First aid

The first aid are the whole of the medical techniques of emergency aid given to wounded and sick by a person who is not necessarily doctor. The purpose of they are to ensure the survival of the person before the arrival of qualified people.

The life of a person can be threatened by a Accident, a Maladie or a dysfunction of the organization (Malaise); these situations in general require to be examined by a doctor (doctor of city, urgencies of the Hôpital, doctor of the Smur speaker in residence or on the public highway). First aid is the whole of the knowledge and know-how which make it possible to recognize a dangerous situation for a person, to transmit alarm to the medical structures, and to avoid the aggravation of the state of the person while waiting for the medical care.

In France, one distinguishes two types of actors (the denominations can vary in the other French-speaking countries):

  • the rescuer: simple Pilot of the accident or faintness, without specific material, its role is to remove the danger if possible, and especially to prevent or make prevent the public helps (in general by Téléphone or terminals of emergency call) and to carry out the instructions given while waiting for the possible helps; as far as its knowledge, it can practice gestures of first aid on the victim. It is what one indicates by first not : p rotéger, has lerter, S to ecourir .
  • the first-aid worker: it is about a person acting in an organized team, having material of help to victim and following a regular drive: Fireman, voluntary first-aid worker within a association.

In addition, one often distinguishes, in an intervention, the part rescue (subtraction with the danger) of the part first aid (gestures to avoid the degradation of the state of the victim).

First aid is a whole of techniques aiming at carrying help to people in danger. One finds there gestures carried out on the victim, aiming at minimizing the consequences of dangerous events, but also the reactions most effective to adopt in the event of Incendie, of electrification or Noyade.

The 3 more important rules as regards first aid are:

  • not to endanger oneself, and not to endanger thirds by its action (to protect oneself).

  • to remove the danger if possible, or failing this to mark out it to prevent suraccident it (i.e. the state of the victim does not worsen or that another person is not wounded).
  • to prevent the helps as quickly as possible; it is in general the only possible gesture for a witness not having formation with first aid.

Another important point is that one should not hesitate to mobilize the people present, if they do not react of themselves: a person alone can alert the helps and to carry first aid to one or more people, there are more effective to charge a person with taking care of protection and another to prevent the helps to be able to remain oneself to supervise the victims.

First aid and national context

The concept of alarm to the helps depends enormously on the infrastructures on the country in which one is. In the countries where the public helps are developed little, the only help which one can hope for to obtain is undoubtedly the intervention of the police force or that of a doctor, the fight against the calamities and the fires resting on solidarity within the population. It is thus necessary to be able to get the phone number of the police station or the doctor and to join it directly; in this context, it can be judicious to bring a patient or a victim to the consulting room of the doctor, the dispensary or the urgencies of the hospital.

In the countries where the public helps are very developed, the victim can obtain from the assistance quickly, it would be thus an error for a witness to want to transport it towards the structure of care without a medical opinion: transport by people not being professionals of the helps could worsen the state of the victim, to even cause its death. In such a context, alarm takes precedence over any other action except protection.

Chain helps

A person victim of a faintness, a disease or an accident must be, in a certain number of cases, dealt with by health professionals, possibly within hospital. The States set up an organization of the care and helps allowing this assumption of responsibility. However, it is necessary that somebody can prevent these services. It is the role, paramount there, of the witness.

Several speakers will take part in the assumption of responsibility of the victim, one thus speaks about the chain of the helps. the witness is the first chain link of the helps. It is thus necessary to this last to prevent the helps, with the risk which the victim is not dealt with.

In addition, in the most serious cases (for example abundant bleeding, stop of breathing, immediate danger), the helps, so fast that they are, will arrive too late: it is estimated that the first gestures must be made in the three minutes which follow the accident. It is there all the importance to know to make the gestures of first aid.

The witness, although being the least qualified, is thus the key of the system of assumption of responsibility of the victims. Without witness, not of help; without gesture of first aid, few chances of survival…

First aid

The three objectives of first aid are to save lives, to prevent the aggravation of the state of the victim and to support its re-establishment. They consist of a whole of simple gestures which can easily save lives. First aid “is divided” into techniques of Réanimation (artificial respiration, cardiorespiratory reanimation and care for smothering at a conscious or unconscious subject) and into techniques of first aid (stop of a serious Hémorragie, stabilization of the wounds to the member S inferiors or superiors (Fracture S, Entorse S, etc), wounds with the Cou, the head or the Spinal column, medical emergency (like the care for the people diabetics, epileptics, asthmatic, etc).

The first-aid worker will act according to a sequence of intervention predetermined in order to ensure a sedentary and effective intervention. This sequence comprises:

1- The evaluation of the situation and the dangers 2- The primary education examination 3- The secondary examination 4- Treatments 5- The continuous care 6- Transmission of information with the SMU

Warning : first aid is not gestures which one can learn in a delivers or on a Web page. It is before a a whole step which can be acquired only in one formation with a qualified monitor. The elements presented below are given as documentation and reflect knowledge at a given time; knowledge being able to evolve/move more quickly than the contents of this page, certain information presented here can be null and void.

