First Aid Question

North Sea Volunteer Lifeguards
First Aid For Lifeguards
First Aid for Lifeguards

Candidate name: Course Start Date: Course Registration Number: Course Trainer(s): Finish Date: Course Venue: Assessment Date:
Preface This first aid manual is designed to be a comprehensive resource for trainees attending a course to gain the nationally recognised HSE First Aid at Work qualification in conjunction with a lifeguard qualification. It is also a valuable revision source for ongoing training and renewal of the qualification. The manual has been developed and written with input from a number of experienced Lifeguard Trainers specifically for First Aid at Work in conjunction with Beach Lifeguard courses run by North Sea Volunteer Lifeguards. However, this Third Edition has been thoroughly revamped to make it equally appropriate to those running First Aid at Work in conjunction with Pool Lifeguard courses. It has also been extended to include a workbook section to allow progress of candidates to be monitored, as well as including a Powerpoint Presentation slideshow for use by trainers which is integrated with the Manual. Wherever appropriate techniques are described in relation to lifeguard operations where trained assistance and further equipment is available, however all techniques are also explained in relation to the usual worst case scenario that you are on your own. Therefore, although it is targeted towards first aid situations found in lifeguarding, it will also provide you with the skills to apply this to any situation or workplace. The use of some specialist equipment is also explained, although this is not required under the First Aid at Work syllabus and is included in order to provide a comprehensive training manual for all first aid techniques used by the professional rescuer. About the author Chris Geoff Wade has only been involved in lifesaving and lifeguarding for a relatively short period, but in that time has become an RLSS Beach Lifeguard Trainer Assessor and has developed this workbook to complement the running of courses. Malcolm Dunn came from a teaching background and has been involved with lifesaving and first aid for over 30 years. He is currently an RLSS National Trainer Assessor for Lifesaving and Beach Lifeguarding, as well as being a First Aid at Work trainer. Author of the first aid handouts which constituted the first edition, Malcolm realised the need for a comprehensive training manual and has worked as an advisor from the Second Edition of the Manual.
First Aid For Lifeguards First Edition Second Edition Second Revised Edition Third Edition 1994 2002 2003 2004
Copyright 1994-2004 Chris Wade of North Sea Volunteer Lifeguards. All rights reserved. In this text the masculine includes the feminine and vice versa. While every effort has been made to ensure that the information contained in this training manual is accurate and complies with the latest guidelines at time of going to press (European Resuscitation Council Guidelines 2000, First Aid Protocols 2002), the authors cannot accept any responsibility for any inaccuracies or for any mistreatment administered to any person howsoever caused. You are advised to attend an approved First Aid training course before attempting any of the treatments outlined in this manual. This publication may be reproduced in its original form for training purposes within other organisations if full acknowledgement of the source is given and permission is sought via e-mail to nsvl@beachlifeguards.co.uk. Revisions and new editions, along with further training resources can be found online at www.nsvl.org.uk/resources
Third Edition|www.nsvl.org.uk/resources
First Aid For Lifeguards COURSE BRIEFING As part of your lifeguard training you will learn about your responsibilities in caring for peoples safety in terms of preventing incidents as well as being prepared to respond in an emergency. The same is true for a first aider, whether working as a lifeguard or in any other workplace. You may come onto this course knowing nothing about First Aid and not having any experience dealing with people who are ill or involved in an accident. The course is intended to give you the practical skills, knowledge and confidence you will need to be a First Aider. What will be expected of you To get the most benefit from the course you will need to play an active role. This includes: Listening to your trainer Watching any presentations/videos Taking part in discussions Asking and answering questions Watching and practising practical skills
How to use this manual This manual has been developed to provide you with as much information as possible, but in order for you to understand things fully you may want to make your own brief notes. A wide outer margin has been provided for this purpose. At the end of each section there will be a list of things you should now be able to do. If you are unsure of any of these objectives, go back and revise the section. At the end of the manual there are a number of questions for each section. You can complete these questions in your own time. You may want to wait until just before your final assessment before doing so in order to identify anything you may need to revise. How you will be assessed Throughout the course you will be asked questions by your trainer. Although you may find this difficult at first it is the best way to assess your understanding of the key points. During the course you will be given two short multiple choice question papers on what you have covered so far. You will be told the results immediately and your trainer will go through the questions to identify any areas that need revising. These tests should be treated as rehearsals to give you experience before the final assessment. They do not count towards the final assessment. On the last day you will have the final question paper, which has 25 multiple choice questions covering the whole course. The questions are designed to test your understanding and there will not be any trick questions. The pass mark is 18, which you should easily pass. All trainees who pass the final question paper will take a practical skills test with an outside assessor. You will be asked to complete a resuscitation sequence with a manikin and also act as the first aider in a role play situation to show what you would do in the event of an incident. You will have plenty of practise of role playing and performing CPR on a manikin during the course. Ongoing Training and Renewal of Qualification The FAW certificate currently lasts for 3 years from the date of assessment, and before the 3 years are up you will have to attend a 2-day refresher course to revalidate your qualification. However, as a lifeguard you will be aware of the necessity to keep skills fresh and attend regular ongoing training. The same is true in first aid, especially with resuscitation skills. Any logged first aid training you attend will count towards your renewal hours for your lifeguard qualification.
First Aid For Lifeguards CONTENTS Tip use the bookmark tab in Acrobat Reader to jump quickly between sections. 7 7 7 7 8 8 8 9 10 11 11 11 11 12 12 12 13 13 13 13 14 15 15 15 16 16 16 17 17 17 17 17 17 18 18 18 19 19 20 21 21 21 21 22 22 22 22 23 24 24 25 3
Section 1: First Aid and the Role of the First Aider in the Workplace What is First Aid? The Aims of First Aid What if the worst happens? Being a First Aider in the Workplace First Aid and the Law Assessing First Aid Needs and Requirements First Aid Kits Record Keeping SECTION 1 UNDERSTANDING Section 2: Incident Management Plan of Action Incident Problems Casualty Problems Calling the Emergency Services Phoning for help Sending someone to phone for help Hygiene and Safety Precautions as a First Aider Casualty Communication Dealing with non-English speaking casualties Dealing with hearing impaired casualties Dealing with visually impaired casualties SECTION 2 UNDERSTANDING Section 3: Life Support Turning a casualty onto his back What to do if the casualty vomits If the casualty is breathing Placing a casualty into the Recovery Position If the casualty is not breathing Adult CPR sequence If the casualty has suffered trauma, near drowning, intoxication etc Broken Ribs Two-operator CPR Mouth to nose rescue breathing Mouth to mask rescue breathing Mouth to stoma rescue breathing Child CPR Baby CPR Extended Life Support Use of the AED Use of Supplementary Oxygen SECTION 3 UNDERSTANDING Section 4: Making a Diagnosis How do we go about prioritising treatment? Signs Symptoms History Top to toe survey Removal of clothing Monitoring the casualtys level of response The AVPU Scale Casualty Observation Chart Casualty Handling Bodies washed up on shore SECTION 4 UNDERSTANDING Third Edition|www.nsvl.org.uk/resources
North Sea Volunteer Lifeguards Section 5: Disorders of the airway and breathing Hypoxia Strangulation, throttling and hanging Suffocation Asthma Gas, smoke and fume inhalation Hyperventilation Drowning Wet drowning Dry drowning Secondary drowning Choking SECTION 5 UNDERSTANDING Section 6: Disorders of Circulation The Circulatory System Shock Anaphylactic Shock Fainting Angina Heart Attack SECTION 6 UNDERSTANDING Section 7: Bleeding Wounds and Bleeding Types of Wounds Types of Bleeding Direct Pressure Embedded objects in wounds Scalp wounds Wounds to the palm of the hand Nose bleeds Ruptured Varicose Vein Bleeding from the ear Bleeding from the mouth Dental Injuries Minor External Bleeding Vaginal Bleeding Internal Bleeding Bruises SECTION 7 UNDERSTANDING Section 8: Major Wounds Penetrating Chest Wounds Abdominal Wounds Crush Injuries Infection in Wounds SECTION 8 UNDERSTANDING
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Section 9: Burns, Scalds and the Effects of Heat and Cold on the Body How to assess a burn 43 Chemical Burns 44 Electric Shock and Electrical Burns 44 The Effects of Heat on the Body 45 Sunburn 45 Heat Exhaustion 45 Heat Stroke 45 Prickly Heat 45 Hypothermia 46 SECTION 9 UNDERSTANDING 47 Third Edition|www.nsvl.org.uk/resources 4
North Sea Volunteer Lifeguards Section 10: Disorders of the Brain Blows to the Head Concussions Cerebral Compression Stroke (CVA) Fractured Skull Seizures Minor Epilepsy Major Epilepsy Seizures in Children SECTION 10 UNDERSTANDING Section 11: Diabetic Emergencies Diabetes Mellitus Hypoglycaemia Hyperglycaemia Section 12: Eye Injuries Examining the Eye Irrigating the eye Object under the upper eyelid An object stuck to or embedded in the eye Injuries to the eyeball Bright light injury SECTION 11/12 UNDERSTANDING Section 13: Poisons What is a poison? Drug poisoning Absorbed poisons Jellyfish sting Insect Sting Weaver Fish sting Food poisoning SECTION 13 UNDERSTANDING Section 14: Injuries to the Muscles and Skeleton Muscles and Joints Strains Sprains Dislocation Fractures Major facial fracture Fracture of the lower jaw Fractured Collar Bone Fractured Arm or Wrist Fractures to the arms and fingers Fractured Pelvis Fractured Ribs Leg Fractures The Knee The Foot Application of an arm support sling Application of an elevated sling Section 15: Spinal Injuries Spinal Recovery Position Application of Cervical Neck Collar SECTION 14/15 UNDERSTANDING APPENDIX Third Edition|www.nsvl.org.uk/resources
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North Sea Volunteer Lifeguards First Aid For Lifeguards Section 1: FIRST AID AND THE ROLE OF THE FIRST AIDER IN THE WORKPLACE Aim: To understand the aims of First Aid and the requirements of the law for First Aid provision in the workplace.
What is First Aid? First Aid is the initial assistance given to a person or persons upon the occurrence of any injury or illness, by applying the appropriate skills and using the facilities and equipment available at the time to care for the casualty until he/she is transferred, if necessary, to more qualified medical personnel (e.g. paramedics, doctors etc). Although as a First Aider or lifeguard you are trying to prevent incidents before they happen, some emergency situations can develop suddenly and without warning. Every situation is different, but hopefully the training you receive will enable you to apply your knowledge and skills to ensure the casualty is dealt with to the best of your ability. The Aims of First Aid The main aims of first aid are known as the three Ps - Preserve, Prevent, Promote. Preserve The primary aim of first aid is to save, or preserve life. Most first aid incidents dealt with will be minor cuts and scrapes and not life threatening, but on occasions your actions really could save a life. Equally, some first aid situations may not be immediately life threatening, but if you do not deal with them promptly and correctly they could become life threatening. Prevent Once any life threatening conditions have been dealt with the next aim of first aid is to prevent further injury / worsening of the casualtys condition. Usually this will involve dressing any wounds and putting the casualty in a comfortable position. Promote The final aim of first aid is to promote recovery of the casualty. For minor first aid this may just be by giving advice to the casualty, but for more major first aid this will usually mean calling for an ambulance and getting them to hospital. What if the worst happens? In some, thankfully rare, cases, the conditions or injuries a casualty suffers from will cause death. In any situation you can only do your best. As long as you gave the best treatment you could according to your training then you have no need to feel guilty. A debrief session shortly after the incident should help to put things into perspective. However, after major incidents, especially where they have involved death, you may be emotionally affected. Post traumatic stress disorder can take many forms and there is no standard reaction. But you need to be aware in yourself and in colleagues of any changes in behaviour that could be signs of PTSD. A close friend of the person affected should try to encourage them to talk about their feelings, but it may be that the person has to seek professional counselling to help them through this difficult period. Being a First Aider in the Workplace Anyone can apply First Aid in an emergency situation, but only qualified people can be classed as First Aiders. When you are acting as a First Aider in the workplace you are undertaking extra responsibilities over and above your normal duties on behalf of your employer and therefore you need to know about the regulations governing First Aid.
North Sea Volunteer Lifeguards First Aid For Lifeguards First Aid and the Law Employers, First Aiders and employees all have responsibilities for health and safety in the workplace. You should have a general understanding of the following legislation: The Health and Safety At Work etc Act, 1974 (HASAWA) Health and Safety (First Aid) Regulations, 1981 Approved Code of Practice L74, First Aid at Work, 1997 (ACOP) The Reporting of Injuries, Diseases and Dangerous Occurrences Regs, 1995 (RIDDOR) Control of Substances Hazardous to Health Regulations, 1994 (COSHH)
The Health and Safety (First Aid) Regulations and Code of Practice L74 require employers to ensure that appropriate equipment and facilities, along with an adequate number of suitable persons being available in the event of employees being injured or becoming ill at work. A suitable person is a fully qualified First Aider who has successfully completed a First Aid at Work course in accordance with Health and Safety (First Aid) regulations, 1981. An Appointed Person is not a First Aider. They are intended to back up qualified First Aiders and should not attempt to give First Aid for which they have not been trained. Employers have a duty to inform employees of the arrangements made with regards to the provision of First Aid, including the location of equipment, facilities and personnel. Where it is a self-employed person the regulations require that he provide adequate first aid equipment for him to render First Aid to himself whilst at work. Assessing First Aid Needs and Requirements As a lifeguard you will be familiar with the need to perform risk assessments in order for practices to be put in place to prevent likely accidents, and to provide adequate provision in the event of an emergency. Although in terms of health and safety legislation for workplace First Aid this only applies to employees of the organisation, as lifeguards you will also be responsible for first aid provision for members of the public visiting your centre or beach. In assessing workplace First Aid requirements, employers need to consider the following: Workplace hazards and risks Number of employees (+ other people for whose First Aid needs you are responsible) Nature and distribution of workforce Remoteness of site from emergency medical services and access issues (eg. on a beach) First Aid cover during First Aiders absence
This risk assessment should give an idea as to the number of First Aiders needed, the provision of First Aid rooms and equipment, along with any additional specialist equipment that may be required (e.g. for lifeguards: spinal collars, defibrillators, oxygen etc.) First Aid Kits There should be at least one suitably stocked First Aid kit for every workplace. First Aid kits should protect First Aid materials from dust and damp, be properly identified (usually green with a white cross), easily accessible and placed near to hand washing facilities where possible. A back up stock should be kept to replenish supplies immediately, but when materials are used they should be reported and replaced as soon as possible. Specific contents will depend upon the need, but as a minimum they should contain: twenty adhesive plasters, two eye pads, four triangular bandages, six medium and two large unmedicated dressings (all of which should be sterile and individually wrapped), six safety pins, and at least one pair of disposable gloves. NB - Tablets and medications should not be kept in first aid kits.
North Sea Volunteer Lifeguards First Aid For Lifeguards Lifeguard units may have access to first aid equipment which would not be found in normal first aid kits. Additional to the above, lifeguard trauma bags will also usually contain a pair of tough scissors for cutting clothing, eyewash and a pocket mask. There may also be oxygen equipment and a defibrillator available which should be stored at an accessible location with the appropriate signage. While on duty, especially for beach lifeguards who may be nowhere near First Aid facilities, you should always carry a bum bag with enough materials for minor first aid and to tide you over until a trauma bag arrives for major first aid. Suggested contents are: 10 adhesive plasters (assorted sizes) 1 eye pad 1 triangular bandage 1 sterile un-medicated medium sized wound dressing 2 alcohol free antiseptic cleansing wipes 2 eye wash sachets Pocket mask or revive aid 1 pair of disposable gloves Notepad and pen for taking details
Remember to take off your bum bag if you have to go into the water to effect a rescue, otherwise the contents will get rather wet! RECORD KEEPING Records must be kept of first aid incidents and the NOP of the site you are working at should detail procedures for record keeping. In general, all first aid incidents, especially where involving employees, must be logged in an Accident Book containing: - Full name and address of the casualty - Casualtys occupation (where applicable) - Details of the person filling in the book - Details of where, when and how the accident happened - Details of any injuries and the treatment given - Signature of the person making the entry While the accident book should be kept in an accessible location, due to Data Protection legislation, all Accident Books should now be on perforated sheets so that the casualtys personal details can be stored separately and securely after completion. Different centres and local authorities may also have their own records that must be completed. For serious first aid you may also have to fill in a Lifeguard Incident Report Form, which will be sent to the RLSS. In certain circumstances the employer must report any injuries, diseases or dangerous occurrences to the H.S.E. (RIDDOR Regulations 1995). You should now be able to Recognise the task of a First Aider State the three aims of First Aid Understand that Post Traumatic Stress Disorder could affect you or others Recognise the responsibility of employers and employees for health and safety at work Recognise the need to liaise with management to establish your own role and responsibilities in the workplace, especially in terms of record keeping and provision of first aid equipment and stock. Be aware of the various legislation governing First Aid Identify the reference sources available for First Aid at Work guidance
North Sea Volunteer Lifeguards Section 1: 1. UNDERSTANDING
What are the 3 Ps of First Aid?
P ____________ P ____________ P ____________

2. List some factors which will affect first aid needs in the workplace.
Number of employees
_________________________________ _________________________________ _________________________________ _________________________________

3. What materials should be kept in standard first aid kits?
Disposable gloves

4.
_________________________________ _________________________________ _________________________________ _________________________________ _________________________________

What specialist first aid equipment might lifeguards have available to them?
Pocket masks
__________________ __________________ __________________

5. What types of paperwork need to be completed for a first aid incident?
_______________ _______________ _______________

