FTACC

First Aid Trauma & Casualty Care © 2020 The ATACC Group Ltd. All Rights Reserved. TAG015_FTACC-MANUAL_V1.1 For further information Call: 03333 222 999 Email: [email protected] www.ataccgroup.com

1 FirstAidTrauma&CasualtyCareThe FTACC course is provided by The ATACC Group First Aid Trauma & Casualty Care Manual

© 2020 The ATACC Group Ltd. All Rights Reserved. For further information Call: 03333 222 999 Email: [email protected] www.ataccgroup.com Empowering People to Save Lives.

For further information Call: 03333 222 999 Email: [email protected] www.ataccgroup.com © 2020 The ATACC Group Ltd. All Rights Reserved.

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 1 FTACC First Aid Trauma and Casualty Care Integrated Emergency Care Programme (IECP) AUTHOR Dr Mark Forrest is the Medical Director and joint founder of The ATACC Group and an NHS Clinical Director in Critical & Medical Care, Consultant in Anaesthetics, Critical and Pre-Hospital Emergency Medicine. Mark is the Medi-cal Advisor for several Police Forces and Fire & Rescue Services throughout the UK and is a Consultant on Helimed 29 Lincolnshire and Nottinghamshire Air Ambulance. CONTRIBUTORS The Anaesthetic Trauma and Critical Care (ATACC) Faculty and Integrated Emergency Care Pro-gramme (IECP) Instructors have made significant contributions to our education offering including the FTACC manual. They include Medical, Clinical and Nursing Educators and Casualty Care Trainers who provide varying levels of pre-hospital and in-hospital emergency and critical care in a wide variety of settings around the world. Dr Halden Hutchinson-Bazely | Anaesthetist and Prehospital Critical Care Doctor, RAF Doctor Dr Jason Van De Velde | Prehospital Emergency Medicine and Critical Care Retrieval Physician Phil Keating | Technical Rescue Specialist and Enhanced Community First Responder BODY OF MEDICAL OPINION In addition to our Medical Director, Contributors and ATACC Faculty. We have a Body of Medical Opin-ion who oversee the content of the manual to ensure it maintains validity and reflects the latest global medical evidence base relevant to first aid. Dr Rob Greenhalgh | Senior Emergency and Prehospital Care Doctor with a background in Medical Education Alistair Greenough | Nurse, Emergency Department Practice Educator and Mountain Rescue Team Member Toby McClane | Paramedic with a background in Prehospital Medical Education, Police PHEM and Medical Rescue Liz Midwinter | Emergency Department Nurse Clinician and Advanced Care Practitioner Lead Dr Jill Selfridge | Consultant Anaesthetist with a background in international retrieval medicine Dr James Tooley | Consultant in Prehospital Critical Care and Neonatal/Paediatric Retrievalist Dr Drew Welch | Consultant and Air Ambulance/Prehospital Critical Care Doctor First Aid Trauma and Casualty Care

2 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Core material Chapter 1 - Introduction Chapter 2 - Safety Chapter 3 - Calling for Help Chapter 4 - Immediate Assessment – B.U.R.P.S Chapter 5 - Bleeding – B.U.R.P.S Chapter 6 - Major Bleeding – B.U.R.P.S Chapter 7 - Unconscious / Very Drowsy – B.U.R.P.S Chapter 8 - No Signs of Life Chapter 9 - Respiratory Distress – B.U.R.P.S Chapter 10 - Pain or Numbness – B.U.R.P.S Chapter 11 - Skin – Appearance & Temperature – B.U.R.P.S Table of Contents: First Aid Trauma and Casualty Care

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 3 The FTACC Course Introduction First Aid trainers are the key to empowering people to save lives and we believe that our first aid programme which is designed by a large faculty of healthcare professionals will help unlock the potential of everyone to make a positive impact on casualty recovery. Whilst the key skills are unchanged, what makes FTACC different isn’t just how we deliver the training, reinforce it and keep the candidates engaged but our new innovative easy assessment method that outlines the most effective course of action that a first aider can take to best help the casualty. Our first aid community delivers the same first aid programme as the emergency services who have already adopted our methodology and aims to empower individuals to feel confident and effective in saving lives and helping the injured, be it at work or in the street. The course has been developed as the first ‘enhanced’ level of The ATACC Group’s four part ‘Integrated Emergency Care Programme’ (IECP) and has been written by specialists in the field of pre-hospital and critical care medicine. The advanced level of IECP is the ATACC course, which has been running for nearly 20 years, has a considerable international reputation and is fully accredited and approved by the Royal College of Surgeons, London (Re-assessed and accredited in 2016-17). Following completion of FTACC, individuals or organisations can then proceed to the higher level of training called BTACC (Basic Trauma & Casualty Care). Dr Mark Forrest The ATACC Group Medical Director Chapter 1: Introduction

4 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Objectives The objectives of this course are clear and traditionally well defined by the Health and Safety Executive. The course must: 1. Inform the candidates about current Health and Safety regulations and how these impacts them at work. 2. Ensures that candidates can make an emergency call and know how to interact with the emergency services and prepare for their arrival. 3. Provide training in practical and effective first aid car. This has always been very simple and straight forward with the approved First Aid at work (FAW) course and training organisations registered with the HSE and approved to deliver the course. Whilst this was simple, it was also far from ideal, as one course simply cannot ’fit all’. For example, an office worker is unlikely to face the same first aid challenges as an operational police officer, a firefighter or a tree surgeon. Deregulation of First Aid at Work In October 2013 this all changed following the Lofstedt report produced by the HSE. This report made a number of key recommendations and based upon these the HSE deregulated first aid training. This means that the onus is now on the employer to ensure that the first aid training for their staff is relevant and fit for purpose. The challenge is therefore to determine the level of first aid training required and then finding a provider who can deliver training to that level, since many traditional providers may not be suitable for more advanced levels. To help with this process the HSE recommend that a risk assessment is conducted which will help to define the key skills and equipment that will be required for any given member of staff. The standards required in terms of the essential elements of FAW still remain and should be covered by any level of first aid training. As such, the traditional FAW is now effectively the minimum and some providers will inevitably go significantly beyond that level because of the nature of their work. Chapter 1: Introduction

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 5 RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 Whenever a serious accident has occurred at work not only is the first aid important, but also the reporting of the incident This will be added to a National database which will allow investigation, follow up or key learning. The reporting process is caller RIDDOR –Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 - which states that: • Accidents resulting in death of any person • Accidents resulting in injuries to workers • Non-fatal accidents requiring hospital for non-employees • Dangerous occurrences. By law, all of these have to be reported to the Health and Safety executive within 10 days of their occurrence by the designated Responsible Officer A Guide to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (Second edition) HSE Books 1999 ISBN 0 7176 2431 5 Chapter 1: Introduction