Evaluation of the situation

The first stage of the evaluation of the situation consists in evaluating the dangers. If the situation involves risks for the first-aid workers (intervention in zone at the risks or restricted space, intervention in the presence of toxic products or of dangerous matters, intervention in the presence of violent people, etc) In the presence of dangerous circumstances, the first-aid worker will contact the competent authorities in order to make make safe the places of the incident. (A wounded first-aid worker will not be great help.) Lastly, one of the dangers with which the first-aid worker will be confronted at the time of his interventions is the infection. Indeed, when the first-aid worker manages first aid, there are tiny risks for him and the victim to contract a communicable disease by organic liquids (Sang, Salive, etc). In order to protect itself and to protect the victim, the first-aid worker will observe the universal precautions: he will wear gloves of latex, nitrile or vinyl; He will use a mask of pocket or a facial screen at the time of the administration of the artificial respiration and he will wash the hands with running water and the soap before and after each intervention. It should not be thought that the wearing of gloves replaces the washing of the hands.

During his evaluation of the dangers, the first-aid worker will be able to determine the number of victims and the mechanism of cause (the way whose person was wounded) in order to direct his intervention. Then, it will take a short report/ratio of the witnesses in order to know of which occurred. The victim often is best placed to know what arrived, but in certain situations (nobody unconscious, confused, etc) the witnesses can be of an invaluable help. Once the report/ratio obtained, the first-aid worker will require of the witnesses to remain close to him in order to carry assistance to him if the situation requires it. (The witnesses can activate the SMU, help to give first aid (their to give gloves), control the passers by or deal with the material).

Lastly, the first-aid worker will present himself to the victim. He will present and obtain the assent of the victim to help it. If the victim is unconscious, it has the tacit assent of the victim and can help it without its approval. If the victim refuses, it can try to convince it to seek of the medical assistance or to activate the SMU in order to obtain their evaluation of the situation. An example of introduction to a victim could resemble that: “Hello, can I am called Louiza, I am first-aid worker, I help you? ”

If the first-aid worker suspects a wound with the neck, the head, the column or the back, he will ask the victim not to move in order to decrease the risks of wound to the spinal column.

Primary evaluation

Then, the first-aid worker will determine if the victim is in prey with vital urgencies. With this intention, it will evaluate in the order:

1 - The state of consciousness

This stage consists in determining if the victim reacts or not to verbal or painful stimuli. The evaluation of the state of the victim is done in particular thanks to the Score of Glasgow.

2 - Activation of the SMU

If the victim is unconscious, i.e. it does not react to the verbal or painful stimuli, it will immediately activate the SMU in order to ensure the fast arrival of advanced medical care.

3- Respiratory tracts

The first-aid worker will check if the respiratory tracts are released. With this intention, it can ask a person conscious of speaking. If the victim is unconscious, it will open the respiratory tracts by rocking the head backwards in order to prevent the language from blocking the higher respiratory tracts.

4- Breathing

The first-aid worker will try to determine if the victim presents a respiratory problem. In the conscious victim, it will evaluate the quality of breathing (rate/rhythm, frequency and amplitude). If the respiratory frequency is too low (less than 8) or too high (more than 30), it will assist breathing.

At an unconscious victim, the first-aid worker will determine if breathing is spontaneous. With this intention, it looks at, listening and perceives breathing. In the absence of breathing, it will give two emergency breathings. (It blows just enough of air to see the rib cage raising itself.)

If the air does not pass, it will begin the care for smothering.

5- Blood circulation

This stage consists in locating the signs of circulation. It can look at the color of the skin (dew at a well oxygenated person), it can take the pulse (carotidien at the person unconscious and radial at the conscious person) or it can check the capillary return (to weigh on the nest of the nail: it becomes white. It should become again red in less than two seconds if circulation is adequate.) In the absence of signs of circulation, it will start the cardiorespiratory reanimation.

This stage ends in a fast examination of the body of the victim in order to locate the hemorrhages, the deformations, decorations of the skin or any other traumatism. In the presence of a traumatism, the first aid will stabilize it. (For example, to stop a serious hemorrhage, it will apply a direct pressure and will raise the area affected above the area of the heart.)

See also: Protection (first aid), assessment (first aid) #Bilan vital, vital Assessment, assessment (first aid) #Bilan organic, organic Assessment

The secondary examination

This stage consists in making to the anamnèse victim, a catch of the basic vital signs and an closer examination of the head to the feet. This stage is carried out only if the medical helps are moved away or delayed in their intervention.

