First aid

First aid is the provision of initial care
for an illness or injury. It is usually performed by non-experts, but
trained personnel to a sick or injured person until definitive medical treatment can be
accessed. Certain self-limiting illnesses or minor injuries
may not require further medical care past the first aid intervention. It generally consists of a series of simple
and in some cases, potentially life-saving techniques that an individual can be trained
to perform with minimal equipment. While first aid can also be performed on all
animals, the term generally refers to care of human patients. History
The instances of recorded first aid were provided by religious knights, such as the Knights
Hospitaller, formed in the 11th century, providing care to pilgrims and knights, and training
other knights in how to treat common battlefield injuries. The practice of first aid fell largely into
disuse during the High Middle Ages, and organized societies were not seen again until in 1859
Jean-Henri Dunant organized local villagers to help victims of the Battle of Solferino,
including the provision of first aid. Four years later, four nations met in Geneva
and formed the organization which has grown into the Red Cross, with a key stated aim
of “aid to sick and wounded soldiers in the field”. This was followed by the formation of St.
John Ambulance in 1877, based on the principles of the Knights Hospitaller, to teach first
aid, and numerous other organization joined them with the term first aid first coined
in 1878 as civilian ambulance services spread as a combination of “first treatment” and
“national aid” in large railway centres and mining districts as well as with police forces. In 1878 Surgeon-Major Peter Shepherd, together
with Colonel Francis Duncan established the concept of teaching first aid skills to civilians. Shepherd, together with a Dr Coleman, conducted
the first class in the hall of the Presbyterian school in Woolwich using a comprehensive first
aid curriculum that he had developed. It was Shepherd who first used the English
term “first aid for the injured” First aid training began to spread through the empire
through organisations such as St. John, often starting, as in the UK, with high risk activities
such as ports and railways. Many developments in first aid and many other
medical techniques have been driven by wars, such as in the case of the American Civil
War, which prompted Clara Barton to organize the American Red Cross. Today, there are several groups that promote
first aid, such as the military and the Scouting movement. New techniques and equipment have helped make
today’s first aid simple and effective. Aims
The key aims of first aid can be summarized in three key points:-
Preserve life: the overriding aim of all medical care, including first aid, is to save lives
and minimise the threat of death. Prevent further harm: also sometimes called
prevent the condition from worsening, or danger of further injury, this covers both external
factors, such as moving a patient away from any cause of harm, and applying first aid
techniques to prevent worsening of the condition, such as applying pressure to stop a bleed
becoming dangerous. Promote recovery: first aid also involves
trying to start the recovery process from the illness or injury, and in some cases might
involve completing a treatment, such as in the case of applying a plaster to a small
wound. First aid training also involves the prevention
of initial injury and responder safety, and the treatment phases. And it is a kit of aid. Key skills Certain skills are considered essential to
the provision of first aid and are taught ubiquitously. Particularly the “ABC”s of first aid, which
focus on critical life-saving intervention, must be rendered before treatment of less
serious injuries. ABC stands for Airway, Breathing, and Circulation. The same mnemonic is used by all emergency
health professionals. Attention must first be brought to the airway
to ensure it is clear. Obstruction is a life-threatening emergency. Following evaluation of the airway, a first
aid attendant would determine adequacy of breathing and provide rescue breathing if
necessary. Assessment of circulation is now not usually
carried out for patients who are not breathing, with first aiders now trained to go straight
to chest compressions but pulse checks may be done on less serious patients. Some organizations add a fourth step of “D”
for Deadly bleeding or Defibrillation, while others consider this as part of the Circulation
step. Variations on techniques to evaluate and maintain
the ABCs depend on the skill level of the first aider. Once the ABCs are secured, first aiders can
begin additional treatments, as required. Some organizations teach the same order of
priority using the “3Bs”: Breathing, Bleeding, and Bones. While the ABCs and 3Bs are taught to be performed
sequentially, certain conditions may require the consideration of two steps simultaneously. This includes the provision of both artificial