6 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Chapter 1: Introduction ATACC is currently the most advanced trauma & critical care course in the life-support style available in the world. Developed over the last 20 years by a large international faculty, ATACC is world renowned for it’s high quality lectures, ground breaking immersive simulation with a focus on human factors and team development. The course is aimed at advanced level providers and covers both pre-hospital (up to FPHC PHEM level H) and in-hospital Major Trauma Centre standards. FTACC Emergency (1 Day) is a Royal College Of Surgeons of England (RCS England) accredited course that meets the Faculty of Pre-hospital Care (FPHC), Pre-hospital Emergency Medicine (PHEM) guidelines level B of The Royal College of Surgeons Edinburgh and is equivalent to Emergency First Aid at Work (EFAW). The objective of FTACC is to provide learners with basic first aid skills in a new and exciting way. FTACC (3 Day) is a Royal College Of Surgeons of England (RCS England) accredited course that meets the Faculty of Pre-hospital Care (FPHC), Pre-hospital Emergency Medicine (PHEM) guidelines level B of The Royal College of Surgeons Edinburgh and is equivalent to First Aid at Work (EFAW). The objective of FTACC is to provide learners with basic first aid skills in a new and exciting way, providing a more enhanced knowledge of basic first aid. BTACC is a Royal College Of Surgeons of England (RCS England) accredited course that meets the Faculty of Pre-hospital Care (FPHC), Pre-hospital Emergency Medicine (PHEM) guidelines level D of The Royal College of Surgeons Edinburgh. The objective of BTACC is to provide learners with a basic knowledge of casualty care and goes beyond First Aid at Work, giving learners the skills and knowledge to deal with life threatening situations. The course introduces blended learning and uses scenarios and immersive training to enhance the candidates experience and provide them with the confidence to use their new skills to save lives. RTACC is a Royal College Of Surgeons of England (RCS England) accredited course that meets the Faculty of Pre-hospital Care (FPHC), Pre-hospital Emergency Medicine (PHEM) guidelines level E of The Royal College of Surgeons Edinburgh. The objective of the course is to prepare learners to deal with more serious medical and trauma incidents in an immersive and engaging manner while developing their knowledge, skills and confidence. The learner will extend their knowledge beyond basic trauma and this course has the added benefit of being bespoke to meet the individual requirements of your organisation. The FTACC course is part of a The ATACC Group’s Integrated Emergency Care Programme (IECP) which is a progressive series of emergency care courses developed by The ATACC Group that runs seamlessly from basic through to the advanced level. The ATACC Group Integrated Emergency Care Programme (IECP)

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 7 Spare the audience In terms of the delivery, we will be using slides and Power Point, but we will not include vast amounts of writing. We will use pictures as much as we can and we will use text to simply highlight the key learning points to remember. We certainly don’t expect to see our candidates zoning out,’ and whilst we are not going to ask difficult questions or put anyone on the spot, we hope that many of the sections will generate healthy discussion and shared knowledge and experience in the group. We will also be moving about a lot. This course consists of short punchy lectures combined with scenarios and skills to practice or watch as key items are demonstrated. A few unpleasant images A number of the images in the course manual and lectures are quite graphic. We make no apology for this as first aiders need to be prepared for whatever they may face. All of our images have been carefully considered and selected for good reason. If you are affected by any of these images, mention it to you instructor and they will discuss it with you, or if necessary remove you from the course, as you may not actually be suitable for first aid training. Chapter 1: Introduction

8 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Providing First Aid Safety? Safety is our greatest priority for both you and the casualty The first step in delivering effective first aid is to be safe yourself. Although, this may sound so easy and obvious now, in reality when confronted with someone in severe distress, especially someone you know, or perhaps a child, first aid providers can forget the simplest and most obvious safety principles. Our world is dominated by health and safety and many of you may feel that we live in a ‘nanny state’ where we wrap people in cotton wool. Signs, rules, restrictions and limits are everywhere but as first aiders we will often face injured people who have ignored the warnings. Sometimes there may not even be any warnings and therefore we have to be extra vigilant to avoid becoming a casualty ourselves.

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 9 Appreciate the risks Every environment we find ourselves in or face as first aiders has risks, whether it be within a kitchen or in industry. Even simple domestic products found in the kitchen or bathroom, for example, can cause burns, eye injuries, breathing problems from fumes or fires. Similarly, devices and machines can also cause serious injury if they are faulty, misused or safety procedures are ignored. In industry, this is an even greater problem as chemicals can be far more concentrated and machines can be larger and more dangerous. Yet again, for a first aider the appreciation of any such risks is all the more important, especially if called to a place or area where you do not normally work. Following an accident, good health and safety may be even more important to prevent further injuries. LEVEL OF RISK? • Nature of work • Environmental • Personal training & PPE • Failure to follow SOPs Chapter 2: Safety

10 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com NATURE OF WORK / ENVIRONMENT If we consider the level of risk, this may be obvious or actually quite subtle, yet still very high. If we consider the nature of work, it is obvious that being a lion keeper and entering the lion’s den each day has very real risks. Similarly, if you work in confined spaces such as a ships engine, then many of the risks are clear and obvious. However, what if you work in a busy coffee shop? Are there any risks? Clearly there are, and although initially you may view them as trivial, bear in mind the fact that you are working with boiling water, steam under pressure, in an environment with wet floors combined with demanding customers from a seemingly never-ending queue. All this plus fatigue and you have the makings of a very dangerous environment. Increased risk? Chapter 2: Safety

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 11 NATURE OF WORK / ENVIRONMENT Even working in an office has risks. These may seem trivial and perhaps they are in comparison to the role of the lion keeper, but they still exist and have the potential to cause real harm. Some of that harm could be minor but cause significant effects, such as repetitive strain injury, but some of it, such as the following, could also be serious: • Electrical fires • Falls downstairs • Slips and trips • Broken glass • Office related injuries • Kitchen related injuries. These are all potential hazards that we could face even in an office environment. The key issue here is that whilst the risks may be far lower than in other industries, hazards exist everywhere and are often not marked or obvious. Increased risk? Chapter 2: Safety

