life saving skills

1. EMERGENCY RESPONSE
&
LIFE SAVING SKILLS

2. Elements of Leadership Training
(a) Introducing of First Aid & Lifesaving
Education among the people for better care
& safety in the community.
(b) Developing compassion & concern for the
wellbeing of people.
(c) Developing competitive spirit in the Youth
through lifesaving water sports.
(d) Developing skills to motivate or leadership
in the Youth to ensure value added life for
themselves and their fellow persons.
(e) Inculcate value assessment and
managerial skills to optimise use of available
resources.

3. EMERGENCY RESPONSE
– Respond Rapidly
– Stay Calm, Don’t Panic
– Think before you Act.
– Do not waste time , do the best with what is
at hand.
– Request professional medical assistance as
soon as possible.
– Do an initial Assessment of the Situation

4. Initial Assessment
1. Safety - Is the area safe? You cannot help the casualty if you
become one yourself.
2. Number of casualties - Look beyond the first casualty, you
may find others. Limit your assessment to open airway,
breathing, bleeding, and circulation, the life-threatening
conditions
3 CALL FOR HELP EARLIEST
4 Mechanism of injury - Determine the extent of injury & how it
happened. If casualty unconscious, look for clues.
5. Medical information devices - Examine the casualty for a
MEDIC ALERT, necklace, bracelet, or identification card.
6. Bystanders - Ask bystanders to help, what happened. calling
for medical assistance, providing emotional support to the
casualty, and keeping onlookers from getting in the way.
7. Introduce yourself - Inform the casualty and bystanders who
you are and that you know first aid. Prior to rendering first aid,
obtain the casualties consent by asking is it "OK' to help them.
Consent is implied if the casualty is unconscious or cannot
reply.

5. General Rules
1. Move casualty no more than necessary. Loosen clothing,
2. Hand on Head. Reassure the casualty. . Main Hoon Naa
3 Do not touch open wounds or burns with your fingers or un-
sterile objects.
4 Place a barrier between you and the casualty's blood or
body fluids, using plastic wrap, gloves, or a clean, folded
cloth.
5 Wash your hands with soap and warm water immediately
after providing care,
6 Do not give the casualty anything to eat or drink. If
casualty complains of thirst, wet lips with wet towel.
7. Splint all suspected, broken or dislocated bones. Do not
attempt to straighten broken or dislocated bones
8. When transporting, carry casualty feet first. This enables the
rear bearer to observe the casualty for any complications.
9. Keep casualty comfortable and warm enough to maintain
normal body temperature.

6. EMRGENCIES
CALL FOR HELP EARLIEST
1. Don’t Leave Casualty alone. Send for Help
2. Always have Emergency Tele Nos:
Ambulance, Police, EMS Centre, Relatives(?)
3. Provide max Info to Emergency Services
• Where, When, How, How many
• Condition, Special help
4. HAND ON HEAD (MAIN HOON NAA)
5. Why Earliest?

7. SAFETY
• Don’t Take unnecessary Risk with your &
Bystanders Safety
• Priority: 1st
- Self, 2nd
- Bystanders,
Last- Casualty
• Don’t Move Cas until absolute necessary
• Don’t give liquid or eatables in any form
• If more than one cas, attend to
Unconscious first.

8. WATER SAFETY
• Know and Understand your level of skill in
water.
• Know the distance you can safely swim
• Update your Life Saving Skills. Enrol in a
Life Saving Course
• To be ready for emergencies, occasionally
practise swimming and diving with your
clothes on.

9. OWN SAFETY
WHEN POSSIBLE
• Wash hands with soap before treating cas
• Wear gloves
• Use sterile bandages
• Dispose off any blood stained material
• Avoid contact with body fluids of victim
• Report to your Dr if you have any doubts
on blood or body fluid contact

10. GENERAL SAFETY
•Accept safety as a necessity and not a hindrance
•Accept safety as a saving and not an avoidable expense
•Accept safety as a mind set to protect people and
equipment.
•Accept safety as an attitude to promote well-being of a
unit and an organization.
•Thinking safety is not “switch on” and ”switch off” affair,
it is an all time thinking and occupation.
•No Great being a Sportsman, if you are not a First Aider
•No Great being a Swimmer, if you are not a Life Saver.
Safety is every ones concern
DON’T BE A BYSTANDER, BE A LIFE SAVER

11. First Aid? What is it?
• When a person is down, sick or injured, he needs
help, without panic ‘knowledgeable and skilled
help’ as a bystander before a paramedic, an
ambulance or a doctor arrives is called ‘First Aid’.
• It saves lives and often makes the difference between
‘Full’ and ‘Partial’ recovery.
• Basic training in first aid skills should be taught in
school, in work places and, in general.
The time to learn first aid is BEFORE you
need to use it!

12. First Aid? (Contd)
The Noble Act of First Aid consists of two
parts: Recovery (Rescue) & Revival
• Recovery is the Rescue from trouble;
water, vehicle, fire, disaster etc. It needs
Presence of Mind, Common Sense, Will to
take a Risk & a bit of Luck
• Revival is medical help and needs
Knowledge & Practice of First Aid
• First Aid in the end is only a matter of
attitude, a lot of Will and a little Acumen

13. First Aid? (Contd)
• Survivability of a victim depends on the attention
he receives in the ‘Golden Hour’, the first hour
after occurrence. .
• But even more important is the treatment
received in the first 15-30 minutes, called the
‘Platinum’ period.
• It is rightly said, “Life is saved at the accident
site , and not in the ICU, where casualty is
brought in dead or alive.”
• Your immediate action as a ‘First Aider’ is thus
very important and can make all the difference
between life and death, full or partial recovery.

14. Administering First Aid
Primary Objectives are To preserve Life
(1) to maintain an open airway, (A)
(2) maintain breathing, and (B)
(3) to maintain circulation. (C)
During this process
• control bleeding,
• reduce or prevent shock.
• prevent further injury or condition from worsening
• protect the unconscious
• promote recovery
• relieve pain
• provide reassurance & comfort to the victim

15. WHY QUICKLY?
• Breathing: When casualty stops
breathing First Aider has only 3-4 mins to
revive him, before victim’s brain cells
begin to die
• Bleeding: Loss of 1.5-2 ltrs blood is fatal
• Shock can kill
• Choking leads to Asphyxiation & Death
Correct Assessment of Injuries
followed by Informed & swift First Aid
is critical for the survival of a casualty

16. CHAIN OF SURVIVAL
Chain of Surivval for an Accident Victim is as
follows
1. First Aider- Any trained passerby in
the Platinum Period from 0-30
minutes
2. Para Medic (Ambulance) in the
Golden Hour
from 30-60 minutes
3. EMS in Hospital
4. Specialist in ICU

17. Principles of First Aid
4 ‘A’s
• ‘Awareness’, you take note of a casualty
and stop to help
• ‘Assessment’, you assess what you can
do against what needs to be done
• ‘Action’ , when you do the best you can,
quickly, deliberately and effectively
• ‘After care’. Stay with the victim till he
gets proper medical aid

18. BODY CHECKS
• Head to Toe Assessment (in this order)
– Head, neck and face
– Shoulder, chest, abdomen, pelvis
– Front and back of Upper limbs
– Front and back of Lower limbs
– Back
The order helps to check life-threatening areas of the body first. Can
be done by another member while one is performing CPR
• Signs
– Sight
– Touch
– Smell
– Hearing
– Question bystanders and the patient, if
possible
– Check and monitor vital signs