Third Edition|www.nsvl.org.uk/resources 10
North Sea Volunteer Lifeguards Section 2: INCIDENT MANAGEMENT
Aim: To provide an action plan to enable you to deal with an incident calmly and effectively. Plan of Action Every incident will be different and there isnt one right way of dealing with an incident. However, unless you have a plan then even a relatively minor incident will be difficult to cope with. Having an action plan can mean the difference between success and failure. Your actions when dealing with first aid incidents are similar to any other incident you deal with as a lifeguard and as always will follow what is laid down in the EAP. As a general guide the sequence of actions should be as follows: 1. 2. 3. 4. 5. 6. Assess the situation look for any dangers Make the area safe for yourself, other rescuers and the casualty Take control of the situation quickly and calmly Assess casualty(ies) and prioritise treatment Get help delegate tasks such as phoning for help to bystanders wherever possible Post-incident complete reports, clear up scene, replenish first aid kits, debrief
Incident Problems Each incident will have its own specific problems to which you will have to adapt. In lifeguarding situations this could include the need to clear the pool, a fire or chemical hazard, or on the beach an inaccessible location making treatment difficult. Your plan may also have to be adapted as it goes along, due to changing circumstances. For example, on the beach if it were decided to remove the casualty by air the rest of the team would then need to clear an area of the beach. Casualty Problems You will also come across problems specific to the casualty. This does not just mean their condition, although obviously changes in their condition will affect your plan. Young children may be more difficult to deal with than adults, a female may not want to be treated by a male, the casualty may have a disability, there may be some reason why the casualty cannot talk to you to give you a history (e.g. if they werent English). There are many factors to consider and you must adapt your plan to deal with these factors. Calling the Emergency Services With any serious emergency it is likely that you are going to require further medical assistance. When working as a lifeguard, the procedures for summoning medical assistance will be detailed in the NOP/EAP of the centre/beach you are working at. It will usually be another member of the team who summons help if you are dealing with the incident, leaving you able to continue your treatment of the casualty. In situations occurring on the beach the first emergency point of contact will usually be the Coastguard either by phone or using Channel Zero on the radio. In first aid situations outside of lifeguarding then you or a bystander will normally phone for an ambulance. Usually ambulances should only be called to casualties with serious or life-threatening injuries/conditions. However, in lifeguarding situations there may be casualties who need to go to hospital to be checked over, but will not have their own means of getting there (e.g. children). In these cases then an ambulance may still need to be called, however may take longer to arrive as it will not be a high priority call. As a general guide, in cases which are life-threatening, the ambulance service aims to get an ambulance or paramedic to you within eight minutes of you making your call. In cases which are serious but not immediately life-threatening, the aim is to get an ambulance or paramedic to you within 14 minutes in an urban area and 19 minutes in rural areas.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Phoning for help Dialling 999 or 112 is free from any phone (though remember with some internal phone systems you may have to dial an extra number to get an outside line.) When the operator answers, ask for the service you want You will be asked for the address where help is needed. If you are using a public phone then this should be written on the information panel. If you are on a mobile phone you may be asked for a nearby landline number in case you get cut off Then briefly tell them: what has happened the number of people involved the gender and approximate age of the casualty/ies the condition of the casualty/ies Give any further information as requested by the emergency service
For serious situations the operator may ask you to stay on the line if possible while treating the casualty. They will be able to offer you further advice and advise you on progress of the ambulance. You can keep the operator informed of changes in the casualtys condition as this may give you priority over other calls. Only hang up when the operator tells you. Sending someone else to phone for help If a bystander is available to phone for help - use them. If they have a mobile phone they will be able to stay with you and you can relay information about the casualty. If they have to leave you to phone, make sure you tell them clearly all the information the operator will need (as below) - if possible write it down to avoid confusion. Make sure to tell them to ask how long the ambulance will be and to come back so that they can confirm to you the ambulance is coming. Hygiene and Safety Precautions as a First Aider Personal safety is the first priority in any incident, including First Aid. Hygiene is an important factor when dealing with First Aid as you need to protect yourself (and the casualty) from cross-infection. There is a risk of infection with blood-borne viruses such as Hepatitis B or C and HIV, which can be transmitted by blood-to-blood contact (if, for example, an infected persons blood made contact with yours through a cut or graze.) You should always have access to a pair of disposable gloves (in a bum bag first aid kit if possible) and these should be worn whenever treating a casualty, but especially where there is blood or other bodily fluids (e.g. vomit). Where possible you should also try to wash your hands with warm soapy water and cover any exposed breaks in your skin with a waterproof dressing. Depending on the situation, while putting gloves on casualties can be instructed to elevate and/or apply pressure to a wound themselves if this is possible. Try not to breathe, cough or sneeze over a wound while treating a casualty. While there is no known evidence of Hepatitis or HIV being transmitted during resuscitation, it is good practice always to use a pocket mask (or revive aid) as a barrier to infection. Not only is it more pleasant for the rescuer to use a pocket mask, but it is also a more effective way of getting air into the casualty. Wherever possible, carry one at all times. Used dressings and other infected materials (e.g. paper towels) should be disposed of as per provisions in the NOP, preferably by placing in a yellow bio-hazard bag for incineration. Any spills of blood or other bodily fluids should be mopped up and disinfected with a solution of 1 part bleach to 10 parts water. Contaminated clothing should be washed on a hot washing cycle. Where there are sharp objects/syringes avoid touching them wherever possible, but if it is unavoidable use extreme caution. Do not carry a syringe around - bring a sharps container to the syringe, wear thick gloves to pick up the syringe (without touching the needle itself) and place it into the container.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Casualty Communication One of the most important things to remember as a First Aider, and one of the things that is frequently forgotten in the artificial training atmosphere, is casualty communication. Communication with the casualty, and bystanders, can help you by finding out history, symptoms, and medical conditions. It can also help the casualty by reassuring them and allow you to monitor their level of responsiveness. Keeping bystanders informed will make them a lot easier to deal with. Even when a casualty is unconscious you should talk to them because they might be able to hear you. ! Make and keep eye contact with the casualty at all times You need to give you casualty your undivided attention and build up a rapport so the casualty knows he or she is your top priority. ! Tell the casualty the truth Always tell the casualty the truth, even when it is unpleasant. casualtys trust in you and will decrease your own confidence. Lying will destroy the
! Do not talk up or down to a casualty and dont use technical medical terms ! Be careful what you say about the casualty to others The casualty may be able to hear you when talking to others or phoning for help so do not say anything which the casualty could misinterpret or find distressing. If phoning for an ambulance within the casualtys earshot describe symptoms rather than saying, for example, heart attack. ! Be aware of your body language Casualties can also misinterpret gestures and movements made to other people, so avoid using them. Also, try to position yourself at the casualtys level so you dont appear threatening. ! Always speak slowly, clearly and distinctly and allow the casualty time to respond ! Ask the casualty what she wants to be called ! Act in a calm, confident manner and attend to the casualtys needs where possible. Dealing with non-English speaking casualties You may occasionally have to deal with non-English speaking people as a lifeguard. In most cases they will still know certain key phrases, or there may be a family member or friend who can act as interpreter. Use short, simple questions and simple words, and point to parts of the body as you ask questions to help the casualty understand. Dealing with hearing impaired casualties When dealing with people with hearing difficulties, do not be patronising. First ensure you have their attention and that your face can be clearly seen. Speak slowly, clearly and distinctly face to face, but do not shout. It may be possible to write down questions and get the casualty write the answer. It is also possible to carry small cards in trauma bags with some short phrases and symbols, such as Dont move, Keep calm, Its OK, Will help. Dealing with visually impaired casualties Establish how much the casualty can see and try to stay in physical contact with them. Explain everything you are doing as you do it and try to avoid sudden movements. You should now be able to Describe an action plan for managing an incident Distinguish between incident problems and casualty problems Phone or send someone else to phone the Emergency Services Understand hygiene precautions you should undertake before applying First Aid Talk to a casualty effectively Third Edition|www.nsvl.org.uk/resources 13
North Sea Volunteer Lifeguards Section 2: UNDERSTANDING
1. What stages would you go through when dealing with an incident?
_____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________

Incident Problems Casualty Problems
2. Make a note of some incident problems and casualty problems:
3. What kind of tasks can a bystander be asked to do?
________________ ________________ ________________
4. List some hygiene/safety precautions that a first aider should comply with:
__________________ __________________ __________________ __________________
5. Why is communication with the casualty important?
_____________________________ _____________________________ _____________________________

Third Edition|www.nsvl.org.uk/resources 14
North Sea Volunteer Lifeguards Section 3: LIFE SUPPORT
Aim: To gain a full understanding of the techniques involved with assessing and treating unconscious casualties with or without breathing and circulation. Lets start with the ABC When dealing with a first aid situation you may be faced with multiple casualties or a single casualty with multiple injuries or conditions. You need to know which of these injuries and conditions are the most life-threatening in order that you can deal with them first. Your initial assessment of the casualty is to check airway, breathing and circulation the ABC as absence of breathing and circulation is the most immediately life-threatening condition. There is also a secondary survey which deals with less immediately lifethreatening conditions, but this will be dealt with in the next section. The Initial Assessment Any casualty who appears to be unconscious should be your first priority. When you come across a casualty you first need to ensure your own safety by checking for any dangers. Secondly you need to check the casualtys response by shaking their shoulders and asking if they are all right. If there is no response you need to go into your ABC checks. Turning a casualty onto his back If the casualty is facing downwards, in order to adequately check and open the airway you will need to turn him over. To do so, lift the arm nearest to you and gently straighten it above the head. Bring the other arm down against the body, then grab hold of the casualtys clothing at the shoulders and waist and pull him half way over, supporting his back with your knees. Once he is half way over, support the head with your hand and gently bring him down the rest of the way. Bring the upper arm down against the waist. From this position you can then check the airway and look for any obstructions. If there is anything visible then you may be able to get it out, but leave any well fitting dentures in place. You will then open the airway by tilting the head back (though this should be avoided if a spinal injury is suspected see section on spinal injury management). Opening the airway may be enough to make the casualty start breathing again. However, at any time the casualty could start to vomit if this happens your actions need to be fast to stop the vomit blocking the airway. What to do if the casualty starts to vomit As soon as the casualty starts to vomit, grab them at the shoulder and waist and turn them away from you. Bring your arm over across their chest to support their head and make sure the airway remains open so it can clear. When they have finished vomiting turn them back onto their back and recheck the airway. Some centres or lifeguard units will have V-Vac suction units available which can be used to help clear the mouth, but do not delay turning the casualty. To use it remove the red cap and place the yellow tip at front of the lower side of mouth in the cheek. Pump for no more than 10 seconds in any 2 minute period (if the casualty is a child flick the plastic toggle to adjust stroke length). Once mouth is clear, return to CPR sequence immediately. Replace the cap and change cartridge the used cartridge should be handed to paramedics. If the casualty is breathing If, when you check the breathing, the casualty is breathing you will still need an ambulance. However you need to make sure that their airway is maintained, especially if you are alone and need to leave the casualty to phone for help. An unconscious person lying on his back is at risk of his airway being blocked by his tongue, vomit or secretions of blood. To prevent this we place the casualty in the Recovery Position. Remember that a casualty involved in an accident e.g. a fall or car crash, may have injured his neck or spine, which demands extra precautions (see section on spinal injuries). Third Edition|www.nsvl.org.uk/resources 15
North Sea Volunteer Lifeguards First Aid For Lifeguards Placing a casualty in the Recovery Position - Remove any spectacles or sharp objects in the pockets. If the casualty has an open wound then it should face downwards when they are turned into the recovery position. - Place the arm nearest to you at right angles to the body, elbows bent, palm facing up - Bring the other arm across the chest and hold back of the hand against victims cheek - With your other hand, grasp the far leg just above the knee and pull it up - Keeping hand pressed against his cheek, pull on leg to roll him towards you onto his side - Adjust the upper leg so that both the hip and knee are bent at right angles - Tilt the head back so the airway remains open, adjust the hand under cheek if necessary - Check thumbnail for circulation in lower arm. Reassess breathing and pulse at regular intervals. If the casualty is in the recovery position for more than 30 minutes then they should be moved onto the other side.
If the casualty is not breathing When you cannot detect any signs of breathing after looking, listening and feeling for 10 seconds, then your main priority is to get an ambulance on its way. You are assuming at this point that the casualty has gone into cardiac arrest. Adult CPR Sequence - Check it is safe before proceeding - Check responsiveness gently shake shoulders and ask Are you all right? - Shout for help use radio, alarm or other communication device where available - Tilt head back with one hand on forehead, remove any obvious obstructions from mouth - Use two fingers to lift the chin and open the airway - Check breathing for up to 10 seconds - look, listen, and feel for signs of breathing - Send someone or phone for an ambulance yourself - stating suspected cardiac arrest - Maintaining the airway with 1 hand under the chin and pinching the nose closed with the other, give 2 effective rescue breaths (out of up to 5 attempts) using mouth to mouth - Check for signs of a circulation for up to 10 seconds - look, listen, feel for any coughing, breathing or movement - If there are no signs of circulation or you are at all unsure, feel up the rib cage to the bottom of the sternum and place 2 fingers on the bottom of the sternum, slide the heel of the other hand down so it is placed above the 2 fingers, place the heel of the other hand on top, interlock fingers and give 15 compressions (it may be helpful to count 1 and 2 and 313-14-15 to yourself or out loud to get the right rate of compressions) - Maintaining the correct hand position, a 4-5cm depth of compression, and the correct rate of just under 2 compressions per second, sustain CPR at 15 compressions to 2 rescue breaths An easy way to remember all the steps is an extension of the ABC, DRS ABSTRACT: Danger Response Shout Airway Breathing Send Telephone Rescue Breaths Assess CPR Ten breaths check for dangers to yourself and the casualty check response by shaking the shoulders and asking Are you all right? - if there is no response you will need to shout for help check the mouth for obstructions, and open the airway maintaining the open airway, check breathing for up to ten seconds send someone to phone for an ambulance, OR use your mobile or the nearest phone to get an ambulance yourself give 2 effective rescue breaths assess for signs of a circulation - coughing, breathing or movement if no signs of circulation start CPR with 15 compressions to 2 breaths if there are signs of circulation, give 10 rescue breaths then recheck 16
If the casualty has suffered trauma, near drowning, intoxication etc In these situations you are not assuming a heart problem and so life support should be given for 1 minute before leaving the casualty to phone for help. If the casualty is hypothermic then up to 1 minute should be allowed to check for signs of a circulation. Broken ribs It is common during chest compressions for ribs to break, especially in the elderly and those with particularly rigid chests. If you are performing chest compressions correctly the likelihood of it happening is reduced, but if it does happen then nothing can be done during resuscitation and you should just continue CPR. Two-operator CPR In lifeguarding situations trained assistance should be instantly available to you. Blood only starts circulating after the seventh compression, so correctly performed two-operator CPR reduces the amount of time that these compressions are interrupted. The important factor with two operator CPR is that the sequence is not interrupted while changing over roles the transition should be seamless. The second lifeguard on scene should ensure an ambulance is on its way before assisting with CPR. When ready to assist, the second lifeguard will come in on the opposite side of the casualty ready to take over compressions. At least the last three compressions should be counted out loud (13-14-15) so the lifeguard performing rescue breaths can come in immediately after. Compressions should start again as soon as the rescue breaths have been given (not waiting for the chest to fall). Lifeguard Lifeguard Lifeguard Lifeguard Lifeguard 1 1 2 2 1 comes across unconscious person and shouts/radios for help continues with checks, Lifeguard 2 arrives and is briefed of situation ensures an ambulance is on its way while Lifeguard 1 starts CPR is instructed by Lifeguard 1 to start 15 chest compressions after the breaths continues rescue breaths while Lifeguard 2 does compressions (ratio 15:2)
An ambulance may take a number of minutes to arrive, which is a long time to perform CPR, even with 2 operators. If other lifeguards are available they should be ready to step in if the first lifeguards become tired, ensuring no interruption to the sequence. Mouth to nose rescue breathing The most common way to perform rescue breathing is mouth to mouth where your mouth is sealed over the casualtys mouth. However, in some situations for example if there has been an injury to the mouth it may be easier to perform mouth to nose rescue breathing. When doing this you must remember to still keep the airway open and use the hand on the chin to close the mouth. Mouth to mask rescue breathing As lifeguards you should always have available, preferably on your person, a resuscitation pocket mask. This not only provides a barrier to infection and is more pleasant for you, but it is also a more effective way of getting air into the casualty and should be used whenever possible. Ideally, you should be positioned above the casualtys head, but if you are alone this may not be possible so you will have to practice getting a seal from the side. Mouth to stoma rescue breathing On rare occasions you may need to give breaths to a casualty whose voice box (larynx) has been removed, and who breathes through a permanent opening (stoma) in the neck. The stoma may be covered by a scarf or fabric filter which will need to be removed first. There may also be a mucus build up in the stoma which you will need to wipe away. To perform mouth to stoma rescue breathing, close off the mouth and nose with your upper hand (using the palm to close the mouth and two fingers to squeeze the nose closed), use your lower hand to support under the neck and seal your mouth around the stoma. Apart from this, rescue breathing is as for a normal adult.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Differences in resuscitation for children and babies A child or baby is much less likely to have had a heart attack than an adult, so unconsciousness is more likely to have been caused by breathing difficulties due to choking on vomit or a small object, near drowning, croup or pneumonia, head, neck or chest injuries or sudden infant death syndrome (cot death) etc. However, if breathing is absent this may lead to cardiac arrest due to lack of oxygen in the blood. Therefore, when you come across an unconscious baby or child, after your initial checks you should continue with rescue breathing/CPR for 1 minute before you leave to phone for help. Child CPR For the purposes of resuscitation, children are deemed to be under 8 years old, though larger children may have to be treated as adults. As a child is smaller there are various differences in resuscitation techniques. When checking for response you should only tap the shoulder of a child, rescue breaths should not put as much air into the casualty, and when performing chest compressions only one hand should be used (making compressions of about one third chest depth). The ratio of compressions to breaths is just 5:1. The rate of compression is still around 100 per minute. Baby CPR Babies are generally considered to be those under 12 months old, however the size of the baby will determine whether you use the baby or child protocols. In order to assess responsiveness tickle the sole of the foot never shake a baby. When giving rescue breaths to a baby you will need to seal your mouth around their mouth and nose and only put in as much air as is needed to make the chest rise (usually the amount of air in your cheeks). When performing chest compressions locate the correct position on the chest by imagining a line between the nipples and placing two fingers just below this in the centre of the chest, give compressions with 2 fingers, using the other hand to support the head (depth of compression should be around a third of the chest). The ratio of compressions to breaths is again 5:1 at a rate of 100 per minute. If you need to leave to phone for help, you can take the baby with you by sliding your hand and arm under the body and supporting the babys head with your hand. Some form of resuscitation can take place in this position while walking to the phone. If the baby starts breathing it can be supported on your arm, with the hand supporting the head and held across your chest to maintain an open and clear airway. Extended Life Support Many centres and beach lifeguard units are now trained in extended life support techniques, mainly the use of automated external defibrillators (AEDs) and oxygen. This is an important step and means lifeguards can be active at the first 3 stages of the Chain of Survival:
When the heart stops pumping blood and the brain is deprived of oxygen, brain damage can occur after only a few minutes. While the basic life support techniques explained above will help buy time for a casualty they will not restart the heart, therefore early access to extended life support is crucial for the greatest chance of recovery. The electric shock given by an AED can often cause the heart to start beating again, but each minute this shock is delayed reduces the chance of survival by 10%. It is vitally important, therefore, to ensure that a defibrillator is on its way. If an AED is available to you then this will hopefully mean you are able to give that shock much more quickly than waiting for an ambulance to arrive. Third Edition|www.nsvl.org.uk/resources 18
Use of the AED If you come across an unconscious casualty who is not breathing and has no signs of a circulation then you will need to call upon the AED (using the procedures outlined in the EAP) as well as calling for an ambulance. Even if a casualty has signs of a circulation, or with a conscious casualty having a suspected heart attack, the AED should come on scene in case the casualtys condition worsens. Different AED units will differ slightly in how they are operated, but the following general rules apply. Lifeguards should perform basic life support until the AED arrives and is set up. The AED operator will then instruct the lifeguards to stop CPR so he can place the pads on the chest so that the AED unit can analyse the casualtys heart rhythm. - If the casualty has a particularly hairy chest then the area where the pads are placed may need to be cut (a razor is usually unsuitable, tough cut scissors should be used) - If the casualty is wet then they will need to be dried, and care should be ensured that they are not lying in any pools of water as this could then electrocute anyone else in contact with the water - If the casualty has a metal-wired brassiere, or piercings directly under the pads area then these will have to be removed as the metal will get white hot during the shock. The AED unit will then decide whether or not to give a shock and will instruct the AED operator what to do. If shocks are required then the operator must ensure everyone is clear of the casualty. If after 3 shocks the casualty has still not regained a normal heart rhythm then CPR will need to be started again for one minute to ensure that some oxygenated blood is circulated. Use of Supplementary Oxygen The air we breathe has approximately 21% oxygen, however the air we exhale has only 16%. This is still enough to keep a casualty alive while rescue breathing, however if we can increase the concentration of oxygen going into the bloodstream then this will increase the casualtys chances of survival. If your centre or lifeguard unit possesses an oxygen kit this can be used as an adjunct in basic life support to provide a greater concentration of oxygen during resuscitation. The oxygen will be applied through a pocket, but will still require you to perform rescue breaths as the casualty is still not breathing and the air has to be pushed down into the lungs. Oxygen can be used in conjunction with AED units to provide the best possible chance of survival for the casualty, however whenever shocking the casualty the oxygen mask should be removed and placed behind you. You must also ensure that there are no naked flames or anyone smoking when you are using the oxygen. Oxygen can also be used on unconscious breathing casualties and conscious casualties who are having difficulties breathing in fact it is beneficial to most conditions with the one exception of someone suffering from a panic attack / hyperventilation, where the casualty has too much oxygen and needs a greater concentration of carbon dioxide. You should now be able to Perform an Initial Assessment Perform casualty handling: turn casualty onto back; action for vomit; recovery position Perform basic life support on adults both on your own and with trained assistance Understand the differences and perform basic life support on children and babies Understand and be able to apply the different techniques of rescue breathing Understand the principles of the Chain of Survival Understand how AEDs and Supplementary Oxygen can improve the chances of survival NB - Full step by step checklists for all the techniques in this section are available in the appendix.
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1. The air we inhale contains 21% oxygen, the air we breathe out contains __ % oxygen. 2. The normal adult breathing rate is about ______ times per minute. 3. The brain must not be starved of oxygen for more than ___ minutes. 4. Before we check ABC, we must first check for D________, R________ then S_________ 5. What is the aim of your initial assessment? ____________________________________ 6. Why do we perform head tilt/chin lift on an unconscious casualty? __________________ 7. To check for breathing we ______ for chest movement, _______ for sounds of breathing, ______ for breath on your cheek and ______ the chin throughout, for up to ___ seconds 8. If we are alone and the casualty is an adult sudden collapse we assume ________ __________ and immediately __________________. If the casualty has suffered
trauma or near drowning then we continue for _____________ before ______________. 9. When giving rescue breaths we have up to __ attempts to achieve __ effective RBs. 10. Aside from mouth to mouth, what other ways can rescue breaths be given? 1 2
_____________________ _____________________
3 4
___________________ ___________________
11. To check for signs of circulation we look for any C________ , B________ or M_______ 12. When there are no signs of circulation we start CPR with ___ compressions to __ RBs 13. CPR should be continued until: ______________________________________ ______________________________________ ______________________________________ ______________________________________
14. List some differences in resuscitation for children and babies: Child CPR differences Baby CPR differences
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North Sea Volunteer Lifeguards Section 4: MAKING A DIAGNOSIS
Aim: To understand how to get a full picture of what is wrong with a casualty in order to give appropriate treatment. How do we go about prioritising treatment? When you come across a situation with multiple casualties, or a casualty with multiple injuries then you need to know how to prioritise your treatment in order to deal with the most life threatening conditions first. As we have already said, ABC is always your first consideration, but after that conditions should be dealt with in the following general order: management of choking control of bleeding (bleeding may need to be controlled before CPR can be effective) management of severe burns care of the unconscious breathing casualty treatment of shock
The initial assessment of a casualty is that which you undertake as part of your life support sequence. If the casualty is found to be unconscious but breathing you will need to ensure an ambulance is on its way. Your next task is to ascertain whether the casualty has sustained any other injuries, or if they suffering from any other conditions. With a conscious casualty we consider three factors when trying to find out the problem signs, symptoms and history. Signs The signs are what you as a first aider can detect with your own senses. You can see blood, vomit, swelling, and changes in skin colour. You can feel the pulse, temperature of the skin, breath on your cheek. You can smell odour on the casualty's breath. You can hear noisy breathing, sucking sounds, responses to touch or speech. Symptoms Symptoms are anything a casualty feels, such as nausea, giddiness, pain (sharp/dull etc), feeling hot or cold, weakness, impaired sensation. You should talk to the casualty to find out any symptoms. However, be aware that severe pain in one place can mask a more serious injury elsewhere in the body. History If you didn't see what happened yourself, ask the casualty (or bystanders if the casualty is confused) what happened. You can also look around to see if there is any evidence of what happened. Finding out the history is important because it will affect your treatment - if the casualty had collapsed then you would treat him differently from if he had fallen, where you would have to be aware of the possibility of spinal injuries. You also need to find out whether they have any medical conditions, are taking any medication, have any allergies and details of their last oral intake (especially where it seems to be an allergic reaction). You can also look for external clues around the casualty. Where possible any information you find out should be noted down and given to paramedics. An easy way to remember the things you need to find out is by using this mnemonic: Signs and symptoms Allergies Medications Past medical history Last oral intake Events leading up to the illness or injury For a casualty who is unconscious but breathing you still need to find a history, symptoms and signs. To find the history you could ask bystanders or relatives - they may also be able to tell you of any symptoms the casualty was complaining of before collapsing. You can find signs by performing a full top to toe examination of the casualty. Third Edition|www.nsvl.org.uk/resources 21
North Sea Volunteer Lifeguards First Aid For Lifeguards Top to toe survey The 'top to toe' examination of the casualty will take place after you have performed the initial assessment of their ABCs. For conscious casualties it will be performed in the position you find them, usually on their back, however if the casualty is unconscious but breathing you will have put them into the recovery position. The history and situation will determine how thorough your top to toe assessment will be, e.g. if you saw what happened. # Examine the head # feel over the skull, nose and jaw for any bleeding, swelling or depression # look into the eyes, ears, nose and mouth, check for any blood or straw coloured fluid # feel skin temperature and moisture state # Examine down the body # look and feel all over and compare sides # check neck, spine, trunk, chest, abdomen, shoulders, pelvic girdles, limbs for any swelling, blood, needle marks, other signs # With you hands on the abdomen ask the casualty to breathe deeply to ensure the chest expands equally on each side # feel under the body for any dampness # Search the casualty # preferably with a witness present, check inside pockets for any medication or inhalers, around neck and wrists for any identification or medic alert bracelets. Removal of clothing You may need to remove some clothing to inspect injuries adequately, but removal of clothing should be kept to a minimum and you must be aware of how the casualty might feel about this. Casualties should be given as much privacy as possible, so other members of the team may have to deal with bystanders. Wherever possible only a lifeguard of the same gender should remove clothing, especially underclothing, and this should always be done in the presence of a witness. Remove upper body clothing (coats, shirts etc) by raising the casualty slightly and slipping the garment over the shoulders, removing from the uninjured side first. With trousers gently pull down from the waist or raise the leg depending on the injury. In some cases garments may have to be cut, but this should not be done unnecessarily. Footwear can be removed by undoing or cutting any laces and removing carefully. Monitoring the casualtys level of response After the top to toe survey for injuries, you should keep the casualty warm and protect from the elements until more qualified medical help arrives. If at any time the casualty becomes conscious speak to them and reassure. Do not give anything to eat, drink or smoke if the casualty complains of thirst moisten the lips only. Where paramedics will be some time, an Observation Chart (overleaf) should be started. If there has been an interruption to the normal working of the brain then our response level deteriorates. Changes in the casualtys level of response will help you assess whether their condition is improving or deteriorating. The AVPU Scale We assess their level of response by watching their ability to open or close their eyes, move their limbs and body and from the coherence of their speech on the AVPU scale. Alert responds to a direct question Voice responds to the voice after giving a command Pain responds to pain Unresponsive Their responsiveness, pulse and breathing rate, should be checked and noted on the Observation Chart every 10 minutes and handed over to the paramedics. Either the carotid pulse (in the neck) or the radial pulse (on the wrist) can be taken by placing the pads of the index and middle fingers on the area and feeling for a pulse. This may take some time if you are not used to finding it.
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North Sea Volunteer Lifeguards First Aid For Lifeguards CASUALTY OBSERVATION CHART Casualtys name: Time (10 minute intervals) Open spontaneously Open to speech Open to pain No response Date:
0 mins 10 mins
Start time:
20 mins 30 mins
Eyes
Tick box opposite appropriate no. in each column 4 3 2 1 6 5 4 3 2 1 5 4 3 2 1
Movement
Obeys commands Points to pain Withdraws from painful stimulus Straightens limbs in response to pain Bends limbs in response to pain No response Normal Confused Used inappropriate words Incomprehensible No response
Speech
Total Score Over 110 101-110 91-100 81-90 71-80 61-70 Below 61 Over 40 31-40 21-30 11-20 Below 11
(add up 3 numbers)
Pulse where measurable