12 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Another key factor is the use of safety equipment. Risks may have been identified, clearly defined and safety equipment can have been provided, but if staff don’t have it, don’t use it or are not trained to use it, those risks have not been mitigated and injury or death is far more likely. You would not expect a steeplejack or rigger not to be wearing all his safety equipment, since the risks of falling are so great. However, he may argue that he is entirely comfortable at height and for a quick and easy job, he does not consider the risk that great. Rules and safety devices are there for a reason, and this is even more important where you may not appreciate the hazards. A crucial part of your safety may be to simply accept that you cannot enter a dangerous area without the necessary training and equipment e.g. a house fire. BASIC LEVEL (PPE) The simplest personal protect equipment (PPE) you will wear as a first aider are gloves, which protect you as well as the casualty. Gloves protect you from contact with blood and body fluids and protect the casualty from the risks of infection from your hands. ADVANCED LEVEL (PPE) At the other extreme, PPE may be there to protect you from some very hazardous materials and therefore must be worn and used correctly with no short cuts or changes. This can be frustrating if the equipment is difficult to wear or operate in, or the environment is very warm or humid. In these situations, training can help to better prepare the individuals. A real awareness of rescuer welfare is crucial to avoid exhaustion or excessive fatigue. INFECTION Other than scene related risks, blood and body fluids present the most significant risk to the first aider and everyone needs to be aware of these risks in order to protect themselves adequately. Body fluids can potentially transmit infection. The most significant risks are from blood borne viruses (BBV) such as Hepatitis B, C and HIV. However, the greatest risks occur from needle-stick injuries. Getting blood onto your skin is highly unlikely to cause a serious infection unless you have cuts and open wounds, in which case you should seek medical advice if contaminated. The other risk is called mucous membrane contamination, which is basically any area of your skin that has a moist lining e.g. mouth, eyes. If infected body fluids or blood comes into contact with these areas of your body, you should also seek medical advice. The incidence of BBV infections in the UK population is less than 1%, so the vast majority of casualties will present no serious risk to you. However, it is impossible to predict that risk. We should be aware that IV drug abusers or known infected patients do present a greater risk, but you may not have this information when you reach a casualty. The key is to protect yourself: • Use gloves • Wear eye or face-shields if there is a risk of splash or spurting • Take care when cleaning up contaminated areas • Clear guidance is available on the HSE website which should be read and adapted for the potential risks in your working environment. Increased risk? Personal - Training & PPE Chapter 2: Safety

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 13 The following points apply regardless of the scale of the spillage: • Gloves should be worn throughout and should be discarded safely after use • If there is broken glass present, it is essential that the fragments are not gathered up by hand either before or after treatment with disinfectant. Bunches of paper towels or newspaper, pieces of card or a plastic dustpan should be used to remove the fragments to a safe container without risk of injury. Small spots of blood or small spills: • Gloves should be worn and cuts or open wounds on exposed skin covered with a waterproof dressing • Contamination should be wiped up with a paper towel soaked in freshly prepared hypochlorite solution containing 10,000ppm available chlorine • Towels and gloves should be placed in a clinical waste bag for incineration and hands washed. For larger spills other than urine (unless the urine is bloodstained). If spillage is extensive: • Disposable plastic overshoes or rubber boots may be necessary • If splashing is likely to occur while cleaning up, other protective clothing should be worn • Liquid spills should be covered with dichloroisocyanurate granules and left for at least two minutes before clearing up with paper towels and/or a plastic dustpan • Alternatively, the spill may be covered with paper towels and the contaminated area gently flooded with hypochlorite solution containing 10,000ppm available chlorine* (again this should be left for at least two minutes before attempting to clear up) • Towels, gloves, disposable overshoes and contaminated clothing should be placed in a waste bag for incineration and hands washed; (rubber boots may be decontaminated with dilute disinfectant) • Finally, the area should be washed with water and detergent and allowed to dry • In open areas, for example playgrounds and roadways the spillage should be hosed down with large amounts of water. Heavily contaminated clothing should be considered high risk and should be professionally laundered to remove all risk of infection transmission. Useful references and advice: www.hse.gov.uk/pubns/indg342.pdf Immunisation against infectious diseases – ‘The Green Book’, 2006 Edition, HMSO, ISBN 9780113225286. Hepatitis B information is available at link: http://www.dh.gov.uk/ prod_consum_dh/idcplg?IdcService=GET_FILE&dID=11 5985&Rendition=Web) A summary of requirements designed to protect health care workers from BBV exposure is provided in The Health Act 2006: Code of practice for the prevention and control of healthcare associated infections -known as The Hygiene Code Guidance on Personal Protective Equipment at Work Regulations 1992. L25 HSE Books 2005 ISBN 0 7176 6139 3 Health Protection Agency - Reporting of occupational exposure to blood borne viruses – history and how to report Safe Management of Healthcare Waste (2007). Royal College of Nursing. ISBN 978 1 904114 76 5. http://www.rcn.org.uk/__data/ assets/pdf_file/0013/111082/003205.pdf *Note that urine may promote the release of free chlorine from the treated area when hypochlorite or other chlorine-containing compounds are applied. Ventilation of the area will be necessary. Increased risk? Personal - Training & PPE Chapter 2: Safety

14 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Injuries and deaths can occur as a failure to follow standard operating procedures (SOPs), rules or simple safety guidance. These include many of the issues raised above but also involve many of the wider practices at work, which if not adhered to correctly, may result in serious injuries that a first aider may face. APPRECIATE ANY INCREASED RISKS TO YOU At the very least there is a need for a clear appreciation of the risk involved with the work you are doing, especially if working with hazardous materials. Is the containment vessel suitable? Simply washing these materials down the drain is neither appropriate or acceptable as there could be huge environmental and public safety issues somewhere further down the water course. Training plays an essential part in this. If you are untrained or not suitably equipped, do not take on the task. This includes first aid, as discussed above. INDUSTRIAL SPILLAGE Where procedures have not been followed, an incident such as a chemical spillage can occur and a casualty may already have been involved. Here the SOPs and the safety or emergency procedures are even more important to prevent further casualties occurring, and to ensure that any casualties are given the best opportunity of being helped or saved. If in doubt then call the experts in your organisation or call the emergency services. SCHOOL LAB Even a chemical spill on a much smaller scale, such as a school laboratory, can still have huge significance and risk if badly managed. A clear protocol or SOP should exist for any dangerous material to define the response if a spillage or accident should occur. In doing this, the incident can often be managed easily and safely without increased risk to anyone. If in doubt, evacuate the area and call the Emergency Services. SAFE APPROACH As discussed earlier in the chapter, some hazards are obvious and we need little convincing not to rush in, but others may not be so obvious. A good example are water rescues. Every year people die attempting to rescue others who have got into difficulty in lakes or open water. The rescuers, who are often strong swimmers, enter the water confident that they can help, but as a result of the cold water, they often become victims themselves. Being within easy reach of the shore often gives a false sense of safety. DO NOT RUSH IN! Even domestic incidents can involve hazards. If you see someone who has collapsed, hold back for a moment and take a look at the scene. What hazards can you see? Why has this person been injured or collapsed? This should not delay us excessively as we obviously need to reach the casualty, but do not rush in and do not under-estimate the dangerous effects of doing so, even for experienced rescuers, especially if the casualty is a child or a loved one. DO NOT BECOME A CASUALTY YOURSELF The best you may be able to do for the casualty is to make an emergency call to get professional help quickly. Increased risk? Failure to follow SOPs Chapter 2: Safety