19. BODY CHECKS
• Symptoms
– Pain
– Tenderness
– Loss of movement
– Loss of sensation
– Cold
– Heat
– Nausea
– Weakness
– Dizziness
– Faintness
– Loss of consciousness
– Loss of memory
• Check the body for
– Bleeds
– Burns
– Fractures
– Other
– Secondary checks carried out after
managing life threatening problems

20. BODY CHECKS
• External Clues
– Handbag
– Pockets
– Briefcase
– Hospital cards
– Medical alerts
– Wallets

21. VITAL SIGNS
• Vital Sign Measures
Good Poor
Heart
Rate
60-100 beats
per minute
<60 or >100
beats
per minute
Respiratio
ns
14-16 breaths
per minute
>20 breaths
per minute
Skin Warm, pink
and dry
Cool, pale
and moist
Conscious
ness
Alert and
orientated
Drowsy or
unconscious

22. ANATOMY & PHYSIOLOGY

23. RESPIRATORY SYSTEM

24. RESPIRATORY SYSTEM
Airway - Includes all structures from the mouth to the larynx
Pharynx -Located where the nose and mouth open and is
the most common area for a blockage to occur. The base of
the throat divides into 2 separate tubes:
– Trachea (windpipe) – The front tube that provides a
passage of air to the lungs
– Oesophagus (gullet) – The back tube that carries
food an liquid to the stomach
Lungs
• Connected to the upper airway by the windpipe
• located in the chest cavity
• separated from the abdomen by a large sheet of muscle
called the diaphragm

25. RESPIRATORY SYSTEM
Breathing
• Moving the air in and out of the lungs –
inspiration & expiration
• Air we breathe contains 21% oxygen. 5% is
taken into the body and 16% exhaled
• average rate of breathing for an adult is about
15 breathes per minute
When breathing and heart stop, oxygen is not being supplied to the body. Damage
from lack of oxygen to the brain begins in less than 4 minutes.
The breathing control centre is located at the base of the brain;
this function centre requires a good supply of oxygen to
operate properly

26. CIRCULATORY SYSTEM
aorta
Pulmonary
artery (de-
oxygenated
blood to lungs)
Pulmonary vein
(oxygenated
blood from
lungs)

27. CIRCULATORY SYSTEM
– HEART - central organ for the circulation of blood and consists of four chambers
• Functions of the heart – pump blood to 2 main areas
– Lung - where oxygen is taken into the body from the air and carbon dioxide is
released
– The rest of the body
– ARTERIES
• carry blood from heart at high pressure, so their walls are strong, muscular and elastic
• Blood is scarlet in color due to oxygen content
• Cut artery – blood spurts
– VEINS
• Carry blood to the right side of the heart from the organs and muscles after oxygen has
bee used
• Blood is dark red and moves at low pressure
• Easily seen on feet, hands, forearms
– CAPILLARIES
• Tiny vessels that link the ends of the smallest arteries with the smallest of
the veins
• Allow oxygen and nutrients to reach eve cell in the body and carbon dioxide
and other waste products to be removed

28. SKELETAL
SYSTEM

29. SKELETAL SYSTEM
– SKELETON
• Rigid framework of bones which supports the rest of the
body and protects the important organs
– JOINTS – LIGAMENTS & TENDONS
• Junctions between bones (e.g. shoulder, hip, knee)
• Ligaments - attach bones to bones (e.g. finger joints)
• Tendons – attach muscle to bone
– PARTS OF THE SKELETON
• Skull – protects the brain
• Backbone (vertebral column) - protects the spinal
cord
• Ribcage – protects the lungs and heart
• Upper limb bones
• Pelvis and lower limb bones
As a lifesaver you may have to deal with many of the common injuries such as sprains,
strains, fractures and dislocations. Also, head, neck and back injuries.

30. NERVOUS SYSTEM
Central Nervous
System

31. NERVOUS SYSTEM
Central Nervous System (CNS)
–BRAIN - controls all parts of the body with
the spinal cord and nerves
– sends messages which control the
– heart beat
– movement of the muscles of breathing
– all other body functions
–SPINAL CORD
• With the brain controls all parts of the
body
Brain protected by skull & Spinal Cord by vertebrae

32. NERVOUS SYSTEM
–SENSORY NERVES
• feed information into the spinal cord and
brain
• send information to the CNS from
internal organs or from external stimuli
Peripheral Nervous System (PNS)
PNS is not protected by any bones
– MOTOR NERVES
• carry messages to other parts of the body from
the brain and spinal cord
• carry information from the CNS to organs,
muscles, and glands

33. NERVOUS SYSTEM
PERIPHERAL NERVOUS
SYSTEM (PNS)

34. WHAT TO DO
D R A B C
• D - Danger (Remove)
• R - Response (Check)
• A - Airway (Clear)
• B - Breathing (Check) . If NO
Breathing…..
• C - CPR
( Cardio Pulmonary Resuscitation)
• Stop Severe Bleeding
• Prevent Shock

35. RESCUSCITATION CHART
CPR
1. Adult
– 2 rescue breaths followed by 30 ECC
– 3 cylces in 1 min
– 90-100 ECC + 6 rescue breaths
– Depth of Compression 4-5 Cm
2. Child
– Same as above, depth only 2.5-3 cm (1/2 depth)
with one hand
3. Infant
– 5 cycles in 2 mins, followed by same procedure
– Depth only 1.5 cm (1/3 depth) with 2 fingers only

36. CPR
Opening the Airway
Jaw Thrust

37. CPR
Position for CPR

38. CPR
Depth of Cardiac Compression
Adult 4 - 5 cm two hands full breath (500 ml)
Child 3 cm one hand half breath (250 ml)
Infant 2 cm two fingers gentle puff (100ml)
30 compressions and 2 breaths per cycle
3 cycles per minute
IMPORTANT
Child – lung capacity is smaller so ensure it is a small breath
DO NOT OVER-INFLATE THEIR LUNGS
Infant – gentle puff – DO NOT tilt head back

39. CPR

40. CPR
CPR on a child – upto 8 years

41. CPR
CPR on an infant

42. Resuscitation
Demonstration
• DRABC procedure
• CPR on adult manikin
• CPR on infant

43. PUSH HARD PUSH FAST
• Summary of CPR steps for adults, children and
infants ---------
• In December 2005, the Lifesaving Society along with
other top training agencies met to outline a consistent
interpretation of training requirements as presented in
the new Cardiopulmonary Resuscitation [CPR] &
Emergency Cardiovascular Care (ECC) guidelines.
• These guidelines are based on an extensive evidence
review of CPR conducted by International Liaison
Committee on Resuscitation [ILCOR] and the
American Heart Association [AHA].
• The objective is to make it easier for rescuers and health
care providers alike to learn, & remember to
• perform better CPR.

44. PUSH HARD PUSH FAST
• We’ve learned that good, effective CPR results in
better outcomes and survival rates.
• Good, effective CPR is:
• Push hard, push fast: Forceful, fast compressions
provide better circulation of blood and oxygen.
• Allow for full chest recoil after each compression:
It allows the heart to refill and pump more blood.
• Minimize interruption in chest compressions: Don’t
stop – blood flow stops when compressions stop.
• Early defibrillation: Victims have a better chance of
surviving when CPR is performed in combination with
early defibrillation.

