First Aid Manual: The Authorised Manual of St. John Ambulance, St. Andrew's Ambulance Association and the British Red Cross. 10th Edition (Dk First Aid)

TUBULAR GAUZE BANDAGES | TRIANGULAR BANDAGES

TRIANGULAR BANDAGES

This type of bandage may be supplied in a MAKING A BROAD-FOLD
sterile pack as part of a first aid kit. You can also BANDAGE
make one by cutting or folding a square metre
of sturdy fabric (such as linen or calico) 1 Open out a triangular bandage and lay it
diagonally in half. The bandage can be used in flat on a clean surface. Fold the bandage
the following three ways.
■■Folded as a broad-fold bandage or narrow- in half horizontally, so that the point of the triangle

fold bandage (below) to immobilise and touches the centre of the base.
support a limb or to secure a splint or
bulky dressing. 2 Fold the bandage in half again in the
■■Opened to form a sling, or to hold a hand, same direction, so that the first folded
foot or scalp dressing in place.
■■If from a sterile pack, folded into a pad and edge touches the base. The bandage should now
used as a sterile dressing.
form a broad strip of fabric.
Point
MAKING A NARROW-FOLD
BANDAGE

1 Fold a triangular bandage to make a broad-fold
bandage (above).

End

2 Fold the bandage horizontally in half again.
It should form a long, narrow, thick strip

OPEN TRIANGULAR BANDAGE Base of material.

STORING A TRIANGULAR BANDAGE

Keep triangular bandages in 1 Start by folding the triangle 2 Continue folding the ends
their packs so that they remain into a narrow-fold bandage into the centre until the
sterile until you need them.
Alternatively, fold them as (above right). Bring the two ends bandage is a convenient size for
shown (right) so that they are
ready-folded for use as a pad of the bandage into the centre. storing. Keep the bandage in a
or bandage, or can be shaken
open for use as a sling. dry place.

249

TECHNIQUES AND EQUIPMENT

REEF KNOTS

When securing a triangular bandage, always comfortable for the casualty. Avoid tying the

use a reef knot. It is secure and will not slip, it is knot around or directly over the injury, since

easy to untie and it lies flat, so it is more this may cause discomfort.

TYING AND UNTYING A REEF KNOT

1 Pass the left end of 2 Lift both ends 3 Pass the end in 4 Pull the ends to
the bandage (dark) of the bandage your right hand tighten the knot,

over and under the above the rest of (dark) over and under then tuck them under

right end (light). the material. the left end (light). the bandage.

Untying a reef knot
Pull one end and one piece of bandage
from the same side of the knot firmly so
that the piece of bandage straightens.
Hold the knot and pull the straightened
end through it.

HAND AND FOOT COVER BANDAGE

An open triangular 1 Lay the bandage 2 Cross the ends 3 Pull the point
bandage can be used flat. Place the over the hand, gently to tighten
to hold a dressing in
place on a hand or casualty’s hand on the then pass the ends the bandage. Fold the
foot, but it will not
provide enough bandage, fingers around the wrist in point up over the knot
pressure to control
bleeding. The method towards the point. Fold opposite directions. Tie and tuck it in.
for covering a hand
(right) can also be the point down over the ends in a reef knot
used for a foot, with
the bandage ends tied the hand. (above) at the wrist.
at the ankle.

250

REEF KNOTS | HAND AND FOOT COVER BANDAGE | ARM SLING

ARM SLING

An arm sling holds the forearm in a slightly immobilise the arm for a rib fracture (p.154).
raised or horizontal position. It provides support An elevation sling (p.252) is used to keep the
for an injured upper arm, wrist or forearm, on a forearm and hand raised in a higher position.
casualty whose elbow can be bent, or to

WHAT TO DO

1 Ensure that the injured arm 2 Fold the lower end of
is supported with the hand the bandage up over the

slightly higher than the elbow. forearm and bring it to meet

Fold the base of the bandage the upper end at the shoulder.

under to form a hem. Place the

bandage with the base parallel

to the casualty’s body and level

with his little finger nail. Slide

the upper end under the injured

arm and pull it around the neck

to the opposite shoulder.

3 Tie a reef knot (opposite) 4 Hold the point of the 5 As soon as you have
on the injured side, at the bandage beyond the elbow finished, check the

hollow above the casualty’s and twist it until the fabric fits circulation in the fingers (p.243).

collar bone. Tuck both free ends the elbow snugly, then tuck it in Recheck every ten minutes. If

of the bandage under the knot (inset). Alternatively, if you have necessary, loosen and reapply

to pad it. Adjust the sling so that a safety pin, fold the fabric and the bandages and sling.

the front edge supports the fasten it to the front.

hand – it should extend to the

top of the casualty’s little finger.

251

TECHNIQUES AND EQUIPMENT

ELEVATION SLING

This form of sling supports the forearm and wounds in the forearm or hand, to minimise
hand in a raised position, with the fingertips swelling. An elevation sling is also used to
touching the casualty’s shoulder. In this way, an support the arm in the case of an injured hand.
elevation sling helps to control bleeding from

WHAT TO DO

1 Ask the casualty to support 2 Place the bandage over his 3 Ask the casualty to let go
his injured arm across his body, with one end over the of his injured arm while

chest, with his fingers resting on shoulder on the uninjured side. you tuck the base of the

the opposite shoulder. Hold the point of the bandage bandage under his hand,

just beyond his elbow. forearm and elbow.

4 Bring the lower end of the 5 Tie the ends in a reef knot 6 Twist the point until the
bandage up diagonally (p.250) at the hollow above bandage fits closely around

across his back, to meet the the bone. Tuck the ends under the casualty’s elbow (inset). Tuck

other end at his shoulder. the knot to pad it. the point in just above his elbow

to secure it. If you have a safety

pin, fold the fabric over the

elbow and fasten the point at

the corner. Check the circulation

in the thumb every ten minutes

(p.243); loosen and reapply

if necessary.

252

ELEVATION SLING | IMPROVISED SLINGS

IMPROVISED SLINGS

If you need to support a casualty’s injured arm but do not have CAUTION
a triangular bandage available, you can make a sling by using a If you suspect that the forearm
square metre (just over one square yard) of any strong cloth is broken, use a cloth sling or
(p.249). You can also improvise by using an item of the casualty’s a jacket corner to provide
clothing (below). Check circulation after applying support (p.243) support. Do not use any other
and recheck every ten minutes. improvised sling: it will not
provide enough support.

Jacket corner Button-up jacket
Undo the casualty’s Undo one button of
jacket. Fold the lower a jacket or coat (or
edge on the injured side waistcoat). Place the
up over his arm. Secure hand of the injured arm
the corner of the hem to inside the garment at
the jacket breast with a the gap formed by the
large safety pin. Tuck and unfastened button.
pin the excess material Advise the casualty to rest
closely around the elbow. his wrist on the button
just beneath the gap.

Long-sleeved shirt Belt or thin garment
Place the injured arm Use a belt, a tie or a pair
across the casualty’s of braces or tights to
chest. Pin the cuff of the make a “collar-and-cuff”
sleeve to the breast of support. Fasten the item
the shirt. To improvise an to form a loop. Place it
elevation sling (opposite), over the casualty’s head,
pin the sleeve at the then twist it once to form
casualty’s opposite a smaller loop at the
shoulder, to keep her front. Place the casualty’s
arm raised. hand into the loop.

253

This chapter is designed as a user-
friendly quick-reference guide to
first aid treatment for casualties with
serious illnesses or injuries. It begins
with an action plan to help you assess a
casualty and identify first aid priorities,
using the primary survey (pp.44–45)
followed by the secondary survey
(pp.46–48) where appropriate.

The chapter goes on to show how to
treat unresponsive casualties, whose care
always takes priority over that of less
seriously injured casualties. In addition,
there is step-by-step essential first aid for
potentially life-threatening illnesses and
injuries that benefit from immediate first
aid. These include asthma, stroke, severe
bleeding, shock, heart attack, burns, broken
bones and spinal injuries. Each condition is
described in more detail in the main part of
the book and cross-referenced here so that
the entry can easily be found if you need
further advice and background information.

AIMS AND OBJECTIVES

■■ To protect yourself from danger and make the
area safe

■■ To assess the situation quickly and calmly and
summon appropriate help

■■ To assist casualties and provide necessary treatment
with the help of bystanders

■■ To call 999/112 for emergency help if you suspect
a serious illness or injury

■■ To be aware of your own needs

EMERGENCY
FIRST AID

EMERGENCY FIRST AID

ACTION IN AN EMERGENCY

Use the primary survey (pp.44–45) to identify START DANGER YES
the most serious injury, and treat injuries in Make sure the area is safe before you
order of priority. Once these are managed approach. Is anyone in danger?
carry out a secondary survey (pp.46–48).
NO
UNRESPONSIVE
CASUALTY RESPONSE YES
NO Is the casualty responding?
AIRWAY
Is the casualty’s airway open Try to initiate a response by asking
and clear? questions and gently shaking his
Open the airway shoulders.
Tilt the head and lift the chin Is there a response?
to open the airway.
CPR/CIRCULATION
Ask someone to call 999/112 for
emergency help and bring an AED
if possible. Begin cardiopulmonary
resuscitation/CPR (adult p.258,
child p.260, infant p.260).

BREATHING NO NO
Is the casualty Are you on your own?
breathing normally?
Check breathing YES
Look along the chest,
and listen and feel CPR/CIRCULATION
for breaths. If the casualty is a child or infant, give
YES FIVE initial rescue breaths and
cardiopulmonary resuscitation/CPR for
CIRCULATION one minute (child p.260, infant p.260).
Check for and treat life-threatening conditions, such Call 999/112 for emergency help, then
as severe bleeding. continue CPR. Take a child or infant to
the phone if necessary.
Call 999/112 for emergency help. If the casualty is an adult, call 999/112
Maintain an open airway. Place the casualty on for emergency help first, then begin
his side in the recovery position. CPR (p.258).
Do not leave any casualty (adult or child)
alone to search for an AED.

CHEST-COMPRESSION-ONLY CPR
If you have not had training in CPR or
you are unwilling or unable to give
rescue breaths you can give chest
compressions only. The emergency
services will give instructions for
chest-compression-only CPR.