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 15 1950’S STYLE SAFETY The image above is a 1950’s view of a ‘safe approach.’ to demonstrate the dangers of electricity and electrocution and to highlight the risks to any rescuer if the power is still turned on or the casualty is still in contact with the source. Increased risk? Failure to follow SOPs 21ST CENTURY This is a 21st century equivalent safety advertisement, which is typically more graphic and hard hitting. In some ways it appears to be less informative, but it is far more hard hitting in its message about electrical safety in the home and also approaching an electrocution victim on a wet floor, when the power may still be on. Chapter 2: Safety

16 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com THE CASUALTY MAY COME TO YOU As a first aider, many of your casualties will approach you and ask for help. This often gives you little time to think or prepare yourself, but if you follow the simple principles shown in this course, you will be able to quickly assess, react and manage the situation confidently. YOU MAY BE CALLED TO THE CASUALTY For other first aid situations you may be called to attend and assist. This may often be in an unfamiliar environment, which may take you out of your comfort zone. In such situations it is all the more important to remain calm and focused on your key principles and methods to avoid missing anything serious that you could identify and manage. INTRODUCE YOURSELF (AND MAKE EYE CONTACT) A crucial element of all first aid is the initial contact with the casualty. Introduce yourself with something such as “Hello, my name is….” and if at all possible make eye contact. Do not simply rush in and grab the casualty. I AM A TRAINED FIRST AIDER Make a clear statement that you are a first aider and that you are there to help. You can open the conversation by asking some general questions and this will also help you to assess what has happened. The following are good examples: • What has happened? • May I take a look at your injury? • Do you have any pain? • Where does it hurt? CAN I TRY TO HELP YOU? Consent can be a confusing area with patients who are injured, combative, disorientated or frightened. It is important that you offer your help and accept that it may be refused. It can come as quite a shock when a casualty refuses help or treatment either if they don’t actually want it, or alternatively because they are confused. It is important to respect the patient’s wishes wherever possible. However, if they refuse your help, but clearly need it for their injuries, you should try and talk them into allowing you to help, whilst awaiting professional support. DO NO HARM - DO SOMETHING A key message from this course is to not be afraid, since with your first aid skills you are highly unlikely to make a situation worse. You are more likely to fail your casualty by not getting involved or missing something potentially serious. The casualty Chapter 2: Safety

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 17 DO NOT ATTEMPT RESUSCITATION (DNAR) A dilemma that can present when attending a casualty you do not know is DNR or DNAR – ‘do not attempt resuscitation.’ In other words, for whatever reason, this person does not wish to be resuscitated in the event of a cardiac arrest. This can be found on medic-alert type bracelets or necklaces, but may also be found on tattoos. In addition, family members may thrust pieces of paper in front of you or declare that the patient is not for resuscitation etc. This can make the whole situation very stressful and confusing and even create fear about doing the right thing. It is difficult to give rigid guidance on this, as orders may have varying conditions or may not be legally binding. However, if the patient is refusing help or clearly has a medical bracelet or legal document from a solicitor stating that they are DNR/DNAR then this should be respected. However, in most other circumstances or if in doubt, do what feels right. This will usually mean starting resuscitation. Do what feels right, which will usually the be the wishes of the patient or the family. DO YOUR BEST Always remember to operate within the scope of your training and do your best, no one could ask anything more. The casualty Chapter 2: Safety

18 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Providing First Aid Calling for Help IMMEDIATE ASSESSMENT OF SITUATION CALL FOR HELP IMMEDIATE ACTIONS LEVEL OF RESPONSE REQUIRED - 999 An essential part of First Aid is to make an effective call for help. However, people are often confused about: • What to do first • How to make the call • What to say • What is needed. There is also the issue of how serious is the injury? FTACC approach - Level of response required

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 19 FTACC approach - Level of response required MINOR FIRST AID For example, an injury such as this laceration to the hand may look very nasty at first with significant bleeding and pain, but on closer inspection it is actually quite a small wound and quickly stops bleeding. However, there may be other things to consider which could be associated with the injury. In this case we would be concerned that there may be tendon injuries affecting finger movements or nerve injuries affecting sensation in the hand. FTACC will help you to make these decisions. Sometimes these may be obvious but on other occasions they could be more challenging. Chapter 3: Calling for Help LIFE SAVING FIRST AID – YOU MAY NEED HELP! In some situations it may be immediately obvious that the injury is very serious or even life threatening. FTACC will help you to identify these quickly and then to manage them in tried and tested ways which are known to work. As described above, FTACC will also guide you on how and when to call for help. This is a key element of this course, as unlike others, we will teach things which are effective and known to work, rather than more traditional skills, which we now know offer little true value, but have simply become the normal approach in many first aid courses.

20 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com CAN SOMEBODY HELP ME PLEASE ? An essential part of asking for help, especially when facing a life-threatening emergency is to shout out to attract the attention of anyone around you. This may mean actually shouting to be heard: HELP Depending upon where you are when the emergency occurs, there may be an emergency button or an automated emergency call such as a Fire Alarm or a cardiac arrest buzzer in the hospital. The emergency button may also stop a machine or halt a process which could prove to be life-saving, such as someone in serious difficulty trapped in a machine. such as an escalator or a lathe. FTACC approach - Level of response required Chapter 3: Calling for Help

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 21 Green usually does not require hospital treatment and can usually be managed with first aid skills. FIRST AID MEASURES GREEN DOES NOT USUALLY REQUIRE AMBULANCE OR HOSPITAL Yellow indicates the need for medical or nursing review. This may be a GP, a walk-in centre or hospital, but does not require a ‘999’ emergency response. You may be able to provide transport yourself, eliminating the need for an ambulance. Remember you can also call the ‘111’ NHS Helpline for advice. You may receive additional guidance and advice about the best place for the situation you are managing. DOCTOR/HOSPITAL YELLOW SUGGEST WHEN TO CONSIDER TRANSPORT TO HOSPITAL/GP - 111 RISK TO LIFE RED INDICATES WHEN THERE IS AN IMMEDIATE OR REAL RISK TO LIFE ‘999’ Ambulance Call Red suggest a life-threatening problem requiring immediate action or a ‘999’ emergency ambulance call, such as someone with severe chest pain. FTACC approach - Level of response required Chapter 3: Calling for Help One of the challenges for a first aider is what to manage yourself, what requires nursing or medical attention and finally what is a life- threatening situation. These may not always be as obvious as you might think. To help with this, throughout the course we will have colour coded slides.