45. PUSH HARD PUSH FAST
ESSENTIALS YOU NEED TO KNOW
1. 30:2 – The new universal compression-to-ventilation ratio
for all rescuers responding to victims of any age – adult,
child or infant – 30:2.
Why? More compressions aim to increase blood flow to the
heart, brain and vital organs.
2 No pulse check – deliver two rescue breaths and immediately
begin cycles of 30 compressions and two rescue breaths.
Why? Rescuers often have trouble assessing pulse, and there
is less harm in providing chest compressions to a victim who
has a pulse, than not providing compressions to a victim who
does not.
3 Kids & Calling EMS – When dealing with an unresponsive
child or infant, a lone rescuer should perform five cycles
(two minutes) of CPR before calling for an ambulance.
Why? Some infants and children may respond to early CPR.

46. PUSH HARD PUSH FAST
4 One-Second Breath – All rescuers deliver one-second
rescue breaths that make the chest rise.
• Why? The less time spent on delivering breaths, the
faster a rescuer resumes compressions.
5 “Normal breathing” – Rescuers should start CPR on
unresponsive adult victims who are not breathing
normally. Agonal breathing or gasping is not normal.
• Why? The word ‘Normal’ helps rescuers identify adult
victims who need CPR.
6 Nipple-line Land Marking – Place the heel of one hand
in the centre of the chest between the nipples for adults
and children. Infant land marking remains the same.
• Why? This is a simplified method of achieving correct
hand position.

47. PUSH HARD PUSH FAST
7 Compression Depth - Adult depth remains the same (1 ½
to 2 inches or 4-5 cm ). Infant and child depth is now
measured as 1/3 to 1/2 the depth of the chest.
• Why? Depths measured in centimetres/inches may not be
appropriate for infants and children since the sizes of these
victims vary.
8 Obstructed Airway (Mild versus Severe) – Act if you see
signs of severe obstruction, i.e. poor air exchange and
increased breathing difficulty, a silent cough, cyanosis or an
inability to speak or breathe.
• Why? The goal is to simplify the assessment and to get
rescuers to act.
9 Airway procedure for a suspected spinal – Use a head-
tilt/chin-lift for all victims.
• Why? All methods of opening the airway may cause
movement of the spine; the jaw-thrust is more difficult to
perform and may not be safer than a head-tilt/chin-lift.

48. RECOVERY POSITION
The Recovery Position
Support the victim’s head and
roll him onto his stomach.
Bend the victim’s arm and
knee that are closest to you.
Carefully tilt back the head so
the airway remains open.
Placing an unconscious victim
who is breathing in the
recovery position will keep the
airway open.
CAUTION: Do not place the
victim in this position if you
suspect a neck or back injury.

49. RECOVERY POSITION
If the casualty is unconscious or still dazed after an
accident/near drowning, the ‘Recovery Position’ ensures
clearer airway and proper breathing. The head, kept lower
than the rest of the body allows fluids to drain out without
choking the victim.
Step 1 Place one hand at the side, bent at the elbow
Step 2 With the other hand cover the opposite ear
Step 3 Bend and lift up the knee opposite the stretched
hand
Step 4 Roll over the victim towards the hand on ground
Step 5 Adjust-upper thigh at right. angle, knee down
straight and parallel to the body. Other leg kept straight
Step 6 Tilt the head back to open the airway fully
Step 7 Put face down so that any fluid flowing out is
discharged without blocking the airway,

50. Recovery Position
• Points to remember for ‘Recovery Position’
• Note 1: In case of injury to head, back and the neck,
normal ‘Recovery Position’ may not be possible.
• Note 2: In case the casualty is already lying in another
position, modify the steps as necessary to reach a stable
‘Recovery Position’.
• Note 3: While rolling the casualty over, be gentle and
support the head.
• Note 4: In choosing which side to turn the victim, try to
position the face away from the danger or scene of
occurrence e.g. it would be appropriate to place the face
of a victim rescued from the Ocean [Near drowning
case] away from the sea and surf denying it first view
of the sea, or site of just experienced trauma, on gaining
consciousness.

51. CHOKING
CHOKING, also known as Airway Obstruction, occurs when airway
becomes blocked. The restoration of Breathing takes priority
over all other measures.
Most Common Causes
1. Swallowing large pieces of improperly chewed food
2. Drinking alcohol before or during meals
3. Laughing while eating
4. Turning of the tongue during an accident
5. Foreign body can cause partial or complete obstruction
ACTION
1. If partial, help and encourage victim to cough
2. Full choke needs help by upwards slaps between the shoulder
blades (five at one time)
3. Use Heimlich Maneuver by placing the fist against the middle of
the abdomen above the navel & below the tip of the sternum,
pressing the fist in a quick upward thrust
4. Repeat till the obstruction is clear, or victim becomes unconscious

52. SELF ABDOMINAL THRUSTS
If you are alone and choking, try
not to panic. Perform an
abdominal thrust on yourself
by ;
1. Do a Heimlich Maneuver on
yourself
2. Lean forward and press your
abdomen over the back of a
chair ( with rounded edges),
a table, railing or sink
BABY CHOKING ?
1. Back blows
2. Chest thrusts
3. Finger sweep
4. Breathe into Infants mouth

53. HEART ATTACK
CAUSE
1 Normally either because of a shortage of blood and, therefore, oxygen to the
heart or
2 blood supply obstructed by a clot or constricted arteries.
3 A serious accident, shock or snakebite suffocation or overdosge of
medication/drugs. could also induce an attack.
Reassurance and early CPR form vital components of First Aid.
Symptoms
• Severe pain in the chest spreading to or also in the left arm/neck.
• Difficulty in breathing.
• Profuse sweating.
• Irregular heartbeat.
• Palpitation & fibrillations.
• Weakness, a sinking feeling and anxiety.
• Nausea or vomiting.
• Dizziness/ Unconsciousness.
• Pale and clammy skin. * Bluish lips or nails.

54. HEART

55. Heart Attack

56. HEART ATTACK
Actions
• Reassure and calm the patient. ‘HAND ON HEAD’
• Make the victim lie down in a half-sitting position, with knees
bent & supported
• Loosen clothing, particularly around the neck, chest and waist.
• Keep the person warm..
• Wipe the face and forehead with a damp cloth.
• Regularly record and monitor pulse and breathing.
• Check if the victim is on medication and has a dose on person.
• Do not try to revive the victim by throwing water or slapping the
person.
• Do not give anything to eat or drink.
• In case the victim becomes unconscious, check signs of life like
speech, movement and BREATHING.
• If breathing, place in the ‘Recovery Position’ otherwise start
CPR.

57. HEART ATTACK
Continue CPR in the ambulance.
Additional Data
• The heartbeat is controlled through electric impulses. A
malfunction in the system could cause the heartbeat to
increase, become irregular or stop.
• As it is important for the system and particularly the brain
and other vital organs to keep getting oxygen through the
blood, CPR must be continu0us till the victim reaches the
Doctor.
• If there are other injuries, prioritise them based on each
individual situation but continue with CPR.

58. HEART ATTACK
PREVENTION OF
HEART ATTACK

59. STROKE
A stroke is to the Brain, what an attack is for the Heart and as
such requires very similar actions. It can be caused by too much
blood in the brain which could lead to a blood vessel bursting or too
little blood and, therefore, starvation of oxygen. A stroke may also
be a consequence to a serious head injury.
Symptoms
*Sudden severe headache.
* Nausea and vomiting.
* Breaking into a sweat.
* Pressure in the skull area could even cause a clear discharge from
the nose/ ear (Cerebral Compression)
* Paralysis.
* Behaviour resembling that of a drunken person.
* Weakness.
* Difficulties of speech.
* Involuntary urination.
* Unconsciousness.