256

ACTION IN AN EMERGENCY

If it is not safe, do not approach. A–Z OF EMERGENCIES
Call 999/112 for emergency help. Anaphylactic shock p.268
Asthma p.268
RESPONSIVE Broken bones p.274
CASUALTY Burns and scalds p.274
AIRWAY AND Choking adult p.264
BREATHING Choking child p.264
If a person is alert and Choking infant p.266
talking to you, it follows Head injury p.272
that her airway is open Heart attack p.262
and clear and she is Hypoglycaemia p.278
breathing. Her breathing Meningitis p.266
may be fast, slow, easy Seizures in adults p.276
or difficult. Assess and Seizures in children p.276
treat any problem found. Severe external bleeding p.270
Shock p.270
Spinal injury p.272
Stroke p.262
Swallowed poisons p.278

CIRCULATION TREAT LIFE-THREATENING
INJURIES OR ILLNESSES
Are there life-threatening conditions, such as YES Call 999/112 for emergency help.
severe bleeding or heart attack?
Monitor and record a casualty's vital
signs – breathing, pulse and level of
NO response (pp.52–53) – while waiting for

help to arrive.

CARRY OUT A SECONDARY SURVEY
Assess the level of response using the AVPU scale (p.52) and
carry out a head-to-toe survey to check for signs of illness or injury.
Call for appropriate help. Call 999/112 for emergency help if you suspect
serious injury or illness. Monitor and record a casualty's vital signs – breathing,
pulse and level of response (pp.52–53) – while waiting for help to arrive.

257

EMERGENCY FIRST AID

CPR FOR AN ADULT

1 POSITION HANDS 2 GIVE 30 CHEST 3 OPEN AIRWAY,
ON CHEST COMPRESSIONS BEGIN RESCUE
BREATHS
Place one hand on the centre Lean directly over the casualty’s
of the casualty’s chest. Place the chest and press down vertically Tilt the casualty’s head with one
heel of your other hand on top of about 5–6cm (2–2½in). Release hand and lift the chin with two
the first and interlock your fingers, the pressure, but do not remove fingers of your other hand. Pinch
but keep your fingers off the your hands. Give 30 compressions the nostrils closed, and allow his
casualty’s ribs. at a rate of 100–120 per minute. mouth to fall open. Take a breath,
seal your lips over the casualty’s
mouth, and blow steadily until the
chest rises.

CHEST-COMPRESSION-ONLY CPR

1 CHECK FOR 2 OPEN THE 3 CHECK
RESPONSE AIRWAY BREATHING

Check for a response. Gently Open the casualty’s airway. Place Check breathing: put your ear as
shake the casualty’s shoulders, one hand on the forehead and near to the casualty’s mouth and
and talk to him. If there is no gently tilt the head – the mouth nose as you can and look along his
response, go to the next step. should fall open. Place the chest. Look, listen and feel for
fingertips of your other hand on breathing for no more than
258 the chin and lift it. 10 seconds. If he is not breathing
call 999/112 for emergency help,
then begin chest compressions.

CPR FOR AN ADULT | CHEST-COMPRESSION-ONLY CPR

FIND OUT MORE pp.66–69

4 WATCH CHEST 5 CONTINUE CPR CAUTION
FALL
■■ If you have not had training in
Maintaining the open airway, Continue CPR (30:2) until: CPR, or you are unwilling or
take your mouth away from the emergency help arrives; the unable to give rescue breaths
casualty’s. Look along the chest casualty shows signs of becoming you can give chest compressions
and watch it fall. Repeat to give responsive – such as coughing, only, see below. The emergency
TWO rescue breaths; each full opening his eyes, speaking or services will give instructions for
breath should take one second. moving purposefully – and starts chest-compression-only CPR.
Repeat 30 chest compressions breathing normally; or you are too
followed by TWO rescue breaths. exhausted to continue. ■■ If the casualty vomits during
CPR, roll him away from you
onto his side, with his head
turned towards the floor to
allow vomit to drain. Clear his
mouth, then immediately roll
him onto his back again and
restart CPR.

■■ If there is more than one
rescuer, change over every
1–2 minutes, with minimal
interruption to CPR.

■■ Ask a helper to fetch an AED.

FIND OUT MORE pp.70–71

4 BEGIN CHEST 5 CONTINUE CHEST CAUTION
COMPRESSIONS COMPRESSIONS ■■ Chest-compression-only CPR is

Kneel level with the casualty's Give compressions at a rate of given only if you have not had
chest. Place one hand on the 100–120 per minute until: help training in CPR, or you are
centre of the chest. Put the heel arrives; the casualty shows signs of unwilling or unable to give
of your other hand on top of the becoming responsive (coughing, rescue breaths. The emergency
first and interlock your fingers. opening his eyes, speaking or services will give instructions for
Press down on his breastbone, to moving purposefully) and starts chest-compression-only CPR.
depress the chest 5–6cm (2–2½in), breathing normally; or you are too ■■ If the casualty vomits during
then release the pressure. exhausted to continue. CPR, roll him away from you
onto his side, ensuring that his
head is turned towards the floor
to allow vomit to drain. Clear his
mouth, then immediately roll
him onto his back again and
restart chest compressions.
■■ If there is more than one
rescuer, change over every
1–2 minutes, with minimal
interruption to chest
compressions.
■■ Ask a helper to fetch an AED.

259

EMERGENCY FIRST AID

CPR FOR A CHILD ONE YEAR TO PUBERTY

1 CHECK THAT 2 3GIVE FIVE INITIAL GIVE 30 CHEST
AIRWAY IS OPEN RESCUE BREATHS COMPRESSIONS

Tilt the child’s head with one hand Pinch the nose to close the Place the heel of one hand on the
and lift the chin with two fingers nostrils. Allow the mouth to fall centre of the chest. Lean directly
of the other hand to ensure the open. Take a breath and seal your over the child’s chest and press
airway is open. lips over the child’s mouth. Blow down to at least one third of its
steadily until the chest rises, then depth, then release the pressure,
watch it fall; a rescue breath but do not remove your hand.
should take one second. Give Give 30 compressions at a rate
FIVE rescue breaths. of 100–120 per minute.

CPR FOR AN INFANT UNDER ONE YEAR

1 CHECK THAT 2 3GIVE FIVE INITIAL GIVE 30 CHEST
AIRWAY IS OPEN RESCUE BREATHS COMPRESSIONS

Place the infant on a firm surface Take a breath and place your lips Place the tips of your index and
or on the floor. Gently tilt the over the infant’s mouth and nose. middle finger on the centre of
head with one hand and lift the Blow gently and steadily into the the chest. Lean over the infant’s
chin with one finger of the other mouth and nose until the chest chest and press down vertically
hand to ensure the airway is open. rises, then watch it fall. Each full to at least one third of its depth.
breath should take about one Release the pressure but not your
260 second. Give FIVE rescue breaths. fingers. Give 30 compressions at a
rate of 100–120 per minute.

CPR FOR A CHILD | CPR FOR AN INFANT

FIND OUT MORE pp.76–79

4 5GIVE TWO CONTINUE CPR CAUTION
RESCUE BREATHS
■■ If you have not had training in
Return to the head and give TWO Continue CPR (30:2) until: CPR, or you are unwilling or
rescue breaths. Repeat 30 chest emergency help arrives; the child unable to give rescue breaths
compressions followed by TWO shows signs of becoming you can give chest compressions
rescue breaths (30:2) for one responsive – such as coughing, only. The emergency services
minute. Call 999/112 for opening her eyes, speaking or will give instructions for chest-
emergency help if this has not moving purposefully – and starts compression-only CPR.
already been done. Take the child breathing normally; or you are too
to the phone with you if necessary. exhausted to continue. ■■ If the child vomits, roll her away
from you onto her side, with her
head turned towards the floor
to allow vomit to drain. Clear
her mouth, then immediately
roll her onto her back again and
restart CPR.

■■ If there is more than one
rescuer, change over every
1–2 minutes, with minimal
interruption to CPR.

■■ Ask a helper to fetch an AED,
ideally with paediatric pads.

FIND OUT MORE pp.82–83

4 5GIVE TWO CONTINUE CPR CAUTION
RESCUE BREATHS ■■ If you have not had training in

Return to the head and give Continue CPR (30:2) until: CPR or you are unwilling or
TWO more rescue breaths. Repeat emergency help arrives; the infant unable to give rescue breaths
30 chest compressions followed shows signs of becoming you can give chest compressions
by TWO rescue breaths (30:2) for responsive – such as coughing, only. The emergency services
one minute. Call 999/112 for opening her eyes, speaking or will give instructions for chest-
emergency help if this has not moving purposefully – and starts compression-only CPR.
already been done. Take the infant breathing normally; or you are ■■ If the infant vomits during CPR,
to the phone if necessary. too exhausted to continue. roll her away from you onto her
side, with her head turned
towards the floor to allow vomit
to drain. Clear her mouth, roll
her onto her back again
immediately and restart CPR.
■■ If there is more than one
rescuer, change over every
1–2 minutes, with minimal
interruption to CPR.
■■ Do not use AED on an infant.

261

EMERGENCY FIRST AID

HEART ATTACK

RECOGNITION 1 2CALL FOR MAKE CASUALTY
EMERGENCY HELP COMFORTABLE
There may be:
■■ Vice-like chest pain, spreading to one Call 999/112 for emergency help. Help the casualty into a
Tell ambulance control that you comfortable position; a half-sitting
or both arms or jaw that does not suspect a heart attack. position is often best. Support his
ease with rest head and shoulders and place
■■ Breathlessness cushions under his knees.
■■ Discomfort, like indigestion, in upper Reassure the casualty.
abdomen
■■ Collapse, with no warning
■■ Sudden dizziness or faintness
■■ Casualty may have sense of
impending doom
■■ “Ashen” skin and blueness of lips
■■ Rapid, weak or irregular pulse
■■ Profuse sweating
■■ Extreme gasping for air (air hunger)

STROKE

RECOGNITION 1 CHECK 2 CHECK
CASUALTY'S CASUALTY'S
Use the FAST (Face – Arms – FACE ARMS
Speech – Time) guide (p.212) to
assess the casualty. Keep the casualty comfortable. Ask the casualty to raise his arms.
■■ Facial weakness – casualty is unable Ask him to smile. If he has had a If he has had a stroke, he may only
stroke, he may only be able to be able to lift one arm.
to smile evenly smile on one side – the other side
■■ Arm weakness – casualty may only of his face may droop.

be able to move his arm on one side
of his body
■■ Speech problems
There may also be:
■■ Sudden weakness or numbness
along one side or both sides of body
■■ Sudden blurring or loss of vision
■■ Sudden difficulty understanding the
spoken word
■■ Sudden confusion
■■ Sudden severe headache with no
apparent cause
■■ Dizziness, unsteadiness or a
sudden fall

262

HEART ATTACK | STROKE

FIND OUT MORE p.211

3 GIVE CASUALTY 4 MONITOR CAUTION
MEDICATION CASUALTY
■■ Be aware of the possibility of
collapse without warning.

■■ Do not give the casualty aspirin
if you know that he is allergic
to it, or if he is under 16 years
of age.