(beats / min)
Respiration (breaths min) /
Further information _________________________________________________________ _________________________________________________________________________ Lifeguard unit __________________________ Name of lifeguard _______________________ Type of incident ____________________ Signature _________________________
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North Sea Volunteer Lifeguards First Aid For Lifeguards Casualty Handling Wherever possible injured casualties should not be moved until further medical assistance arrives due to the high likelihood of aggravating any injuries, especially spinal injuries. In most cases casualties can be examined in the position they are found and first aid treatment given while waiting for further help. Only where the casualty is in immediate danger, such as falling debris, a fast incoming tide in danger of engulfing the area, poisonous gas/fumes, or fire will you need to move the casualty. Wherever possible remove the danger from the casualty rather than the casualty from the danger. Whenever a situation dictates that you do have to move a casualty, a risk assessment should take place before the casualty is moved. This should include factors such as: the the the the the injuries the casualty has sustained weight and build of the casualty ground underfoot distance and route to be travelled number of helpers
In most cases moving a casualty will only be done under the direction of paramedic / Coastguard teams who will have specialist stretchers for moving casualties from these situations. However, especially with casualties trapped on rocks, a large number of people will be needed to move the casualty safely and your help will almost certainly be needed. Before moving a casualty, everyone involved (including the casualty) should be aware of exactly what is going to happen and what they need to do. Where removal is over rough terrain, a plan of action and route to safety should be agreed beforehand. The stronger members of the team should support the heavier parts of the body wherever possible. Once positions and a route are agreed and everyone is ready, the person in charge should direct each movement and at any point if anyone feels their grip slipping, they should tell the rest of the group. The following general principles apply when lifting: Do not attempt to lift something that is too heavy for you Recruit as much assistance as possible Make sure you have a good grip, using as much of the palms of the hands as possible Keep your back straight to avoid strain on ligaments Keep your feet shoulder width apart, one slightly in front of the other Keep your knees bent and lift using your leg muscles Keep your arms close to your body, elbows flexed, lift the object close to your body
Bodies washed up on shore Occasionally beach lifeguards may come across bodies washed up on shore, which could be a traumatic sight for anyone to see. Where the body is obviously dead, go through the Coastguard to call the Police. Do not touch the body and make sure to keep people and dogs away from the area while awaiting a police presence. You should now be able to Describe how to find out what is wrong with conscious and unconscious casualties Describe what clues you look out for to find out what is wrong Determine the casualtys level of response Monitor a casualtys condition using an observation chart, including checking for pulse Perform a top-to-toe survey Understand what factors need to be taken into consideration before moving a casualty Understand the principles of safe lifting procedure
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1. When examining a casualty you need to find the:
S ___________ S ___________ H ___________

2. What kind of clues would you look for when trying to find out what is wrong with a casualty? Sort into the columns as per the words in question 1.
3. You can assess the level of responsiveness on the AVPU scale:
A _______________ V _______________ P _______________ U _______________

4. What is the purpose of a top to toe survey? _________________________ 5. List the things you would look for when performing a top to toe survey: Head Torso Limbs
6. If the casualty is unconscious then the top to toe survey may have to be done with the casualty in what position? __________________________ 7. While waiting for an ambulance you should monitor the casualtys level of ________, ____________ rate and __________________ rate.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Section 5: DISORDERS OF THE AIRWAY AND BREATHING Aim: To recognise and be able to treat disorders of the airway and breathing Remember your priorities If you find any unconscious casualty your first priority is always to follow the life support sequence i.e. check airway, breathing, circulation and perform resuscitation as necessary. Hypoxia Hypoxia is when insufficient oxygen in the blood to pass to the tissues of the body to enable them to function correctly. It can be caused by a number of conditions, anything that inhibits oxygen intake into the body, if there is an inadequate level of oxygen in the air breathed in or where the heart and lungs have ceased to function effectively: If the casualtys air supply is cut off for more than 3 mins then their brain cells will start to die, causing brain damage and ultimately death. Your priority is to get air into the casualty. General Recognition - Flushed skin, quickly becoming pale followed by blueness of head/neck/lips - Difficult and noisy breathing, possible frothing at the mouth, breathing stops altogether General Treatment - Remove the cause from the casualty or the casualty from the cause - Check airway, breathing, circulation and treat accordingly - In most cases giving the casualty oxygen (if available) will be beneficial Strangulation, throttling and hanging Hanging can occur by accident potential hanging hazards, especially for children, can include washing lines and cords from blinds/curtains - not always as a result of an attempt on someones life or suicide. Recognition There will usually be either an obvious constriction or marks around the neck. There may also be rapid, distressed breathing, blue skin, and a congested face with tiny red spots. Treatment - Remove the constriction from the neck as soon as possible. If the casualty is hanging support the body first. - If the casualty is unconscious check airway, breathing, circulation and treat accordingly. - If the casualty is conscious reassure him and make sure he goes to hospital for a check up, even if recovery seems complete - he could be suffering from a lack of oxygen. Suffocation As with hanging, suffocation is not always as a result of an attempt on the casualtys life. In the beach environment there is the specific hazard of sand which could cause suffocation. There is a game that children play where they cover each other with sand. Great fun, except if a child gets too carried away and covers another child's face. (How could a small child understand that this is dangerous?) Another possibility is that the child might get caught in a fall of sand on a steep dune and be buried. The child will not have enough air to breathe. Treatment - Uncover their mouth and nose to see if just doing that will allow breathing to start again - If not then the sand could be weighing down on the chest preventing the chest from rising and falling. You will have to dig the casualty out. - Check airway, breathing, circulation and treat accordingly
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North Sea Volunteer Lifeguards First Aid For Lifeguards Gas, smoke and fume inhalation In these situations there may be confusion about the number of casualties affected, how long they have been exposed and the type of gas or smoke involved. Smoke - irritates the air passages causing spasm, swelling and burning Carbon monoxide can cause headaches, nausea and breathing difficulties. The casualty's skin will have a red tinge because the gas is being absorbed by the blood instead of oxygen. Carbon dioxide breathlessness, headaches, dizziness, leading to unconsciousness. Chlorine irritation to eyes, chest pain, vomiting, coughing, difficulty breathing Solvents - abusers often use a plastic bag to concentrate the vapour. Can cause headaches and vomiting, leads to unconsciousness and can cause the heart to stop. Lighter fuels - on discharge these are extremely cold and if inhaled can cause cardiac arrest. Treatment - Help from fire and ambulance services will be required urgently. - If possible without endangering your own life, remove the casualty from the danger - Check A.B.C. and treat accordingly (with oxygen if available and you are trained in its use) - Treat any burns. Asthma Asthma attacks can be triggered by an allergy to animal fur or dust, nervous tension or physical exertion. During an attack the air passages go into spasm and there is excretion of a thick, sticky mucus in the lungs which further reduces the air passages. Breathing in is often normal, but only partial expiration can be achieved. Recognition - Difficulty in breathing with long, wheezy breathing out phases - Distress and anxiety - Blueness of the skin due to lack of oxygen in some cases Treatment - Reassure the casualty and sit them down in a comfortable position (usually leaning forward on a support). DO NOT make them lie down. - Assist them to take their own medication (often an inhaler with a blue cap) but do not allow another asthma sufferer to offer them their inhaler. If the medication is elsewhere ask someone else to fetch it. - Monitor their condition most attacks should ease within 3 minutes. If not, get the casualty to take another dose from the inhaler. - If the casualty recovers he/she will usually be able to manage themselves from then on, but suggest they see their doctor. - If the attack is severe or medication has no effect, or it is the casualty's first attack call for an ambulance. During a severe attack a casualty may not be able to talk, will have a rapid pulse rate of 120 per minute or more and rapid breathing of 30+ breaths a minute. Hyperventilation Hyperventilation (over-breathing) is associated with panic attacks and can often occur when people are faced with a traumatic experience. Therefore, in a lifeguarding context it might be seen in the relatives or friends of casualties who have been rescued. When hyperventilating, a casualty will be breathing unnaturally quickly and deeply and there will be a lack of carbon dioxide in the body which is needed to stimulate the breathing from within the brain. You need to restore the balance of carbon dioxide being breathed in. - Reassure the casualty and if possible take them away from any traumatic situation - If the casualty is experiencing continued tingling and cramp, instruct the casualty to cup their hands round their mouth and nose (or get them to breathe through a paper bag) in order that they re-breathe their expired air with a greater concentration of carbon dioxide. Stop this once normal breathing has returned. - Advise them to see their doctor to treat any underlying state of anxiety
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North Sea Volunteer Lifeguards First Aid For Lifeguards Drowning Drowning is death by asphyxia following immersion in water. It often occurs in late spring/early summer when the sun comes out but people dont realise that the water hasnt warmed up yet. Alcohol can be an important contributory factor. Immersion in cold water will cause an initial gasping (similar to that you may experience if you have a cold shower) and then hyperventilation this is known as cold shock. The area around the larynx may go into spasm, preventing breathing altogether. This will starve the body of oxygen and cardiac arrest could occur (dry drowning), or the asphyxia could cause relaxation of the airway, allowing water to enter the lungs (wet drowning). Wet drowning this is inhalation of water into the lungs, preventing them from functioning properly. Death is more rapid in fresh water as it is absorbed into the bloodstream damaging the red blood cells. Dry drowning muscle spasm in the larynx region caused by the shock of entering cold water cuts off the air supply and the casualty eventually goes into cardiac arrest. There is a further type of drowning known as secondary drowning: Secondary drowning in most near drownings relatively small amounts of water enters the lungs, sometimes this could be water vapour inhaled. These small amounts are enough to interfere with the normal transfer of oxygen. The water also irritates the lungs which try to cope with this by producing more fluid to counteract the water, but this just further impairs oxygen transfer. This can happen up to 72 hours after an incident, so it is vital that all cases of near drowning i.e. anyone who has had to be rescued by lifeguards - are advised to go hospital to get checked. Treatment Your lifeguard rescue skills will come into play here as you need to get to the casualty as quickly as possible so you can lift their head out of the water and perform rescue breathing if necessary. You will then need to get them to shore quickly so you can treat them properly. The pressure of water has a squeezing effect on the body, so the normal amount of body fluid is relatively too great and some is got rid of through the kidneys. When the casualty is rescued, the body re-expands but there is now insufficient blood and fluid to fill the restored volume. As a result, blood circulation become inadequate and signs of shock can appear and the casualty may go into post-immersion collapse. Therefore, wherever possible casualties should be removed horizontally from the water to prevent this post immersion collapse, especially where the casualty has been in the water a long time. Once on shore, check airway, breathing, circulation and perform resuscitation as necessary. Treat the casualty for shock (see next page). If a casualty has been rescued from ice cold water death should not be assumed, especially in children, as the bodys need for oxygen is reduced when cold. People have been resuscitated even after prolonged immersion. It is important to remember that if an unconscious casualty has been rescued from open water, but has clearly been able to keep his face clear of the water (e.g. if he is wearing a lifejacket) then he is more likely to be suffering from the effects of cold than near drowning.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Choking Choking is caused by an obstruction in the air passage. You need to remove the obstruction to allow the casualty to start breathing again. Recognition - The casualty may have been eating or a child may have put an object into its mouth - The casualty may grip their throat with their hands - With partial airway obstruction the casualty will be distressed and coughing. Breathing may be noisy or wheezy - If the airway is completely obstructed, the casualty will be unable to speak, breathe or cough. His face may become blue and congested with the veins standing out in the neck. Treatment - Encourage the casualty to bend over and cough - If blockage is complete or attempts at breathing are ineffective give up to 5 back slaps support the chest and lean the casualty forwards, give up to 5 back slaps using the heel of your hand between the shoulder blades, checking the mouth after each blow. - If obstruction is still present, carry out up to 5 abdominal thrusts standing behind the casualty lean him over and put your arms round his chest. Clench your fist, place it between the navel and the sternum, grasp it with your other hand and pull sharply inwards and upwards up to five times, checking the mouth each time. Continue alternating back slaps and abdominal thrusts until the object becomes dislodged or the casualty loses consciousness - If the casualty is about to go unconsciousness, lay him down, remove any visible obstructions, and check ABC. If your attempts at giving rescue breaths fail, then go straight into CPR without checking for signs of a circulation. If you can get rescue breaths in carry on with your life support sequence as normal. - If you are alone and an ambulance has not been called, phone for help after 1 minute. If the casualty is a child you should attempt up to 5 chest thrusts after unsuccessful back slaps. These are given in the same position as chest compressions, but each thrust is sharper and they are delivered at a slower rate. If these do not work then check ABC and attempt to give rescue breaths, followed by another 5 back slaps, then 5 abdominal thrusts. To give abdominal thrusts to an unconscious child, lay the child on his back, and push inwards and upwards with the heel of one hand placed in the middle of the abdomen. The sequence continues until the obstruction is removed or you can get rescue breaths in: rescue breaths $ back slaps $ chest thrusts $ rescue breaths $ back slaps $ abdominal thrusts etc. If the child is too large to handle easily then he should be treated as an adult. For babies the sequence is the similar as for child, however only back slaps $ chest thrusts $ rescue breaths should be given as abdominal thrusts are not safe to give to a baby. To give back slaps, pick up the baby face downwards with your arm under the chest and hand holding the airway open, use the heel of your hand to hit between the shoulder blades, ensuring your fingers do not hit the babys head. Chest thrusts should be given in the same way as chest compressions, but slightly sharper and at a slower rate, checking the mouth each time. Comprehensive training checklists for adult, child and baby choking sequences are available in the appendix or from www.nsvl.org.uk/resources. You should now be able to: Recognise and treat disorders of the airway and breathing Recognise the conditions which may cause low blood oxygen (hypoxia) Recognise and treat conditions which cause airway obstruction Recognise and treat choking/suffocation/hanging/strangulation/drowning/asthma/ hyperventilation/inhalation of fumes, smoke and gas
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1. What is hypoxia? _______________________________________________ 2. Causes of hypoxia: Condition Insufficient oxygen in air breathed in Cause of condition
Airway obstruction
Conditions affecting the chest wall
Impaired lung function
Damage to the brain or nerves controlling breathing
Impaired oxygen uptake by tissues
Suffocation by smoke or gas
Condition Suffocation/Strangling/ Hanging/Throttling Gas/smoke/fume inhalation Drowning
Recognition Features
Treatment
Asthma
Choking
Hyperventilation
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North Sea Volunteer Lifeguards Section 6: DISORDERS OF CIRCULATION
Aim: To be able to diagnose and treat conditions which arise due to disorders of the circulatory system. The Circulatory System Once oxygen from the air is transferred across into the blood by the alveoli in the lungs, it has to be circulated to all the body tissues via the blood vessels. Oxygen rich blood is carried from the lungs to the heart through the pulmonary veins and the heart works as a pump to keep this oxygenated blood circulating round the body through arteries. Veins bring deoxygenated blood back from the tissues to the heart and the heart pumps this blood back to the lungs where it is reoxygenated and carbon dioxide removed. Shock The definition of shock is a failure of the circulation which results in an inadequate supply of blood to vital organs. This means that the vital organs such as the heart, brain and kidneys do not receive as much oxygen as they need and stop functioning properly it can be fatal. The body contains around 10 pints (5.68 litres) of blood. An adult can lose up to a pint of blood without any serious effect, but once we start losing upwards of 3 pints it becomes serious and a casualty will suffer from hypovolaemic shock. This loss can be caused by: - External bleeding - Burns - Diarrhoea - Internal bleeding - Vomiting - Profuse Sweating
It is also caused when there is inadequate blood circulation usually due to heart attack (cardiogenic shock), but treatment in these cases will follow airway, breathing, circulation. Neurogenic shock is where inefficient nervous control of the blood vessels leads to a fall in blood pressure. Typical causes include getting a fright, drugs, heat or emotional crisis. The body tries to compensate for the lack of circulating blood caused by shock in 3 ways: a) by directing blood away from the skin and towards the more important areas b) by increasing the rate of breathing to get more oxygen into the blood c) speeding up the heart to circulate the blood more rapidly Recognition These three compensatory measures give us clues into how we can recognise shock. a) skin will become pale and cold and clammy to the touch b) breathing will become rapid, though shallow, and the casualty will gasp for air c) The casualty will have a rapid but weak pulse Additionally, the casualty may also be dizzy or faint, confused and sweating. You may also be able to see obvious injuries that have caused the fluid loss. Be aware that it is unlikely that you will see all the signs and symptoms of shock in one casualty as the illness or injury may disguise them or they may not appear immediately. NB: The signs of shock are similar to a diabetic emergency, so it important to ascertain whether a casualty is diabetic first where there is no obvious loss of bodily fluids. Treatment - Stop any external bleeding / dress any burns / treat any injuries - Position the casualty 1) Lay the casualty flat with the legs raised (where conscious / breathing normally) 2) Legs raised, head and shoulders raised (where there are breathing difficulties) 3) Head low, support under the knees (where abdominal pain or injury) 4) Recovery position (if unconscious) - Keep the casualty at normal temperature and protect from the elements - Keep reassuring, do not give them anything to eat or drink, call for an ambulance Third Edition|www.nsvl.org.uk/resources 31
North Sea Volunteer Lifeguards First Aid For Lifeguards Anaphylactic Shock This is a massive allergic reaction within the body. It is a serious, potentially fatal condition that may develop, in sensitive individuals, within a few minutes of: - The injection of a particular drug - The sting of a particular insect or jellyfish - The ingestion of a particular food The reaction causes substances to be released into the blood that dilate the blood vessels and constrict air passages. Blood pressure falls dramatically and breathing becomes difficult. Swelling to the face and neck increases the risk of suffocation as the amount of oxygen reaching the vital organs becomes severely reduced. Recognition - anxiety - widespread red, blotchy skin - puffiness around the eyes - impaired breathing; the casualty may wheeze and gasp for air - a rapid pulse Treatment 1. Send for an ambulance, they will be able to give a lifesaving injection of adrenaline 2. Help a conscious casualty sit up in a position which most relieves any breathing difficulty 3. Ask if are aware of any allergies. If they are they may have medication (usually an injection of epinephrine from a special pen) which you should assist them to take, but do not administer it yourself 4. If available, and if you have been trained in its use, give the casualty oxygen 5. If the casualty goes unconscious check airway, breathing and circulation and go into your resuscitation sequence as necessary. Fainting Fainting occurs when there is a temporary reduction of blood to the brain. It can be caused by a number of factors including fear, hearing bad news, or being in a hot atmosphere and standing for long periods. Often the valves in the legs arent stimulated causing the blood to pool in the lower limbs and depriving the brain of oxygen and causing the person to pass out. Once horizontal, the heart can pump blood back to the brain and the person will usually regain consciousness fairly quickly. Recognition - Pale face, possible sweating - Possible swaying or yawning - Pulse slower than normal Treatment - Get the casualty to lie down - Loosen tight clothing around the neck and waist - Raise their legs on a support to about 45 degrees - Reassure the casualty and let them sit up when colour returns - Give sips of water when fully conscious - Ensure a fresh supply of air if in a hot atmosphere
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North Sea Volunteer Lifeguards First Aid For Lifeguards Angina Angina occurs when the arteries that supply blood to the heart become narrowed due to wear and tear on the heart associated with diet, smoking, stress and hereditary diseases. Recognition This condition often occurs after physical exertion or stress when the coronary arteries cannot deliver the correct volume of blood to the heart. There will usually be a history of angina if not assume it is a heart attack. - Chest pain, often severe, spreading down the left arm and jaw - Pain or tingling in the hand, shortness of breath - Symptoms and signs of shock Treatment - Ascertain that the casualty does suffer from angina - Assist the casualty to take his own medication (usually a tablet or spray under the tongue) - Advise the casualty to see his/her doctor, when the pain subsides - If the pain persists, summon medical assistance - If casualty goes unconscious check airway, breathing, circulation and treat as necessary - Treat for shock Heart Attack A heart attack is usually caused when a blood clot in the coronary artery (a coronary thrombosis) obstructs the blood supply to the heart. A complete block can cause myocardial infarction pain similar to angina, but this pain will not be relieved by medication and the heart could stop altogether (cardiac arrest). Recognition The symptoms of heart attack (myocardial infarction) can be clear, diffuse or absent. Classic symptoms are strong, persistent pain in the middle of the chest, which may radiate to the shoulders or neck, shortness of breath, symptoms of shock and an irregular, weak pulse. A heart attack can sometimes be confused with indigestion. It is more common in older people. Treatment Your priority is to get further medical help urgently, even if the casualty is still conscious. If the casualty is conscious then you need to relieve any pressure from the heart. - Reassure the casualty and make him comfortable by sitting him in a half sitting position with support under the knees - Make sure medical assistance has been called but be aware that the casualty will be able to hear what you say. Stating that the casualty is having a heart attack over the radio will be distressing for the casualty, so instead describe symptoms. (If your beach lifeguard unit has an AED then make sure this is also on its way.) - Offer the casualty one aspirin to chew slowly whilst waiting for the ambulance, making sure the casualty is not allergic to it or not allowed to take it for another reason (aspirin should not normally be kept in first aid kits.) - If casualty is unconscious, or goes unconscious, check A.B.C. and treat accordingly In all cases, CPR will only bide time. A casualty who has gone into cardiac arrest will need the electric shock given by an AED to get the heart beating again. When an AED arrives (either with paramedics or other lifeguards) do not stop CPR until the AED is set up and you are given instructions from the AED operator (see extended life support section). You should now be able to: Recognise Recognise Recognise Recognise Recognise and and and and and treat treat treat treat treat someone suffering from shock a casualty who has been electrocuted a casualty suffering from anaphylactic shock a casualty suffering from Angina a casualty having a heart attack
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1. What is shock? _______________________________________________________ 2. Shock can be caused by the loss of blood or other bodily fluids through: 1 3 5
____________ ____________ ____________