22 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com To request an ambulance we have two choices, we can either call ‘999’ or call’ 112’ - both will immediately connect you to an emergency operator who will ask which service you require. Remember that you can even make an emergency call on anyone’s mobile phone, even if it is blocked.’ CALLING AN AMBULANCE Before actually making the call, take a second or two to compose your thoughts. • Which service do you require? Police, Fire or Ambulance • What has happened – explain in a short, concise fashion • When you ring they will usually know what number you are ringing from and they will usually repeat it to confirm your identity • Make sure that you know where you are and be as specific as possible • Be prepared for the operator to ask you questions which may appear to be unnecessary They are working through a well-defined process • Do not hang up unless they tell you to and do not be surprised if they ring you back. EVERYONE FEELS ANXIOUS Do not worry about feeling anxious. This is perfectly normal as people rarely ring the Emergency Services, and it will usually be a stressful situation that makes the call necessary. You may also feel like this when handing over to the ambulance paramedic or crew. Adrenaline will help you to respond to such an emergency but it will also make you shaky or anxious and you may feel your heart racing, but do not worry as this is normal. FTACC approach - Level of response required RISK TO LIFE Chapter 3: Calling for Help

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 23 ISBAR HANDOVER One way to perform the handover of the casualty details is to use something generally used in hospitals, called the SBAR handover. This sometimes extends to ISBAR with the ’I’ being included for ‘I am… To give your name and status’ The ISBAR acronym stands for: I – Introduce yourself S – The situation, as in what is the problem? B – What is the background, in terms of the preceding events or any known medical problems? A – Your assessment of the current situation? R – What response do you require? Consider an example of an elderly gentleman with crushing central chest pain who is clearly distressed. Let’s prepare our ISBAR message. SPECIFIC QUESTIONS? As discussed earlier, the ambulance control room staff will ask you a number of specific questions and may also give you specific advice. Listen carefully and if necessary put the phone on to ‘speaker mode,’ so that you can do as they request. AN AMBULANCE CAR WILL OFTEN COME FIRST The first ambulance to arrive for a serious emergency may be a car or ‘rapid response vehicle’ which will usually be driven by an experienced paramedic. This vehicle will not carry a casualty but will provide some immediate response for any serious emergency. It is essential that you have considered how the ambulance will find you, how they will access your building, and even your site if there is security controlled access. You may need to assign someone the role of meeting the ambulance and then escorting them to the incident. AN AMBULANCE The main ambulance will arrive with a crew of two and the stretcher etc. Ideally provide access so that it can get as close as possible to the incident. Even at the scene, make room for them to work, remove any unnecessary staff or witnesses and provide some privacy and dignity for the patient. HELP THE AMBULANCE CREW • Inform main gates, security or reception • Arrange for someone to meet them • Ensure doors or access points are open • Make space for them to work. FTACC approach - Level of response required RISK TO LIFE Chapter 3: Calling for Help ISBAR - Handover (Example) I INTRODUCE: I am our First Aid Trainer S SITUATION: I have a 63 year old man with severe chest pain B BACKGROUND: History of angina for several years, he is also a diabetic. Collapsed rushing up the stairs. A ASSESSMENT: Conscious, but says angina is worse than normal, he looks unwell & has vomited with the pain. R RESPONSE / RECOMMENDATION: I have reassured him, called an ambulance, encouraged him to use his Angina spray. I also have our AED here.

24 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Skill session 1 - Call for an ambulance / handover scenario SBAR SCENARIOS This session will be followed by a series of short exercises which can be conducted individually or in groups of up to four people. As a group, we would like you to assess the casualty outside, formulate an SBAR handover (one element each if in a group of four) and then come back in and handover to the rest of the candidates. THREE INCIDENTS TO REPORT. GROUPS OF 4 • Each group assess one casualty with SBAR • Take a minute to prepare • Give SBAR hand over to group. Chapter 3: Calling for Help SBAR Scenario 1 – Severe stomach pain S SITUATION: I am ‘X’ a Trained First Aider at ‘Y’ I have a: 25YR OLD LADY WITH SEVERE LOWER ABDOMINAL PAIN B BACKGROUND: She is normally fit and well but this started 2 hrs ago A ASSESSMENT: She looks unwell, has vomited and feels very hot. Her pain score is 5 out of 5 R RESPONSE: I have reassured her, called an ambulance and laid her down here in the first aid room

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 25 Skill session Call for an ambulance / handover scenario Chapter 3: Calling for Help SBAR Scenario 3 – Patient Fitting S SITUATION: I am ‘X’ a Trained First Aider at ‘Y’ I have a: 18YR OLD MALE CASUALTY WHO HAS HAD A 2 MINUTE SEIZURE B BACKGROUND: He just collapsed in the reception area A ASSESSMENT: He has a Med-alert bracelet confirming epilepsy. He is breathing and un-injured R RESPONSE: I have put him into the recovery position SBAR Scenario 2 – Fallen Downstairs S SITUATION: I am ‘X’ a Trained First Aider at ‘Y’ I have a: 30YR OLD FEMALE WHO FELL DOWN A FLIGHT OF STAIRS B BACKGROUND: She is apparently normally fit and well A ASSESSMENT: She was unconscious for 30s but is awake and complaining of pain in her lower back. She can feel her legs & move her toes R RESPONSE: I have not moved her and she is safe here

26 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Immediate Assesment – B.U.R.P.S A key part of providing first aid is how we assess the casualty, especially if the problem is not immediately obvious or we are unsure how serious it is. RELIABLE METHOD TO ASSESS A CASUALTY? Courses traditionally talk of primary surveys, ABC, MARCH and many similar approaches to casualty assessment. However, these are not based on conditions, but rather body systems such as airway, breathing, circulation. We are going to offer you an alternative approach, which rather than confuse things further, will actually offer a far more practical and simple assessment process to rapidly identify problems and their likely causes.

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 27 B.U.R.P.S – Immediate assessment We will be using the acronym ‘B.U.R.P.S’ which allows immediate assessment, simply and quickly to identify serious problems and also avoids missing injuries or signs. In other words, when we approach the casualty we ask: B – Bleeding: Is there any sign of bleeding? Each element will be further broken down to identify the serious from minor. U – Unconscious: Is the person unconscious or very drowsy? R – Respiratory Distress: Is the patient having difficulty breathing? P – Pain or Numbness: is there any pain or altered sensation. Pain is obviously very variable in its intensity and this spectrum will be considered in the pain section later in the course. S – Skin Changes: Are there any rashes, heat, blisters or skin changes? In the skin section we will highlight the important signs to look for, such as: • RASH • TEMPERATURE - HOT • TEMPERATURE - COLD • WOUNDS & ABRASIONS • BURNS & BLISTERS. BURPS B BLEEDING U UNCONSCIOUS OR SEMICONSCIOUS R RESPIRATORY/BREATHING DIFFICULTY P PAIN, DISTRESS OR NUMBNESS S SKIN CHANGES Chapter 4: Immediate Assessment - B.U.R.P.S B.U.R.P.S Supporting questions Once the B.U.R.P.S assessment is completed, additional supporting questions may prove useful, depending upon the problem. These include: • Do you have any health problems? • Has this ever happened before? • Are you taking any medication? • Do you have any allergies?