■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–59).

Assist the casualty to take one Encourage the casualty to rest.
full dose aspirin tablet (300mg Keep any bystanders away.
in total); advise him to chew it Monitor and record the casualty’s
slowly. If the casualty has tablets vital signs – breathing, pulse and
or a spray for angina, allow him to level of response – while waiting
take it. Help him if necessary. for help to arrive.

FIND OUT MORE pp.212–13

3 CHECK 4 CALL FOR CAUTION
CASUALTY'S EMERGENCY ■■ Do not give the casualty
SPEECH HELP
anything to eat or drink; he
Ask the casualty some questions. Call 999/112 for emergency help. will probably find it difficult
Tell ambulance control that you to swallow.
Can he speak and/or understand suspect a stroke. Reassure the ■■ If the casualty becomes
casualty and monitor and record unresponsive, open the airway
what you are saying? his vital signs – breathing, pulse and check breathing (p.256).
and level of response – while Be prepared to begin CPR
waiting for help to arrive. (pp.258–59).

263

EMERGENCY FIRST AID

CHOKING ADULT

RECOGNITION 1 ENCOURAGE 2 GIVE UP TO FIVE
CASUALTY TO BACK BLOWS
Ask the casualty: “Are you COUGH
choking?” If the casualty cannot speak,
For mild obstruction: If the casualty is breathing, cough or breathe, bend her
■■ Difficulty in speaking, coughing and encourage her to cough to try to forward. Give up to five sharp
remove the obstruction herself. blows between the shoulder
breathing If this fails, go to step 2. blades with the heel of your hand.
For severe obstruction: Check her mouth. If choking
■■ Inability to speak, cough or breathe persists, proceed to step 3.
■■ Eventually casualty will become

unresponsive

CHOKING CHILD ONE YEAR TO PUBERTY

RECOGNITION 1 2ENCOURAGE GIVE UP TO FIVE
CHILD TO COUGH BACK BLOWS
Ask the child: “Are you choking?”
For mild obstruction:
■■ Difficulty in speaking, coughing and

breathing
For severe obstruction:
■■ Inability to speak, cough or breathe
■■ Eventually child will become

unresponsive

If the child is breathing, If the child cannot speak, cough
encourage her to cough to try to or breathe, bend her forward.
remove the obstruction herself. If Give up to five sharp blows
this fails, go to step 2. between the shoulder blades with
the heel of your hand. Check her
mouth. If choking persists,
proceed to step 3.

264

CHOKING ADULT | CHOKING CHILD

FIND OUT MORE p.94

CAUTION
■■ Do not do a finger sweep when

checking the mouth.
■■ If the casualty becomes

unresponsive, open the
airway and check breathing
(p.256). Be prepared to give
CPR (pp.258–59).

3 GIVE UP TO FIVE 4 CALL FOR
ABDOMINAL EMERGENCY HELP
THRUSTS THEN CONTINUE

Stand behind the casualty. Put If the obstruction has not cleared,
both arms around her, and put one call 999/112 for emergency help.
fist between her navel and the Repeat steps 2 and 3 – rechecking
bottom of her breastbone. Grasp the mouth after each step – until
your fist with your other hand, and emergency help arrives, the
pull sharply inwards and upwards obstruction is cleared or the
up to five times. Recheck the casualty becomes unresponsive.
casualty’s mouth.

FIND OUT MORE p.95

CAUTION
■■ Do not do a finger sweep when

checking the mouth.
■■ If the child becomes

unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.260–61).

3 GIVE UP TO FIVE 4 CALL FOR
ABDOMINAL EMERGENCY HELP
THRUSTS THEN CONTINUE

Stand behind the child. Put both If the obstruction has not cleared,
your arms around her, and put call 999/112 for emergency help.
one fist between her navel and Repeat steps 2 and 3 – rechecking
the bottom of her breastbone. the mouth after each step – until
Grasp your fist with your other emergency help arrives, the
hand, and pull sharply inwards and obstruction is cleared or the child
upwards up to five times. Recheck becomes unresponsive.
the child’s mouth.

265

EMERGENCY FIRST AID

CHOKING INFANT UNDER ONE YEAR

RECOGNITION

Mild obstruction:
■■ Able to cough but difficulty in

breathing or making any noise
Severe obstruction:
■■ Inability to cough, make any noise

or breathe
■■ Eventually infant will become

unresponsive

1 GIVE UP TO FIVE 2 CHECK INFANT’S
BACK BLOWS MOUTH

If the infant is unable to cough or Turn the infant over so that she is
breathe, lay her face down along face up along your other leg and
your forearm and thigh, and check her mouth. Check the
support her head. Give up to five mouth – do not sweep the mouth
back blows between the shoulder with your finger. Pick out any
blades with the heel of your hand. obvious obstructions. If choking
persists, proceed to step 3.

MENINGITIS

RECOGNITION 1 SEEK MEDICAL 2 TREAT FEVER
ADVICE
Some, but not all, of these signs Keep the casualty cool and give
and symptoms may be present: If you notice any signs of plenty of water to replace fluids
■■ Flu-like illness with a high meningitis, such as the casualty lost through sweating. An adult
shielding her eyes from light or may take the recommended dose
temperature a stiff neck, seek urgent medical of paracetamol tablets; a child
■■ Cold hands and feet advice. may have the recommended dose
■■ Joint and/or limb pain of paracetamol syrup.
■■ Mottled or very pale skin
As infection develops:
■■ Severe headache
■■ Neck stiffness
■■ Eyes become sensitive to light
■■ Drowsiness
■■ A distinctive rash of red or purple

spots that look like bruises and do
not fade when pressed
■■ In infants, a high-pitched moaning or
whimpering cry, floppiness and a
tense or bulging fontanelle (soft part
of the skull)

266

CHOKING INFANT | MENINGITIS

FIND OUT MORE p.96

3 GIVE UP TO FIVE 4 CALL FOR CAUTION
CHEST THRUSTS EMERGENCY HELP
THEN CONTINUE ■■ Do not do a finger sweep when
With the infant lying on your leg, checking the mouth.
place two fingertips on the lower If the obstruction is still not clear,
half of her breastbone, a finger’s call 999/112 for emergency help. ■■ Do not use abdominal thrusts on
breadth below the nipples. Give Take the infant with you to make an infant.
up to five sharp downward thrusts, the call if necessary. Repeat steps
similar to chest compressions 1 to 3 until emergency help arrives, ■■ If the infant becomes
(p.260), but sharper and slower. the obstruction is cleared or the unresponsive, open the airway
Recheck the infant’s mouth. infant becomes unresponsive (see and check breathing (p.256).
caution, above right). Be prepared to begin CPR
(pp.260–61).

FIND OUT MORE p.220

CAUTION
■■ If the casualty becomes

unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).

3 CHECK FOR SIGNS 4 CALL FOR
OF A RASH EMERGENCY
HELP
Check the casualty for signs
of the meningitis rash: press Call 999/112 for emergency help
against the rash with the side of a if you see signs of the rash, or if
glass. Most rashes will fade when medical help is delayed. Reassure
pressed; if you can still see the the casualty. Keep her cool and
rash through the glass, it is monitor her vital signs –
possibly meningitis. breathing, pulse and level of
response – until help arrives.

267

EMERGENCY FIRST AID

ASTHMA

RECOGNITION 1 HELP CASUALTY 2 ENCOURAGE
USE INHALER SLOW BREATHS
■■ Difficulty in breathing
■■ Wheezing
■■ Coughing
■■ Distress and anxiety
■■ Difficulty in speaking
■■ Grey-blue colouring in skin, lips,

earlobes and nailbeds
In a severe attack:
■■ Exhaustion and casualty may

become unresponsive

Keep calm and reassure the Help the casualty into a
casualty. Help her to find her comfortable position. Tell her to
reliever inhaler (it is usually blue) breathe slowly and deeply. A mild
and take her usual dose; use a attack should ease within a few
spacer device if she has one. The minutes. If it does not ease, the
reliever inhaler should take effect casualty may take one to two
within minutes. puffs from her inhaler every two
minutes, up to ten puffs.

ANAPHYLACTIC SHOCK

RECOGNITION 1 CALL FOR 2 HELP CASUALTY
■■ Anxiety EMERGENCY WITH
■■ Red, blotchy skin, itchy rash and red, HELP MEDICATION

itchy, watery eyes Call 999/112 for emergency help. If she has an adrenaline auto-
■■ Swelling of hands, feet and face Ideally, ask someone to make the injector, help her to use it. If you
■■ Puffiness around the eyes; call while you treat the casualty. are trained, give it to her. Hold the
■■ Abdominal pain, vomiting and Tell ambulance control that you injector in your fist, pull off the
suspect anaphylaxis. safety cap and push the tip against
diarrhoea her thigh until it clicks. Hold it
■■ Difficulty breathing, ranging from for ten seconds, remove it and
massage the site for ten seconds.
tight chest to severe difficulty, which
causes wheezing and gasping for air
■■ Swelling of tongue and throat
■■ A feeling of terror
■■ Confusion and agitation
■■ Signs of shock (p.270) leading to
casualty becoming unresponsive

268

ASTHMA | ANAPHYLACTIC SHOCK

FIND OUT MORE p.102

3 4CALL FOR MONITOR CAUTION
EMERGENCY HELP CASUALTY
■■ Do not leave the casualty alone
Call 999/112 for emergency help Monitor and record the casualty’s since the attack may quickly
if the attack is severe and one of vital signs – breathing, pulse and worsen.
the following occurs: the inhaler level of response – until she
has no effect; breathlessness recovers or help arrives. Help her ■■ If this is a first attack and she
makes talking difficult; the to reuse her inhaler as required. has no medication, call 999/112
casualty is becoming exhausted. Advise the casualty to seek for emergency help
medical advice if she is concerned immediately.
about the attack.
■■ If the attack worsens, the
casualty may become
unresponsive. If this happens
open the airway and check
breathing (p.256). Be prepared
to begin CPR (pp.258–61).