2
2 4
_____________ _____________
3. The body tries to compensate for shock by doing three things: 1
_________
____________
__________
4. Recognition features of shock include:
____________________________________ ___________________________________
5. What is the general treatment for shock? ______________________________ 6. What is anaphylactic shock? _____________________________________________ 7. List three ways anaphylactic shock may be caused: 1
_________
____________
__________
8. Recognition features of anaphylactic shock include:
____________________________________ ____________________________________
9. How is fainting caused?__________________________________________________ _________________________________________________________________________ 10. Heart Attack Recognition features Treatment
Angina
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North Sea Volunteer Lifeguards Section 7: BLEEDING
Aim: To recognise and treat different types of bleeding, wounds and burns. Wounds and bleeding When a wound bleeds the body reacts to try and repair itself. - When blood stops circulating and meets the air clotting occurs. A scab on a minor wound is a blood clot that has dried. - Blood vessels contract at the surface to make it more difficult for blood to escape - With severe bleeding the body goes into shock, causing a drop in blood pressure The main aim with bleeding, therefore, is to control it as quickly as possible. Remember, for hygiene reasons you should, wherever possible, put disposable gloves on before treating any bleed. Disposable gloves should be readily available to you at all times when on duty, so keep a pair in your bum bag. Types of wounds Incised e.g. a clean cut by a sharp object such as a knife or razor These can bleed quite severely and sometimes damage underlying tendons that control movements to limbs, fingers, toes etc. Lacerated e.g. skin torn on barbed wire Bleeds less than a clean cut wound, but more susceptible to infection. Abrasion e.g. a grazed knee, elbow etc Little bleeding, but wound can be filled with gravel. Puncture e.g. standing on a nail Danger of damage to underlying organs and tissues and risk of infection. Stab e.g. by a knife, especially dangerous if to the trunk Projectile e.g. gun shot wound Bullet can damage anything in its path, and also cause a much larger and more ragged exit wound. Contusion bruises caused by a bump or knock to part of the body A bruise is internal bleeding a large bruise can be dangerous. Types of bleeding Artery Bleeding from an artery can be identified by the spurting motion of the blood, in time with the heart, and can become fatal very quickly. Capillary Capillaries are under less pressure than arteries, blood oozes from the skin. Venous The blood in veins has had its oxygen used and so will be of a dark red colour and will gush out. Direct Pressure The main treatment for severe bleeding is direct pressure using an appropriate sterile dressing. A dressing must be large enough to cover the wound and extend beyond the wounds edges, so a variety of sizes and types should be kept in first aid kits. The pad of the dressing should be placed directly on top of the wound (not slid into position) ensuring that pressure is applied in the right place. With roller bandages wrap the short end of the bandage once around the limb and dressing to secure the pad, then wind the other end of the bandage around the limb to cover the whole pad, leaving the short end of the bandage hanging free. To secure the bandage tie a reef in the two ends above the pad to exert firm pressure on the wound. Circulation can be checked beyond the bandage by pressing on a nail until it goes pale, releasing the pressure and ensuring colour returns. If not the bandage should be loosened. NB - If possible ask the casualty to apply direct pressure to the wound and elevate it while you are putting gloves on and unwrapping the dressings. If sterile dressings are not available and the bleed is severe then the priority is to stop the bleeding rather than wait for sterile dressings, so use any material or clothing you can find to wrap round the wound. Third Edition|www.nsvl.org.uk/resources 35
North Sea Volunteer Lifeguards First Aid For Lifeguards After the dressing has been applied, elevate the injured part (unless there is a reason not to, such as a fracture) and position the casualty for shock. Apply another dressing over the top of the first if blood soaks through, but be careful not to impede circulation. If blood soaks through the second bandage remove both dressings and apply a new dressing to make sure pressure is applied accurately to the point of bleeding (if bleeding has been partially controlled it may be easier to locate the bleeding point with a new dressing it would continue to seep through without the pressure applied at the correct point.) If the casualty has an open wound ask whether they have had a tetanus inoculation within the last 10 years if not suggest they will need to see their doctor. ANY CASUALTY WITH SEVERE BLEEDING WILL NEED TO GO TO HOSPITAL. Embedded objects in wounds If there is an embedded object in a wound, do not pull it out as this could worsen any internal injuries. Similarly, if a casualty is impaled on something do not try and lift them off. Instead of applying pressure directly over the wound, put pressure on either side of the wound. Use unrolled dressings to build up padding at either side of the object and hold them in place with a narrow-fold bandage or another dressing, taking care not to press on the object. In the case of an embedded fish hook, where medical aid is not readily available you need to remove the fish hook. If the barb is visible use wire cutters to cut it off and then carefully remove the hook by its eye. If the barb is not visible, carefully push the hook further in until the barb emerges, then cut it off. Scalp wounds The scalp has a rich supply of blood, which can make bleeding look worse than it is. However, with all head injuries there is a possibility of concussion or compression (covered later) which could lead to unconsciousness, and also underlying injuries such as skull fractures and neck or spine injuries, which the first aider needs to be aware of. Lay the casualty down with head and shoulders raised if possible, replace any skin flaps, then cover and apply pressure to the wound using a sterile dressing or pad. If necessary secure with a head bandage using a triangular bandage, however it may be easier to let the casualty keep pressure on the wound while transferring them to hospital as a head bandage will not exert enough pressure to control bleeding. Monitor the casualtys level of response and send or take the casualty to hospital depending upon the severity of the injury. Wounds to the palm of the hand The palm of the hand also has a rich supply of blood, but due to the shape of the hand it is difficult to apply direct pressure with a dressing. Use an unrolled dressing and place lengthways along the wound. If the wound is horizontal across the palm, instruct the casualty to clench his fist over it, or if the wound is vertical up the palm ask the casualty to hold the dressing in place with his other hand. Bandage around the hand using a narrow-fold bandage or other dressing. Elevate the hand with an elevated sling or clothing. Send the casualty to hospital. Nose bleeds Most nose bleeds are not dangerous, but if the casualty loses a lot of blood, or there are signs of straw coloured fluid in the blood (indication of a fractured skull) then it could be. 1. Sit the casualty down with the head leaning well forward 2. Get casualty to pinch his nose on the fleshy part just below the bridge for about 10 mins 3. If bleeding persists for longer than 30 minutes take or send the casualty to hospital Once bleeding is under control advise casualty not to sniff or blow his nose for a few hours.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Ruptured Varicose Vein When valves in the veins become diseased, other valves have to take on the extra workload. This process can continue and lead to a build up of blood in the area which causes pressure and makes the veins bulge out varicose veins. If they rupture, blood can escape extremely quickly. 1. Lay the casualty down and raise the leg up high 2. Expose affected area and apply direct pressure, use your hand if a sterile pad is not immediately available. 3. Place a large dressing over the area and bandage firmly. 4. Remove any constrictions which would restrict blood flow back to the heart e.g. stockings 5. Treat for shock by raising both legs and ensure an ambulance is on its way. Bleeding from the ear This can be caused by a number of reasons, so the history is important. If there has been a blow to the head and the blood is mixed with a straw coloured fluid this can indicate a fractured skull. Bleeding can also be caused by a ruptured ear drum or by something sharp being stuck in the ear. Treatment depends upon the casualtys condition. Conscious casualties should be placed in a position with their head and shoulders raised, inclined towards the injured side and a pad placed over the ear. Where unconscious check A.B.C. and treat accordingly. If placing the casualty in the recovery position make sure the bleeding ear is to the ground, with a sterile pad underneath. If the casualty has suspected spinal injuries follow procedures for spinal injuries. Bleeding from the mouth Bleeding from the mouth can be minor such as a cut to the tongue or more major. As bleeding can be profuse there is a danger that blood may be inhaled into the lungs, causing problems with breathing. Treatment 1. Sit casualty down and tilt the head towards the injured side to allow blood to drain 2. Get the casualty to hold a gauze pad in place over the wound 3. Blood should be allowed to dribble out, as if it is swallowed it may induce vomiting 4. If the wound is large or bleeding continues for more than 30 minutes seek medical/dental advice Dental Injuries A blow to the mouth may knock out teeth. There may be bleeding in the mouth, so wash the mouth with warm water and apply a cold pack on the outside of the cheek. The knocked out tooth can often be reset, so place the tooth in a cup of milk, being careful not to touch the root, and get the casualty to a dentist. Do not wash the tooth. Minor external bleeding Small cuts and grazes are commonplace in lifeguard situations, especially with children, and usually there is no treatment needed beyond first aid where your aim is to stop the bleeding and prevent infection. Treatment 1. Put on disposable gloves 2. Clean the wound by rinsing under cold water 3. Use an alcohol free antiseptic cleansing wipe to clean the area around the wound 4. Dry gently by patting with a clean tissue and cover with a sterile plaster or dressing placed directly over the wound. 5. Advise casualties to keep their tetanus inoculation up to date.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Vaginal bleeding This is most likely to be menstrual bleeding, but it can also indicate a possible miscarriage, internal disease or injury from a sexual assault. Whatever the cause, this can be very embarrassing for the woman concerned and will need very sensitive care from the first aider. If possible a female member of the team should provide treatment and move the casualty to somewhere private if this will not aggravate any injuries. Circumstances may mean the casualty will not want to give reasons or a full history, so your aim is to make her as comfortable as possible and provide plenty of reassurance until an ambulance arrives. The ideal position for the casualty would be sitting with support under her knees to take pressure away from the abdominal area. A sanitary pad or clean towel can be given to the woman for her to use. NB - If you suspect a sexual assault the area around the victim will be a crime scene. While your immediate aim is first aid, people should be kept away from the area as much as possible and nothing should be removed from the area before the police arrive. The woman should be advised not to wash or use the toilet until a police doctor has examined her. Internal bleeding Internal bleeding cant be stopped with First Aid, but its effects can be reduced until medical help arrives. Recognition of internal bleeding may be more difficult than external bleeding, but there will be the signs and symptoms of shock and blood may become visible externally: Fracture to base of skull blood and straw coloured fluid coming from ear canals or nose Bleeding from inside the lungs casualty coughing up bright, red, frothy blood Bleeding in the stomach dark red blood vomited Bleeding from the kidneys or bladder Smoky coloured urine Bleeding in upper bowel black, tarry stools Bleeding in lower bowel normal coloured blood passed in stools However, some internal bleeding will remain concealed: Bleeding from the brain look for signs and symptoms of compression Bleeding from a fracture blood cannot escape, so look for swelling in the area Bleeding from the liver or spleen this can be very serious. Blood can only escape into the abdominal cavity, therefore the front of the abdomen will become very tight. General Treatment - Treat casualty for shock - Ensure an ambulance is on its way, note level of responsiveness every 10 minutes - Note the amount and source of any blood loss. Retain a sample if possible. Bruises Bruises are a minor form of internal bleeding, the result of damage to the capillaries, causing leakage of fluid and blood into the tissues. They are often accompanied by swelling and can be very tender. For minor bruises your aim is to reduce blood flow to the injury by elevating and then apply a cold compress (if a cold pack is not available you could use a bag of frozen peas wrapped in a wet tea towel) for 10 minutes. A more severe type of bruise is a haematoma - which is the rupture of a much larger blood vessel. Here the swelling is much more rapid and extensive, and the sufferer is usually in severe pain. In these cases your treatment is as for internal bleeding. You should now be able to: Recognise the six different types of wound Understand the hygiene precautions that should be taken when dealing with blood Understand the principles of treating wounds inc. the use of direct and indirect pressure Be able to apply dressings and bandages to a wound on any part of the body Be able to apply dressings to wounds with embedded objects Understand how to recognise and treat a casualty with internal bleeding Third Edition|www.nsvl.org.uk/resources 38
1. State how you would recognise bleeding from each type of blood vessel:
Artery _________________________________ Vein _________________________________ Capillary _________________________________

2. List and describe the types of wound:
____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________
3. What risk should you always be aware of when dealing with bruises? _______________________________________________________________ 4. In what three ways does the body help itself to stop bleeding? 1. __________________________________________________________________ 2. ___________________________________________________________ 3. ___________________________________________________________ 5. What should the first aider always do before dealing with external bleeding? _______________________________________________________________ 6. What are the treatment priorities for external bleeding?
______________________________________ ______________________________________ ______________________________________