28 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com FIRST AID MEASURES BURPS – Isolated headache B NO MAJOR BLEEDING U FULLY CONSCIOUS R NO BREATHING DIFFICULTY P BAD FRONTAL HEADACHE S NO SKIN CHANGES B.U.R.P.S Assessments DOCTOR/HOSPITAL BURPS – Hand wound with nerve injury B NO MAJOR BLEEDING U FULLY CONSCIOUS R NO BREATHING DIFFICULTY P PAIN FROM WOUND & NUMB LITTLE FINGER S WOUND Chapter 4: Immediate Assessment - B.U.R.P.S Consider these first aid problems and apply the B.U.R.P.S assessment and the colour coded triage for the recommended level of response required.

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 29 RISK TO LIFE BURPS – Severe chest pain B NO MAJOR BLEEDING U FULLY CONSCIOUS R SHORT OF BREATH P SEVERE CHEST PAIN S SWEATY AND PALE B.U.R.P.S Assessments Chapter 4: Immediate Assessment - B.U.R.P.S DOCTOR/HOSPITAL BURPS – Significant ankle injury B NO MAJOR BLEEDING U FULLY CONSCIOUS R NO BREATHING DIFFICULTY P PAIN & UNABLE TO WEIGHT BEAR S BRUISING & SWELLING

30 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com DOCTOR/HOSPITAL BURPS – Toe Injury B NO MAJOR BLEEDING U FULLY CONSCIOUS R NO BREATHING DIFFICULTY P PAINFUL BUT BEARABLE S MILD SWELLING & REDNESS B.U.R.P.S Assessments Chapter 4: Immediate Assessment - B.U.R.P.S RISK TO LIFE BURPS – Dislocated Shoulder B NO MAJOR BLEEDING U FULLY CONSCIOUS R BREATHING QUICKLY P SEVERE PAIN FROM SHOULDER S SWEATING WITH SEVERE PAIN

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 31 RISK TO LIFE BURPS – Bacterial Meningitis B NO BLEEDING U DROWSY, IRRITABLE CHILD R INCREASED BREATHING RATE P IRRITABLE, HEADACHE S SKIN RASH – NON BLANCHING B.U.R.P.S Assessments Chapter 4: Immediate Assessment - B.U.R.P.S

32 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Bleeding – B.U.R.P.S Working from the B.U.R.P.S assessment we are going to considering bleeding. MINOR BLEEDING MAJOR BLEEDING SHOCK Now in traditional approaches to first aid, this would come much later, but as trauma care has progressed there has been an increasing realisation that in the most severe injuries blood loss can be the biggest preventable killer. As such, with early recognition of such major bleeding and prompt action, we may well be able to save that person, but if we get bogged down in airway and breathing assessments then it may well be too late. The majority of bleeding injuries will not be too severe. We will therefore be able to temporarily dismiss them and move on to assess the other essentials such as airway and breathing

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 33 Minor bleeding, major bleeding and shock We need to quantify what we mean by bleeding and in simple terms we can split it into MINOR and MAJOR. The latter is clearly of more concern and can ultimately result in elements of shock and even death. That said, we must also appreciate that even a small and relatively minor bleed, if left unattended for a prolonged period, may eventually become major, much like a dripping tap or leaking pipe. BLOOD IS ESSENTIAL TO LIFE Blood is essential to life and we only have a limited amount of it, which in a typical adult is 5 litres. This is equivalent to 15 cans of Coke or one gallon of petrol. Smaller adults and children have significantly less blood and are at even greater risk from blood loss as a result. Once the blood is gone, we cannot quickly replace it and make more of it. MINIMISE BLOOD LOSS Traditionally we think of people simply having a blood transfusion, but there are problems associated with this. Firstly, we have to have transfused blood immediately available, blood has to be of the correct blood type and it will still never be the same or as good as the patient’s own blood. In emergencies, the paramedics will use saline as a ‘temporary fix’ but this is just ‘salty water’ and doesn’t have the special properties as blood and may actually create more problems. As a result, the best way of managing blood loss is the most obvious, and that is to control or reduce it, preserving your own precious blood in your body. Your blood is the best blood to have in your circulation. Chapter 5: Bleeding - B.U.R.P.S REMEMBER YOUR OWN SAFETY FIRST – What caused the injury and are you protected from the casualty’s blood? With effective pressure in the right place, 90% of bleeding will stop, but to do this we must first expose the wound and find out where the bleeding is coming from. In a serious bleed, simply pressing on blood soaked clothing or generally in the direction of the bleeding may mean the difference between life and death. However, for most first aid bleeding, we need to find the wound and use simple measures such as: • Applying direct pressure • If bleeding is from a limb, elevate it where possible • Only move to bandaging or dressings once the bleeding is controlled. In other words, bandaging is fiddly and awkward if you are not doing this regularly. If you add in the ‘gloves of panic,’ inevitably you will be all fingers and thumbs. Even experienced providers can drop a bandage or get it tangled etc, but more importantly, this won’t be providing effective direct pressure. FIRST AID MEASURES Bleeding DIRECT PRESSURE WILL CONTROL 90% OF BLEEDS FIND THE SOURCE ELEVATION OF LIMBS ONLY ‘BANDAGE’ ONCE BLEEDING CONTROLLED Stopping bleeding can be very simple or from a more major wound it can be hugely challenging. There are two things to remember: • Firstly you may well be saving that persons life • Their body will help you to try and stop bleeding, it just needs a chance to form a blood clot

34 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com As with many things, the simple measures work well. Sit them down and make sure they are calm Encourage them to lean over a sink or bowl without stretching or straining and to spit out any blood in the back of the throat which has trickled down the back of the nose. Get them to gently pinch the uppermost soft part of the nose firmly but comfortably and to keep hold for 10 minutes – stress that they must not let go or they may have to start again. Tell them to avoid talking, coughing or moving and especially to not release their hand early ‘just to see.’ Reassure them about the blood and tell them not to swallow it as it will make them feel unwell. The majority of bleeds will simply stop. Nose bleeding DELICATE VESSELS SNEEZING FOREIGN OBJECTS These are one of the commonest first aid presentations and many patients will have suffered from them previously. They may be as a result of a bang to the nose, foreign body insertions such as toys, but in other cases it can be as simple as sneezing, picking their nose or even spontaneously for no reason. The lining of the nose has a rich blood supply and delicate blood vessels and trauma to these vessels can result in bleeding. This bleeding will usually just stop by itself, but sometimes can continue and be distressing. In children especially, a persistent nose bleed can result in the loss of a significant amount of their blood and should not be ignored. FIRST AID MEASURES Nose Bleeding – Treatment CALMLY LEAN OVER A SINK OR BOWL PINCH SOFT PART OF NOSE – 10 MINS AVOID COUGHING, TALKING, MOVING REASSURE (ESP CHILDREN) – MAJORITY WILL STOP We will now consider bleeding further but separating minor bleeding from the more major bleeds which are mentioned later in this chapter. Minor bleeding Chapter 5: Bleeding - B.U.R.P.S