FIND OUT MORE p.223

3 MAKE CASUALTY 4 MONITOR CAUTION
COMFORTABLE CASUALTY
■■ An adrenaline autoinjector can
Reassure the casualty and help Monitor and record vital signs – be delivered through clothing.
her to sit in a position that eases breathing, pulse and level of
any breathing difficulties. If she response – while waiting for help ■■ If the casualty becomes
becomes very pale with a weak to arrive. Repeat the adrenaline unresponsive, open the airway
pulse, lay her down with legs dose every five minutes if there is and check breathing (p.256).
raised as for shock (pp.270–71). no improvement or the casualty’s Be prepared to begin CPR
symptoms return. (pp.258–61).

■■ If a pregnant casualty needs to
lie down, lean her towards her
left side to prevent the pregnant
uterus restricting blood flow
back to the heart.

269

EMERGENCY FIRST AID

SEVERE EXTERNAL BLEEDING

1 APPLY DIRECT 2 IF THERE IS AN 3 CALL FOR
PRESSURE TO OBJECT IN THE EMERGENCY
WOUND WOUND HELP

Apply direct pressure over the Press either side of the embedded Call 999/112 for emergency help
wound with your fingers or the object to control bleeding. Do – ideally ask a helper to to do this.
palm of your hand using a sterile not press directly on the object Give the ambulance control
dressing or clean, non-fluffy pad. If and do not make any attempt to details of the injury and extent
you do not have a dressing, ask remove it. of the bleeding.
the casualty to apply direct
pressure himself. Remove or cut
any clothing if necessary.

SHOCK

RECOGNITION 1 HELP CASUALTY 2 CALL FOR
TO LIE DOWN EMERGENCY
■■ Rapid pulse HELP
■■ Pale, cold, clammy skin Treat any cause of shock, such as
■■ Sweating bleeding (above) or burns Call 999/112 for emergency help
As shock develops: (pp.274–75). Help the casualty to – ideally ask a helper to do this.
■■ Rapid, shallow breathing lie down, ideally on a blanket. Tell ambulance control that you
■■ Weak, “thready” pulse Raise and support his legs above suspect shock.
■■ Grey-blue skin, especially inside lips the level of his heart.
■■ Weakness and giddiness
■■ Nausea and vomiting
■■ Thirst
As the brain’s oxygen supply
weakens:
■■ Restlessness and aggressive

behaviour
■■ Gasping for air
■■ Casualty will become unresponsive

270

SEVERE EXTERNAL BLEEDING | SHOCK

4 APPLY BANDAGE 5 MONITOR FIND OUT MORE pp.114–115
AND TREAT CASUALTY
FOR SHOCK CAUTION
Monitor and record vital signs – ■■ Do not apply a tourniquet.
Secure a pad over the wound with breathing, pulse and level of ■■ If there is an object in the
a bandage. Check the circulation response – while waiting for
beyond the bandage every ten emergency help to arrive. wound, apply pressure on either
minutes. Loosen and reapply the side of the wound to control
bandage if necessary. Treat bleeding.
casualty for shock, see below. ■■ If blood seeps through the
bandage, place another pad on
top. If blood seeps through the
second pad, remove all dressings
and apply a fresh one, ensuring
that it exerts pressure on the
bleeding area.
■■ Do not give the casualty
anything to eat or drink as an
anaesthetic may be needed.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).

FIND OUT MORE pp.112–13

3 LOOSEN TIGHT 4 KEEP CASUALTY CAUTION
CLOTHING WARM
■■ Do not give the casualty
Loosen any tight clothing to Cover the casualty with a blanket anything to eat or drink because
reduce constriction at the neck, to keep him warm. Advise the an anaesthetic may be needed.
chest and waist. casualty not to move. Monitor
and record vital signs – breathing, ■■ Do not leave the casualty
pulse and level of response – while unattended, unless you have to
waiting for help to arrive. call for emergency help.

■■ Do not let the casualty move.
■■ Do not try to warm the casualty

with a hot-water bottle or any
other form of direct heat.
■■ If the casualty is in the late
stages of pregnancy, lean her
towards her left side so the
pregnant uterus does not
restrict blood flow to the heart.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).

271

EMERGENCY FIRST AID

HEAD INJURY

RECOGNITION 1 APPLY DIRECT 2 SECURE
PRESSURE TO ANY DRESSING WITH
There may be: WOUND BANDAGE
■■ Level of response may be impaired
Replace any displaced skin flaps Secure the dressing over the
for a brief period over the wound. Put a sterile wound with a roller bandage to
■■ Possible scalp wound dressing or a clean, non-fluffy pad help maintain direct pressure on
■■ Dizziness and/or nausea over the wound. Apply firm, direct the injury.
■■ Loss of memory of events at the time pressure with your hand to control
the bleeding.
of, or immediately before, the injury
■■ Mild headache
■■ Confusion
For severe injury:
■■ History of severe blow to the head
■■ Deteriorating level of response
■■ Casualty may become unresponsive
■■ Leakage of blood or bloodstained

watery fluid from the ear or nose
■■ Unequal pupil size

SPINAL INJURY

RECOGNITION 1 CALL FOR 2 STEADY AND
EMERGENCY SUPPORT HEAD
■■ Can occur after a fall from a height HELP
onto the back, head or feet Sit or kneel behind the casualty’s
Tell the casualty not to move. Call head and, resting your arms on
There may be: 999/112 for emergency help. If the ground. Grasp either side of
■■ Pain in neck or back possible, ask a helper to make the the casualty’s head and hold it
■■ Step, irregularity or twist in the call while you support the head still. Do not cover her ears.
and neck. Tell ambulance control
normal curve of the spine that a spinal injury is suspected.
■■ Tenderness in the skin over the spine
■■ Weakness or loss of movement in the

limbs
■■ Loss of sensation, or abnormal

sensation
■■ Loss of bladder and/or bowel control
■■ Difficulty breathing

272

HEAD INJURY | SPINAL INJURY

FIND OUT MORE pp.144–45

3 HELP CASUALTY 4 MONITOR CAUTION
TO LIE DOWN CASUALTY
Seek medical advice if after the
Help the casualty to lie down, Monitor and record the casualty’s injury you notice signs of
ideally on a blanket. Ensure that vital signs – breathing, pulse and worsening head injury such as:
his head and shoulders are slightly level of response. Call 999/112 for ■■ Increasing drowsiness
raised. Make him as comfortable emergency help if there are any ■■ Persistent headache
as possible. signs of severe head injury. ■■ Confusion, dizziness, loss of

balance and/or loss of memory
■■ Difficulty speaking
■■ Difficulty walking
■■ Vomiting episodes
■■ Double vision
■■ Seizure

FIND OUT MORE pp.157–59

3 PLACE EXTRA 4 MONITOR CAUTION
SUPPORT CASUALTY
AROUND HEAD ■■ Do not move the casualty unless
Monitor and record the casualty’s she is in danger.
Continue to hold her head. Ask vital signs – breathing, pulse and
a helper to place rolled towels, level of response – while waiting ■■ If the casualty is unresponsive,
or other padding, on either side for help to arrive. open the airway by gently lifting
of the casualty’s head for extra the jaw, but do not tilt the head,
support. then check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).

■■ If you need to place the casualty
into the recovery position use
the log-roll technique (p.159).

273

EMERGENCY FIRST AID

BROKEN BONES

RECOGNITION 1 SUPPORT 2 PROTECT INJURY
INJURED PART WITH PADDING
■■ Deformity, swelling and bruising
at the injury site

■■ Pain and difficulty in moving the
injured part

There may be:
■■ Bending, twisting or shortening of

a limb
■■ A wound, possibly with bone ends

protruding

Help the casualty to support the Place padding, such as towels or
affected part at the joints above cushions, around the affected
and below the injury, in the most part, and support it in a
comfortable position. comfortable position.

BURNS AND SCALDS

RECOGNITION

There may be:
■■ Possible areas of superficial, partial-

thickness and/or full-thickness burns
■■ Pain in the area of the burn
■■ Breathing difficulties if the airway

is affected
■■ Swelling and blistering of the skin
■■ Signs of shock

1 START TO COOL 2 CALL FOR
BURN EMERGENCY
HELP
Immediately flood the injury
with cold water; cool for at least Call 999/112 for emergency help
ten minutes or until pain is if necessary. Tell ambulance
relieved. Make the casualty control that the injury is a burn
comfortable by helping him to and explain what caused it, and
sit or lie down and protect the the estimated size and depth.
injured area from contact with
the ground.

274

BROKEN BONES | BURNS AND SCALDS

FIND OUT MORE pp.136–38

3 SUPPORT WITH 4 TAKE OR SEND CAUTION
SLINGS OR CASUALTY TO
BANDAGES HOSPITAL ■■ Do not attempt to move an injured
limb unnecessarily, or if it causes
For extra support or if help is A casualty with an arm injury further pain.
delayed, secure the injured part to could be taken by car if not in
an uninjured part of the body. For shock; a leg injury should go by ■■ If there is an open wound, cover
upper body injuries, use a sling; ambulance, so call 999/112 for it with a sterile dressing or a
for lower limb injuries, use broad- emergency help. Treat for shock. clean, non-fluffy pad and bandage
and narrow-fold bandages. Tie Monitor and record the casualty’s it in place.
knots on the uninjured side. breathing, pulse and level of
response while waiting for help. ■■ Do not give the casualty anything
to eat or drink as an anaesthetic
may be needed.

■■ Do not raise a broken leg when
treating a casualty for shock.

FIND OUT MORE pp.174–75

3 REMOVE ANY 4 COVER BURN CAUTION
CONSTRICTIONS
■■ Do not apply lotions, ointment or
While you are cooling the burn, When cooled cover the burn with fat to a burn; specialised burn
carefully remove any clothing or kitchen film placed lengthways dressings are also not
jewellery from the area before it over the injury, or use a plastic recommended.
starts to swell; a helper can do this bag. Alternatively, use a sterile
for you. Do not remove anything dressing or clean, non-fluffy pad. ■■ Do not use adhesive dressings.
that is sticking to the burn. Monitor and record the casualty’s ■■ Do not touch the burn or burst
vital signs while waiting for help
to arrive. any blisters.
■■ If the burn is severe, treat the

casualty for shock (pp.270–71).
■■ If the burn is on the face, do not

cover it. Keep cooling with water
until help arrives.
■■ If the burn is caused by contact
with chemicals, wear protective
gloves and cool for at least
20 minutes.
■■ Watch the casualty for signs of
smoke inhalation, such as difficulty
breathing.