7. Site Ear Nose Mouth Appearance of blood - Fresh, bright red - Thin, watery - Fresh, bright red - Thin, water - Fresh, bright red - Coughed up, frothy, bright red - Vomited blood, dark red/brown like coffee grounds - Fresh or dark What it indicates 39
Vagina
Anus Urethra
- Fresh, bright red - Black, tarry, offensive-smelling stool - Red or smoky looking urine
North Sea Volunteer Lifeguards Section 8: MAJOR WOUNDS
Aim: To be able to recognise and treat a variety of major wounds. Penetrating chest wounds A penetrating chest wound is life threatening. Air usually enters the body through our nose or mouth and goes into the lungs, but with a penetrating chest wound - usually a stab wound from a sharp object - air will be drawn into the chest. If the lung has not been punctured itself then the air and blood will be drawn into the chest cavity and cause pressure on the lung, possibly causing it to collapse. Further pressure will prevent the heart from working properly. If the lung has been punctured there will also be damage and bleeding inside the lung and the casualty may cough up blood with the risk of the casualty choking on the blood. Recognition Apart from the history of something sharp stabbing the casualtys chest, other symptoms and signs will include: 1. 2. 3. 4. Difficulty in breathing, coughing up blood Weak, or difficult breathing Signs of shock A sucking sound near the site of the wound where air is being drawn in
Treatment 1. Send for an ambulance urgently 2. Expose the site of the wound and cover with your hand, or that of the casualty 3. Assist the casualty to a comfortable position, ideally lying the casualty down inclined towards the injured. Keep the hole covered. 4. Cover the hole with a sterile pad or dressing, and cover with something plastic if possible to prevent air entering the casualty (e.g. a plastic bag). 5. Secure the plastic with adhesive tape on three sides only so that pressure can escape. 6. If the casualty goes unconscious, place in the recovery position with injured side down to allow drainage and for the good long to function effectively. If the object is still embedded in the chest do not remove it as this could cause further damage. Keep the casualty as still as possible to prevent the object moving. Amputation If a limb has become partially or completely detached from the body then it will be very distressing for everyone involved, not least the casualty. However, with the correct action from the first aider, in many cases the limb can be reattached by microsurgery, so reassure the casualty of this fact. Your first priority in these situations will be controlling bleeding from the body as this will be very severe. 1. Control blood loss using the methods covered previously 2. Treat for shock and reassure the casualty 3. Wearing gloves, retrieve the amputated part and place it into a clean plastic bag or wrap it in cling film 4. Wrap again in gauze or soft fabric to protect it 5. Place into another plastic bag containing crushed ice (if ice is not available then frozen peas can be a good substitute) 6. Write the name of the casualty and time of the injury on the package 7. Hand it over personally to paramedics DO NOT wash the amputated part or allow direct contact with ice as you might kill it.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Abdominal wounds The abdomen is the part of the trunk below the diaphragm and contains many organs, such as the liver, spleen, kidneys, pancreas, bladder, stomach and also the intestines. A severe blow to the abdomen can cause internal damage and bleeding. If the history and your top to toe check indicate that there is an injury to the abdomen but it is not open, then treat the casualty for internal bleeding. If there is an open wound it will not necessarily bleed severely, but there could be parts of the abdomen, usually the intestine, protruding out of the wound. Your priorities here are to reduce the risk of infection and treat for shock. Treatment 1. Lay the casualty down and use something to support them under the knees to relieve pressure from the abdomen. 2. If there is nothing protruding, cover the wound with a large sterile dressing and secure it in place with a broad-fold bandage. If the casualty coughs or vomits, press firmly over the dressing to prevent contents of the abdomen pushing through the wound. 3. If part of the intestine is protruding DO NOT TOUCH IT. Cover it with a clean plastic bag or cling film to prevent it drying out. If not cover with a sterile dressing. 4. Ensure an ambulance has been called Crush injuries Crush injuries occur when something heavy falls on the body, or part of the body is trapped, for example in machinery. Although the natural instinct when someone is crushed is to free the person, in some cases this could be fatal. When part of the body is crushed the blood may not be able to circulate through it so the toxins and waste that would normally be taken away by the blood build up. If the weight is suddenly released the blood will rush to the area, collect all the toxins and waste and carry them to the kidneys to be filtered. But if the kidneys cannot cope with all the toxins they could fail, and the casualty could die. This is known as crush syndrome. Therefore, we have to be aware of the amount of time the casualty has been crushed. Treatment 1. If the casualty has been crushed for longer than 15 minutes do not release unless the weight is on the chest and is preventing the casualty from breathing. Ensure an ambulance has been called, treat the casualty for shock and reassure until help arrives. Make a note of the time of the crush. 2. If the casualty has been crushed for less than 15 minutes, release and treat any wounds. Note the time of the crush and subsequent release. Call for an ambulance. Infection in wounds With minor wounds, you as the first aider are likely to be the only person who deals with the casualty, therefore it is your job to try and prevent infection. However, if a casualty has a wound that is already infected, he will usually show some of the following signs and symptoms: Pain or soreness at site of wound with possible swelling and pus oozing from the skin Pain or swelling at armpits or groin, faint red trails on the skin around that area A raised temperature In these cases dress the wound as normal, elevate it and ensure the casualty goes to see his or her own doctor as soon as possible. You should now be able to: Recognise and treat a penetrating chest wound Treat a casualty with an amputated limb and ensure correct care of the amputated part Recognise and treat abdominal wounds Deal with a victim of a crush injury Be able to recognise infection in wounds Third Edition|www.nsvl.org.uk/resources 41
1. What are your main aims when dealing with a penetrating chest wound?
_______________________________________ _______________________________________ _______________________________________ _______________________________________
2. What are the aims, in order of priority, when dealing with an amputation? (Assume you have sent someone to phone for an ambulance already)
_______________________________________ _______________________________________ _______________________________________
3. Describe how you would attempt to preserve an amputated part: _______________________________________________________________ ______________________________________________________________________ 4. What are your aims when dealing with an abdominal wound?
_______________________________________ _______________________________________ _______________________________________
5. When treating a casualty with an abdominal wound: Position the casualty __________________________________________________ Raise the knees if the wound is __________________________________________ If part of the intestine is protruding _______________________________________ Lightly secure a large dressing over the wound If the casualty starts to cough or vomit ___________________________________ 6. Why should you not immediately release a casualty who has been crushed for more than 15 minutes? _______________________________________________________________________ _______________________________________________________________________ 7. Note down the appropriate treatment for crush injuries in the table below. Casualty crushed for less than 15 minutes Casualty crushed for more than 15 minutes
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North Sea Volunteer Lifeguards First Aid For Lifeguards Section 9: BURNS, SCALDS AND THE EFFECTS OF HEAT AND COLD ON THE BODY Aim: To be able to recognise and treat a variety of different types of burns and scalds. How to assess a burn Skin that has been damaged by burning will no longer function properly as a barrier to infection. Body fluid may also be lost leaking through the skin or collecting under the skin to cause blisters. You need to assess a burn before starting treatment so you can judge whether there are likely to be any related injuries, significant fluid loss or infection. In order to assess a burn you need to consider four factors: the location, the cause, the depth and the extent of the burned area. Location Burns to some areas of the body can be more serious than others as they can cause other complications. Burns to the face and airway area can be extremely serious, as the air passages can become swollen very quickly, constricting the casualtys airway and preventing them breathing. In these cases you will always need to send for an ambulance as soon as possible and try and get the casualty to sip cold water. Burns to the hands, feet and genital area will also require immediate hospital treatment. Cause There are different types of burns, and awareness of these will help you to identify a burn. Dry burn Scald Electrical burn Cold injury Chemical burn Radiation burn caused caused caused caused caused caused by by by by by by flames, hot objects, friction steam, tea/coffee, hot fat low/high voltage, railway lines frostbite, freezing metal, liquid gases industrial chemicals, caustic soda, bleach sunburn, sun lamps, radioactive sources
Depth The depth of a burn into the skin tells you how severe the burn itself is. If a burn only affects the surface of the skin it is said to be superficial. Burns caused by tea/coffee or touching something hot lightly would usually be superficial. If the burn blisters, making it look raw, then it has damaged the part of the skin and is said to be partial thickness If the skin has been damaged through all the layers, possibly affecting nerves and muscles, then it is said to be full thickness.
Extent The amount of the body the burn covers will affect how serious a condition the casualty is in. As a rough guide to measure the extent, an area of burn about the size of the casualtys palm will be approximately 1% of the surface area of the skin. As a general guide, you will always need to send for an ambulance/get the casualty to hospital immediately: - if the casualty is a child - with any full thickness burn - with any burns involving the feet, hands, face/airway or genital area - with all burns that extend around a limb - with any electrical burn, however small due to the depth of the injury - with partial thickness burns of more than 1% of the body (an area the size of the casualtys palm) - with superficial burns of more than 5% of the body (an area the size of five palms) - with burns with a mixed pattern of depth - If you are unsure about the extent or severity of the burns
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North Sea Volunteer Lifeguards First Aid For Lifeguards General Treatment Your first priority is your own safety. Be aware of the dangers of fire/electricity/chemicals. Treatment follows the same general pattern for major and minor burns: Cool the burn with cold water or any other cold liquid for a minimum of 10 minutes If the burn is serious ensure an ambulance has been called For serious burns treat casualty for shock, keeping the burnt area off the ground. For minor burns elevate the affected area. Where there are burns to the airway area, assist the casualtys breathing in any way you can, give oxygen if available Remove constricting items which could cause complications if tissues swell, e.g. belts, rings, watches. Only remove burnt clothing if it has not stuck to the skin Cover with a dressing, burns dressing, or cling film (discard first 2 turns from roll). DO DO DO DO NOT NOT NOT NOT touch the affected area unnecessarily burst blisters apply creams, butter, sprays or anything else remove stuck burnt clothing
Where -
a casualtys clothes are still burning your priorities are to: Make the casualty stay still to reduce the flow of oxygen Get him to lie down as quickly as possible, burning side uppermost Put out the flames with water, or a thick cover (must not be made of Nylon) Roll the casualty only if the clothes are still burning
Chemical burns Chemical burns have an additional effect, as not only can they affect the contact area, but they can also be absorbed into the body (see section on poisoning). The burning effect is usually slower than with heat burns, but the treatment is along the same lines: Flood the affected area for at least 20 minutes, but take care not to allow the rinsing water to come into contact with you or the casualty. If the substance has splashed in the eye, follow irrigate as described in the eye injuries section. Remove contaminated clothing while rinsing, wearing gloves if possible Locate the COSHH hazard sheet if you know what the substance is If the substance has come from a container or drum washed ashore note any information/warning symbols to give to paramedics and inform relevant authorities.
Electric shock and electrical burns When someone makes contact with electricity they will get a shock, unless something stops it going all the way through the body. An electric current passing through the body can stun a casualty, and cause breathing and even the heartbeat to stop, along with causing muscular spasms which prevent the casualty from breaking contact with the current. Electrical burns may be apparent at both entry and exit, along with a track of internal damage. The location and direction of the entry and exit wounds will give you an indication of the likely internal damage and hence the degree of shock the casualty may suffer. There are two types of current that can electrocute. Alternating current (AC) is the type of current found in the house or workplace. Relatively small voltages can kill. Direct current (DC) is the type you get in a battery. An electric shock from DC is only likely to be dangerous is the supply is high voltage (such as in some railway lines). Overhead power lines carry thousands of volts and can 'arc' (jump) up to 18 metres. Never approach any kind of incident involving high power electricity until help arrives. Treatment - Approach the scene with caution - make sure the power supply is switched off BEFORE you go near the casualty. If you cannot get the power switched off attempt to move the casualty away from the source of the current with a piece of DRY wood (anything damp will conduct current and you will be electrocuted). - Once the supply has been switched off check ABC, and treat any burns as above.
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North Sea Volunteer Lifeguards The effects of heat on the body As a lifeguard, whether on a hot and especially aware of the effects of the members of the public, but if you dont as you are exposed to the elements for
First Aid For Lifeguards humid poolside or a sunny beach, you need to be sun and heat on the body. Not only can it affect take the necessary precautions it can also affect you prolonged periods.
Sunburn Sunburn is caused by over exposure to the sun, or sunbeds. It is usually only superficial with the burnt areas going lobster-red and possible blistering. Someone suffering from sunburn should be taken into the shade and given sips of water, then gently sponge the affected area with cold water. If the sunburn is severe then medical attention may need to be sought. The best way to deal with sunburn is to stop it happening in the first place. Encourage people to cover up, regularly apply sun cream of at least SPF15, wear a sun hat, drink plenty of fluids and find shade when the sun is at its hottest around midday. Heat Exhaustion This is a minor form of shock caused by the body losing salt and water through sweating. It usually develops gradually in hot, humid environments, especially after physically exertion and for those not used to the heat. People who are unwell, especially with illnesses causing vomiting or diarrhoea, are also more susceptible. Recognition - Pale and clammy skin, plus other features of shock (e.g. Nausea) - Cramps in the limbs and possible headaches caused by lack of salt Treatment 1. Take the casualty to a cool place in the shade 2. Let the casualty sip a drink of water with one teaspoon of salt per litre of water 3. Lay the casualty down and raise legs to treat for shock 4. Recovery should be rapid, but advise the casualty to see his or her doctor Heat Stroke Heat stroke, often caused by sunstroke, is different from heat exhaustion and altogether more serious. It occurs when the thermostat in the brain that controls body temperature fails to work and the body continues to heat up to a point where brain damage could occur. It can also occur in people who have taken drugs like Ecstasy, where prolonged exertion leads to profuse sweating and dehydration. The drug affects the brains ability to regulate temperature if sweating ceases then the body cant be cooled by evaporation of sweat. Recognition - A hot, flushed and dry skin - Possible headache, dizziness, restlessness and level of response deteriorating - Body temperature over 40C - A strong, bounding pulse - The casualty could go unconscious at any time Treatment 1. Take the casualty to a cool place and remove outer clothing 2. If there is a good level of response call for a doctor, if not call an ambulance 3. Wrap the casualty in a cool, wet sheet and fan to create a wind chill factor 4. Keep cooling the casualty until the under the tongue temperature is 38C Prickly Heat This is a kind of heat rash caused by blocked sweat ducts which form red bumps on the skin and give a constant prickling or itching sensation. In severe cases there may be small blisters. It usually occurs where there is high temperature and humidity, so is not often seen in the UK. There is no treatment beyond cooling casualty and sponging with water. Third Edition|www.nsvl.org.uk/resources 45
North Sea Volunteer Lifeguards First Aid For Lifeguards Hypothermia The normal core body temperature is around 37C. Hypothermia is said to exist when the core body temperature falls below 35C, although a casualty can suffer ill effects from the cold even if the body temperature does not fall this low. The onset of hypothermia can be caused by an extremely cold environment, a combination of exhaustion and exposure, or in an only moderately cold environment in a casualty whose heat production is impaired due to exhaustion, intoxication by drugs or alcohol, or an injury. Alcohol widens the blood vessels which means that heat is lost much more quickly, though the body actually feels warm. For lifeguards this can create problems for people who swim after alcohol consumption. Recognition Everyone is susceptible to the cold, but the old and young are particularly vulnerable. Body cooling may occur very slowly. Early signs may include: Shivering Changes in behaviour Slurring of speech Inco-ordination/stumbling Slowing of physical and mental activity A casualty may be considered to be suffering from the effects of cold if the body feels as cold as marble and, in particular, if the armpit feels profoundly cold. Treatment - Ensure an ambulance has been called - Lay the casualty flat and undertake any necessary first aid - Prevent further heat loss by wrapping the whole body and head in a blanket - Insulate from the ground and from the wind - Create shelter round the casualty or take to shelter keeping the casualty horizontal - Wet clothing can then be replaced if dry clothing is available - Keep casualty wrapped up to prevent warming from the surface - Use a loose scarf to cover the mouth and nose if this doesnt restrict breathing - Offer a warm, sweet drink if the casualty is able to swallow easily. No alcohol. - Reassure casualty and enquire about co-existing illnesses such as diabetes, epilepsy etc - Maintain close observation of the casualtys circulation and respiration NB if you re-warm a casualty too quickly shock can increase by causing an after drop, which could be fatal. Hypothermic casualties should be kept as still as possible because the heart will be very irritable and prone to cardiac arrest. If this does happen then the techniques for rescue breathing and compressions are the same as with other casualties. However, up to 1 minute should be taken to assess for signs of a circulation because the heart and body will have slowed down due to the cold. Hypothermia may also cause stiffness in the chest wall so compressions may be more difficult to perform. You should now be able to: State the difference between a burn and a scald, giving examples of the causes of each State the recognition features of burns and scalds Assess the severity of burns and scalds Describe the treatment for burns and scalds Describe the treatment for burns and scalds to the mouth Recognise and treat chemical burns Recognise and treat electrical burns Recognise that extremes of heat and cold can make us ill Recognise that the normal body temperature control mechanisms protect us from the effects of heat and cold Recognise and treat sunburn, heat exhaustion, heat stroke and prickly heat Recognise and treat a casualty suffering from hypothermia Third Edition|www.nsvl.org.uk/resources 46
1. List six types of burn: 1. ___________________ 2. _______________________ 3. ____________________ 4. ___________________ 5. _______________________ 6. ____________________ 2. What would you take into consideration when assessing the severity of a burn? 1. _______________________ 2. ___________________________ 2. _______________________ 4. ___________________________ 3. What is the general treatment for burns? _______________________________________________________________ 4. What is the additional problem that could occur with chemical burns? _________________________________________________________________________________________ 5. The normal core body temperature is ___ C. 6. Describe the recognition features of heat exhaustion: __________________________________________________________________________________________ 7. Describe the treatment for heat exhaustion: _______________________________________________________________ 8. Describe the recognition features of heat stroke: _______________________________________________________________ 9. Describe the treatment for heat stroke: _______________________________________________________________ 10. What could happen at any time to a casualty suffering from heat stroke: _______________________________________________________________ 11. Hypothermia is said to exist when the body core temperature falls to ___ C. 12. List some recognition features of a casualty suffering from hypothermia: 1. ___________________ 2. _______________________ 3. ____________________ 4. ___________________ 5. _______________________ 6. ____________________ 13. How would you treat a casualty suffering from hypothermia? ______________________________________________________________________ ______________________________________________________________________ _________________________________________________________________________________________
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North Sea Volunteer Lifeguards Section 10: DISORDERS OF THE BRAIN
Aim: To be able to recognise and treat some of the conditions which may affect the brain Blows to the head A heavy blow to the head is a common form of unconsciousness, and causes disturbance to the brains normal activity. When there has been a heavy blow to the head such as this, then damage to the neck should also be suspected and treatment for neck injuries should be made a priority, preferably by applying a neck collar (see section on spinal injuries). Depending on the severity of the blow, if the casualty is conscious with slight bruising or swelling at the point of impact, but apart from that has a good level of response and is of normal colour, then the treatment may need to be no more than a cold compress on the swelling. However, all casualties having suffered a head injury should be advised to see their doctor, especially if they suffer headaches. The advice you have given them should be noted in the accident book and where possible they should be given a Head Injury advisory leaflet. Any casualty who has suffered a head injury, no matter how minor, should not be allowed back into the water. More serious head injuries will always require medical attention. Where the casualty has had a serious blow to the head their responses to questions may be extremely confused, so wherever ask people with them to find out about the history. Concussion Concussion is caused by a blow to the head (perhaps caused by a road accident or sports injury), shaking the brain inside. There will be widespread but temporary disturbance of normal brain activity. This impaired consciousness will only last for a short time and there should be a full recovery afterwards, however you can only be sure it is concussion once the casualty has completely recovered. Recognition - shock-like signs and symptoms, e.g. pale face, clammy skin, rapid pulse - dizziness, loss of memory, feeling sick, impaired consciousness (assess on AVPU scale) Treatment The casualty will need to be seen by a doctor their level of response will give you an idea as to how urgent this is. If the casualty is capable of getting into a car, place them in the care of a responsible person and send them to their doctor/hospital, if not call an ambulance. Dress any open wounds or apply a cold compress if there is any swelling, but remember you will need to ensure care of the neck at all times. Cerebral Compression This is a very serious condition where there is a build up of pressure on the brain caused by swelling of injured brain tissues or blood it will usually require surgery. Compression is usually caused by a head injury (either immediately or up to four days after the injury was sustained), but can also be caused by a stroke, infection or a brain tumour. Recognition - find out whether the casualty has a recent history of a head injury - hot, flushed face, possible raised temperature - slow, strong pulse and noisy, slow breathing - unequal pupils in severe cases - intense headache, confusion, weakness on one side of the body - impaired consciousness or changes in behaviour Treatment With a compression injury the casualty is in urgent need of medical attention and possibly lifesaving surgery. Position the casualty in the most comfortable position for them, usually with the head and shoulders raised, and monitor them until help arrives. Third Edition|www.nsvl.org.uk/resources 48
North Sea Volunteer Lifeguards First Aid For Lifeguards Stroke (CVA - Cerebrovascular Accident) A stroke occurs when the brain is suddenly seriously starved of blood, either by a blood clot or a ruptured artery. The seriousness will depend on the part of the brain in which bleeding occurs, for example it could affect the part of the brain that controls breathing and heart functions which could be fatal, however many people who suffer from a stroke make a full recovery. Recognition A severe headache that came on suddenly A confused, emotional mental state that could be mistaken for drunkenness Sudden or progressive loss of consciousness Strong pulse Signs of weakness or paralysis, usually (but not always) confined to one side e.g. drooping, dribbling, loss of movement in limbs, unequal pupils, loss of bladder control Slurred or impaired speech Treatment The casualty will need to go to hospital urgently. While waiting for an ambulance: Lay the casualty down with head and shoulders raised if conscious Incline the head to one side and place a cloth underneath to absorb any dribbling Loosen restrictive clothing Support any paralysed limbs in the most suitable position Do not give the casualty anything to eat or drink Reassure the casualty even if he/she cannot speak If the casualty goes unconscious, check A.B.C and treat accordingly Fractured Skull The skull is made up of two parts: the base, which supports the brain in place, and the vault, which is the dome shape at the top of the head. The brain is in a sealed unit surrounded by fluid protected by the skull. If the skull is fractured this fluid can leak out and cause serious infections in the brain, or the fractured bone can damage the brain directly. Recognition A history of a blow to the head, or indirect force from a blow to the jaw or falling heavily on the feet A wound to the head, possibly bleeding, or a soft are or depression on the scalp Bruising or swelling behind one ear, or around one or both eyes Signs and symptoms of compression Straw coloured liquid, perhaps with blood, leaking from the ear and/or nose Bloodshot eyes Poor levels of response, possible lapsing into unconsciousness Treatment 1. Send for an ambulance as soon as possible 2. Remembering care of the neck at all times, place an unconscious casualty in the recovery position with any discharge from the ear flowing downwards with a pad under the ear. Conscious casualties should lie down with their head and shoulders raised. 3. Keep the casualty warm 4. Regularly monitor the casualtys responsiveness on an observation chart
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North Sea Volunteer Lifeguards First Aid For Lifeguards Seizures A seizure is caused by disturbance in the electrical activity of the brain and will lead to involuntary contractions of many of the muscles in the body along with loss or impairment of consciousness. The most common cause of seizures is epilepsy, other causes include head injuries, some brain-damaging diseases, shortage of oxygen or glucose in the brain or intake of certain poisons, including alcohol. The priorities with any seizure are ABC, making sure the casualty doesnt injure himself during the seizure and then arranging appropriate aftercare. Minor epilepsy Also known as petit mal, this is the lesser form of the condition epilepsy, in which brief, sudden disturbances of the brain cause little more than a momentary blurring of consciousness that resembles day dreaming. On recovery, the casually may simply have lost the thread of what he or she was doing. However it is not uncommon for a major fit to follow a minor one. Recognition Sudden switching off the casualty may be staring blankly ahead. Slight twitching movements of lips, eyelids or head. Strange automatic movements - lip smacking, chewing, making odd noises, fiddling with clothes. The casualty may be confused and disorientated Treatment 1. Help the casualty to sit down in a quiet place, and remove any possible sources of harm - for example, hot drinks - from the vicinity. 2. Talk to them calmly and reassuringly. Do not pester them with questions. Stay with them until you are sure that they are themselves again. 3. If the casualty does not know about his condition, advise him to see his own doctor. Major epilepsy This condition, also known as grand mal, is characterised by recurrent major disturbances of brain activity, resulting in violent seizures and severe impairment of consciousness. Epileptic fits can be sudden and dramatic, but the casualty may have a brief period of warning - a strange feeling, or a special smell or taste - known as an aura. Recognition An epileptic fit usually follows a pattern: The casualty suddenly falls unconscious, often letting out a cry. He often becomes rigid, arching his back Breathing may cease. The lips may show a blue tinge (cyanosis) and the face and neck may become congested. Convulsive movements begin. The jaw may be clenched and breathing may be noisy. Saliva may appear at the mouth, blood stained if the lips or tongue have been bitten. There may be a loss of bladder or bowel control. The muscles relax and breathing becomes normal: the casualty recovers consciousness, usually within a few minutes. He may feel dazed, or behave strangely in a state of automatism, being unaware of his actions. A fit may also be followed by a deep sleep.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Treatment on dry land If you see the casualty falling, try to support him or ease his fall. Make space around him and ask bystanders to move away. Do not restrain the casualty and only move him if he is in danger of injuring himself or falling into water. Remove any objects which he may hit. Put something soft under his head to prevent it banging on the ground, but don't restrict any movement of the head. Loosen clothing around his neck if possible without restricting movement of the head. Do not put anything between his teeth. When the convulsions cease, place him in the recovery position. Stay with them until they have recovered. Do not call an ambulance or doctor unless the casualty; - is injured - is having their first fit - has a fit lasting longer than 5 minutes, or - takes longer than 10 minutes to recover after the fit has finished - is having repeated attacks without consciousness being regained in between times Note the time and duration of the fit. Treatment in the water Keep the casualty's face above the water, either by holding his head or lifting him under his arms from behind. Be careful not to allow his head to hit you If possible, tow to shallow water and continue supporting his head until the attack is over. Remove him from the water with assistance as soon as the abnormal movements cease. Be prepared to start rescue breathing if breathing does not restart There is a possibility that someone who had a seizure in the water inhaled some water, therefore he/she will need to go to hospital to check for secondary drowning. Seizures in children These are more common than epileptic fits in adults, because a childs brain is still developing. Causes vary, often as a result of raised body temperature caused by a throat or ear infection, but only in rare cases will a febrile convulsion be a sign of something more serious. Recognition Signs of fever with a hot flushed skin Violent muscle spasms similar to an epileptic fit Breath holding Loss or impairment of consciousness Treatment Keep the child cool by removing layers of clothes, and ensuring a supply of fresh air Use a sponge and tepid water to cool the child from the head down Place something soft around the child to prevent injury Place into the recovery position once the fit has ceased Make sure an ambulance has been called to take the child to hospital You should now be able to: Recognise the function of the brain and nervous system in controlling the body Recognise and treat a casualty suffering from concussion Recognise and treat a casualty suffering from compression Recognise and treat a skull fracture Recognise and treat a casualty suffering from a stroke State the general definition for the term seizure and list some causes Recognise and treat a person suffering from a minor epileptic fit Recognise and treat a major epileptic fit on dry land and in the water Recognise and treat seizures in children Third Edition|www.nsvl.org.uk/resources 51
1. List some recognition features of concussion: 1. _______________________ 2. ___________________________ 3. _______________________ 4. ___________________________ 2. As a lifeguard what should any casualty be advised after a head injury? __________________________________________________________________________________________ 3. List some recognition features of compression: 1. ____________________ 2. ___________________________ 3. _____________________ 4. ___________________________ 5. _____________________ 6. ___________________________ 4. What is the main priority when treating a casualty with compression? __________________________________________________________________________________________ 5. How is a stroke caused? _______________________________________________________________ 6. What are the recognition features of a stroke? 1. ____________________ 2. ___________________________ 3. _____________________ 4. ___________________________ 5. _____________________ 6. ___________________________ 7. What are your treatment priorities when dealing with a stroke? __________________________________________________________________________________________ __________________________________________________________________________________________ 8. List some recognition features of a fractured skull: 1. _______________________ 2. ___________________________ 2. _______________________ 4. ___________________________ 9. How would you deal with an adult having a major epileptic seizure? __________________________________________________________________________________________ __________________________________________________________________________________________ 10. How would you treat a child having a seizure? __________________________________________________________________________________________ __________________________________________________________________________________________
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North Sea Volunteer Lifeguards Section 11: DIABETIC EMERGENCIES
Aim: To recognise and give appropriate treatment to a casualty with a diabetic emergency. Diabetes Mellitus Diabetes is a condition which occurs when there is a disturbance in the bodys ability to produce sufficient amounts of insulin to regulate the sugar levels in the blood. It results in two conditions: Hypoglycaemia Hypoglycaemia is where there is too little blood sugar, for example if the sufferer has undereaten or missed a meal, or has used too much insulin for the amount of food eaten. Its onset will be rapid. Recognition - The casualty may have a bracelet or warning card saying he is diabetic - The casualty is known not to have eaten after injecting their insulin - Pale, cold skin and profuse sweating - Deteriorating levels of response, possibly aggressive (can mistaken for drunkenness) - Casualtys limbs may tremble , there may be palpitations - Shallow breathing (no odour to the breath) and rapid pulse - Rapid loss of consciousness Treatment You need to give the casualty sugar to correct the imbalance. - Give a drink sweetened with 2 or 3 tablespoons of sugar or glucose, sugar lumps or sweets (the casualty may carry some for this type of emergency) - Condition should improve rapidly give more sweet food until back to normal - Advise casualty to eat a meal and see a doctor if necessary. If the casualty is unconscious he should be placed in the recovery position to ensure an open airway and breathing checked regularly while awaiting an ambulance. Hyperglycaemia Hyperglycaemia is when there is too much sugar in the blood. It develops gradually and it is difficult to distinguish from hypoglycaemia therefore the treatment is the same. The casualty may have fruity/sweet smelling breath and excessive thirst and may become drowsy, then unconscious. Giving the casualty more sugar will not harm the casualty, but there will be no immediate improvement to the casualtys condition (unlike with hypoglycaemia) and once you realise this you will need to phone an ambulance urgently and check A.B.C.
You should now be able to: Understand what diabetes is Recognise and treat hypoglycaemia Recognise and treat hyperglycaemia
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North Sea Volunteer Lifeguards Section 12: EYE INJURIES
Aim: To learn how to examine the eye methodically and give appropriate treatment. For beach lifeguards children with sand in their eye will be a common problem, but it usually needs little more treatment than irrigating the eye. However, eyes are a vulnerable part of the body and more serious injuries need delicate handling from the first aider. Examining the eye Advise the casualty not to rub his eyes. Sit him in a chair facing a natural light source and use your thumb and index finger to open his eye. Ask him to look up, down, left and right so you can examine the eye thoroughly. Do not touch anything sticking to or embedded in the eye. If you cant see anything, but the history suggests that something has flown into the eye (e.g. from machinery) then send the casualty to hospital to be examined. Irrigating the eye Where there is an object floating in the white of the eye, e.g. an eyelash or sand, you will need to irrigate the eye. Lean the casualty towards the injured eye keeping the head back and use eye wash, or if unavailable run tap water, over the eye from the nose side. If this is unsuccessful, carefully lift off the object using a moist corner of a tissue. If a corrosive or poisonous substance has been splashed in the eye irrigate the eyelid inside and out for at least 10 minutes. You may need to gently pull the eyelids open to do this. Then close and cover the eye with an eye pad and arrange for transport to hospital. Object under the upper eyelid Grasp the eyelashes and pull the lid down over the lower lid so the lower eyelashes can sweep under and remove the object. If this fails, ask the casualty to blink under water. An object stuck to or embedded in the eye It is beyond the scope of first aid to remove objects stuck to or embedded in the eye. The first aid treatment is to keep the eye as still as possible to prevent the condition worsening. 1. Do not touch the eye or embedded object 2. Cover eye with an eye pad, without putting pressure on the eye (the pad is cupped to prevent this). Also cover the uninjured eye to help prevent movement of injured eye. 3. Bandage the eye carefully to ensure protection of the eye. Send casualty to hospital. 4. With objects that are too large to place an eye pad over, support the object in the position found and call for an ambulance. Make sure head is kept as still as possible. Injuries to the eyeball These can potentially result in the loss of the eye if there has been penetration of the eyeball and loss of fluids. They are usually caused by the impact of a blunt object, e.g. golf or squash ball, so history is an important indicator. Also look out for: 1. Bloodshot appearance to the eye 2. Loss of some or all vision 3. Leakage of clear fluid from the eye Treatment is the same as for an embedded object, although keeping the head still, the casualty should be lain down with the head slightly raised. Bright light injury Usually seen in welders where the bright light of a welding torch burns the surface of the eye, it may only becoming painful some hours after exposure when the nerves rejuvenate. The casualty may complain of a feeling of sand being thrown into the eyes and the eyes may be red, watery and sensitive to light. There is no first aid treatment beyond covering the eyes with eye pads (leaving contact lenses in place) and sending to hospital. You should now be able to: Describe how to examine the eye and deal with objects embedded in the eye Understand how to recognise and treat bright light injuries Third Edition|www.nsvl.org.uk/resources 54
1. What is hypoglycaemia? ____________________________________________________________ 2. What is hyperglycaemia and how does its onset differ from hypoglycaemia? ____________________________________________________________ 3. What are the recognition features of hypoglycaemia? 1. _____________________ 2. ___________________________ 3. _____________________ 4. ___________________________ 5. _____________________ 6. ___________________________ 4. How would you treat someone suffering from hypoglycaemia? ____________________________________________________________ ____________________________________________________________
Section 12:
UNDERSTANDING
1. Describe how you would examine the eye: ____________________________________________________________ ____________________________________________________________ 2. Describe how you would irrigate the eye: ____________________________________________________________ ____________________________________________________________ 3. Describe how you would treat an embedded object in the eye: ____________________________________________________________ ____________________________________________________________
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North Sea Volunteer Lifeguards Section 13: POISONS
Aim: To be able to recognise and treat a casualty who has been poisoned. What is a poison? Anything can be poisonous if taken in sufficient quantities even water. A poison is anything administered into the body in sufficient quantities that it causes damage, whether temporary or permanent. In the working environment of the pool, aside from cleaning substances there will be various chemicals used in the pool which if leaked could poison people. Their specific effects will be noted on the COSHH hazard sheets and you should be aware of the procedures in place if there is a leak. Beach Lifeguards are less likely to come into contact with dangerous chemicals, but occasionally chemical drums may be washed up, in which case any information on the drum should be noted. As with other causes of unconsciousness your priority is airway and breathing. When dealing with poisoning you should take care not to increase the absorption rate (e.g. by giving fluids), and also make sure you dont become contaminated yourself. Poison can enter the body in four different ways: 1. 2. 3. 4. Swallowed through the mouth Inhaled into the lungs Injected through the skin Absorbed through the skin e.g. e.g. e.g. e.g. drugs or corrosive substances gas, smoke and fumes (dealt with previously) insect/weaver fish stings, drugs Strong chemicals
There is also a further type of poisoning food poisoning. This can range from mild stomach upset to a severe condition that needs hospital attention. Drug poisoning Drugs can be swallowed, injected or inhaled. Where you suspect drug poisoning you should look out for any pill bottles, hypodermic syringes, needle marks or other evidence to give you an idea of what the casualty has taken. Different drugs will have different effects, but there is little first aid treatment beyond calling for an ambulance and keeping the casualty comfortable. Treatment - Check A.B.C. Use a pocket mask for resuscitation if corrosive poisoning is suspected. - Place the casualty in the recovery position, even when conscious. - Phone for an ambulance giving as much information about signs/symptoms as possible - Find out what the casualty has taken, and if combined with anything else, e.g. alcohol. - Keep pill bottles or any other evidence of substance (including vomit) to give to paramedics. If the casualty has swallowed anything corrosive you should not try to induce vomiting as the poison could burn on the way up as well. Instead, give sips of cold water or milk to reduce swelling of the airway. Absorbed Poison Where poisons have been absorbed into the skin you could also be in danger, so make sure the area is safe before approaching. Look for any evidence of a substance or chemical that could have been absorbed e.g. some weed killers or pesticides. Treatment Carefully wash away any chemical left on skin, rinsing for at least 10 minutes. Advise the casualty to see their doctor, or if serious send the casualty to hospital If there are any convulsions or severe reactions maintain ABC, call an ambulance.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Jellyfish sting Jellyfish, Portuguese man-of-war, corals and sea anemones found around the UK coastline will not usually be dangerous, but can give a painful sting when brushed against as their stinging cells will stick to the skin. There may be redness and acute pain around the area. Treatment - Pour vinegar over affected area to incapacitate cells that have not fired (if unavailable use sea water or dust the area with talcum powder) - If pain is still severe hold a cold compress against the skin for 10 minutes to relieve pain and swelling - Observe the casualty to ensure there is no allergic reaction to the sting, if swelling becomes more severe or the casualty starts to have difficulty breathing then they may be in anaphylactic shock and will need an ambulance. Insect Sting There will usually be localised slight pain and a red rash, however an insect sting will not usually be dangerous unless the casualty suffers an allergic reaction from the sting. With insect stings a poison sac may still be in the skin. Treatment - Remove the sting if present by brushing it off with your fingernail, but be careful not to squeeze the poison sac into the casualty. - Apply a cold compress to relieve pain and swelling, raise the affected part - Tell the casualty to see his/her own doctor if swelling and pain persist or increase over the next few days If the sting is around the casualtys mouth or airway call for an ambulance immediately. If possible get the casualty to suck an ice cube, or sip iced water. If there are breathing difficulties, put the casualty into the recovery position. If they go unconscious check A.B.C and treat accordingly. Weaver fish sting Weaver fish are usually found in the sand at low tide (especially on spring tides) and if trodden on their spines can puncture the skin. There will be swelling and redness around the area and there may be a spine left embedded in the foot. Treatment - Put the injured part in water as hot as the casualty can stand for at least 30 minutes, topping up water as it cools. Be careful not to scald the casualty. - If there are spines left embedded in the foot then the casualty will need to go to hospital to have them removed. Food Poisoning History of what and when the casualty ate e.g. uncooked meat, rewarmed food Recurrent diarrhoea, vomiting, abdominal pains Possible raised temperature and headache Poor hygienic conditions
Treatment - Assist the casualty to rest in the most comfortable position - Give the casualty sips of water to replace lost fluids - Arrange for the casualty to see a doctor - If condition is severe, especially in children, send them to hospital urgently You should now be able to: State the methods by which poisons may enter the body Give examples of the potential poisons you may encounter at the beach/pool Be able to recognise and treat a casualty who has been poisoned Be able to recognise and treat jellyfish stings and weaver fish stings Third Edition|www.nsvl.org.uk/resources 57
1. State and give examples of the ways in which poisons may enter the body: 1. _______________________ e.g. _______________________________ 2. _______________________ e.g. _______________________________ 3. _______________________ e.g. _______________________________ 4. _______________________ e.g. _______________________________ 2. Aside from signs and symptoms, what might make you suspect that a casualty had been poisoned? 1. _____________________ 2. ___________________________ 3. _____________________ 4. ___________________________ 3. What is the general treatment for swallowed corrosive poisons? _______________________________________________________ 4. What should you not do when treating someone who has swallowed a corrosive poison and why? _______________________________________________________ 5. Find out the potential poisons you may encounter at the beach or pool and note down any special treatment requirements: _______________________________________________________ _______________________________________________________ 6. How would you treat a jellyfish sting? _______________________________________________________ 7. How would you treat a weaverfish sting? _______________________________________________________
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North Sea Volunteer Lifeguards First Aid For Lifeguards Section 14: INJURIES TO THE MUSCLES AND SKELETON Aim: To be able to recognise injuries to the skeleton and muscles and give the appropriate treatment. Muscles and joints There are two types of muscles in our body, voluntary and involuntary. An involuntary muscle will work without a conscious demand from the brain to work our internal organs. Voluntary muscles work in groups/pairs, contracting and relaxing to perform a task, e.g. bending the arm. Where one bone meets another there will be a joint. These joints can be movable, such as the ball and socket joint in the arms and legs and hinge joints in the knees and elbows. Some joints are immovable, such as those in the top of the skull. Bones in the spine are slightly movable. Strains Injuries to muscles and tendons are known as strains, when over-stretching partially, or in severe cases completely, tears a muscle or tendon. There will be a history of overstretching the muscle, especially if it has not been warmed up properly, and it will be characterised by a sudden sharp pain and swelling in the area, and possible cramp. Sprains A sprain is an injury to the ligaments that bind the ends of bones together at a joint. There will be a history of twisting a joint (e.g. the ankle), along with pain, swelling and possible discoloration at the joint. The joint is unlikely to be able to bear any weight. Treatment First aid treatment of all sports injuries is similar, and based upon the RICE principle, which stands for Rest, Ice, Compress and Elevate. Rest - Rest the injury in the most comfortable position for the casualty. Ice - Apply a cold compress with, for example a bag of frozen peas wrapped in a tea cloth, to the injury for periods of 5 minutes at a time. Cooling an injured area gives relief to the pain and also helps reduce inflammation by reducing the blood flow to the affected area. Compress - Bandage the injured area and the areas around it securely, taking care not to restrict circulation. This will help limit swelling. Elevate Elevate the affected part to help drain off fluid and seek medical advice. Dislocation This is when a bone has come out of its joint and will be extremely painful for the casualty who will need hospital treatment to re-align the bone (commonly the shoulder, thumb, fingers, jaw). Recognition Inability to move the injured part in any direction (fixity of the joint) Severe pain, possible nausea Swelling and bruising in the area Treatment 1. Support the injury in the position found (e.g. with a sling if possible). Do not put any pressure on the joint. 2. Arrange for transport to hospital. 3. Treat for shock if necessary and without moving the injured part. DO NOT try to reset the bone!
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North Sea Volunteer Lifeguards First Aid For Lifeguards Fractures There are two types of fracture we need to know about in first aid, closed where the bone has not broken the skin, and open where the bone is protruding out and is open to infection. Both an open or closed fracture can be complicated this is where it causes another injury to an underlying organ, muscle, or blood vessel, e.g. a fractured rib puncturing the lung. Fractures can be caused in three ways: Direct force caused either by a fall or a blow to the bone Indirect force shock waves from a fall travel up through the body and cause a fracture away from the point of impact, e.g. landing heavily on feet can fracture the base of the skull and/or pelvis, landing on an outstretched arm can fracture the collar bone. Muscular contraction can occur when a person attempts to kick a ball but misses, leading to a fractured kneecap, or twisting the foot when stepping on a kerb. General Recognition As a first aider in some cases you may not be able to tell whether a bone is actually broken, but you should look out for: - Pain at the site and very tender to the touch, swelling to the surrounding tissues - Unable to move the injury or lack of sensation - Abnormal looking compared to uninjured side - Symptoms and signs of shock - Possible grating of bones General Treatment - Treat any breathing difficulties, bleeds or burns as your first priority - Steady and support the fracture in a comfortable position. Do not move the casualty unless in immediate danger. - Immobilise the limb to stop any movement, only raise it if you can do so without moving the fracture (e.g. raising the arm is possible if it is only a broken finger) - Treat for shock and arrange transport to hospital NB remember that in many cases you will be able to do nothing more than put the casualty in a comfortable position and reassure them until further help arrives. Major facial fracture With a major facial fracture there can be distortion to the eye sockets, general swelling or bruising (possibly looking like a black eye), and also bleeding from the nose/mouth which could cause breathing difficulties. As it is likely to have been caused by a blow to the head you also need to be aware of the risk of concussion or compression. Treatment is the same as for a fracture to the lower jaw. Fracture of the lower jaw When there is a blow to the lower jaw, especially from the side, it can become fractured or dislocated. This can make swallowing and coughing either impossible or very painful. Recognition - Severe pain, especially when speaking, swallowing etc - Swelling and tenderness around the face - Teeth may seem out of line, the casualty may be dribbling Treatment - Ensure that the casualty has a clear airway - If unconscious, place casualty into recovery position with a soft pad under the jaw. If conscious and responsive assist the casualty to sit forward to allow any fluid in the mouth to drain out. Apply a cold compress to limit swelling. - Support the jaw with your hand and a soft pad underneath. - Arrange transport to hospital. - If the casualty vomits, support the jaw and assist with clearing out the mouth.
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North Sea Volunteer Lifeguards First Aid For Lifeguards Fractured Collar Bone The collar bone is between the breastbone and the shoulder blade and supports the upper limbs as a coat hanger holds a coat. Recognition - Pain and tenderness at the injured site - Casualtys head slightly inclined to the injured side a crick in the neck - Casualty holding his own elbow to support the weight of the arm Treatment 1. Sit the casualty down and support the arm with an elevated sling 2. Secure a broad-fold bandage around casualty to stop arm moving, tie at uninjured side 3. Treat for shock if necessary and ensure the casualty is sent to hospital Fractured arm or wrist One of the most common fractures, especially in people with weaker bones such as children and the elderly. It is likely that the casualty will not want you to touch the arm as it is so painful. Recognition - Casualty holding onto the injured arm, keeping it close to the body - Pain at the point of impact and with any movement. Possible swelling. - Loss of power in the hand when gripping - Tender to the touch - Abnormal looking compared to the other arm - Bone protruding if it is an open fracture Treatment of closed arm fracture Sit the casualty down, offer reassurance and support the arm across the body, preferably with an arm sling if not too painful. Secure it with a broad-fold bandage tied off at the uninjured side Treatment of an open arm fracture 1. Control any bleeding by gentle pressure either side of the wound 2. Dress the wound in any way possible as the casualty will let you 3. Support in an arm sling if possible and send the casualty to hospital 4. If you have difficulty immobilising the arm keep it as still as possible, call for an ambulance Fractures to the arm and fingers Fractures to these areas are usually caused by crushing injuries, e.g. fingers trapped in door. Recognition - Severe pain and throbbing at the site of injury - Swelling and possible bruising - Loss of power in the hand when trying to grip - Tender to the touch - Abnormal looking compared to other hand Treatment 1. Sit casualty down, reassure and remove any rings if possible 2. Cover the hand with a dressing or bandage 3. Raise the hand and apply an elevated sling. Send the casualty to hospital. Fractured Pelvis Fractures to the pelvis are usually caused by crush injuries or indirect force. Internal bleeding can be severe in this area due to the large amount of body tissue in this area, therefore shock can develop quickly.
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North Sea Volunteer Lifeguards Recognition - Casualty will be unable to walk or stand - Pain and tenderness in the area - Casualty may have urinated - Sign and symptoms of shock
Treatment 1. Assist the casualty to lie on her back, lift and support the knees to relieve pain 2. Ensure an ambulance has been called 3. If not too painful and the arrival of an ambulance is not imminent, bandage the legs together with a broad-fold bandage around the knees and a narrow-fold bandage in a figure of eight around the feet 4. Cover the casualty and treat for shock Fractured Ribs The rib cage has two functions: to draw out the lungs to enable us to breathe and also to protect the heart and lungs. A rib fracture can therefore sometimes affect the function of the lungs and heart. Recognition - History of a direct blow to the chest, or ribs heard to crack during CPR - Sharp pain, especially when breathing in - Additionally for a complicated fracture: Coughing up blood Signs and symptoms of shock Open wound at site of fracture Simple Rib Fracture - Treatment There is no medical treatment for a broken rib, but the casualty will still need to go to hospital to confirm there were not complications. 1. Sit casualty down and reassure, confirm whether any blood has been coughed up 2. Place the arm on the injured side into an arm sling to prevent movement that could aggravate the injury 3. Send casualty to hospital Complicated Rib Fracture or Flail Chest Treatment A complicated rib fracture is where the broken rib has punctured the lung causing internal bleeding. Flail chest is where there are multiple rib fractures caused by severe crush to the chest. In both cases the lungs will not be able to work effectively. 1. 2. 3. 4. 5. Cover and treat any sucking wound to the chest Lay the casualty down in a half sitting position to help breathing Incline casualty towards the injured side Support the arm on the injured side with an elevated sling if possible Treat for shock and make sure an ambulance is on its way.
Leg fractures There are three main bones in the leg, not including the knee. The bone in the upper leg, the femur, is the longest bone in the body and if fractured can cause a large amount of blood loss. Usually it takes incredible force to break the bones in the leg, such as a road accident or falling from a height, although the thinner bone behind the shin can be fractured by twisting it. Recognition - Pain at the site of the injury - The casualty will usually be unable to walk - The foot may be turned outwards - Possible open wound with a bone protruding
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Treatment - Lay the casualty down and ensure an ambulance has been called - Control bleeding and dress if there is an open wound, this is done in the same way as for an embedded object - With assistance immobilise the leg by holding above and below the fracture - Keep casualty warm and treat for shock The Knee Knees can easily be damaged by a sudden twisting action and should be treated in the same way as sprain and strains. If the knee cannot bend and starts to swell then you will need to call an ambulance. Even in apparently minor knee injuries suggest the casualty seeks medical advice as this is the best way to ensure a quick recovery. The Foot Injuries to the foot are usually caused by something heavy falling on the foot or a crush injury, e.g. being run over by a car wheel. Recognition - Difficulty in walking, or at least stiffness in the foot - Swelling and bruising Treatment 1. Lie the casualty down 2. If not too painful remove the shoe and treat any bleeding 3. Raise the leg and place the foot on a soft pad 4. Gently apply a cold compress 5. Send the casualty to hospital, keeping the foot elevated if possible Application of an arm support sling An arm sling supports and immobilises an injured arm or wrist, or provides support and reduces the weight on an injured shoulder. 1. Sit casualty and stand at injured side of body, get casualty to support injured arm 2. Slide one end of triangular bandage between chest and forearm 3. Take upper end over shoulder on uninjured side and round onto the other shoulder 4. Carry lower end of bandage up over the forearm leaving fingertips exposed 5. Tie off with a reef knot at the hollow above the collar bone on the injured side 6. Bring point forward, tuck it in or secure it with a safety pin so it supports elbow 7. Check circulation by monitoring colour and temperature of thumb and fingers
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North Sea Volunteer Lifeguards First Aid For Lifeguards Application of an elevated sling An elevated sling supports the arm in an elevated position which helps control swelling and bleeding to injuries in the hand or lower arm and also reduces the weight on the shoulder. 1. Sit casualty down and stand next to their injured side 2. Place or ask them to move their forearm on the injured side across their chest with the fingertips on their opposite shoulder 3. Support the elbow of the injured arm, or ask them to 4. Lay the triangular bandage over their arm and hand with the point pointing towards you, extending well out from their elbow, the upper end over the casualtys shoulder. 5. Ask the casualty to lean slightly forwards and gently ease the base of the bandage under their forearm and behind the elbow 6. Draw the lower end of the bandage across their back and up to meet the end lying across the shoulder and tie the two ends together using a reef knot 7. Fold the point of the bandage forwards and either twist and tuck in behind the bandage, or secure with a safety pin 8. Check circulation by monitoring colour and temperature of thumb and fingers
NB it can be confusing remembering how to apply the two types of sling if you havent practised regularly. If you can remember the starting position of the triangular bandage for each one then this will make it easier. For both slings the starting position is with the point of the bandage just beyond the elbow of the injured arm, however for an arm sling the bandage is placed under the forearm, whereas for an elevated sling the bandage is placed over the forearm. In many situations the casualty will be in too much pain to let you put them in a sling. In these situations try to get them to support their arm in the most comfortable position, or improvise a sling using their own clothing. You should now be able to: Recognise and treat injuries to the muscles - strains Identify the types of joints and their functions Recognise and treat injuries to the joints - sprains and dislocations Understand the different types of fracture (closed, open, complicated) Recognise and treat fractures of the jaw, collarbone, hand and fingers, arm and wrist, ribs, pelvis, and lower limbs. Understand the purpose of slings and apply an arm sling and an elevated sling
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North Sea Volunteer Lifeguards Section 15: SPINAL INJURIES
Aim: To be able to recognise and deal with casualtys suffering from a spinal injury. Spinal injuries are perhaps the most feared incident for any lifeguard to deal with in 50% of spinal injury cases the damage caused by the initial impact will not be complete and irreparable, so your handling will directly influence the casualtys recovery. It will be a team effort and good communication is vital. But its not only a worry for you - the casualty will be worried that he/she might never walk again. The 33 vertebrae in the spine protect the spinal cord, which send signals from the brain to the rest of the body. If this spinal cord becomes damaged, the signals from the brain will not be able to travel any further down from the site of the injury, therefore the higher the site of the injury the more severe it will be. Monoplegia Hemiplegia Paraplegia Quadraplegia Paralysis Paralysis Paralysis Paralysis of of of of a single limb one side of the body the lower limbs (may involve paralysis of bladder and/or rectum) all four limbs
Spinal cord injury in the neck is particularly dangerous, sometimes fatal, because the messages which tell the heart to work come from the neck area. Recognition Spinal injuries can be caused in two ways, though the principles of treatment are the same: Vertebral fracture if theres a fracture of a vertebra, the fragments may be able to move and crush the spinal cord.
Vertebral dislocation The vertebrae are held together by ligaments. If these ligaments are torn then the vertebrae can move and can crush the spinal cord. If the head is forced forward, then the ligaments at the back will tear - this is known as a Flexion injury. If the head is forced backwards the ligaments at the front will tear this is known as an Extension injury. You would suspect a spinal injury if the casualty has fallen from a height, in road accidents, or if there is a history of any serious blow to the head (e.g. diving in shallow water). Dont assume a casualty with a spinal injury they will be lying on the ground unable to move. Some casualties with spinal injuries may walk up to you, so it is important to find out the history. The casualty may: - Complain of pain at the site of impact - Be unable to move one or more limbs - Complain of numbness or tingling in the limbs Treatment - Conscious Casualty Wherever possible approach any spinally injured casualty from directly in front and tell them not to move their head - if you approach from the side the casualty may try and turn his head to look at you. Unless you are in immediate danger do not move the casualty. Keep the casualty as still as possible in the position found. - Approach casualty from the front and tell him to keep his head as still as possible - Steady and support the head and neck. Place your hands over his ears, gently but firmly keep the head in the neutral position (head forward, chin in line with naval) - Depending upon the position of the casualty, another lifeguard should apply a cervical neck collar if available (at least 2 people are needed to apply a spinal collar) - Sand, coats, bags etc could be placed around the casualty to support the body - Keep reassuring the casualty lack of feeling or sensation does not necessarily mean permanent damage. - If the person goes unconscious or is likely to vomit, and there are enough people to help, log roll the casualty into the spinal recovery position. Third Edition|www.nsvl.org.uk/resources 65
North Sea Volunteer Lifeguards First Aid For Lifeguards Treatment - Unconscious Casualty Although a spinal injury could cause paralysis, if the casualty cannot breathe then he could die. Airway is still the first priority, but protection of the spinal cord comes a close second. - Send for an ambulance, stating possible spinal injury, unconscious casualty - Open the persons airway using the jaw thrust technique. From above the head, place your hands each side of the casualtys head with the fingertips at the angle of the jaw. Gently lift the jaw upwards to open the airway. If you cant get an airway this way slowly tilt the head back just enough to open the airway. - Check breathing for up to 10 seconds. If not breathing, normal resuscitation procedures should be followed. Rescue breaths should be given from above the head using a pocket mask, keeping the head as still as possible while maintaining an airway. - If the casualty is breathing, and there are at least 4 people, log roll the casualty into the spinal recovery position. - A second lifeguard should apply a cervical neck collar as soon as possible. NB - Even when the breathing is clear and unobstructed, spinal injuries are associated with lack of muscle control, which can lead to chronic vomiting if the casualty is lying on his back this could cause him to choke. Therefore, with any unconscious spinal injury you should immediately turn them into the spinal recovery position when enough people become available. Rescue of spinally injured casualty from the water Rescue techniques for spinal injuries are rigorously trained in the pool lifeguard course and should be followed to the letter. In beach situations dealing with spinal injuries is more difficult as there are more variable factors, however you still need to rescue the casualty according to first aid priorities: A casualty with a spinal injury will usually be face down in the water with the arms outwards. Your priority when you reach the casualty is to establish an airway. The depth of the water will dictate how you do this, but if the casualty is not breathing he should be brought ashore as quickly as possible, giving rescue breathing on the return. Although as much care as possible should be taken, a quick return is imperative to commence full resuscitation. If you are in shallow water and other lifeguards are readily available then a spinal lift can be attempted to get the casualty to shore with as much care for the back as possible. Where the casualty is conscious more time can be taken for a rescue (whether bringing him ashore or trawling out to beyond the breaking waves for recovery by lifeboat) but remember that a casualty with spinal injuries has a high susceptibility to hypothermia and action is urgent. Spinal Recovery Position When you are alone with an unconscious spinally injured casualty then the normal recovery position should be used if you have to leave the casualty. However, when working in lifeguarding situations help should be close at hand. If there are two people then one should take control of the head, while the second person turns. If a third person is available he should help to keep the back in alignment with the head. Where there are 4 or more lifeguards, the log roll technique should be used. 1. 2. 3. 4. 5. 6. Person in charge holds the casualtys head in the neutral position Instruct one lifeguard to straighten casualtys legs carefully without jerking Next instruct them to bring the casualtys nearest arm out at right angles The rest of the lifeguards should position themselves along the body and on your command roll the casualty slowly away from them, keeping their knees up against the body. Again, you should control the head in the neutral position Once in this position, hold it and do not allow the head to drop. If not already applied, one of the lifeguards who is not at the head should apply a neck collar. Build up sand, or position coats or bags around the casualtys body
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North Sea Volunteer Lifeguards First Aid For Lifeguards Application of a cervical neck collar Many centres and beach lifeguard units now carry cervical collars to help with the immobilisation of suspected spinal injuries. As with all other aspects of dealing with a spinal injury, applying a collar needs to be done extremely carefully, and always takes more than one person. It is good practice to apply a neck collar in any situation where a casualty has had a serious blow to the head, even if there appears to be no spinal injury. Collars will either come in different sizes for different sizes of neck, or will be adjustable to different neck sizes. Described here are instructions for use of the Stifneck collars. You need to be familiar with the type your centre or lifeguard unit uses, but the general rules for application are the same. Proper sizing is critical for good patient care. Too short a collar may not provide enough support, while too tall a collar may hyperextend a patient. You need to find the tallest collar size that does not hyperextend the neck. The key dimension on a patient is the distance between an imaginary line drawn across the top of the shoulders, where the collar will sit, and the bottom plane of the patients chin, which can be measured in fingers. This relates to the key dimension of the collar the distance between the black fastener (on a traditional Stifneck) or the correct sizing tab (on a Stifneck Select) and the lower edge of the rigid plastic band (not the foam padding). 1. While another lifeguard holds the head in the neutral position, use your fingers to visually measure the distance from the shoulder to the chin (key dimension). 2. Then use your fingers to select the size of Stifneck collar that most closely matches the key dimension of the patient. On a Stifneck Select adjust collar to the correct size. 3. With a sitting casualty slide the collar up the chest wall so that the point at the bottom is in line with the sternum. Carefully bring the back of the collar round and fasten the Velcro strip tight enough so the casualtys chin covers the central fastener in the chin piece if it doesnt, carefully tighten the collar. 4. If the casualty is on the floor then it may not be possible to apply a collar without lifting the head, in which case the head should be held in the neutral position until medical assistance arrives. If it is possible, slide the Velcro strap of the collar under the neck before bringing the collar into place. 5. Wherever possible the casualtys head should still be held in the neutral position once the collar is applied until the casualty is fully immobilized, usually by paramedics. NB if a collar is fitted properly then paramedics will not usually remove it. Most ambulance services now use the Stifneck Select collars, so if your centre or lifeguard unit uses this type then paramedics will usually offer a straight swap as replacement. If not, then your collar will need to be retrieved from the hospital.
You should now be able to: Be aware of the possible causes of a spinal injury Understand the principles of dealing with a casualty suffering from a spinal injury Understand the principles involved with turning an unconscious spinal casualty (i) alone (ii) with additional helpers (log roll technique) Apply a cervical neck collar
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1. What is a strain? _______________________________________________________ 2. What is a sprain? _______________________________________________________ 3. What is a dislocation? _______________________________________________________ 4. What are the treatment principles for all of the above?
R I C E
__________ __________ __________ __________