respiration and chest compressions to someone who is not breathing and has no pulse, and
the consideration of cervical spine injuries when ensuring an open airway. Preserving life
In order to stay alive, all persons need to have an open airway—a clear passage where
air can move in through the mouth or nose through the pharynx and down into the lungs,
without obstruction. Conscious people will maintain their own airway
automatically, but those who are unconscious may be unable to maintain a patent airway,
as the part of the brain which automatically controls breathing in normal situations may
not be functioning. If the patient was breathing, a first aider
would normally then place them in the recovery position, with the patient leant over on their
side, which also has the effect of clearing the tongue from the pharynx. It also avoids a common cause of death in
unconscious patients, which is choking on regurgitated stomach contents. The airway can also become blocked through
a foreign object becoming lodged in the pharynx or larynx, commonly called choking. The first aider will be taught to deal with
this through a combination of ‘back slaps’ and ‘abdominal thrusts’. Once the airway has been opened, the first
aider would assess to see if the patient is breathing. If there is no breathing, or the patient is
not breathing normally, such as agonal breathing, the first aider would undertake what is probably
the most recognized first aid procedure—cardiopulmonary resuscitation or CPR, which involves breathing
for the patient, and manually massaging the heart to promote blood flow around the body. Promoting recovery
The first aider is also likely to be trained in dealing with injuries such as cuts, grazes
or bone fracture. They may be able to deal with the situation
in its entirety, or may be required to maintain the condition of something like a broken bone,
until the next stage of definitive care arrives. Training Basic principles, such as knowing to use an
adhesive bandage or applying direct pressure on a bleed, are often acquired passively through
life experiences. However, to provide effective, life-saving
first aid interventions requires instruction and practical training. This is especially true where it relates to
potentially fatal illnesses and injuries, such as those that require cardiopulmonary
resuscitation; these procedures may be invasive, and carry a risk of further injury to the
patient and the provider. As with any training, it is more useful if
it occurs before an actual emergency, and in many countries, emergency ambulance dispatchers
may give basic first aid instructions over the phone while the ambulance is on the way. Training is generally provided by attending
a course, typically leading to certification. Due to regular changes in procedures and protocols,
based on updated clinical knowledge, and to maintain skill, attendance at regular refresher
courses or re-certification is often necessary. First aid training is often available through
community organizations such as the Red Cross and St. John Ambulance, or through commercial
providers, who will train people for a fee. This commercial training is most common for
training of employees to perform first aid in their workplace. Many community organizations also provide
a commercial service, which complements their community programmes. Australia
In Australia, nationally recognized first aid certificates may only be issued by registered
training organisations that are accredited on the National Training Information System. Courses are based on the delivery and assessment
of units of competency from various training packages. Most first aid certificates are issued at
one of three levels:: Provide Basic Emergency Life Support. Formerly Level 1 this is a 1-day course covering
primarily life-threatening emergencies. It involves the training and assessment of
HLTFA201A from the HLT07 Health Training Package Apply First Aid. Formerly Level 2 is either a 2-day face to
face course or 1 day face to face combined with 4 – 8 theory work at home or online. It involves the delivery and assessment of
HLTFA301B Apply First Aid. It covers all the aspects of training in “Provide
Basic Emergency Life Support, as well as specialized training for treatment of burns, bites, stings,
electric shock and poisons and the use of an AED. Apply First Aid must be re-accredited every
three years to remain current for use in the workplace Reaccreditation of the CPR component
is generally required annually, although individual states set the specific requirements. Apply Advanced First Aid. Formerly Level 3 is a one-day course covering
advanced first aid, use of oxygen and automated external defibrillators and documentation. It is suitable for workplace first aiders
and those who manage first aid facilities. It is based on the training and assessment
of a group of units of competency – HLTFA301B Apply first aid, HLTFA402B Apply advanced
first aid and HLTFA403A Manage first aid in the workplace – that are generally delivered