60. Stroke

61. STROKE
Actions
• Reassure and calm the patient.
• Make the victim lie down, with head raised very slightly and
to one side. This would permit saliva to drain out.
• Loosen clothing, around the neck, chest and waist.
• Keep the person warm in a thick sheet.
• Do not give the victim anything to eat or drink.
• In case the victim becomes unconscious, check signs of life
like speech, movement and BREATHING. If breathing place
in the ‘Recovery Position’ otherwise start CPR.
• Rush to hospital and seek urgent medical help.
Continue CPR in the ambulance if necessary.

62. STROKE- Blood Letting
When stroke strikes, the capillaries in the brain will gradually
burst.'
Important When a stroke occurs, stay calm.
1 No matter where the victim is, do not move him/her.
Because, if moved, the capillaries will burst.
2 Help the victim to sit up where he/she is to prevent him/her
from falling over again.
3 Blood Letting can begin.
If you have in your home an injection syringe that would be the
best.
Otherwise, a sewing needle or a straight pin will do.

63. STROKE- Blood Letting
1. First sterilize the needle/pin over fire and then prick the tip of
all ......10 fingers.
2. There are no specific acupuncture points, just prick about a mm
from the fingernail.
3. Prick till blood comes out.
4. If blood does not start to drip, then squeeze with your fingers.
5. When all 10 digits is bleeding, wait a few minutes then the
victim will regain consciousness.
6. If the victim's mouth is crooked, then pull on his ears until they
are red.
7. Then prick each earlobe twice until two drops of blood comes
from each earlobe.
After a few minutes the victim should regain consciousness.
Wait till the victim regains his normal state without any
abnormal symptoms then take him to the hospital. Otherwise,
if he was taken in the ambulance in a hurry the hospital, the
bumpy trip will cause all the capillaries in his brain to burst.

64. LOSS OF CONSCIOUSNESS
A person may become unconscious for a variety of reasons. Where possible
try and assess the cause. This must be done quickly, as time at a premium.
Symptom
Victim lying unconscious.
Actions
 Remove the victim from the danger.
 Loosen clothing around the neck, waist and chest.
 Check signs of life like speech, movement and BREATHING.
 If breathing place in the ‘Recovery Position’ IF NOT start CPR.
 When in the ‘Recovery Position’, keep the person warm.
 If the temperature is high, cool forehead with a damp cloth.
 DO NOT Try to revive the victim by throwing water or slapping the
person.
DO NOT Give anything to eat or drink
DO NOT Raise head high as this may block the airway.
Additional Data
• Important for the system and particularly the brain to keep getting oxygen.
Resuscitation is, therefore, vital and must be continued till medical help
Continue CPR in the ambulance.

65. BLEEDING [EXTERNAL]
1 An adult has between five to six litres of blood. The loss of
more than one to 1.5 litre is considered very serious.
2. Bleeding can prevent oxygen from reaching the vital organs
of the body, leading to irreparable damage to them.
3. A severed part may be chilled, but not in direct contact with
water/ice.
4. Today’s micro-surgery may be able to patch this back on the
casualty if the operation is done soon enough.
5. On all such occasions, reach the person to hospital as soon
as possible. Important to telephone and warn the hospital in
advance;
6. Risk of infection a very major threat in all cases of bleeding.
This is not merely to the casualty, but also to the First-Aider.
Protect yourself and the casualty with great stress on hygiene
7. Never cough or breathe over an open wound.

66. BLEEDING [EXTERNAL]
IMPORTANT
If the bleeding is severe, call
DOCTOR
For specific bleeding sites, see also
Nose Emergencies, Eye
Emergencies, & Ear Emergencies.
External Bleeding can be controlled
by applying local pressure, arterial
pressure and by placing the
wounded area above the heart.

67. BLEEDING [EXTERNAL]
1. Lay the victim flat on his back. Raise the victim’s feet
several inches. If possible, elevate the wound above heart
level.
2. Check the victim’s BREATHING. If the victim is not
breathing begin CPR.
3. Remove any visible objects from the wound.
CAUTION Do not remove any object or pull on any clothing that
is stuck in the wound. Do not probe the wound or disturb it.
4. Apply direct pressure to the wound with a clean cloth or
your hand.
5. If blood seeps through the cloth do not remove it; put another
cloth on top and keep pressing. You may need to apply firmer
pressure if blood continues to seep through.
6. For an embedded object, put pressure around the wound, not
on the object e.g. with a doughnut bandage.
7 CAUTION Do not apply pressure to arteries leading to the head
or neck unless bright red blood is spurting from an injured neck

68. BLEEDING [EXTERNAL]
6.When the bleeding stops, apply a bandage. Do not
remove any cloths placed on the wound to help stop
the bleeding; place a clean cloth over the wound. If
there is an object embedded in the wound, bandage
around it to support it.
7. Keep the victim calm and still.
TYPES OF OPEN WOUNDS
INCISION [Cut] – Incised by a knife or blade.
LACERATION [Tear/rip] – When rubbed against barbed
wire.
ABRASION [Rubbing or scraping away] – Rubbed by a
sander or scraped on a road.
CONTUSION [Bruise]– Hit by a blunt object like a
hammer or stone.
PENETRATION – Hole made by a drill or bullet.

69. BLEEDING [EXTERNAL]
Applying Direct Pressure. Use a
clean cloth, or your hand if
necessary, to put pressure directly
on the wound. Hold the edges of
flesh together. Use a glove or a
clean plastic bag to avoid direct
contact with victim’s blood.
Applying Pressure at an Arterial
Pressure Point. Apply pressure with
your fingers held flat against the
arterial pressure point that is closest
to the wound, between the wound
and the heart.
MAIN ARTERIAL PRESSURE POINTS

70. Pressure points

71. BLEEDING [EXTERNAL
CAUTION
DO NOT Clean the wound from out to in as infection can set in.
Always wash/ clean outward.
DO NOT Remove a major object that has initially caused the
wound and is now embedded. This could damage more tissues,
as also increase bleeding.
DO NOT Keep arterial pressure for more than 15 minutes, as
this could permanently damage the area and may even result in
gangrene.
DO NOT Allow the casualty to swallow blood, as this could lead
to vomiting. Instead spit it out.
DO NOT Unnecessarily move the casualty. This may increase
bleeding.
DO NOT Touch the wound with your bare hands. Use gloves/
sterile cloth/ polythene bag whenever possible. Never cough
over the wound.
DO NOT Give water to drink. At best, a wet cloth may be used
to moisten the lips.
DO NOT Push back any organs that have come out of the
abdomen. Cover them and isolate them

72. INTERNAL BLEEDING
IMPORTANT
CALL EMERGENCY NUMBER.
SYMPTOMS
* Bruises
* Coughing or vomiting blood
* Rectal bleeding
* Blood in urine
* Bleeding from the nose or ear
* Skull, chest or abdominal wounds
* Dizziness
* Fainting
* Weak pulse
* Shortness of breath
* Shallow breathing
* Dilated pupils
* Pale, clammy skin

73. INTERNAL BLEEDING
CAUTION:
If you suspect a head, neck or back injury, take
precautions as taught
1. Check victim’s BREATHING.
If the victim is not breathing or does not have any signs of
life, begin CPR.
2. If breathing, continue to monitor casualty’s condition,
periodically rechecking.
3. Reassure casualty and keep him/her calm and still.
4. Do not give him/her anything to eat or drink.
5. If the victim’s arm or leg is swollen or misshapen,
immobilize it.
6. Remove to hospital as soon as possible or seek
professional medical aid urgently.
7. Begin First Aid for shock while you wait for medical help.