1. _______________________ description: ______________________________ 2. _______________________ description:______________________________ 3. _______________________ description:______________________________
5. List and describe the 3 types of fracture we need to know about in first aid?
6. What are the general treatment priorities for fractures? 1. _____________________ 2. ___________________________ 3. _____________________ 4. ___________________________ 7. What is the purpose of an arm support sling? _______________________________________________________ 8. What is the purpose of an elevated sling? _______________________________________________________ Section 15: UNDERSTANDING
1. In what type of circumstances might you expect to find spinal injuries? ____________________________________________________________ 2. What is the main priority when dealing with conscious spinal casualties? ____________________________________________________________ 3. What is the main priority when dealing with unconscious spinal casualties? ____________________________________________________________
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North Sea Volunteer Lifeguards APPENDIX
Contents First Aid Multiple Choice Questions DRS ABSTRACT Basic Life Support Checklist First Aid Checklist Extended Life Support (Airway Management) Checklist Extended Life Support (Use of AEDs) Checklist First Aid Signs and Symptoms Chart All available to download from www.nsvl.org.uk/resources
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North Sea Volunteer Lifeguards SECTIONS 1-3: 1. MULTIPLE CHOICE QUESTIONS
Which of these statements is not true for a first aider? a. A first aider acts only within the scope of his knowledge b. A first aider may need to use his initiative when dealing with a situation c. A first aider will not always be able to prevent loss of life d. A first aider will always be able to reach an accurate medical diagnosis
a. Place into the recovery position b. Control and severe bleeding c. Establish levels of consciousness
2. What is the chief priority in the treatment of an unconscious person?
d. To establish a clear airway