275

EMERGENCY FIRST AID

SEIZURES IN ADULTS

RECOGNITION 1 PROTECT 2 PROTECT HEAD
CASUALTY AND LOOSEN
Seizures often follow a pattern: TIGHT CLOTHING
■■ Sudden loss of responsiveness Try to ease the casualty’s fall. Talk
■■ Rigidity and arching of the back to him calmly and reassuringly. If possible, cushion the casualty’s
■■ Breathing may be noisy and become Clear away any potentially head with soft material until the
dangerous objects to prevent seizure ceases. Place padding
become difficult. The lips may show injury to the casualty. Ask around him to protect him from
a grey-blue tinge (cyanosis) bystanders to keep clear. Make a objects that cannot be moved.
■■ Convulsive movements begin note of when the seizure began. Loosen any tight clothing around
■■ Saliva (bloodstained if he has bitten the casualty’s neck.
his lip or tongue) may appear at
the mouth
■■ Possible loss of bladder or bowel
control
■■ Muscles relax and breathing
becomes normal again
■■ After the seizure the casualty
may be dazed and unaware of
what has happened
■■ Casualty may fall into a deep sleep

SEIZURES IN CHILDREN

RECOGNITION 1 PROTECT CHILD 2 HELP THE CHILD
FROM INJURY COOL DOWN
■■ Loss of or impaired response
■■ Vigorous shaking with clenched fists Clear away any nearby objects Remove bedding and clothing,
and surround the child with soft such as a vest or pyjama top; you
and arched back padding, such as pillows or rolled may have to wait until the seizure
There may also be: towels, so that even violent stops to do this. Ensure a good
■■ Signs of fever, such as hot, flushed movement will not result in injury. supply of cool air, but do not let
the child become too cold.
skin
■■ A twitching face and squinting, fixed

or upturned eyes
■■ Breath-holding, with red, puffy face

and neck
■■ Drooling at the mouth
■■ Possible vomiting
■■ Loss of bladder or bowel control

276

SEIZURES IN ADULTS | SEIZURES IN CHILDREN

FIND OUT MORE pp.216–17

3 PLACE CASUALTY 4 MONITOR CAUTION
IN RECOVERY CASUALTY'S
POSITION RECOVERY ■■ Do not attempt to restrain the
casualty.
Once the seizure has stopped the Monitor and record vital signs –
casualty may fall into a deep sleep. breathing, pulse and level of ■■ Do not put anything in the
Open the casualty's airway and response – until he recovers. Note casualty's mouth during a
check breathing (p.256). If he is the duration of the seizure. seizure.
breathing, place him in the
recovery position. Call 999/112 for emergency
help if the casualty:
■■ Is having repeated seizures
■■ Has a seizure that lasts more

than five minutes
■■ Is having his first seizure
■■ Remains unresponsive for more

than ten minutes after the
seizure has stopped
■■ Has sustained an injury

FIND OUT MORE p.218

3 PLACE CHILD IN 4 CALL FOR CAUTION
RECOVERY EMERGENCY
POSITION HELP ■■ Do not let the child get too cold.
■■ Do not sponge a child to cool
Once the seizure has stopped, Call 999/112 for emergency help.
open the airway and check Reassure the parents or carer, if him as there is a risk of over
breathing (p.256). If the child necessary. Monitor and record cooling.
is breathing, place him in the the child’s vital signs – breathing, ■■ If the child becomes
recovery position. pulse, level of response and unresponsive, open the airway
temperature – while waiting for and check breathing (p.256).
help to arrive. Be prepared to begin CPR
(pp.260–61).

277

EMERGENCY FIRST AID

SWALLOWED POISONS

RECOGNITION 1 IDENTIFY THE 2 CALL FOR
POISON EMERGENCY HELP
■■ A history of ingestion/exposure to
poison; evidence of poison nearby

Depending on what the casualty
has taken, there may be:
■■ Vomit that may be bloodstained, and

later diarrhoea
■■ Cramping abdominal pains
■■ Pain or burning sensation
■■ Empty containers near the casualty
■■ Impaired level of response
■■ Seizures

Reassure the casualty. If she Call 999/112 for emergency help.
is responsive, ask her what she has Give ambulance control as much
swallowed and if possible how information as possible. This will
much and when. Look for clues help the medical team to give the
such as poisonous leaves or casualty the correct treatment.
berries, containers or pill bottles.

HYPOGLYCAEMIA

RECOGNITION 1 GIVE CASUALTY 2 GIVE MORE
There may be: SUGAR SUGARY FOOD
■■ A history of diabetes – the casualty
Help the casualty to sit down. If If the casualty responds quickly,
may recognise the onset of a he has his own emergency sugar give him more food or drink and
hypoglycaemic (low blood sugar) remedy, help him to take it. If not let him rest until he feels better.
episode give him the equivalent of 15–20g Help him to find his glucose
■■ Weakness, faintness or hunger of glucose – a 150ml glass of fruit testing kit so that he can check
■■ Confusion and irrational behaviour juice or non-diet fizzy drink, three his glucose levels.
■■ Sweating with cold, clammy skin teaspoons (or lumps) of sugar or
■■ Rapid pulse three sweets such as jelly babies.
■■ Palpitations and muscle tremors
■■ Deteriorating level of response
■■ Diabetes medical warning bracelet
or necklace
■■ Emergency sugar remedy such as
glucose gel or sweets with the
person
■■ Glucose testing kit and medication
such as insulin pen or tablets

278

SWALLOWED POISONS | HYPOGLYCAEMIA

FIND OUT MORE p.200

3 MONITOR 4 IF CASUALTY'S CAUTION
CASUALTY LIPS ARE BURNT
■■ Do not attempt to induce
Monitor and record the casualty's If the casualty has swallowed a vomiting.
vital signs – breathing, pulse and substance that has burnt her lips,
level of response – while waiting give her frequent sips of cool milk ■■ If the casualty is contaminated
for help to arrive. Keep samples of or water. with chemicals, wear protective
vomited material and any other equipment such as disposable
clues and give them to the gloves, a mask and goggles.
ambulance crew.
■■ If the casualty becomes
unresponsive, make sure that
there is no vomit or other matter
in the mouth. Open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–60).

■■ If there are chemicals on the
casualty’s mouth, protect
yourself by using a face shield
or pocket mask when giving
rescue breaths.

FIND OUT MORE p.215

CAUTION
■■ If the operson is not fully

responsive do not give him
anything to eat or drink.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).

3 MONITOR 4 CALL FOR
CASUALTY EMERGENCY HELP

Monitor and record the casualty’s If the casualty’s condition
vital signs – breathing, pulse and does not improve, look for other
level of response – until he is fully causes of his condition. Call
recovered. 999/112 for emergency help.
Continue to monitor his vital
signs – breathing, pulse and level
of response – while waiting for
help to arrive.

279

APPENDIX

FIRST AID REGULATIONS

First aid may be practised in any situation ACCIDENT BOOK
where injuries or illnesses occur. In many
cases, the first person on the scene is a An employer has the overall responsibility for
volunteer who wants to help, rather than an accident book, but it is the responsibility of
someone who is medically trained. However, the first aider or appointed person to look after
in certain circumstances the provision of first and note details of incidents in the book.
aid, and first aid responsibilities, is defined by
statutes. In the UK, these regulations apply to If an employee is involved in an incident
incidents occurring in the workplace and at in the workplace, the following details should
mass gatherings. be recorded in the accident book:
■■Date, time and place of incident
FIRST AID AT WORK ■■Name and job of the injured or ill person
■■Details of the injury/illness and what first aid
The Health and Safety (First Aid) Regulations
1981 (as amended) place a duty on employers was given
to make first aid provision for employees. The ■■What happened to the person immediately
practical aspects of this statutory duty for
employers and for the self-employed are set afterwards (for example, went home or taken
out in the Guidance on Regulations, which was to hospital)
amended on 1 October 2013. In order to meet ■■Name and signature of the first aider
their regulatory requirements, employers have or person dealing with the incident
a responsibility to carry out an assessment of
their first aid needs based on hazards and risks REPORTING OF INJURIES, DISEASES
involved in their work, select a suitable training AND DANGEROUS OCCURRENCES
provider and undertake due diligence on that
provider. In the event of injury or ill health at work, an
employer has a legal obligation to report the
The Voluntary Aid Societies are cited in the incident. The Reporting of Injuries, Diseases
Guidance on Regulations as the standard setters and Dangerous Occurrences Regulations
for currently accepted first aid at work. The 1995 (RIDDOR) requires an employer to
training provided by the Voluntary Aid Societies report the following:
meets the requirements of employers identified ■■Deaths
in the needs assessment. ■■Major injuries
■■Injuries lasting more than seven days –
The Guidance on Regulations encourages all
employers to assess their organisation’s ability where an employee or self-employed person
to meet certain first aid standards. The number is away from work or unable to perform their
of first aiders required in a specific workplace is normal work duties for more than seven
dependent on your needs assessment, which consecutive days
should be carried out by your Health and Safety ■■Injuries to members of the public or people
Representative. The checklist opposite will not at work, where they are taken from the
assist in determining the number and type of scene of an accident to hospital
first aid personnel required in a workplace. ■■Some work-related diseases
■■Some dangerous occurrences such as a
Comprehensive advice can also be found at near miss, where something happened that
www.hse.gov.uk/firstaid/ although no injury occurred could have
resulted in an injury

280

FIRST AID REGULATIONS

CHECKLIST FOR ASSESSMENT OF FIRST AID NEEDS

FACTORS TO CONSIDER

Is your workplace low risk (for The minimum provision is: An appointed person to take charge of first aid
example, shops, offices and arrangements ■ A suitably stocked first aid box. As there is a possibility of an
libraries)? accident or sudden illness consider providing a qualified first aider
First aider requirements: For fewer than 25 employees, one appointed
person ■ For 25–50 employees, at least one first aider trained in Emergency
First Aid at Work (EFAW) ■ For over 50 employees, one First Aid at Work
(FAW) trained first aider for every 100 employees (or part thereof)
Where there are large numbers of employees consider: Additional first aid
equipment ■ A first aid room

Is your workplace higher risk (for The minimum provision is: An appointed person to take charge of first aid
example, light engineering and arrangements ■ A suitably stocked first aid box
assembly work, food processing, First aider requirements: For fewer than five employees, one appointed
warehousing, extensive work with person; for 5–50 employees, at least one first aider trained in Emergency First
dangerous machinery or sharp Aid at Work (EFAW) or First Aid at Work (FAW) dependng on the type of
instruments, construction or injuries that could occur; for over 50 employees, at least one First Aid at Work
chemical manufacture). Do your (FAW) trained first aider for every 50 employees (or part thereof)
work activities involve special Consider: Additional training for first aiders to deal with injuries resulting from
hazards, such as hydrofluoric acid special hazards ■ Additional first aid equipment ■ Precise siting of first aid
or confined spaces? equipment ■ Providing a first aid room ■ Informing the emergency services
if there are chemicals on site.