together. Other courses outside these levels are commonly
taught, including CPR-only courses, Advanced Resuscitation, Remote Area or Wilderness First
Aid, Administering Medications and specialized courses for parents, school teachers, community
first responders or hazardous workplace first aiders. CPR Re-accreditation courses are sometimes
required yearly, regardless of the length of the overall certification. Canada
In Canada, first aid certificates can be issued under the auspices one of four training organizations
that authorize ‘course providers’ to provide their particular “brand” of first aid training
in up to ten provinces and three territories: Canadian Red Cross Society,Lifesaving Society,
St. John Ambulance, and Canadian Ski Patrol. Besides first aid courses for the general
public, such as “Emergency” and “Standard” first aid, which incorporates and includes
CPR, most of these organizations also administer more specialized training, for example “Aquatic
Emergency Care” for life guards, “Wilderness First Aid”, first aid that meets regulations
for employment as a child care worker and first aid training that meets regulations
for first aid attendants employed in the workplace. Workplaces can come under occupational health
and safety and insurance regulations that are either provincial or federal. Therefore, these national first aid training
organizations offer workplace first aid training that complies with the specific training requirements,
standards and syllabi set either by a given province or else by the particular federal
regulatory requirement. First aid training leading to certification
that meets provincial workplace standards can also be offered through private training
companies that have to be accredited and authorized by the relevant provincial regulatory agency
or ministry. For example, the British Columbia provincial
Workers Compensation Board sets out OFA Occupational First Aid training and certification standards
and requirements at 3 levels ranging from 8 to more than 40 hours. Beyond ‘first aid’ training and certification
are standards for ‘pre-hospital care’ such as ‘first responder’, ’emergency medical responder’,
paramedic and other titles. For example, fire-rescue personnel and paramedical
personnel provide care that goes beyond ‘first aid’. Yet a police officer might only be required
to hold a first aid, not a pre-hospital care first aid ‘ticket’ as part of his or her current
qualification. The military train in first aid and pre-hospital
emergency care that is oriented to combat and other military situations and environments. The training syllabi for “Emergency” First
Aid and “Standard” First Aid are set out by Health Canada, a federal department of the
Government of Canada which accredits a training organization as a course provider of these
two basic certificates, needed by those people employed in federally regulated workplaces. Workplace safety regulations and standards
for first aid vary by province depending on occupation. However, as some occupations are governed
by federal, not provincial, workplace safety regulations, such as the transportation industry,
trainees need to confirm with their employer as to exactly what specific training and certification
standards comply with the applicable regulatory agencies, federal or provincial. Emergency First Aid: is an 8-hour course covering
primarily life-threatening emergencies: CPR, bleeding, choking and other life-threatening
medical emergencies. Standard First Aid: is a 16-hour course that
covers the same material as Emergency First Aid and will include training for some, but
not all, of the following: s; burns; poisons, bites and stings; eye injuries; head and neck
injuries; chest injuries; wound care; emergency child birth; and multiple casualty management. CPR certification in Canada is broken into
several levels. Depending on the level, the lay person will
learn the basic one-person CPR and choking procedures for adults, and perhaps children,
and infants. Higher-level designations also require two-person
CPR to be learned. Depending on provincial laws, trainees may
also learn the basics of automated external defibrillation. Level A is the lowest level of CPR training. Trainees learn how to perform the standard
one-rescuer CPR and choking procedures on adults. Level B requires the same procedures as Level
A, but trainees learn to perform these maneuvers on children and infants in addition to adults. Level C requires the same maneuvers as Level
B, and trainees are also taught how to perform two-person CPR. Level HCP was introduced in Canada in response
to new guidelines set by the International Liaison Committee on Resuscitation. In addition to the techniques taught in Level
C, artificial resuscitation, AED use, and bag-valve-mask use is taught. Anyone with CPR-HCP certification is considered
AED certified. France
In France, first aid certificates are delivered by organisations that are approved by the
Minister of the Interior, following the official national reference document. There are about 20 approved associations;