74. SHOCK
CIRCULATORY SHOCK
Shock may develop as a result of a major accident, profuse
bleeding, severe burns or loss of body fluids and can cause
severe disorders of the blood circulation system. It needs very
urgent attention, as without timely action it may be fatal due to
the brain, heart, kidneys being starved of oxygen and
thereby failing.
PSYCHOGENIC/EMOTIONAL SHOCK.
Should a person suffer emotional shock, e.g. fright, bad news
or even extraordinarily good tidings, involuntary changes in
the person’s biorhythm can cause Psychogenic Shock. In this,
a momentary stoppage of the heart/ skipping of a heartbeat can
act as a barrier thereby preventing re-circulation of blood.
Severe pain, both external and internal can further aggravate
the conditions.

75. SHOCK
Symptoms
Restlessness and anxiety.
Victim in a dazed state or breaking into a cold sweat.
Victim shivering.
Pale skin, with area not regaining colour when
pressed.
Changes in breathing pattern/ gasping.
Pulse rapid, but weakening.
Chest pain.
Excessive thirst.
Dilated pupils.
Dizziness and general weakness.
Nausea or vomiting.]
Victim becoming unconscious.

76. SHOCKActions
• Immediately try to determine the cause of shock.
• To minimise its effects, constantly reassure the casualty.
• ‘Hand on Head’ whilst giving solace.
• Place the casualty in a lying position with feet raised.
• Loosen clothing and make comfortable.
• Keep the person warm & treat for injuries, if any.
• Give a cold compress, if sweating.
• Keep airway open in case the victim vomits.
• Do not unnecessarily move the person, particularly if you
suspect a major injury.
• Do not leave the person unattended, even for a short period.
• Do not give anything to eat or drink. At best, let the casualty
suck on a damp clean cloth.
• Do not allow the patient to smoke as this consumes a lot of
oxygen.
• In case the victim becomes unconscious, check signs of life like
speech, movement and BREATHING. If breathing place in the
‘Recovery Position’ otherwise start CPR.

77. ANAPHYLACTIC or ALLERGIC SHOCK
1.Separate from the trauma caused by a Circulatory/
Psychogenic Shock,
2.Major allergy due to adverse reaction to some
food/medicine, poison or a bite/sting.
3.can be fatal if the reaction results in changes to the
breathing pattern, pulse or heavy swelling of the face and
throat/neck.
Symptoms
* Itching.* Hives. * Warm skin. * Impaired breathing.
* Wheezing/ gasping. * Flushed face. * Abdominal
cramps/pain.
* Spreading pain or tingling sensation. * Pulse rapid, but
weak.
* Dizziness. * Nausea or vomiting. * Victim becoming
unconscious.

78. ANAPHYLACTIC or ALLERGIC SHOCK
Actions
• Immediately determine cause of the allergy.
• In case of an allergic reaction, check with the patient about
his/her medical history. Keep the person calm.
• Treat the person as for shock.
• Place in a position that the person finds most comfortable for
breathing.
• Loosen clothing.
• Do not use tweezers to pull out a sting in the case of a bite or
a sting.
• Do not make the victim walk in the case of poisoning. Instead,
carry the person.
• Do not rub the wound/area of sting whilst cleaning.
• In case the victim becomes unconscious, check signs of life
like speech, movement and BREATHING. If breathing place in
the ‘Recovery Position’ otherwise start CPR.
Continue CPR in the ambulance.

79. ELECTROCUTION or ELECTRIC
SHOCK
Symptoms
* Victim in a state of shock, after feeling
the jolt.
* Dilated pupils.
* Severe muscle pain.
* Bleeding.
* Headache/dizziness.
* Victim unconscious with an electric wire/
other liquids under or near the person.
* Burn marks on the body at point of entry
and exit of a high voltage current/lightning.

80. ELECTROCUTION or ELECTRIC SHOCK
Actions
• Immediately switch off power supply/ disconnect
appliance.
• In case this is not possible, use a non-conductive
material like a wooden rod or chair to either remove the
wire from the casualty or move the casualty away. Stand
on a piece of rubber/wood or even a thick book/
telephone directory.
• Do not approach less than 25 feet, if you suspect that
the contact is with a high voltage cable. Arcing can
occur at lesser distances, with the current discharging
through the air.
• Minimise effects of shock. Reassure the casualty. HOH
• Place in lying position with feet slightly raised.
•

81. ELECTROCUTION or ELECTRIC SHOCK
• Treat burns/wounds as applicable and if casualty
conscious.
• If casualty unconscious, give a cold compress.
• Do not touch the patient till sure that the main
supply has been disconnected.
• Do not touch the switch on the faulty appliance, as this
may be the cause. Instead remove the main plug.
• Do not give anything to eat or drink
• In case the victim becomes unconscious, check ABC.
• If breathing, place in the ‘Recovery Position’
• otherwise start CPR.
• Continue CPR in the ambulance.

82. DROWNING
RESCUE
-- Dry
– Non- Contact
– Contact
REVIVAL

83. DROWNING
• Drowning
– Death caused by asphyxia, i.e. insufficient
oxygen reaching the tissues of the body following
immersion in water
– Small quantities of water enter the lungs –
enough to interfere with normal transfer of
oxygen
– Secondary drowning caused by water in lungs –
cause irritation and results in fluid collecting in
the alveoli – further reducing the transfer of
oxygen to the blood

84. DROWNING
– Cold, pale skin
– Blue face
– Unconsciousness
– No exhaled breath
– Recognize type of casualty
(non-swimmer, weak
swimmer, injured swimmer
or unconscious victim)
– Use appropriate approach
to pull victim to safety
– Check for breath
– If breathing, recovery
position
– Not breathing – CPR
– Remove wet clothing
– Cover with coat or blanket
– Keep victim calm and still
• Symptoms • Action

85. DROWNING
• WATER RESCUE
Unconscious victim
– If possible, wade out and tow victim face up to the shore –
being careful of strong currents
– If water is too deep for wading, look for a boat
– ONLY if you are a strong swimmer, swim up to victim and tow
face up
Conscious victim
– Pull victim to safety using DRY rescue methods – stick, oar,
towel, life buoy, boat, etc.
DO NOT swim out to victim
unless you have been trained
in water rescues methods

86. BURNS AND SCALDS

87. BURNS AND SCALDS
Scalds are caused by hot liquids, gases and vapours.
Burns are caused by fire, friction, radiation, electrocution,
chemicals and even by touching very cold/frozen metals.
Symptoms
1. Victim’s clothing and skin smouldering or on fire.
2. Skin damage with redness, blisters, charred or white
patches on skin and/or fluid oozing out.
3. Entry and exit wounds due to a high voltage shock/
lightning strike, with possible internal damage to some
organs between these points.
4. In severe cases, cardiac arrest is very likely and
may require immediate resuscitation (CPR)
5. Breathing problems due to smoke inhaled.& Suffocation
due to burns near mouth and internally in the airway.
6. Headache, pain or seizures.
7. Dizziness or unconsciousness.
8. Severe pain from chemical reactions due to burns
9. Skin peeling off on touching very cold structures/objects.