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 35 If the bleeding is more severe it may be a recurrent problem or the patient may be on blood thinning medication (eg Warfarin or similar drugs for a previous thrombosis or embolism) which impairs their blood clotting process. Anything more than a tea-cup full, or bleeding for more than 30 minutes with the first measures followed, becomes YELLOW and needs to be seen by a nurse or doctor. This could be a medical walk-in centre, GP or failing that, the Accident and Emergency Department of the hospital. DOCTOR/HOSPITAL Nose Bleeding SEVERE BLEEDING (CUP FULL OR MORE) BLEEDING MORE > 30 MINUTES SHOULD BE SEEN BY A NURSE OR DOCTOR If the nose bleed is related to a major trauma, such as a head injury and is associated with a period of unconsciousness, loss of memory or confusion, the casualty warrants an emergency transfer to hospital. The other emergency group are those with torrential and uncontrollable bleeding, where the nose, which is literally pouring or pumping blood out. This is very unusual, but simple measures are usually effective. RISK TO LIFE Nose Bleeding ASSOCIATED WITH MAJOR HEAD INJURY – Period of unconsciousness – Loss of memory/confused MASSIVE/TORRENTIAL BLEEDING Bleeding from the ear OUTSIDE THE EAR Bleeding from outside the ear will usually be as a result of trauma, a scratch or possibly an infected spot or blister. This is unlikely to be serious. Simply apply gentle pressure with a dressing and then a plaster or bandage once the bleeding is controlled. Chapter 5: Bleeding - B.U.R.P.S Nose bleeding

36 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com If we now consider when we would be more concerned about bleeding from the ear canal which requires professional medical review. The factors are bleeding from the ear canal with: • Any recent history of head injury. Or association with any of the following: • Sickness or vomiting • Worsening dizziness • Visual disturbance • Drowsiness/seizures. DOCTOR/HOSPITAL Bleeding from ear canal HISTORY OF MAJOR HEAD INJURY SICKNESS, VOMITING DIZZINESS VISUAL DISTURBANCE DROWSINESS/SEIZURES Bleeding from the ear INSIDE THE EAR Chapter 5: Bleeding - B.U.R.P.S

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 37 Bleeding from the eyes is relatively uncommon and should be taken seriously in all cases. The default position must be ‘if in doubt,’ seek expert advice. SMALL BLEED – NO TREATMENT Small amounts of bleeding like this are probably the most common bleeds seen in the eyes and can occur spontaneously or following trauma. They are small and are located in a small part of the ‘white’ of the eye. They do not affect vision and only require medical review if they fill the white of the eye or occur on a regular basis. This is not an emergency. INFLAMED EYE A similar appearance can occur with eye infections where the eye is described as ‘injected,’ looking as though red dye has been injected into all the small blood vessels in part, or more frequently, in all of the eye. There may be yellow pus coming from the tear duct or other parts of the eye. This can lead to ‘sticky eye’, where the eye is difficult to open. The eye will usually be sore or irritated and it is essential to avoid rubbing with the hand as this may then lead to the infection spreading to the other eye. This is not a medical emergency but it does require treatment, which could be obtained at a Pharmacy, Walk-in centre or the GP. Bleeding from the eyes Chapter 5: Bleeding - B.U.R.P.S

38 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com DEBRIS OR FOREIGN BODIES A similar appearance can occur far more rapidly when dust or foreign material gets in to the eye. The material can produce an abrasive effect on the surface of the eye, or it can cause a chemical or inflammatory reaction. These need to be managed urgently, will be very uncomfortable and if left untreated may cause further problems later. The key is to remove the irritant. This may initially mean moving it out of the contaminated environment and then by irrigating the eye with saline eye wash (if this isn’t available then cold tap water will do). When doing this it is essential to have the infected side down over the sink or bowl to allow contaminants to wash way rather than simply run into the unaffected eye.’ Never wipe objects off the surface of the eye but instead persevere with copious amounts of washout. Ask the patient to look up, down and to the sides while you wash out and then ask them to pull back their eyelids to look for further debris. If there are stubborn objects, ask them to close the eye and then to look around with the lid closed, using their natural tears to help remove the debris. If there are stubborn particles, a medical review will be needed. DOCTOR/HOSPITAL Eyes – when to go to Hospital METALS, GLASS FRAGMENTS OR IRRITANT DUST CHEMICALS / THERMAL INJURIES PENETRATING OBJECTS OR DO NOT WASH OUT BLOOD / FLUID LEAKING FROM EYE LOSS OF VISION DOCTOR/HOSPITAL Bleeding from eyes OFTEN ASSOCIATED WITH FOREIGN BODY/TRAUMA LIGHT PAD DRESSING – AVOID PRESSURE TRANSFER TO HOSPITAL DO NOT USE PRESSURE OR PUT DRESSING IN EYE Bleeding from the eyes BLEEDING FROM EYES If larger foreign bodies are stuck in the eyes, these must never be removed. Dress the eye if necessary without applying pressure to the object or the eye and then arrange immediate transfer to the Accident and Emergency Department at the hospital. Whilst this isn’t a red slide, as it is not a life-threatening situation, it is vision threatening and requires a real degree of urgency in transport to hospital. Chapter 5: Bleeding - B.U.R.P.S

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 39 Bleeding from the scalp can be trivial and superficial or it can be major and even life threatening, from slow and often insidious bleeding, especially from the back of the scalp. If we consider the wounds in our typical GREEN, YELLOW and RED perspective then: FIRST AID MEASURES GREEN Small wounds, no history of confusion or reduced conscious level, although the casualty may be upset or slightly shaken up DOCTOR/HOSPITAL YELLOW Actively bleeding open wound, may be a little dazed, but no history of being unconsciousness RISK TO LIFE RED Extensive major bleeding, soaked hair, ground or carpet or a period of unconsciousness The scalp Chapter 5: Bleeding - B.U.R.P.S