many administrations — army, fire services, national education, … — are also approved. at school: basics must be taught at the primary
school grande das. Tou section de maternelle: to detect a danger,
to look for an adult, cours élémentaire 1: to protect oneself,
to call for help, cours moyen 2: to make a complete phone call,
to place a casualty in an adapted position; at the Journée défense et citoyenneté:
IAPS, Initiation à l’alerte et aux premiers secours
Securing. Calling for help. The casualty is not alert. The casualty is not breathing. PSC1: Prévention et secours civiques de niveau
1: 10 hours, Securing. Calling for help. The casualty is choking. The casualty bleeds deadly. The casualty is not alert. The casualty is not breathing. The casualty complains about illness. The casualty complains after a trauma. SST: Sauvetage-secourisme du travail: similar
to PSC1, with a study of the specific risks of the activity of the worker;
PSE: premiers secours en équipe: PSE1: 35 hrs, acting as a member of a first
aid organisation general principles, advanced assessment, cervical
collar, suction, oxygen first aid, basic bandages and tourniquets, methods with two team members,
specific cases, simple patient transport; PSE2: 35 hrs, acting as a member of a rescue
team managing the medical wastes, cleaning an ambulance
and the first aid material, reacting to an accidental contact with blood, complete assessment,
two-way radio, specific cases, advanced bandages, preservation of an amputated limb, member
realignment and splints, casualty lifting, casualty transport, situations with multiple
casualties. Ireland
In Ireland, the workplace qualification is the Occupational First Aid Certificate. The Health and Safety Authority issue the
standards for first aid at work and hold a register of qualified instructors, examiners
and organisations that can provide the course. A FETAC Level 5 certificate is awarded after
passing a three-day course and is valid for two years from date of issue. Occupational First Aiders are more qualified
than Cardiac First Responders but less qualified than Emergency First Responders but strangely
Occupational First Aid is the only one of the three not certified by PHECC. Organisations offering the certificate include,
Ireland’s largest first aid organisation, the Order of Malta Ambulance Corps, the St
John Ambulance Brigade, and the Irish Red Cross. The Irish Red Cross also provides a Practical
First Aid Course aimed at the general public dealing primarily with family members getting
injured. Many other organisations offer training. Russia
In Russia, first aid education is mandatory for police officers, rescues and EMERCOM staff. In secondary school, teenagers are trained
in basic first aid skills. Adults can be trained in commercial organizations. Such training is based on the international
guidelines, there are no country-specific guidelines for first aid in Russia. Providing first aid to the victims is the
right of every man, but medications can be used by certified ambulance crews, physicians
and hospital staff only. There are no national first aid certificates
in Russia. Singapore
In Singapore, the workplace qualification is the Occupational First Aid Certificate. The Ministry of Manpower issue the standards
for first aid at work and qualifies first aid instructors, occupational nurses and doctors
and registered safety officers as examiners and organisations that can provide the course. Instructors are required to undergo an ACTA
certification, a nationally recognised training standard endorsed by the Workforce Development
Agency. Workplaces with more than 25 employees are
required to have certified Occupational First Aiders. The Occupational First Aid Course recently
incorporated a CPR and AED segment which is accredited by the National Resuscitation Council
of Singapore and is valid for 2 years. Occupational First Aiders learn more workplace
related topics than Cardiac First Responders and is the industry standard in Singapore. However, they may be less qualified than EMTs.Also
in schools basic training is given of first aid. The Netherlands
In the Netherlands basic level lay first-aid training is mostly provided by the Dutch Red
Cross, local Lifeguard organizations, first-aid association or commercial companies. First-aiders are mostly certified by the “Dutch
Red Cross” and the foundation “Het Oranje Kruis”. The foundation “LPEV” certifies mainly advanced
and first responder level’ first-aid training. Medical first-aid must always be provided
by certified ambulance crews, physicians and hospital staff. United Kingdom
In the UK, as is well as general and practical first aid courses for the public environment,
there are also two main types of first aid courses offered for the workplace environment
as required by the Health and Safety Regulations 1981; Emergency First Aid at Work and First
Aid at Work. An “Emergency First Aid at Work” course
typically lasts one day, and covers the basics, focusing on critical interventions for conditions