Are there inexperienced workers on Consider: Additional training for first aiders ■ Additional first aid equipment
site, or employees with disabilities ■ Local siting of first-aid equipment
or special health problems? Your first aid provision should cover any work-experience trainees

What is your record of accidents Ensure your first aid provision caters for the type of injury and illness that
and ill health? What injuries and might occur in your workplace. Monitor accidents and ill health and review
illness have occurred and where? your first aid provision as appropriate

Do you have employees who travel Consider: Personal first aid kits ■ Personal communicators or mobile phones
a lot, work remotely or work alone? for remote or lone workers
Do any of your employees work Ensure there is adequate first aid provision at all times while people
shifts or work out of hours? are at work

Are the premises spread out; for Consider: First aid provision in each building or on each floor
example, are there several buildings
on the site or multi-floor buildings?

Is your workplace remote from Consider: Special arrangements with the emergency services ■ Informing the
emergency medical services? emergency services of your location

Do any of your employees work at Make arrangements with other site occupiers to ensure adequate provision of
sites occupied by other employers? first aid. A written agreement between employers is strongly recommended

Do you have sufficient provision Consider what cover is needed for: Annual leave and other planned absences
to cover absences of first aiders ■ Unplanned and exceptional absences
or appointed persons?

Do members of the public visit Under the regulations, there is no legal obligation to provide first aid for
your premises (for example, non-employees, but the Health and Safety Executive (HSE), strongly
schools, places of entertainment, recommends that you consider the members of the public when planning
fairgrounds, shops)? your first aid provision

281

INDEX Arms Bandages continued
bandaging 245 immobilising limb 243
INDEX slings 251 roller bandages 236, 244–47
examining for injury 50 triangular bandages 236, 249–52
A immobilising 243 tubular bandages 236, 248
injuries 149–55
ABC check 45 elbow 151 Barbiturates, overdose 201
Abdomen forearm and wrist 152 Bee stings 204
hand and fingers 153
examining for injury 51 upper arm 150 allergy to 222
pain 226 muscles 134 Benzodiazepines, overdose 201
stitch 226 wounds Biohazard bags 18
wound 128 amputation 117 Birth 228–29
Abrasions 20, 111 bleeding at elbow crease 127 Bites and stings 190, 203–07
Absence seizures 216 fingers 126
Aches anaphylactic shock 223
abdominal pain 226 Arteries animal bites 190, 203
earache 225 bleeding from 110 human bites 190, 203
headache 224 circulatory system 108 insect stings 190, 204–05
toothache 225 pulse 53 marine creatures 190, 207
Adhesive dressings 235 severe bleeding 114–15 rabies 203
applying 241 snake bites 206
Adhesive tape 237 Artificial ventilation tetanus 203
securing roller bandages 244 see Rescue breathing ticks 205
Adrenaline autoinjector 48 Bleeding
anaphylactic shock 223, 268–69 Aspirin bruising 119
Afterbirth, delivery of 228, 229 heart attack and 211, 263 checking for 49–51
Agonal breathing 59 overdose 201 childbirth 229
Aids emergency first aid 270–71
HIV infection 16 Assessing casualties 39–53, 256–57 from ear 123
human bites 203 examining casualty 49–51 from mouth 125
Air travel, earache 225 primary survey 41, 44–45 internal bleeding 116
Airway secondary survey 41, 46–48 miscarriage 228
breathing difficulties 88–105 symptoms and signs 50–51 nosebleeds 124
burns 177 unresponsive casualties: severe bleeding 114–15
checking 44 adults 62 shock 112–13
croup 103 children 72 types of 110
hanging and strangulation 97 infants 80 types of wound 111
inhalation of fumes 98–99 vaginal 128
obstruction 92–95 Assessing a situation 28 varicose veins 129
opening 59 Asthma 102 see also Wounds
Blisters 120
adults 63 emergency first aid 268–69 burns 183
children 73 inhalers 48 Blood
infants 80 Auto-injectors 48 circulatory system 56, 88, 108–09
jaw thrust method 159 using, 223, 268 clotting 110
respiratory system 90–91 Automated external defibrillators composition 109
unresponsive casualty 93 (AED) 54, 57, 84–87 see also Bleeding
Alcohol poisoning 202 for children 87 Blood pressure 108
Allergy 222 Autonomic nerves 143 Body temperature 171
anaphylactic shock 223 AVPU code, checking level of response fever 219
asthma 102 52, 144 frostbite 189
Alveoli 56, 90 heat exhaustion 184
Ambulances, telephoning for B heatstroke 185
help 21–22 hypothermia 186–88
Amphetamines, overdose 201 Babies see Infants taking 53
Amputation 117 Back injuries 157–59 Bones
Anaesthetic, poisoning 201 joints 135
Anaphylactic shock 223 emergency first aid 272–73 skeleton 132–33
emergency first aid 268–69 examining for 51 structure 134
Angina pectoris 210 pain 156 see also Fractures
drugs 48 recovery position 65, 75 Bracelets, medical warning 48
Animal bites 203 treatment 158–59 Brachial pulse 53
Ankles Bacteria, food poisoning 199 Brain
bandaging 160 Bandages 236, 242–49 absence seizures 216
fractures 163 checking circulation 243 cerebral compression 144
sprains 140–41 choosing correct size 244 concussion 144
Anus, bleeding from 116 elbow and knee 246
Approved Code of Practice first aid kit 236–37
(ACOP) 280 general rules 242–43
hand and wrist 247
282

INDEX

Brain continued Cardiopulmonary resuscitation Circulatory system continued
head injury 144–45 see CPR children 76–79, 260–61,
heatstroke 185 infants 82–83, 260–61
meningitis 220, 266–67 Carotid pulse 53 problems 112–13, 212
nervous system 142–43 Cartilage 135 anaphylactic shock 223
oxygen deprivation 54, 59 Casualties fainting 221
seizures 216–17 heart disorders 210–11
skull fracture 144 assessing 31, 39–53, 256–57 internal bleeding 116
stroke 212–13 unresponsive 62, 70, 78 shock 112–13
see also Unresponsive casualty pulse 53
dealing with 19–21
Breathing examining 49–51 Cleansing wipes 237
agonal 59 handling 234 Clips 237
airway obstruction 93 monitoring vital signs 52–53
asthma 102, 268–69 moving 234 securing roller bandages 244
checking 44, 52 multiple 31 Closed fractures 136
unresponsive adult 63 passing on information 23
unresponsive child 73 removing clothing 232 treatment 137
unresponsive infant 81 resisting help 20 Clothing
circulatory system 56 unresponsive 54–87
croup 103 see also Emergencies on fire 33
examining for injury 49, 50 Central nervous system 143 improvised slings 253
fume inhalation 98–99 Cerebral compression 144 removing 233
hyperventilation 101 Cerebrospinal fluid 143 Clotting, blood 110
opening airway 59 Cheekbone fractures 147 Cocaine, overdose 201
adults 63 Chemicals Cold
children 73 burns 172, 179–80 burns 172
infants 80 CS spray 181 frostbite 189
rescue breathing 59 Hazchem symbols 31 hypothermia 186–88
adults 68–69 in eye 180, 199 temperature control 171
children 76–77 inhaled gases 199 Cold compresses 241
infants 82–83 pepper spray 181 Collar bone, fractures 148
respiratory system 91 on skin 199 Colles’ fracture 152
swallowed poisons 200 Coma see Unresponsive casualty
Broad-fold bandages 249 Chest, “flail-chest” injury 154 Compresses, cold 241
Bruises 111 Chest compressions 57 Concussion 144
adults 66–67, 70–71, 258–59 Consciousness see Response, levels of,
cold compresses 241 chest-compression-only CPR 70–71, and Unresponsive casualty
treatment 119 Contusions 111
Bullet wounds 111 children 78 Convulsions
Burns 172–81 children 77–78, 261 see Seizures
airway 177 infants 83, 261 Coral stings 207
assessing 172–73 pregnant casualties 68 Cornea, flash burns 181
chemical 179–80 Chest injuries Coronary arteries 210–11
depth 173 penetrating wounds 104–05 CPR 57
dressing 176 ribcage fractures 154 adults 66–71, 258–9
electrical 172, 178 Chest pain 104, 210, 211 chest-compression-only 70–71,
emergency first aid 274–75 Childbirth 228–29
flash burns to eye 181 miscarriage 208, 228 258–59
minor burns and scalds 176 stages 228 in children 78
severe burns and scalds 174–75 Children children 76–79, 260–61
sunburn 183 chest compressions 77–78, 259 infants 82–83, 260–61
swallowed poisons 200 choking 95, 264–65 Cramp 167
Bystanders 29–31 croup 103 stitch 226
dealing with 19 Crash helmets, removing 233
C dehydration 182 Cross infection, preventing 16–18
nosebleeds 124 Croup 103
Capillaries recovery positions 74–75 Crush injuries 118
bleeding 110 rescue breathing 76–77, 260–61 CS spray injury 181
circulatory system 90, 108 resuscitation 61, 72–79, 260–61 Cuts 119
seizures 218, 276–77
Car accidents see also Infants D
see Traffic accidents Choking 94–96
adults 94 Defibrillators 54, 84–87
Carbon dioxide children 95 Dehydration 182
hyperventilation 101 emergency first aid 264–67
inhalation of 98 infants 96 vomiting and diarrhoea 227
respiratory system 90 Circulatory system 56, 90, 108–09 Delayed reactions 25
checking circulation after bandaging Delivery, childbirth 228–29
Carbon monoxide 33 Diabetes, insulin pen for 48
inhalation of 98 243 Diabetes mellitus 214, 214–15
CPR, adults 66–71, 258–59
Cardiac arrest 84 hyperglycaemia 214
in water 36 hypoglycaemia 208, 215, 278–79