40 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Green injuries e.g. small wounds simply need the bleeding to be controlled with pressure. Wash out any gravel or debris with saline or water (may increase bleeding for a short while, so may require further pressure). Apply a dressing or head bandage (diagonally from top under the skull, rather than simply round and round the head, to avoid it slipping off). FIRST AID MEASURES Scalp & head wounds CONSCIOUS LEVEL – OK APPLY PRESSURE TO BLEEDING POINT WASH OUT DEBRIS – STERILE WATER/SALINE DRESSING & BANDAGE Anyone who is either unconscious, been unconscious, vomiting, has a severe headache or has a seizure following a head injury needs an immediate 999 ambulance. RISK TO LIFE Head Injury UNCONSCIOUS/SEMI-CONSCIOUS CONFUSED VOMITING HEADACHE SEIZURES CALL 999 AMBULANCE The scalp Chapter 5: Bleeding - B.U.R.P.S

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 41 MINOR CUTS AND LACERATIONS Minor cuts and lacerations from various parts of the body can be managed with some simple principles based upon our colour coding. FIRST AID MEASURES Minor cuts & lacerations EXPOSE THE WOUND APPLY PRESSURE IF BLEEDING CLEAN THE WOUND – SALINE WASH APPLY A PLASTER OR SMALL BANDAGE It is essential to fully expose all wounds in order to assess the full extent of the injury. This may simply mean looking, or involve the removing or even cutting of clothing. Do not be afraid to look. Explain to the casualty what you are doing and reassure them. Many deaths as a result of bleeding have occurred because the casualty’s carers simply didn’t find or fully expose the bleeding point, so they were unable to effectively manage it. GREEN INJURIES – simply apply pressure to control the bleeding. If necessary wash any contaminants such as dirt and gravel out of the wound and apply further pressure. Finally, apply a suitable dressing or bandage. Cuts and lacerations Chapter 5: Bleeding - B.U.R.P.S

42 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com DOCTOR/HOSPITAL Bleeding - Lacerations INDICATION FOR ‘STITCHES’ • More than skin depth • >2cm in length • Continues to bleed through dressings. LOSS OF FUNCTION OR NUMBNESS A ROUND WOUND FOREIGN MATERIAL IN WOUND E.G. GRAVEL, GLASS Decisions about needing medical advice are usually based upon several factors: • Nature of the wound – more than skin depth, >2cm long or ongoing bleeding despite effective pressure • Possible tendon or nerve damage: loss of function or numbness related to the injury • Contamination of the wound which is difficult to clean. These all require effective medical review and potential intervention such as thorough cleaning, debridement or closure (eg stitches) which also requires a local anaesthetic. Cuts and lacerations Chapter 5: Bleeding - B.U.R.P.S Puncture wounds and holes to the torso Any holes in the trunk or torso, such as stab and gunshot wounds appear alarming, but they are not always immediately life threatening. Often simple measures and emergency transport to hospital will be sufficient to ensure that the casualty is safe.

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 43 RISK TO LIFE BURPS – Stab wound to chest B BLEEDING U CONSCIOUS R BREATHING QUICKLY P SEVERE PAIN FROM WOUND S SWEATING WITH SEVERE PAIN If we consider our BURPS assessment, then puncture wounds can manifest in the following way: B – Bleeding: There may be external bleeding, but we must also consider that internal bleeding into the body cavities is very common. This can rarely be seen or appreciated externally unless we recognise the signs of worsening shock. Remember that we can quietly bleed to death internally with little or no external signs other than shock. U – Unconscious: whilst the wound will not affect conscious level, as any internal blood loss increases the features of shock may lead to a reduction in conscious level. R – Respiratory Distress: The respiratory rate may be increased as a result of either injuries to the lung or worsening shock (It is interesting to note that in an otherwise fit individual a collapsed lung from a stabbing to the chest is rarely fatal and often just creates breathlessness and pain – this does not mean that we should delay getting expert help and emergency transport to hospital). P – Pain or Numbness: Pain associated with the wound. S – Skin Changes: Wounds in the skin, which can be very small such as a small knife wound or bullet hole, through to much larger holes. Even larger holes are not always immediately life threatening and all holes or wounds in the torso need emergency 999 transport to hospital. Puncture wounds and holes to the torso Chapter 5: Bleeding - B.U.R.P.S

44 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Puncture wounds and holes to the torso Chapter 5: Bleeding - B.U.R.P.S If a wound is into the abdomen or back, that does not mean it has not gone up or down into the chest or pelvis. It is always difficult to predict the extent of damage simply from an entry wound and as first aiders it is unimportant. The type of weapon used can cause very variable damage and any information that you can get may help. Once a hole is identified in the torso or trunk, the casualty requires emergency attention and transfer to hospital as soon as possible. In the meantime apply some simple first aid measures which may help them: • Approach safely (especially if this is a victim of an assault or gunshot) • Expose the wound and check for any others as best you can (pain and blood on the clothes may help you locate other wounds and always check the back and sides of the torso • If possible get the casualty to place their hand over the wound and keep it there. For wounds on the back, you need to cover them with your hand or that of a passer-by • Press firmly if there is any obvious external bleeding • Do not try to create improvised dressings e.g. a three-sided dressing, as these rarely work well and waste time) • Call for help including 999, for an ambulance • If the casualty is losing consciousness or feeling faint, lie them down and consider elevating their legs • Ideally lie them with the INJURY SIDE UPPERMOST (this contradicts many old school first aid courses, but allows you to monitor the wound and physiologically is far better for the patient) • If the casualty is having difficulty breathing, sit them up and ensure that the hole is being covered, using your hand if necessary • Reassure the casualty as they are likely to be very anxious. Other major bleeding will be considered further in the next section. In the final section we will consider a series of typical minor wounds and injuries and how we may address them based on the principles of: • Approaching the casualty • Introductions and consent • Exposing and finding the wound • Controlling major bleeding • Cleaning the wound • Checking that bleeding is controlled • Applying a dressing • Seeking expert advice when required. Minor injury care

Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com 45 Major Bleeding – B.U.R.P.S The previous section discussed minor bleeds. We will now consider bleeds which may be more major or potentially life threatening. MOUTH BOWEL/RECTAL VAGINAL As a starting point, any bleeding coming from ‘inside’ the body should raise concern. Although this is not always serious, it must be Investigated.

46 Tel: 03333 222 999 | Eml: [email protected] | www.ataccgroup.com Bleeding from the mouth is most commonly a result of trauma. Cuts to the lips, tongue or cheek can produce an alarming amount of blood, especially when mixed with saliva. Another common source is loss of a tooth or bleeding from the gums, especially after brushing the teeth. Any bleeding from the gums requires advice from a dentist or oral hygienist, but it is neither an emergency or a life-threatening situation. If there is no suggestion of trauma, further investigation is needed, especially if the casualty is unwell or has been vomiting or coughing. Bleeding from the mouth Chapter 6: Major Bleeding - B.U.R.P.S