such as cardiac arrest and severe bleeding, and is usually not formally assessed. A “First Aid at Work” course is usually
a three-day course that covers the full spectrum of first aid, and is assessed throughout the
course by the trainers. As of 1st October 2013, regulations from the
HSE changed regarding the delivery of training, meaning they will no longer monitor educators. The responsibility for ensuring the course
content, and those delivering it are fit for purpose is now entirely the responsibility
of the company needing the certification. Certification for the “First Aid at Work”
course are issued by the training organization and are valid for a period of three years
from the date the delegate qualifies. Other first aid courses offered by the major
UK training organizations such as St. John Ambulance, St Andrew’s First Aid or the
British Red Cross include Sports First Aid, Baby and Child courses, manual handling, people
moving, and courses geared towards more advanced life support, such as defibrillation and administration
of medical gases such as oxygen and entonox. The British Armed Forces use First Aid ranging
from levels 1–3, to assist the medical staff on their Ship, Squadron, Section, Base or
any other purpose required. They are trained in both Military and Civilian
First Aid and often utilise their knowledge in aid stricken regions around the world. First Aid is vital on board warships because
of the number of people in a small area and the space given to perform their task, it
is also vital for the Army and Royal Marines to know basic first aid to help the survival
rate of injured soldiers when in combat. United States
In the United States, there is no universal schedule of First Aid levels that are applicable
to all agencies that provide first aid training. Training is provided typically through the
American Red Cross, but may also be completed by local fire departments and the American
Heart Association in terms of CPR. The American Red Cross, however, offers the
following courses: CPR
CPR-Adult CPR-Child and Infant
CPR-Adult and Child CPR-Adult, Child, and Infant CPR/Automated External Defibrillator
CPR/AED-Adult CPR/AED-Adult and Child
CPR/AED for the Professional Rescuer First Aid
First Aid Basics Standard First Aid
First Aid – Responding to Emergencies Wilderness and Remote First Aid
Emergency Medical Response Specialty
Administering Emergency Oxygen Bloodborne Pathogens Training
Lifeguarding Epinephrine Auto-Injector Use
First Responder in the Workplace training Dog, Cat, and Dog/Cat First Aid
Babysitter’s Training Instructor Certification Red Cross training programs may vary by Chapter
and season. Lay First Aid Providers in the United States
are subject to Good Samaritan law protections as long as their treatment does not extend
beyond training or certification. First Aid training in the United States is
limited to basic life support functions needed to sustain life, and training instills the
importance of activating the Emergency Medical System before beginning assistance. Training classes range from a few hours for
a specific course, or several days for combination, specialty, and instructor courses. Red Cross volunteers are required to be Standard
First Aid plus CPR/ACI certified, as well as passing the FEMA NIMS Introductory certification. Specific disciplines
There are several types of first aid which require specific additional training. These are usually undertaken to fulfill the
demands of the work or activity undertaken. Aquatic/Marine first aid is usually practiced
by professionals such as lifeguards, professional mariners or in diver rescue, and covers the
specific problems which may be faced after water-based rescue and/or delayed MedEvac. Battlefield first aid takes into account the
specific needs of treating wounded combatants and non-combatants during armed conflict. Hyperbaric first aid may be practiced by SCUBA
diving professionals, who need to treat conditions such as the bends. Oxygen first aid is the providing of oxygen
to casualties who suffer from conditions resulting in hypoxia. Wilderness first aid is the provision of first
aid under conditions where the arrival of emergency responders or the evacuation of
an injured person may be delayed due to constraints of terrain, weather, and available persons
or equipment. It may be necessary to care for an injured
person for several hours or days. Hydrofluoric Acid first aid is taught to first
aiders in the chemical industry where hydrofluoric acid may be used. Instructs the first aider how to initially
treat any skin that has been splashed with the acid. Mental health first aid is taught independently
of physical first aid. How to support someone experiencing a mental
health problem or in a crisis situation. Also how to identify the first signs of someone
developing mental ill health and guide people towards appropriate help. Equine first aid is the provision of first
aid for horses, mules and donkeys under conditions where the arrival of a verinarian or other