283

INDEX Eyes 192 Fractures 136–38
chemical burn 179–80 closed fractures 136
Diarrhoea 227 examining for injury 49 treatment 137
Digestive system flash burns 181 emergency first aid 274–75
foreign objects 196 open fractures 136
diarrhoea 227 incapacitant spray injury 181 treatment 138
food poisoning 199 sterile eye pads 235 protruding bone 138
vomiting 227 wounds 123 stable fractures 136
Dislocated joints 139 type of
shoulder 149 F ankle 162–63
Dressings 235, 238–41 arm 150–52
adhesive 241 Face collar bone 148
applying 239–41 burns 175, 177 facial 146–47
burns 175 examining for injury 50 foot 166
first aid kit 235 fractures 146–47 hand 153
gauze 240 hip 160–61
improvised 240 FAST test 212, 262 leg 160–63
non-sterile 240 Face shields and masks 236 pelvis 155
sterile 235 ribcage 154
for rescue breathing 69, 79 skull 144
applying 239–40 Fainting 221 spine 157–59
Drowning 100 Febrile convulsions 218 unstable fractures 136
Drugs Feet
Frostbite 189
administering 24 bandaging: triangular bandages 250 Fuels, inhalation of 98
assessing a casualty 48 checking circulation 243 Fumes 33
poisoning 199 cramp 167
Drunkenness 202 examining for injury 51 inhalation of 98–99
fractures 166
E frostbite 189 G
Femur 132
Ears 193 fractures 160–61 Gases, inhaled 199
bleeding from 124 Fever 219 Gauze pads 237
earache 225 febrile convulsions 218 Germs, cross infection 16–18
examining for injury 49 Fibroblast cells 110 Gloves, disposable 236
foreign objects 197 Fibula 132 Glue, poisoning 199
internal bleeding 116 fractures 162–63 Grazes 111
“Fight or flight response” 15
Ecstasy Fingers treatment 119
heat exhaustion 184 fractures 153 Gunshot wounds 111
heatstroke 201 frostbite 189
overdose 199 wounds 126 H
tubular bandages 248
Elbows see also Hands Haemorrhage see Bleeding
bandaging 246 Fires 32–33 Hallucinogens, overdose 199
bleeding from joint crease 127 burns 172 Handling and moving casualties 234
injuries 151 smoke inhalation 98–99 Hands
First aid 11–37
Elderly people being a first aider 14–15 bandaging
hypothermia 188 emergency first aid 254–79 roller bandages 247
giving care with confidence 15 slings 252
Electrical injuries 34–35 looking after yourself 16–18 triangular bandages 250
burns 168, 178 materials 235–53
high voltage 34 priorities 14 bones 132
lightning 35 regulations and legislation 280 checking circulation 243
low-voltage 35 First aid courses 11 injuries 153
First aid kit 235–37 palm wounds 127
Elevation slings 252 Fish-hooks, embedded 195 see also Fingers
Emergencies, action at 19–37 Fits 216–18 Hanging 97
“Flail-chest” injury 154 Hazchem symbols 31
assessing casualty 39–53, 256–57 Food poisoning 199 Head injuries 144
assessing situation 28 Foot see Feet cerebral compression 144
controlling bystanders 29 Forearm, injuries 152 concussion 144
electrical injuries 34–35 Foreign objects 190–97 emergency first aid 272–73
emergency first aid 254–79 in ear 197 examining for 49
fires 32–33 in eye 196 scalp wounds 122
major incidents 37 in nose 197 skull fracture 144
moving casualties 234 Foreign objects continued wounds 122
multiple casualties 31 swallowed 195 Headache 224
telephoning for help 22 in wounds 115, 121 Headgear, removing 233
traffic incidents 30–31 Health and Safety (First Aid)
triage 37 Regulations (1981) 280
water rescue 36
Emotions, after an incident 24–25
Epiglottitis 90
Epilepsy 216–17
drugs 48
Epinephrine see Adrenaline

284

INDEX

Heart Infection continued Ligaments continued
cardiac arrest 84 in wounds 120 sprains 140–41
circulatory system 56, 90–91, 108–09
disorders 210–11 Information, passing on 23 Lighter fuel, poisoning 201
angina 210 Inhalation Lightning 35
heart attack 211 Limbs see Arms; Legs
emergency first aid 262–63 fumes 98–99 Lips, burned 200
heartbeat 108 gases 199 “Log-roll”, moving casualties 159
restoring rhythm 59 respiratory system 91 Low-voltage electricity 35
defibrillators 59, 84–85 Inhalers, asthma 48, 102 LSD, overdose 201
see also Resuscitation Injuries, mechanisms of 42–43 Lungs 90
Insects
Heat in ears 197 airway obstruction 93
body temperature 171 stings 190, 204–05 asthma 102
heat exhaustion 184 Insulin penetrating wounds 104–05
heatstroke 185 diabetes mellitus 214 respiratory system 90–91
sunburn 183 pen for diabetes 48
Internal bleeding 116 M
Helicopter rescue 29 Intervertebral discs 133, 155
Helmets, removing 233 Major incidents 37
Help, requesting 22–23 J Marine stings 190, 207
Hepatitis Masks, in rescue breathing 69, 79
Jaw thrust 159 Mass gatherings 280
B 16 Jaws Mechanisms of injuries 43
C 16 Medical warning jewellery 48
human bites 203 dislocation 147 Medication see Drugs
Heroin, overdose 201 fractures 147 Meningitis 220, 266–67
High-voltage electricity 35 Jellyfish stings 207 Menstrual bleeding 128
Hip fractures 160–61 Joints 135 Migraine 224
HIV 16 injuries Miscarriage 128, 208, 228
human bites 203 Monitoring vital signs 52–53
Hooks, fish 195 dislocation 139 Morphine, overdose 201
Hormones, “fight or flight response” 15 elbows 151 Mosquitoes 205
Hornet stings 204 fingers 153 Mouth 198
Human bites 190, 203 knees 164
Humerus 132 shoulders 149 bleeding from 125
Hygiene sprains 140–41 burned lips 200
childbirth 229 wrists 152 examining for injury 50
preventing cross infection 16–18 wounds in creases 127 insect stings 204, 205
Hyperglycaemia 214 internal bleeding 116
Hyperventilation 101 K knocked-out tooth 125
Hypoglycaemia 208, 215 sore throat 225
emergency first aid 278–79 Ketamine, overdose 201 toothache 225
Hypothermia 186–88 Kidney failure, “crush syndrome” 118 Mouth-to-mouth breathing
Hypoxia 92 Knees see Rescue breathing
Mouth-to-nose rescue breathing 69, 79
I bandaging 246 Mouth-to-stoma rescue breathing 69
injuries 164 Moving casualties 234
Ice packs 241 Knots, bandages 250 hip and thigh injuries 160–61
Immunisation 16 lower leg injuries 162–63
Impalement 117 L “log-roll” 159
Improvised dressings 240 splints 160
Improvised slings 253 Labour, childbirth 228–29 Multiple casualties 31
Incapacitant spray exposure 181 Lacerations 111 Muscles 134
Incised wounds 111 Legislation 280 ruptures 140
Industrial chemicals 199 Legs stitch 226
Infants strains 140–41
bandaging 243 tears 140
assessing casualties 80 cramp 167
childbirth 228–29 examining for injury 51 N
choking 96, 266–67
dehydration 182 hip and thigh 160–61 Nails, checking circulation 243
hypothermia 188 knee 164 Narcotics, overdose 201
pulse 53 lower leg 162–63 Narrow-fold bandages 249
recovery position 81 varicose veins 129 Neck
rescue breaths 82, 260–61 immobilising 243
resuscitation 61, 82–83, injuries back pain 156
amputation 117 examining for injury 50–51
260–61 ankle sprain 140–41, 165
Infection Level of response spinal injury 157–59
impaired 144 whiplash injury 42
childbirth 229 monitoring 52 Needles, sharps containers 18
cross infection 16–18 Ligaments 135
shoulder injuries 149

285

INDEX

Nervous system 142–43 Pregnancy Resuscitation continued
seizures 216–17 childbirth 208, 228–29 choking 94–96
children 218 miscarriage 228 defibrillators 84–86
spinal injury 157–59 infants 61, 80–83
stroke 212–13 Pulse, checking 53 chest compressions 83, 261
structure 142–43, 155 Puncture wounds 111 CPR 80–81, 260–61
see also Brain; Unresponsive casualty rescue breathing 80–81, 260–61
animal bites 203 sequence chart 61
Nose 193 marine stings 207 priorities 57–8
examining for injury 50 snake bites 206 recovery position 64–65, 74–75, 81
foreign object in 197
fractures 147 R Ribcage, fractures 154
internal bleeding 116 “RICE” procedure, strains and sprains
mouth-to-nose rescue breaths Rabies 203
69, 79 Radial pulse 53 140, 141
Radiation burns 172 Road accidents
Nosebleed 124, 147 Radius 132
see Traffic incidents
O fractures 152 Roller bandages 236
Reactions, delayed 25
Open fractures 136 Recovery position applying 245–47
treatment 138 choosing correct size 244
adults 64–65 elbow and knee 246
Orifices, bleeding from children 74–75 securing 244
ear 123 infants 81 Ruptured muscles 140
mouth 125 spinal injuries 65, 75
nose 124 Red blood cells 109 S
vagina 128 Reef knots 250
Regulations, first aid 280 Safety
Over-breathing, Rescue breathing 59 emergencies 28, 30
hyperventilation 101 adults 66–69 fires 32
moving casualties 234
Overdose, drug 201 with chest compressions 66–69 personal 14
Oxygen children 76–79 traffic incidents 30