88. BURNS AND SCALDS-2
Actions
• Remove the victim from the source of burn. Ensure main supply
disconnected before you touch a victim with an electrical burn/shock.
• Put out the fire by smothering the flames with a carpet/blanket/coat or any
other thick clothing. Ensure no synthetic content as this will immediately
stick to the body.
• Tell the victim to roll on the ground to smother the fire.
• Douse with water.
• After extinguishing the fire, subject the burnt portion of the body to running
water for up to 15 minutes or cool by placing wet cloths over the burnt area.
• For severe burns, lay the victim down on a sheet to reduce the effects of
shock. Direct contact with the ground may cause infection.
• Cover large burns with sterile, dry cloth. This will limit contamination and
restrict open contact with air/germs. If fluid is oozing out, do not remove this
cloth or other clothing sticking to the burn. Instead, place another clean cloth
over it.
• Remove burnt shreds of clothing, jewellery, watches, rings, bangles etc., as
these would hurt due to body swelling after the burn.
• Gently separate burnt fingers/toes and place a clean, dry cloth in between.
• Elevate severely burnt arm/leg above the level of the heart.
• Brush away all dry chemicals from the wound. cool/wash other chemicals
under running water for approximately 20 minutes.

89. Burns and Scalds-3
Actions Continued…..
• Do not pull off any clothing stuck to the burnt skin
• Do not place ice on the burnt area.
• Do not apply any water or cover the skin with wet cloth if
the burnt area is very large/deep so as to avoid infection.
• Do not cough over the burnt area as this could cause
infection.
• Do not use cotto n wool or other fluffy materials to cover
the burnt areas. These stick to the skin and their removal
after reaching the Doctor may cause great pain.
• Do not burst any blisters.
• Do not apply any ointments/lotions/oils on the burns.
Seek urgent medical help for severe burns.

90. First Aid at Fire Scenes
• Burns
– Slight- small, on surface, reddening of skin. Apply cold running
water or ice to relieve pain.
– Serious-large or deep, blistering or charring. Call for medical aid
(physician or trained EMT), remove clothes, cut around sticking
cloth. Don't attempt to clean wound. Cover loosely with clean,
dry dressing. Treat for shock. Never use iodine, cotton, grease,
or oil on burns.
• Inhalation of Smoke or Fumes - dizzy or unconscious, violent coughing,
irregular breathing, ringing ears, seeing spots.
– Get to fresh, warm air.
– Lay person down
– If victim is not breathing, give artificial respiration.
– Give oxygen if available
– Call for medical aid (physician or EMT), treat for shock.
• Shock - severe upset to nervous system-symptoms are a pale, cold sweat,
clammy skin, irregular breathing, listlessness.
– Lay person down - raise hips, legs - loosen clothes.
– Keep warm - maintain body temperature - wrap blankets under
as well as over person - but don't overheat. Call for medical aid.

91. BURNS AND SCALDS-4
• Additional Data
The Skin. The primary function of the skin is to maintain
body temperature and act as a barrier against external
threats and infections.
The four levels of the skin.
• The Epidermis or top layer is very sensitive to pain, but
grows again very easily when damaged.
• The next two layers of the Dermis and Subcutaneous
layer would also recover in time, but could need a graft.
The hair follicles and the sweat/oil secretion glands are
in these layers and govern the release of sweat to cool
the body when hot or signal to the epidermis to form
goose pimples when the body feels cold. Similarly,
shivering is a form of generating heat for the body.
• The deepest (fourth) layer comprises portions of the
muscle linked to the bone. Damage to this is normally
permanent and beyond repair.

92. Burns and Scalds-5
1st Degree – Superficial Burns – Recognition
Redness, slight charring, severe pain.
Actions – Place under running water.
Repair Time – Couple of days.
2nd Degree – Minor Deep Burn
Recognition – Red edges, Black charring,
Blisters
Actions – cover with clean wet cloth.
Repair Time – Couple weeks or months.
3rd Degree – Deep Burn –
Recognition – Red edges, Black charring, burst
Blisters, few white patches (burnt skin) ,Fluid
oozing
.Actions – Place clean dry cloth over burnt
area.
Repair Time – Couple of years + plastic
surgery.
4th Degree – Very deep Burn –
Recognition – Red edges – Black charred ring –
Burst blisters – Large white patches (burnt
skin) – Fluid oozing out – Bone visible.
Actions – Leave open and prevent infection.
Repair Time – Many years with repeated
plastic surgery and skin grafting.
Highly magnified cross section of skin

93. 9% Rule

94. Scalds & Burns cont…..6
The 9% RULE.
The method of reporting or assessing the extent of a burn is in percentage
of the body surface.
This surface area of the body is divided into 11 parts of 9% each;:-
1. 1 part for Head- all around……………………....................9%
2. 1 part for upper arm from shoulder to finger tips [Left].......9%
3. 1 part for upper arm from shoulder to finger tips [Right]…9%
4. 1 part for chest ……………………………………………. 9%
5. 1 part for stomach ………………………………………… 9%
6. 1 part from nape to mid back…………………………… …9%
7. 1 part from mid back to hips……………………………… . 9%
8. 1 part for upper leg from hip to knee [Left]........................ 9%
9. 1 part for upper leg from hip to knee [Right]……………… 9%
10. 1 part for lower leg from knee to toes[Left]........................ 9%
11. 1 part for lower leg from knee to toes[Right]…………….... 9%
11 x 9 = 99%
Genitals …………………………………….........................................1%
Total 100 %
The injury is considered very serious if the burns aggregate to more
than 30% for a normal adult. For a child or an elderly/sick person this
percentage may be reduced even further, as their ability to
resist/sustain is much less.

95. FRACTURES AND DISLOCATIONS
FRACTURES AND
DISLOCATIONS

96. Fractures & Dislocations
• What is a Fracture?
– A break or crack in the continuity of a bone – caused
by direct blow or indirect force such as twisting
• What is a Dislocation
– A dislocation is when a bone is moved out of its
normal position in relation to another bone usually
knee, ankle, or shoulder
• What is a Sprain?
– A sprain is when the connecting tissues (ligaments)
and other soft tissue structures of the joints have
been torn or stretched.
• What is a Strain?
– A strain is when the muscles and tendons have been
torn or stretched.

97. Sprains & Strains
– Pain
– Swelling
– Possible
discolouration
– Don’t move area that causes
pain
– Apply ice packs for 5 to 15
mins
– Raise the area
– Apply compression bandage
– Check circulation beyond
damage
– If further treatment required,
call for medical help
RICE
• Rest
• Ice
• Compression
• Elevation
• Symptoms • Action

98. Dislocations
– Pain
– Bone out of normal position
– Swelling
– Possible discolouration
– Don’t move area that
causes pain
– Check for pulse below
dislocation; no pulse
immediate medical help
– Apply ice packs for 5 to
15 mins
• Symptoms
• Action

99. Fractures
• Types of fractures
– Closed Fracture:
– a broken bone that does not break the
overlying skin.
– Tissue beneath the skin may be
damaged.
– Open Fracture:
– a broken bone that breaks (pierces) the
overlying skin.
– The broken bone may come through
the skin, or a missile such as a bullet
or shell fragment may go through the
flesh and break the bone.
– An open fracture is subject to infection.
Cracked
Bone
Chipped
Bone
Broken
Bone

100. FRACTURES AND DISLOCATIONS
• CAUTION: If you suspect a head, neck or back injury, see protocol for same.
1. Check the victim’s Response and Breathing. If the victim does not have signs
of life like speech, movement or breathing, begin CPR.
2. Do not move the victim.
• CAUTION: Do not move someone with an injured hip, pelvis or upper leg unless it
is absolutely necessary. If you must move him to safety, immobilize the victim’s
head between your arms, grab his clothes at his shoulders and drag him.
3. Check for and attend to any other serious injuries.
• CAUTION: If the victim is bleeding around or near a broken bone, do not wash or
probe the wound. Place a clean cloth over the wound and tie a bandage over it.
4. Immobilize the injured bone or joint. If a finger or toe is broken, apply a cold
compress to it and elevate it above the level of the victim’s heart. Place a small
cloth or piece of cotton between the injured digit and an uninjured one, and then
tape them together..
• CAUTION: Do not attempt to straighten or change the position of any misshapen
bone or joint. When applying a sling or splint, do not cut off blood circulation to the
injured limb.
• Do not tie the splint in place over the break.