professional may be delayed due to distance, constraints of terrain, weather, and available
persons or equipment. It may be necessary to care for an injured
animal for several hours. Symbols Although commonly associated with first aid,
the symbol of a red cross is an official protective symbol of the Red Cross. According to the Geneva Conventions and other
international laws, the use of this and similar symbols is reserved for official agencies
of the International Red Cross and Red Crescent, and as a protective emblem for medical personnel
and facilities in combat situations. Use by any other person or organization is
illegal, and may lead to prosecution. The internationally accepted symbol for first
aid is the white cross on a green background shown below. Some organizations may make use of the Star
of Life, although this is usually reserved for use by ambulance services, or may use
symbols such as the Maltese Cross, like the Order of Malta Ambulance Corps and St John
Ambulance. Other symbols may also be used. Conditions that often require first aid
Also see medical emergency. Altitude sickness, which can begin in susceptible
people at altitudes as low as 5,000 feet, can cause potentially fatal swelling of the
brain or lungs. Anaphylaxis, a life-threatening condition
in which the airway can become constricted and the patient may go into shock. The reaction can be caused by a systemic allergic
reaction to allergens such as insect bites or peanuts. Anaphylaxis is initially treated with injection
of epinephrine. Battlefield first aid—This protocol refers
to treating shrapnel, gunshot wounds, burns, bone fractures, etc. as seen either in the
‘traditional’ battlefield setting or in an area subject to damage by large-scale weaponry,
such as a bomb blast. Bone fracture, a break in a bone initially
treated by stabilizing the fracture with a splint. Burns, which can result in damage to tissues
and loss of body fluids through the burn site. Cardiac Arrest, which will lead to death unless
CPR preferably combined with an AED is started within minutes. There is often no time to wait for the emergency
services to arrive as 92 percent of people suffering a sudden cardiac arrest die before
reaching hospital according to the American Heart Association. Choking, blockage of the airway which can
quickly result in death due to lack of oxygen if the patient’s trachea is not cleared,
for example by the Heimlich Maneuver. Childbirth. Cramps in muscles due to lactic acid build
up caused either by inadequate oxygenation of muscle or lack of water or salt. Diving disorders, drowning or asphyxiation. Gender-specific conditions, such as dysmenorrhea
and testicular torsion. Heart attack, or inadequate blood flow to
the blood vessels supplying the heart muscle. Heat stroke, also known as sunstroke or hyperthermia,
which tends to occur during heavy exercise in high humidity, or with inadequate water,
though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the victim has
been unconscious, often causes major damage to body systems such as brain, kidney, liver,
gastric tract. Unconsciousness for more than two hours usually
leads to permanent disability. Emergency treatment involves rapid cooling
of the patient. Hair tourniquet a condition where a hair or
other thread becomes tied around a toe or finger tightly enough to cut off blood flow. Heat syncope, another stage in the same process
as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from
the latter by some authorities. Heavy bleeding, treated by applying pressure
to the wound site and elevating the limb if possible. Hyperglycemia and Hypoglycemia. Hypothermia, or Exposure, occurs when a person’s
core body temperature falls below 33.7°C. First aid for a mildly hypothermic patient
includes rewarming, but rewarming a severely hypothermic person could result in a fatal
arrhythmia, an irregular heart rhythm. Insect and animal bites and stings. Joint dislocation. Poisoning, which can occur by injection, inhalation,
absorption, or ingestion. Seizures, or a malfunction in the electrical
activity in the brain. Three types of seizures include a grand mal
and petit mal. Muscle strains and Sprains, a temporary dislocation
of a joint that immediately reduces automatically but may result in ligament damage. Stroke, a temporary loss of blood supply to
the brain. Toothache, which can result in severe pain
and loss of the tooth but is rarely life-threatening, unless over time the infection spreads into
the bone of the jaw and starts osteomyelitis. Wounds and bleeding, including lacerations,
incisions and abrasions, Gastrointestinal bleeding, avulsions and Sucking chest wounds,
treated with an occlusive dressing to let air out but not in. References External links
First Aid Guide at the Mayo Clinic What is CPR
First aid from St Johns ambulance – first aid information and advice
First aid from St Andrew’s First Aid – first aid information cards
First aid from the British Red Cross – including first aid tips and first aid training information