First aid

First aid is the first and immediate assistance given to someone with an illness or injury, usually at the place where it happened.

The purpose of first aid is to save life, prevent the condition or injury from getting worse, reduce pain and protect the person until medical help arrives.

Pause and assess

In an emergency, many things may demand your attention at the same time. 

To keep yourself and others safe, make sure you pause and assess the situation before taking any action.

• Quickly observe what has happened.
• Look for dangers to yourself and any casualties.
• Make the area safe.

Then assess any casualties.

• Give priority to anyone who is unconscious as they may need help to breathe.
• Then assess and treat any injuries, particularly heavy bleeding.

Primary assessment

Note: If someone is unconscious AND has extreme bleeding (massive amounts of blood pouring, gushing or spurting from a significant injury) the bleeding must be dealt with first. Apply direct pressure to the wound.

Airway

When assessing people who are unconscious, the first priority is to check the airway.

The airway is the pipe at the back of the throat leading down to the lungs. If this becomes narrow or blocked, an unconscious person cannot breathe and will die. 

Check that there is nothing in the mouth or throat blocking the airway. If possible, remove anything that is causing an obstruction.

To open the airway, place two fingers under the chin, and then with the other hand on the forehead, tilt the head back. If you think the neck may be injured, tilt the head very carefully, just enough to open the airway.

Breathing

Next, check for breathing by placing your ear above their mouth and looking down at their chest. Listen for sounds of breathing and see if you can feel their breath on your cheek. Watch to see if their chest moves. Do this for no more than ten seconds.

If they are unresponsive and not breathing, you need to start CPR straight away.

Cardiopulmonary resuscitation (CPR)

CPR combines chest compressions and rescue breaths to give a person the best chance of survival if they have stopped breathing or their heart has stopped beating.

Chest compressions

Kneel close to the casualty and put the heel of your hand on the middle of their chest. Put your other hand on top of your first hand and if you can, interlock your fingers.

Lean forwards so your shoulders are over your hands, keep your arms straight and press down hard, to a depth of about 5-6cm. Then release the pressure and allow the chest to come back up.

Push at a rate of 100 to 120 compressions per minute.

After 30 compressions, provide two rescue breaths. If you are unable or unwilling to provide rescue breaths, give continuous chest compressions.

Rescue breaths

Tilt the casualty’s head backwards, lift their chin and pinch the soft part of their nose closed.

Take a breath and put your mouth around the person’s mouth, to make a seal.

Blow into their mouth steadily and firmly for up to one second, until the chest rises.

Remove your mouth and watch the chest fall.

This is a rescue breath: do this twice.

Keep alternating 30 compressions with two breaths until help arrives or the heart starts beating again and the person starts to breathe normally.

Drowning

If someone has been rescued from water and is unresponsive, check the airway is open and then give five initial rescue breaths. 

Follow by giving chest compressions, alternating 30 compressions with two breaths.

Many people who have been rescued from water bring up stomach contents, so be prepared to roll them onto their side so they do not choke.

If the person shows signs of becoming responsive, such as coughing, opening eyes or speaking, and starts to breathe normally, put them in the recovery position. Cover them with warm clothes or blankets to prevent them from getting cold. 

Monitor the person’s level of response and prepare to give CPR again if necessary.

Recovery position

Kneel by the person and straighten their legs. If they are wearing glasses, remove them.

Place the arm that is nearest to you at a right angle to their body, with the elbow bent and their palm facing upwards.

Bring their other arm across their chest and place the back of their hand against the cheek nearest to you. Hold it there.

With your other hand, pull their far knee up so that their foot is flat on the floor.

Keeping the back of the person’s hand pressed against their cheek, pull on the far leg to roll the person towards you on to their side. You can then adjust the top leg so that it is bent at a right angle.

Gently tilt the person’s head back and lift their chin to make sure their airway stays open. You can adjust the hand under their cheek to do this.

Injuries

Bleeding

If possible, wear plastic gloves or plastic bags over your hands, especially if you have a wound yourself. HIV, hepatitis and other diseases can be passed between people via the blood. 

If someone is bleeding badly, ask them to lie down. If the injury is to an arm or leg and there is no broken bone, raise the arm or leg slightly. This will help to reduce bleeding. 

Wash the wound with clean water, making sure you remove all the dirt, and cover it with a clean cloth. Apply pressure over the wound with your hand for about 15 minutes to stop the bleeding. Secure this cloth by tying a different clean cloth firmly around the wound. Do not tie it so tightly that it completely cuts off the blood supply. 

Broken bones

Place the injured limb in the most natural and pain-free position possible. Do not attempt to push broken bones back into place. 

Support a broken limb by tying on a splint. Be careful not to tie it too tightly. A splint could be made from a straight piece of wood, or other material.

Broken legs can be tied together, or you can place a smooth piece of wood between the legs. Use simple slings for arms. 

If a bone is sticking out of a wound, cover lightly with a clean dressing to reduce the danger of infection. 

People with neck or back injuries should be secured onto something flat and firm, eg a door, before they are moved to safety.

Burns

Treat burns by soaking them in clean, cool water. If possible use running water, or change the water every five minutes. 

Cover the burns with a clean cloth. Never try to pull off loose pieces of skin or clothing. 

Do not:

• break blisters, as they help the burn to heal
• put ice on the burn
• put grease, butter, hides, coffee, herbs or faeces on a burn

Babies

If a baby is unresponsive, you need to open the airway and provide baby CPR as quickly as possible. If they are responsive but their airway is blocked, you need to treat them for choking (see below).

Airway

Place a hand on the baby’s forehead and very gently tilt their head back until it is flat to the sky. Be careful not to tip the head further back than this. With your other hand use a fingertip to gently lift the chin.

Breathing

Check if the baby is breathing in the same way as for children and adults.

If they are not breathing, start baby CPR.

Baby CPR

Gently give five initial rescue breaths (see below), checking that the chest is rising each time.

Then give chest compressions. Put two fingers in the centre of the baby’s chest and push down a third of the depth of the chest (about 4cm). Release the pressure allowing the chest to come back up fully.

Repeat this 30 times at a rate of 100 to 120 pumps per minute. Then give two rescue breaths, checking that the airway is still open.

Keep alternating 30 pumps with two breaths until help arrives or the baby starts to breathe normally. 

Choking

When a baby is choking, their airway is partly or completely blocked, meaning that they may be unable to breathe properly. 

If the baby cannot breathe, cry or cough, they may be choking and you will need to give five back blows.
Lay the baby face down along your forearm and thigh, making sure you support their head and neck. Give five sharp back blows between the shoulder blades with the heel of your hand, checking to see if the obstruction has cleared between each blow.

Turn them over on your thigh and check their mouth. Remove any obvious visible obstruction.

Do not search in the mouth with your finger as this could push the object further down the throat.

If back blows fail to clear the obstruction, give five chest thrusts with your baby facing upwards and their head pointing slightly downwards, making sure you are supporting their head and neck. 

Put two fingers in the centre of their chest just below the nipple line and give five sharp chest thrusts.
Check their mouth after each chest thrust. 

Prevent choking

Never leave a baby unattended when they are eating, and keep small objects that could cause choking out of reach.

Information in this article is based on guidance provided by St John ambulance.