1 - Anamnèse

S - Symptoms With - Allergies M - Diseases M - Drugs D - Last meals E - Event

or

S - Signs and symptoms With - Allergies M - Diseases P - Catch of drugs L - Buffet E - Event

2 - Vital signs

To take the pulse, breathing and to evaluate the level of conscience. To evaluate the skin for signs and symptoms of the state of shock.

3 - To examine the wounded areas or to make an examination of the head to the feet to detect unperceived last traumatisms.

Treatments

It is the stage where the first-aid worker lavishes first aid not connected to the vital urgencies.

To prevent the helps

As indicated higher, to prevent (or make prevent) the helps is the most important point, in order to ensure a true medical assumption of responsibility of the victims. The evaluation carried out initially takes all its importance here: the helps will be able to intervene much more effectively if good information is communicated to them.

See also: Alarm (first aid)

Once the prevented helps, it are necessary if possible to return towards the victim to supervise it while waiting for the helps. Some gestures can avoid the aggravation of the state of the victim and improve the chances of survival of the victims, in the following cases:

Gestures of first aid

See also: Gestures of first urgency

Conclusion

One sees the importance of the initial evaluation easily, some gestures being dangerous if they are applied ill-advisedly. Reanimation cardiorespiratory is traumatisante for somebody which is not in stopped state cardiorespiratory (but it is the only gesture which can save if it is it), to put somebody in side position of safety can worsen the traumatism unnecessarily if the person is conscious (but it is the only gesture which can save if it is unconscious). Prudence is thus of mise.
It should not be forgotten that to reassure the victim in any circumstance is also very important.
It should not be forgotten that first aid is only one emergency solution, while waiting for qualified helps.

In addition, the teaching of first aid is done by presenting “academic cases”. The real situation corresponds only seldom to these ideal cases, but it can break up into under-cases which can be treated individually and correspond them to the academic cases (“inductive” method of teaching known as).

Set fire to

In the event of fire, it is always necessary to start by preventing the helps. Then, it is necessary to alert the occupants of the building, in order to enable them to evacuate (for example, by starting the alarm signal). Then, so of the means of fire control are available (extinguisher, fire hose, etc), one can try to start to fight against the fire, without however endangering itself. If not, it is preferable to keep away.

Drowning

It is necessary to start by preventing the helps. Then, a good swimmer, preferably trained with the rescue, will be able to try to leave the victim water - attention however, the victim drowning panic, it can be clutched with the rescuer and involve it in his drowning. There exist taken release which make it possible to make release taken with the victim for then being able to seize it correctly (by behind, while passing a hand under its armpit)   these techniques are taught in France in diploma BNSSA (national patent of rescue and watery safety). They are also taught in Canada in the course of Crosses of bronze and are deepened in the course of National Rescuer (SN).

Once brought back to ground, it is advisable to act as for a normal victim: assessment, put in PLS if the person is unconscious and breathes, kiss of life or stop-with-nose if it does not breathe, associated with the cardiac massage if it is moreover in circulatory stop.

Even if the person is conscious, it is imperative that the victim is followed médicalement: so of water entered its lungs, that can cause several hours later a pulmonary edema which will prevent it from breathing (plasma, part of blood, passes in the lungs, the victim “drowns interior”).

Contrary to a spread idea, one should not especially not try to empty the lungs of the victim. Indeed, that is not used for nothing:

  • 10 with 20  % of the “true” drownings are made with “lungs dryness”, i.e. the victim stops breathing (apnea reflex caused by the closing of the épiglotte when the first water drop penetrates in the larynx, still called spasm laryngé or spasm glottic) and it is this respiratory stop which causes the drowning; in certain cases, the respiratory stop occurs before the drowning (for example heart attack, drowning known as white);
  • if there is water in the lungs, there is very little of it (the victim very quickly stops breathing, the épiglotte is closed and water does not have time to return);
  • the presence of water does not prevent artificial ventilation (kiss of life or stop-with-nose), indeed, this one is done with positive pressure, the air drives out the water of the air cells.
On the other hand, to try to empty water will have catastrophic consequences: the majority of swallowed water are in the stomach, therefore in fact, one will empty the contents of the stomach. This water, mixed with gastric secretions (acid) then will pass in the lungs via the throat, and will destroy air cells (syndrome of Mendelson). That will involve a pulmonary edema which terribly will compromise the survival of the victim. The draining of the stomach will be done by a medical team, once the air routes protected by intubation, in order to reduce the pressure which the stomach exerts on the lungs and to evacuate the cold; but is not to in no case spring of a rescuer or first-aid worker.

At the time of the practice of artificial ventilation, the risk is very great to have an increase of the contents of the stomach (see above), one will thus stick to insufflate delicately: two seconds a continuous expiry which stops when the belly or the bottom of the chest is raised. So by misfortune one noted a gastric backward flow, it is necessary to turn the victim on the side to empty the liquid, then to take again ventilation, preferably with the stop-with-nose to avoid putting his mouth on “vomit”.

Formation with first aid

See also: Basic training with first aid

See too

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