101. IMMOBILIZING AN INJURED ARM
LOWER ARM, WRIST, OR HAND
1. Stabilizing the arm: Support the injured
bone or wrist with your hands, and place the
lower arm at a right angle over the victim’s
chest. The victim’s thumb should be pointing
upward. Place the arm and wrist on a
magazine or newspaper padded with a towel
or pillow, and tie the magazine in place.
.PLACE THE ARM IN A SLING
2. Position a cloth to be used as a sling.
Locate a large piece of cloth or a long-
sleeved shirt or sweater; fold the cloth in half,
so it forms a triangle. Slide the cloth or shirt
between the victim’s arm and body, so the
long side of the cloth or the shirt top is closest
to the injured arm.
3. Tie the cloth in place. Pull one end of the cloth
behind the victim’s neck; place the other half
over the injured side; fold over any extra
material that is behind the elbow and pin it in
place. Make sure the sling is snug but not
tight.

102. IMMOBILIZING AN INJURED LEG
LOWER LEG
• Using boards as a splint. Locate
two long boards; one should
extend from the victim’s hip to the
heel, and the second should
stretch from the groin to the heel.
Pad the boards with blankets or
pillows, then place the boards so
the padded side touches the
injured leg. Tie the boards in place
at the groin, thigh, knee and
ankle.
• Using blanket as a splint. If
boards are unavailable, roll up a
blanket, place it between the
victim’s legs, and tie the victim’s
legs together at the groin, thighs,
knees and ankles

103. UPPER LEG OR HIP
Using Boards as a Splint.
Locate two long boards
one to extend from the
victim’s armpit to the
heel, and the other from
the groin to the heel. Pad
the boards with blankets
or pillows and then place
the boards padded side
in. Tie the boards in place
at the chest, waist, groin,
thigh, knee, and ankle.

104. IMMOBILISATION
Splint and Sling for
a Fractured Upper Arm

105. IMMOBILISATION

106. Carries

107. One Rescuer Carries

108. Arm Carries
One-person arm carry
The one-person arm carry should not
be used to carry a casualty who is
seriously injured. Unless the casualty
is considerably smaller than you, you
will not be able to carry the casualty
very far.

109. Shoulder Drag
The shoulder drag supports the
head of the victim. It requires
the rescuer to bend over at the
waist while pulling.
1.Grasp the victim by the clothing
under the shoulders.
2.Keep your arms on both sides
of the head.
3.Support the head.
4.Try to keep the pull as straight
and in-line as possible.

110. Feet Drag
The feet drag is the fastest method for
moving a victim a short distance over
a smooth surface.
1. Grasp the victim by both ankles or
pant cuffs.
2. Pull with your legs, not your back.
3. Keep your back as straight as
possible.
4. Try to keep the pull as straight and
in-line as possible.
5. Keep aware that the head is
unsupported and may bounce over
bumps and surface imperfections.

111. Blanket Drag
The blanket drag can be used to move a casualty who,
due to the seriousness of the injury, should not be lifted
or carried by one person alone.
1. Fold the blanket into several folds, working it very close
to and under the body.
2. Reaching over the body, grasp the shoulder or upper
back with one hand and the hip with the other and
slowly roll the victim toward you onto his side.
3. Gently roll him to his back and on to the blanket.
4. Wrap the victim in a blanket.
5. Squat at the victim's head and grasp
the blanket behind the victim's head.
6. Drag the victim clear of the hazard.

112. Pack Strap Carry
The pack-strap carry can be used to move a
heavy casualty for some distance .
1. Place the casualty face up.
2. Lie down on your side along the casualty's
uninjured or less injured side. Your shoulder
should be next to the casualty's armpit.
3. Pull the casualty's far leg over your own, holding
it there if necessary.
4. Grasp the casualty's far arm at the wrist and
bring it over your upper shoulder as you roll and
pull the casualty onto your back.
5. Rise up on your knees, using your free arm for
balance and support. Hold both of the casualty's
wrists close against your chest with your other
hand.
6. Lean forward as you rise to your feet, and keep
both of your shoulders under the casualty's
armpits.
Do not attempt if the casualty has an injured
arm, ribs, neck, or back!

113. Fireman’s Carry
The Fireman's Carry is one of the easiest ways to carry
an unconscious casualty.
1. Place the casualty face down. Face the casualty, and kneel
on one knee at the casualty's head. Pass your hands under
the armpits; then slide your hands down the sides and grasp
them across the back.
2. Raise the casualty to his knees. Take a better hold across
the casualty's back.
3. Raise the casualty to a standing position and place your right
leg between the casualty's legs. Grasp the right wrist in your
left hand and swing the arm around the back of your neck
and down your left shoulder.
4. Stoop quickly and pull the casualty across your shoulders
and, at the same time, put your right arm between the
casualty's legs.
5. Grasp the casualty's right wrist with your right hand and
straighten up. The procedure for lowering the casualty to the
deck is also illustrated.
Do not attempt if the casualty has an injured arm, ribs,

114. Fireman’s Carry
http://www.brooksidepress.org

115. Two Rescuer Carries

116. Chair Carry
The chair carry can be used to move a casualty away
from a position of danger. This is a good method to
use when you must carry a casualty up or down steps
or through narrow, winding passageways. .
Do not attempt if the casualty has an injured neck, back, or
pelvis!
1. Pick the victim up and place them or
have them sit in a chair.
2. The rescuer at the head grasps the chair
from the sides of the back, palms in.
3. The rescuer at the head then tilts the chair
back onto its rear legs.
4. For short distances or stairwells, The second
rescuer should face in and grasp the chair legs.
5. For longer distances, the second rescuer should
separate the victim's legs, back into the chair
and, on the command of the rescuer at the
head, both rescuers stand using their legs.

117. Arm Carry
Arm carry
The two-person carry unless absolutely
necessary, should not be used to
carry a casualty who is seriously
injured.
1. Two rescuers kneel beside the
casualty at the level of the hips, and
carefully raise them to a sitting
position.
2. Each rescuer puts one arm under the
casualty's thighs; hands are clasped
and arms are braced.
3. Both rescuers rise slowly to a standing
position.
Do not attempt if the casualty is seriously
injured!

118. Two-handed seat
An alternate two-person carry
also can be used.
1. Pick up the victim by
having both rescuers squat
down on either side if the
victim.
2. Reach under the victim's
shoulders and under their
knees.
3. Grasp the other rescuer's
wrists.
4. From the squat, with good
lifting technique, stand.
5. Walk in the direction that
the victim is facing.

119. Four-handed seat
This technique is for carrying conscious
and alert victims moderate distances.
The victim must be able to stand
unsupported and hold themselves
upright during transport.
1. Position the hands as indicted in the
graphic.
2. Lower the seat and allow the victim to
sit.
3. Lower the seat using your legs, not
your back.
4. When the victim is in place, stand
using your legs, keeping your back
straight.

