold running water on the burnt area immediately. Place the injured part under slowly running cold water for at least 10 minutes. If no water is available, use any cold harmless liquid such as milk, soda instead. Remove wherever possible, rings, watches and constricting clothing from the injured area before it starts to swell. Cover the burnt area with a clean cloth or bandage. Note: Do not apply lotions, ointments or fat to the injury. Do not break blisters, remove any lose skin or otherwise interfere with the injured area.
A fracture is a broken or cracked bone. In case of a fall or severe traumatism, always keep in mind that a fracture is possible. Never move a victim until you are sure that there is no apparent bone damage. Check for injuries of the limbs and spine. A spinal injury, in particular of the neck is very serious and can be complicated by damage to the spinal cord. Immobilize the suspected fracture area before moving the victim . Fractured limb: The limb is very painful; the victim cannot move it. Swelling appears rapidly, sometimes accompanied by deformity. The fracture is called open if the overlying skin is broken so that the fractured bone or bones are in direct communication with the surface and surrounding environment. In a closed fracture the skin surface which envelops the fractured bone is not broken. Casualty's with fractures should be treated initially at the site of the accident, warned to lie still, and not be moved until the affected part has been properly immobilized, unless life is in danger-fire, risk of explosion . Remove wristwatch, rings, etc. before swelling sets in . Immobilize the fractured bone by splintage. The most natural form of splintage is the casualty's own body. For upper limb fractures , bandage the arm to the trunk, by placing the limb in a sling by using either the victim's garments or a triangular piece of fabric. For a lower limb fracture, bandage the injured leg to the opposite leg. Bring the leg. into line by moving the uninjured to the injured leg.
Contrary to popular opinion, snakebites are only rarely fatal. One or two small puncture wounds are found. There is sharp pain and swelling which can spread to the entire limb. The casualty may experience disturbed vision, nausea or be vomiting. There may be signs of shock with difficulty breathing, a rapid pulse. In rare cases the casualty may become unconscious. Calm the casualty. Lay the casualty down and advise him not to move. Immobilize the affected part, but do not elevate it. Clean the wound with soap and water if available .
In many accidents, casualties may have to be removed in order to save lives-that of the casualty and that of the rescuer. In hazardous situations there are several ways to move a casualty based on the situation.
If the terrain is flat and the victim is unconscious or heavy, grasp the victim by the ankles without lifting the legs too high and drag in the axe of the patient's body. If possible to not bend, twist or turn any part of the patient's body.
If the terrain is not flat or if the victim's feet are not accessible, place yourself behind the casualty, sit him up, grab his wrists with your arms crossed, stand up and pull the casualty backwards.
If the casualty in the car is endangered by fire: 1) Open the door carefully, undo the safety belt and remove it. Make sure that the feet are not stuck under the pedals, 2) Slide your arm under the casualty's armpit closest to the door, grasp and maintain the casualty's chin with your hand placing his head against your opposite shoulder. 3) Slide the other arm (the one closest to the rear of the vehicle) between the casualty's back and the car seat and firmly grasp either the belt of his pants or his armpit 4) Pivot the casualty on his seat and drag him out of the vehicle by standing up. Drag the casualty at least thirty feet away from the vehicle. Squat down, one knee maintaining the casualty's back. 5) The hand which holds the belt or the armpit grasps the victim's neck to firmly maintain the head in the axis while the victim is laid to the ground.
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