breathing 56 with chest compressions 76–77 Safety pins
circulatory system 56, 90 face shields 69, 79 securing roller bandages 244
hypoxia 92 infants 82–83
respiratory system 90–91 Scalds 172
with chest compressions 83 minor burns and scalds 176
P mouth-to-nose 69, 79 severe burns and scalds 174–75
mouth-to-stoma 69
Painkillers, overdose 201 pocket masks 69, 79 Scalp
Palm wounds 127 Respiratory system 88–105 examining for injury 50
Panic attacks, hyperventilation 101 airway obstruction 93 wounds 122
Paracetamol, overdose 201 asthma 102, 268–69
Pelvis breathing 91 Sciatica 156
choking 94–96 Scissors 237
examining for injury 51 croup 103 Scorpion sting 205
fractures 155 disorders 92–105 Sea anemone stings 207
Pepper spray injury 181 drowning 100 Sea creatures, stings 207
Peripheral nerves 143 hanging and strangulation 97 Sea urchin spines 207
Personal belongings 21 hyperventilation 101 Seizures
Pins 237 hypoxia 92
Placenta, delivery of 228, 229 inhalation of fumes 98–99 absence seizures 216
Plants, poisonous 199 inhaled gases 199 in adults 216–17
Plasters 235 penetrating chest wounds 104–05 in children 218
applying 241 Response, levels of 52 emergency first aid 276–77
Platelets 109–10 AVPU 52, 144 Sensory organs 192–93
Pneumothorax 104 checking level of response 52 Serum 110
Poisoning 190, 198–202 impaired response 144 Sexual assault 128
alcohol 202 See also Unresponsive casualty Sharps containers 18
chemicals on skin 199 Resuscitation Shock 112–13
drugs 201 adults 62–71 anaphylactic shock 223, 268–69
emergency first aid 278–79 burns and 172
food 199 chest compressions 66–71, 258–59 emergency first aid 274–75
in eye 199 chest-compression-only CPR 70–71 Shoulders
inhaled gases 199 CPR 66–71, 258–59 dislocation 139
injected poisons 199 rescue breathing 68–69, 259 injuries 149
plants 199 sequence chart 60 Signs, assessing a casualty 51
swallowed poisons 199, 200, children 72–79 Skeleton 132–33 see also Bones
chest compressions 77–79, 261 Skin
278–79 CPR 76–77, 260–61 allergies 222
types of poison 199 rescue breathing 76–77, 79, bites and stings 203–07
Portuguese man-of-war burns and scalds 172–81
stings 207 260–61 chemical burns 179, 199
sequence chart 61 embedded fish-hooks 195
286

examining for injury 50 Teeth continued INDEX
splinters 194 sockets, bleeding 125 Unresponsive casualty continued
structure 170 toothache 225
sunburn 183 infant 81
temperature control 171 Telephoning for help 22–23 seizures in adults 216–17
Skull 133 Temperature, body 171 seizures in children 218
examining for injury 50 skull fracture 144
fractures 144 fever 219 spinal injury 157–59
see also Head injuries frostbite 189 stroke 212–13
Slings 251–53 heat exhaustion 184 see also Resuscitation
elevation 252 Temperature continued Urethra, internal bleeding 116
improvised 253 heatstroke 185
Smoke 33 hypothermia 186–88 V
inhalation of 98–99 taking 53
Snake bites 206 Tendons 135 Vaginal bleeding 116, 128
Soft tissue injuries 140–41 shoulder injuries 149 childbirth 229
Solvents Tetanus 119, 203 miscarriage 228
inhalation of 98 Thermometers 53
poisoning 201 Thighs, fractures 160–61 Varicose veins, bleeding 129
Sore throat 225 Throat Veins 104
Spider bites 205 insect stings 204, 205
Spinal cord sore 225 bleeding 110
injuries 157 see also Airways varicose veins 129
nervous system 142–43 Tibia 132 Vertebrae 133
protection 142, 155 fractures 162–63 injuries 157
Spine 142 Tick bites 205 Vital signs, monitoring 52–53
back pain 156 Toes see Feet Vomiting 227
examining for injury 50–51 Tooth sockets, bleeding 125
spinal injury 157–59 Toothache 225 W
Traffic incidents 30–31
emergency first aid 272–73 safety 28, 30 Wasp stings 204
moving casualty 159 Tranquillisers allergy to 222
recovery position 65 overdose 201
Splinters 194 Transient ischaemic attack Waste material 18
Splints 160 (TIA) 212 Water
Sprains 140–41 Transporting casualties see Moving
ankle 140–41, 165 casualties drowning 100
cold compresses 141, 241 Travel, air travel 225 electrical injuries 35
finger 153 Triangular bandages 236, 249–53 hypothermia 186
shoulder 149 folding 249 rescue from 36
Stab wounds 111 hand and foot cover 250 Weever fish spines 207
Sterile dressings 235 reef knots 250 Whiplash injury 42
applying 239–40 slings 251–52 White blood cells 109
Stimulants, overdose 201 storing 249 “Wind chill factor” 186
Stings Tubular bandages 236 Windpipe see Airway
allergy to 222 applying 248 Work, first aid at 280–81
anaphylactic shock 223 Tweezers 237 Wounds
insects 204–05 abdominal 128
marine creatures 190, 207 U amputation 117
Stitch 226 animal bites 203
Stoma, mouth-to-stoma rescue breaths 69 Ulna 132 at joint creases 127
Strains, muscles 140–41 fractures 152 blood clotting 110
Strangulation 97 chest 104–05
Stress, looking after yourself 24 Ultraviolet light, flash burns cross infection 16–18
Stroke 212–13 to eye 181 crush injuries 118
emergency first aid 262–63 cuts and grazes 119
Sunburn 183 Umbilical cord, childbirth 229 dressing and bandaging 238–50
Surveying casualties Unconsciousness see Unresponsive emergency first aid 270–71
primary 44–45 eyes 123
secondary 46–48 casualty fingers 126
Survival bags 237 Unresponsive casualty foreign objects 115, 121
Swallowed poisons 200, 201 head injury 144–45
emergency first aid 278–79 cerebral compression 144 healing 110
Symptoms, assess a casualty 51 checking response 44, 62, 72, 80 impalement 117
choking 94–96 infection 120
T concussion 144 palm 127
diabetes mellitus 214, 215 scalp and head 122
Teeth emergency first aid 256, 258–61 severe bleeding 114–15
knocked out 125 examining 49–51 types of 111
impaired level of response 144 Wrist
penetrating chest wound 105 bandages 247
recovery position injuries 152

adult 64–65 287
child 74–75

ACKNOWLEDGMENTS

ACKNOWLEDGMENTS

AUTHORS OF REVISED 10TH EDITION TRIPARTITE COMMERCIAL COMMITTEE
St John Ambulance St John Ambulance
Dr Margaret Austin dstj lrcpi lrsci lm Andrew New
Chief Medical Adviser Head of Training
Richard Fernandez
St Andrew’s First Aid Head of of Public Affairs
Mr Rudy Crawford mbe bsc (hons) mb chb frcs Deji Soetan
(glasg) frcem Marketing Manager
Chairman of the Board
St Andrew’s First Aid
British Red Cross Grant MacKintosh
Dr Barry Klaassen bsc (hons) mb chb frcs (edin) National Sales Manager
frcem Laura Dennett
Chief Medical Adviser Marketing and Fundraising Executive
Dr Vivien J. Armstrong mbbs drcog frca pgce (fe) Jim Dorman
Operations and Policy Director
CONTRIBUTORS TO THE REVISED 10TH EDITION
Dr Meng Aw-Yong bsc mbbs dfms dfmb British Red Cross
Medical Adviser, St John Ambulance Patrick Gollop
Jim Dorman Head of Training
Operations and Policy Director, St Andrew's First Aid Paul Stoddart
Joe Mulligan Marketing Manager
Head of First Aid Education, British Red Cross

AUTHORS’ ACKNOWLEDGMENTS

The authors would like to extend special thanks to: St John Ambulance Clinical Directorate – Sarah Flynn Project Assistance;
St Andrew's First Aid – Stewart Simpson Training Manager; British Red Cross – Christine Boase Product Development Manager, Marenka
Vossen Project Assistance First Aid Education, Tracey Taylor First Aid Education Development Manager.

PUBLISHERS’ ACKNOWLEDGMENTS

Dorling Kindersley would like to thank: Alex Lloyd for design assistance; Daniel Stewart for organising locations for photography; Bev
Speight and Nigel Wright of XAB Design for art direction of the original photography shoots.

Dorling Kindersley would also like to thank the following people who appear as models:
Lyndon Allen, Gillian Andrews, Kayko Andrieux, Mags Ashcroft, Nicholas Austin, Neil Bamford, Jay Benedict, Dunstan Bentley, Joseph
Bevan, Bob Bridle, Gerard Brown, Helen Brown, Jennifer Brown, Val Brown, Michelle Burke, Tamlyn Calitz, Tyler Chambers, Evie Clark, Tim
Clark, Junior Cole, Sue Cooper, Linda Dare, Julia Davies, Simon Davis, Tom Defrates, Louise Dick, Jemima Dunne, Maria Elia, Phil Fitzgerald,
Alex Gayer, John Goldsmid, Nicholas Hayne, Stephen Hines, Nicola Hodgson, Spencer Holbrook, Jennifer Irving, Dan James, Megan Jones,
Dallas Kidman, Carol King, Ashwin Khurana, Andrea Kofi-Opata, Andrews Kofi-Opata, Edna Kofi-Opata, Joslyn Kofi-Opata, Tim Lane, Libby
Lawson, Wren Lawson-Foley, Daniel Lee, Crispin Lord, Danny Lord, Harriet Lord, Phil Lord, Gareth Lowe, Mulkina Mackay, Ethan Mackay-
Wardle, Ben Marcus, Catherine McCormick, Fiona McDonald, Alfie McMeeking, Cath McMeeking, Archie Midgley, David Midgley, Eve Mills,
Erica Mills, Gary Moore, Sandra Newman, Matt Robbins, Dean Morris, Eva Mulligan, Priscilla Nelson-Cole, Rachel NG, Emma Noppers, Phil
Ormerod, Julie Oughton, Rebekah Parsons-King, Stefan Podohorodecki, Tom Raettig, Andrew Roff, Ian Rowland, Phil Sergeant, Vicky Short,
Lucy Sims, Gregory Small, Andrew Smith, Emily Smith, Sophie Smith, Bev Speight, Silke Spingies, Michael Stanfield, Alex Stewart, Adam
Stoneham, David Swinson, Hannah Swinson, Laura Swinson, Becky Tennant, Laura Tester, Pip Tinsley, Daniel Toorie, Helen Thewlis, Fiona
Vance, Adam Walker, Jonathan Ward, David Wardle, Dion Wardle, Francesca Wardell, Angela Wilkes, Liz Wheeler, Jenny Woodcock, Nigel
Wright, Nan Zhang.

Picture credits Dorling Kindersley would like to thank the following for their kind permission to reproduce their photographs: Getty
Images: Andrew Boyd 168–69.

All other images © Dorling Kindersley. For further information see www.dkimages.com

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