3. Individually sealed, sterile, unmedicated dressings should be used:a. On all occasions, unless unavailable b. In preference to any other combination c. Only when really necessary a. Not at all
4. What is the legislation governing the contents of first aid boxes in the workplace? a. The Social Security Act, 1975 b. The Control of Substances Hazardous to Health Regulations, 1994 c. The Reporting of Injuries, Diseases & Dangerous Occurrences Regulations, 1985 d. The Health and Safety (First Aid) regulations, 1981 5. As a general rule, which of the following items should not be kept in a first aid box? a. A sling b. Tablets c. Dressings d. Disposable gloves 6. What is your action plan for managing an incident? a. Assess the situation, make safe, emergency aid, get help, aftermath b. Make safe, assess the situation, emergency aid, get help, aftermath c. Get help, make safe, assess the situation, emergency aid, aftermath d. Make safe, emergency aid, assess the situation, get help, aftermath 7. When getting someone else to phone for an ambulance, what should you tell them? a. Approximate ages, gender and condition of casualty(ies) b. Ensure they know where you are to give an address for the ambulance c. Tell them to come back and tell you how long the ambulance will be d. All of the above 8. Which of these is not a suitable hygiene precaution? a. Putting gloves on before treating a casualty b. Lift the casualty off the ground to avoid germs c. Trying not to cough, breathe or sneeze over wounds d. Using a pocket mask wherever possible for resuscitation
9. In cases of Cardiac Arrest the skin becomes: a. Ashen b. Flushed c. Pale d. Very pink
10. The average adult at rest breathes at a rate of:

a. b. c. d. 60-80 45-60 20-35 12-20 times times times times per per per per minute minute minute minute
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11. The safest and most effective method of giving rescue breaths is? a. Mouth to mouth b. Mouth to nose c. Mouth to mouth and nose d. Mouth to mask 12. During a. b. c. d.
resuscitation in an adult, when should external cardiac compression be started? If the heart beat is failing rapidly When rescue breaths have failed to restore normal breathing Immediately before commencing rescue breaths When you have determined that there are no signs of circulation
13. The pulse rate of an average adult at rest is: a. 20-30 beats per minute b. 30-40 beats per minute c. 60-80 beats per minute d. 80-100 beats per minute 14. When blood circulation stops, permanent damage to the brain commences after: a. 1 minute b. 3 minutes
c. 5 minutes d. 6 minutes 15. What is the correct sequence of checks to be made in the initial assessment of an unconscious casualty? a. Airway, breathing, circulation, get help b. Danger, response, airway, breathing, shout help, circulation c. Danger, response, shout help, breathing, circulation d. Danger, response, shout help, airway, breathing 16. At what point should you go for help when you are alone with a casualty who is unconscious and not breathing, with no suspected injuries? a. After checking breathing b. After giving two rescue breaths c. After checking for signs of a circulation d. After administering CPR for one minute 17. How long should you check for breathing before deciding it is absent? a. 5 seconds b. 10 seconds c. 15 seconds d. 20 seconds 18. What a. b. c. d. 19. is the main advantage of placing a casualty in the recovery position? Heart beats more easily More comfortable It maintains the airway Casualty stays warmer
When giving rescue breaths to an adult, roughly how long should each breath last to ensure full inflation? a. 4 seconds b. 3 seconds c. 2 seconds d. 1 second a. b. c. d. It It It It Why do we need to lift the chin of an unconscious casualty? aids the swallowing of saliva prevents spasm of the throat prevents swallowing of vomit lifts the tongue 71
20.
North Sea Volunteer Lifeguards Sections 4-6: MULTIPLE CHOICE QUESTIONS

He is conscious. a. b. c. d. What is the first thing you should you do? Give up to five back slaps Give up to five abdominal thrusts Nothing at all Instruct the casualty to bend over and cough
1. While at a restaurant you are confronted by a middle-aged man who is choking on a piece of food.
2. Which of the following is a symptom? a. Swelling b. Tenderness c. Deformity d. Bruising
3. What condition would you suspect if a casualty complained of pain spreading down the left shoulder and arm?
a. b. c. d. Angina pectoris Coronary obstruction Congestive heart disease Stroke
4. After encouraging a choking casualty to cough has had no effect you will have to give back slaps, with which back slap are you aiming to relieve the obstruction?
a. b. c. d. First Second Third Fifth
5. Which of the following would be a symptom which could be determined by the examination of a conscious casualty?
a. b. c. d. Pallor Cyanosis of the lips Numbness of the limbs Flushed face
6. The signs and symptoms of a stroke may sometimes be confused with: a. Drunkenness b. Asthma c. Heart attack d. Minor epilepsy (an absence seizure) 7. Which of the following is not true for fainting? a. An ambulance should be called immediately b. The casualty should recover quickly c. It is caused by a temporary reduction of the blood flow to the brain d. During a faint the pulse rate will become very slow 8. If faced with multiple casualties, which casualty would take priority? a. A casualty with severe bleeding b. A casualty with severe burns c. A casualty with a broken leg d. A casualty who was choking 9. A casualty with a. b. c. d. anaphylactic shock may display breathing which is? Shallow and gasping Yawning and sighing Normal Wheezing and gasping
10. A sudden, crushing, vice-like pain in the chest would indicate: a. Heart attack b. Angina pectoris c. Congestive heart disease d. Indigestion
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11. The main aim of raising the legs above the level of the head when treating shock is: a. To help improve breathing b. To prevent nausea c. To prevent muscular contraction d. To ensure blood supply to the brain, heart and lungs 12. Which of the following will not occur during shock? a. The heart rate will increase b. The blood supply to the brain and vital organs is decreased c. The breathing rate will decrease d. Skin will become cold and pale 13. If a conscious casualty is suffering from shock and their condition allows, they should be: e. Placed in the recovery position f. Gently supported and walked around to aid circulation g. Seated with their head between their knees h. Laid flat on their back, head low and to one side, with legs raised 14. When doing your top to toe you discover that the casualty is carrying an anti-coagulant card. This indicates that the casualty: a. Is prone to fits b. Suffers from Angina Pectoris c. Is of Blood Type O d. Is likely to bleed more freely than usual from wounds 15. A 40-year-old man complains of severe pain in his chest, radiating into the left upper arm. He is short of breath and his pulse is weak and irregular. The first aider should: a. Place in the recovery position b. Commence rescue breathing c. Put him in a half sitting position with support under the knees d. Commence CPR 16. At what point should abdominal thrusts first be given to a choking adult casualty? a. Immediately they start choking b. After back slaps have failed c. After checking the airway and breathing d. After the casualtys attempts at coughing have proved unsuccessful 17. Which of the following is not a treatment for asthma? a. Give sips of water b. Place the casualty in a position which he or she finds most comfortable c. Allow the person to take his or her own medication d. Ask casualty to breathe slowly and deeply 18. A casualty shows anxiety, puffiness around the eyes, swelling of the face and neck and impaired breathing. From what condition are they suffering? a. Choking b. Asthma c. Angina Pectoris d. Anaphylactic shock 19. When performing abdominal thrusts, where should the hands be placed?
a. b. c. d.
Just above the navel On the bottom of the breastbone In the same position as for chest compressions Just below the navel
20. What is the main reason for a top to toe survey? a. To monitor levels of consciousness b. To check breathing and circulation c. To determine the cause of any injuries d. To find the extent of injuries
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North Sea Volunteer Lifeguards Sections 7-9: MULTIPLE CHOICE QUESTIONS
1. Which treatment would you apply first when treating major external bleeding? a. Indirect pressure b. Direct pressure c. Apply dressings and bandages d. Elevate the injured part 2. A scalp bandage a. b. c. d. is used to: Apply pressure to the wound control bleeding Hold dressings in place over a scalp wound Apply pressure around the head to reduce blood flow to wound All of the above
3. A hypothermic person will usually be: a. Acting normally b. Bright and rational c. Aggressive d. Dulled and irrational 4. If a nose bleed has not stopped after 10 minutes, the nose should be plugged. a. True b. False 5. A casualty who is suffering from shock complains of being cold, you should: a. Give him a hot water bottle b. Tell him to rub his hands together c. Put blankets over and under the casualty d. Give him a hot drink 6. It is not usually possible to control internal bleeding by first aid: a. True b. False 7. At what core body temperature will hypothermia begin to set in? a. 34C b. 36C c. 37C d. 35C 8. A conscious casualty who has swallowed a corrosive poison should be made to vomit: a. In all cases b. Only if the lips and mouth are not burned c. Under no circumstances d. Only if the poison has been taken within the last 2 minutes 9. If bleeding continues after you have applied a dressing, and another on top, what would you do next? a. Remove the dressings and redress the wound with new dressings b. Apply a tourniquet c. Remove the dressings and just apply indirect pressure d. Apply another dressing on top 10. The body reacts to prevent blood loss from a wound. Which of the following is not true a. Severed or damaged blood vessels constrict (narrow) b. Blood clots at the wound c. Serum is released by the clot to repair the damaged area d. Blood is redirected away from the wound 11. Pain from one injury may mask a more serious injury: a. True b. False 12. When dressing a wound which of these statements is incorrect? a. The pad should be large enough to cover wound and extend beyond its edges b. The pad should be placed above and slid onto the wound c. The bandage should be wrapped around the wound, covering the whole pad d. The ends of the bandage should be tied off directly over the pad
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13. Which of the following is a treatment for heat exhaustion? a. Frequent sips of salted water b. Cover with a thermal blanket c. Exercise the casualty to encourage sweating d. Shield the casualty from the wind
14. Which of the following statements about heatstroke is incorrect? a. Heatstroke is caused by a failure of the thermostat in the brain which regulates body temperature b. If a casualty is suffering from heatstroke always call for an ambulance c. Heatstroke will usually develop gradually d. Unconsciousness can occur within minutes of a casualty feeling unwell 15. In what position should a casualty who has a sucking wound to the chest be placed? a. Flat on their back b. On their back with head and shoulders raised, inclined towards the injured side c. On their side, with injured side uppermost d. Face down 16. If a dressing becomes blood stained immediately after application, it should be: a. Removed b. Untied and retightened c. Left in place and covered with another dressing d. Left alone completely 17. When treating a. b. c. d. open fractures you should control the bleeding by: Apply pressure over the bone Applying pressure above the wound Applying pressure around the wound Applying pressure below the wound
18. Chemically burnt areas should be flooded with cold water for at least: a. 10 minutes b. 15 minutes c. 20 minutes d. 30 minutes 19. Bright red frothy blood that is coughed up indicates internal bleeding in the: a. Stomach b. Liver c. Spleen d. Lungs 20. When treating a. b. c. d. a casualty with the following injuries/conditions, which would you treat first? Hypothermia Severe external bleeding Leg fracture Internal bleeding
21. You have a conscious casualty with a deep horizontal wound of the abdominal wall, though no organs are protruding. The casualty should be placed:a. On their back and supported with a pillow under their knees b. On their back with head low & turned to one side, lower limbs raised & supported c. On their back with head and shoulders raised and body inclined to the injured side d. In the recovery position 22. A person suffering from a nosebleed should be told to: a. Sit upright and apply pressure to the bridge of the nose b. Bend forward and exhale sharply c. Lean forward and pinch the soft part of their nose d. Sit with their nose plugged 23. When giving immediate treatment for a burst varicose vein, pressure should be applied: a. Above the wound b. On the wound c. At a pressure point d. Pressure should not be applied
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24. The main danger of burns to the mouth and throat is: a. Internal bleeding b. Shock c. Infection d. Asphyxia 25. The behaviour a. b. c. d. of a baby which is suffering from Hypothermia will be: Normal Noisy and hyperactive Unusually quiet, drowsy and limp Continued crying
26. Any intestine protruding from a wound to the abdomen should be: a. Cut off b. Replaced into the abdomen c. Covered with cling film, plastic bag or sterile dressing d. Left alone completely 27. After applying a dressing to a wound on the arm, you notice that the beds of the fingernails have a blue tinge. What does this indicate? a. The casualty is suffering from shock b. The wound is becoming infected c. The bandage is too loose d. The bandage is too tight 28. The chief aim in the treatment of burns and scalds is to: a. Reduce the effect of the heat by cooling b. Prevent infection c. Prevent loss of serum d. Relieve pain 29. A casualty suffering from heatstroke may become unconscious: a. Gradually b. Quickly c. After a long period d. Very rarely 30. An amputated a. b. c. limb should be: Placed in any available container Placed in a plastic bag filled with ice Wrapped in cling film or a plastic bag, covered with something soft, placed in a container of crushed ice or suitable alternative d. Washed before doing anything else from a wound in time with the heartbeat indicates: A torn artery A ruptured varicose vein A vein has been severed Bleeding from capillaries
31. Blood spurting a. b. c. d.
32. What is the correct treatment for a casualty suffering from hypothermia? a. Protect from the environment and give hot sweet drinks b. Lay them down with blankets and a hot water bottle c. Sit in a hot place and give a warm drink d. Protect from the environment, warm slowly and keep them still 33. A casualty a. b. c. d. with greater than ?% partial thickness burns must be seen by a doctor? >25% burns >50% burns >1% burns >9% burns
34. Which of the following items is likely to have caused an incised wound? a. A knife b. Barbed wire c. A hammer d. A nail
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North Sea Volunteer Lifeguards Sections 10-15 MULTIPLE CHOICE QUESTIONS
1. When examining the eyes they should be examined: a. Together b. Separately
2. When dealing with a conscious casualty who is believed to have been in contact with a poison, what should you do first?
a. b. c. d. Place them in the recovery position Ask them what has happened Try to induce vomiting Give them sips of cold milk or water
3. A child who is suffering from a febrile convulsion should have tepid water applied: a. Around the head and then down the body b. Around the head only c. Around the chest area d. Water should not be used in this situation 4. When dealing with a major epileptic fit which of the following statements is incorrect? a. You must move the casualty away from any dangers immediately b. Nothing should be placed in the casualtys mouth c. You should not forcibly restrain the casualty d. You should place something soft under the head 5. If you find a foreign object embedded in the coloured part of the eye, you should: a. Encourage the casualty to blink and move their eyes to sweep the object out b. Irrigate the eye c. Make no attempt to move it d. Apply an eye pad to the injured eye and leave the other eye open 6. When irrigating eye to remove a foreign object floating in the white of the eye, the head should be: a. Tilted forwards b. Tilted backwards c. Tilted with the injured eye downward d. Tilted with the uninjured eye downward 7. Which of the following groups of symptoms would make you suspect concussion? a. Pale face, dry skin, shallow breathing and normal pulse b. Flushed face, dry skin, shallow breathing and rapid pulse c. Noisy breathing, pale face, clammy skin and slow pulse d. Pale face, cold and clammy skin, shallow breathing and rapid pulse
8. A casualty who is suffering from a drug overdose is complaining of ringing in the ears, what would you suspect he had taken?
a. b. c. d. Aspirin Depressants Hallucinogens Paracetamol
9. A dressing should always be applied on a wound: a. From above the site of the wound and slide down b. From the left side of the wound c. Directly onto the wound d. From the right side of the wound 10. In cases of cerebral compression, the body temperature may rise and the casualtys face: a. Becomes flushed but remains dry b. Becomes flushed but is clammy c. Will have no noticeable change d. Becomes pale and cold 12. Which a. b. c. d. of the following is true of a fractured collar bone:It will often be caused by indirect force, such as a heavy fall onto the feet The head will incline towards the injured side The affected arm should be supported in an elevated position All of the above
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13. The signs of a diabetic emergency include: a. The face is flushed and the pulse is rapid b. The face is pale and the pulse is slow c. The face is pale and sweating, the pulse is rapid d. The face is pale and sweating and the pulse is slow
16. A casualty with heatstroke who is conscious should be placed in which position? a. On their backs with legs raised b. Flat on their back c. Half sitting position with head and shoulders raised d. Recovery position 17. Burnt clothing which is stuck to the skin should be: a. Removed immediately b. Left alone c. Gently removed later d. Cut off 18. When dealing with a known epileptic undergoing a major fit, when would you call an ambulance? a. After 5 minutes b. After 10 minutes c. After 20 minutes d. After 25 minutes 19. The most serious danger from electrocution from the domestic supply is: a. Possibility of internal injuries b. Depth of burns c. Possibility of cardiac arrest d. Possibility of fits 20. The first priority when dealing with an unconscious casualty with a suspected spinal injury is: a. To prevent any movement b. To maintain an open airway c. To get an ambulance d. To put the casualty in the recovery position 21. A casualty with straw-coloured fluid coming from the ears is probably suffering from: a. Concussions b. Ear infection c. Foreign object in the ear d. Skull fracture 22. Which a. b. c. d. of the following is part of the first aid treatment for a sprain? Cold compress Warmth Keep the injury low Massage gently
23. A complicated fracture is: a. Where the bone is protruding through the skin b. Where more than one bone is broken c. Where underlying organs could also be damaged d. Where the bone is broken in two places 24. If someone had swallowed a corrosive poison would you: a. Lay them flat with legs raised b. Give a drink of cold water or milk c. Place them in the recovery position d. Call for an ambulance and let them deal with situation 25. Which a. b. c. d. of the following casualties would you treat first? A man sitting with a bruised head A teenage boy lying quietly on his back with no obvious injuries A child with a broken arm, shouting for help A Lady lying on her side with a bleeding leg
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First Aid Question

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North Sea Volunteer Lifeguards

First Aid For Lifeguards

First Aid for Lifeguards

North Sea Volunteer Lifeguards

North Sea Volunteer Lifeguards

First Aid For Lifeguards 26 26 26 27 27 27 28 28 28 28 29 30 31 31 32 32 33 33 34 35 35 35 36 36 36 36 36 37 37 37 37 37 38 38 38 39 40 41 41 41 42

First Aid For Lifeguards 48 48 48 49 49 50 50 50 51 52 53 53 53 54 54 54 54 54 55

North Sea Volunteer Lifeguards

First Aid For Lifeguards

North Sea Volunteer Lifeguards Section 1: 1. UNDERSTANDING

First Aid For Lifeguards

What are the 3 Ps of First Aid?

P ____________ P ____________ P ____________

_________________________________ _________________________________ _________________________________ _________________________________

_________________________________ _________________________________ _________________________________ _________________________________ _________________________________

__________________ __________________ __________________

_______________ _______________ _______________

North Sea Volunteer Lifeguards Section 2: INCIDENT MANAGEMENT

First Aid For Lifeguards

North Sea Volunteer Lifeguards Section 2: UNDERSTANDING

First Aid For Lifeguards

1. What stages would you go through when dealing with an incident?

_____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________

2. Make a note of some incident problems and casualty problems:

3. What kind of tasks can a bystander be asked to do?

________________ ________________ ________________

__________________ __________________ __________________ __________________

5. Why is communication with the casualty important?

_____________________________ _____________________________ _____________________________

North Sea Volunteer Lifeguards Section 3: LIFE SUPPORT

First Aid For Lifeguards

North Sea Volunteer Lifeguards

First Aid For Lifeguards

North Sea Volunteer Lifeguards

First Aid For Lifeguards

North Sea Volunteer Lifeguards Section 3: UNDERSTANDING

First Aid For Lifeguards

North Sea Volunteer Lifeguards Section 4: MAKING A DIAGNOSIS

First Aid For Lifeguards

Tick box opposite appropriate no. in each column 4 3 2 1 6 5 4 3 2 1 5 4 3 2 1

Pulse where measurable

Respiration (breaths min) /

North Sea Volunteer Lifeguards Section 4: UNDERSTANDING

First Aid For Lifeguards

1. When examining a casualty you need to find the:

S ___________ S ___________ H ___________

3. You can assess the level of responsiveness on the AVPU scale:

A _______________ V _______________ P _______________ U _______________

North Sea Volunteer Lifeguards Section 5: UNDERSTANDING

First Aid For Lifeguards

Conditions affecting the chest wall

Impaired lung function

Damage to the brain or nerves controlling breathing

Impaired oxygen uptake by tissues

Suffocation by smoke or gas

Condition Suffocation/Strangling/ Hanging/Throttling Gas/smoke/fume inhalation Drowning

North Sea Volunteer Lifeguards Section 6: DISORDERS OF CIRCULATION

First Aid For Lifeguards

North Sea Volunteer Lifeguards Section 6: UNDERSTANDING

First Aid For Lifeguards

____________ ____________ ____________

3. The body tries to compensate for shock by doing three things: 1

4. Recognition features of shock include:

P P P

_________________ _ _ _________________

_________________ _ _ _ _________________

__

_______ _ _________

_______________ _ _ _ _ _______________

_______________ _ _______________

S _____ S _ H _______

A _______ V _ P _ U _______

Artery _________________ Vein _ Capillary _________________

__

___________________ _ _ ___________________

___________________ _ _____________________

___________________ _ _____________________