120. Three Rescuer Carries

121. Hammock Carry
Three or more rescuers get on both sides of the
victim. The strongest member is on the side
with the fewest rescuers.
1. Reach under the victim and grasp one wrist
on the opposite rescuer.
2. The rescuers on the ends will only be able to
grasp one wrist on the opposite rescuer.
3. The rescuers with only one wrist grasped will
use their free hands to support the victim's
head and feet/legs.
4. The rescuers will then squat and lift the
victim on the command of the person
nearest the head, remembering to use
proper lifting techniques.

122. Stretcher Lift
This technique is for lifting a patient into
a bed or stretcher, or for transporting
them short distances.
1. Each person kneels on the knee
nearest the victim's feet.
2. On the command of the person at the
head, the rescuers lift the victim up
and rest the victim on their knees.
3. At this point, the rescuers will rotate
the victim so that the victim is facing
the rescuers, resting against the
rescuers' chests.
4. On the command of the person at the head,
all the rescuers will stand.
5. To walk, all rescuers will start out on
the same foot, walking in a line

123. Log Roll
Preparation
Step1: Appoint a leader: The most experienced person on
the scene is the leader, who issues all commands.
Position the Rescuers
Step1: Place the leader at the top of the injured person's head,
facing the injured person's toes. The leader holds the head
with both hands, stabilizing it by holding firmly and allowing no
motion.
Step2: Position two other rescuers on one side of the injured
person, one at the chest and one at the pelvis.
Step3: Place the pad or litter along the other side of the injured
person, as close to him or her as possible.
Step4: Direct the rescuer positioned at the chest to reach across
the injured person and grab hold of the upper arm and
shoulder.
Step5: Direct the rescuer positioned at the pelvis to reach across
the injured person and grab hold of the lower back and pelvis.

124. Log Roll
Roll the Injured Person
Step1: Roll the injured person upon the leader's
call: "Roll on three. One, two, three!" Slowly
and carefully roll the injured person until he or
she is on his or her side.
Step2: Direct the one remaining rescuer to push
the pad or litter to where the injured person was
just lying.
Lower the Injured Person
Step1: Roll the person down on the leader's
call: "Down on three. One, two, three!"
Slowly and carefully lower the injured person
until he or she is down onto the pad or litter.

125. CARRIAGE

126. CARRIAGE

127. CARRIAGE

128. HEAD, NECK, AND BACK INJURIES
1. Keep the victim calm and still.
2. 2Check the victim for signs of life and
BREATHING. If the victim is not breathing begin
CPR.
3. If you suspect the victim has suffered a head injury and
he is bleeding from his nose, eye, or ear, give first aid
as described below. Also tend to injuries to nose, eye,
or ear as prescribed.
4. Try to find out how the victim was injured. A head,
neck, or back injury is particularly likely if the victim
was in an accident involving sudden acceleration or
deceleration (as in car accidents) or from jumping or
diving, or if here are gunshot wounds to the head or
chest. Multiple wounds and unconsciousness after
physical trauma are other possible indicators.

129. HEAD, NECK, AND BACK INJURIES
CAUTION:
i. Do not move the injured person unless it is absolutely
necessary.
ii. If you need to place the victim on his back, support his
head, neck and back together and carefully roll him on to
his back. Make sure you keep the head, neck and back
aligned as you roll him. It is best to have at least one other
person help you do this LOG ROLLING of the casualty.
iii. Do not put a pillow under the victim’s head, as this may
aggravate injuries and cause the airway to become
blocked.
iv. When opening the victim’s airway, just lift the chin. Do not
tilt the head back.
v. Do not give him any thing to eat or drink.
5. Tend to other injuries.

130. HEAD, NECK, AND BACK INJURIES
IMPORTANT
6. Call Emergency & send for an Ambulance.
Make the victim comfortable. Keep the victim warm with
blanket or coat until medical help arrives.
7. Keep the Airway Open. If the victim begins to choke or vomit
or becomes unconscious, support his head, neck and back
together and carefully roll him on to his side. It is best to
have some one else help you do this.
8. Immobilise and remove to hospital earliest.
SYMPTOMS
HEAD INJURIES
* Head wound * Bruise or lump on scalp
* Bleeding from ear, nose, or mouth that is not due to injury to
those areas * Fluid draining from ear or nose *
Black eyes * Bruise behind ear
* Headache, nausea or vomiting * Altered mental state
* Vision changes * Slurred speech
* Irregular pulse * Unconsciousness

131. HEAD, NECK, AND BACK INJURIES
NECK OR BACK INJURIES
• Tingling sensation in arm and legs
• Loss of movement in arms or legs
• Loss of bowel or bladder control
• Odd position head, neck, or back
• Unconsciousness

132. SNAKEBITES
India has 216 species of
snakes. Of these only 52
species (Five varieties) are
poisonous to varying degrees.
These five varieties are: -
(1) Cobras – Cobra and King
Cobra.
(2) Kraits – Banded Krait,
Common India Krait and Black
Krait.
(3) Vipers – Russell’s Viper,
Saw-scaled Viper, Horned
Viper and Pit Viper.
(4) Coral Snakes – Coral and
Slender Coral
(5) Sea Snakes

133. SNAKEBITES
Points to Note
• Reaction can set in within 6-8 minutes of the bite.
• The surest remedy is an early injection of the anti-
venom serum.
• Poisonous snakes invariably leave two distinct fang
marks as shown.
• The point of bite and its proximity to the heart could
hasten reaction.
• Since shock rather than poison can also cause death,
reassurance is a
• vital part of first aid for a snake-bite.

134. SNAKEBITES
Symptoms
Bite, with or without fang marks or bleeding.
Severe anxiety.
Redness, discolouration, swelling and/or severe pain near
the bite.
Dizziness, nausea or vomiting
Salivation/sweating.
Difficulty in swallowing/speaking.
Blurred vision/dilated pupils.
Drowsiness/ convulsions/ paralysis.
Bleeding from orifices.
Changes in breathing/ pulse and unconsciousness.
Actions
 Reassure the victim. This is extremely essential as more
persons die of shock and trauma, rather than the venom.
 Unless you have positively identified the snake to be non-
poisonous, always assume the bite to be from a poisonous
snake and act accordingly

135. SNAKEBITES
 Brush outward from the wound, wash well and pat dry. Do not
rub the area.
 Rush the victim to the hospital. If the snake has been caught/
killed carry it along. (Avoid crushing the snake’s head while
killing)
 Alert the hospital so that the anti-venom serum is kept ready.
 Tie a pressure bandage from the point of bite towards the
heart.
 Avoid all unnecessary movement of/ by the victim. Do not
allow him/ her to walk. Whilst transporting keep the victim as
still as possible- preferably in a reclining position such that the
area of the bite is lower than the level of the heart (Should this
be possible)
 The earlier remedies of slashing the wound, sucking by mouth
or applying a tourniquet are no longer recommended.
Slashing increases blood circulation. Sucking by mouth in
dangerous for the First-Aider. Instead, attempts can be made
for mechanical sucking using rubber cups or suction cups.
 Resuscitate CPR if breathing stops.

136. SEIZURES
CAUTION : Do not try to restrict his movements, unless he is
going to hurt himself.
5. When the seizure has ended, help the victim into a
comfortable position on his side. The victim is likely to be
tired, confused and may fall asleep.
6. Check the victim’s BREATHING. If the victim is not
breathing or does not show signs of life begin CPR.
IMPORTANT
If this is the first time the victim has had a Seizure; or the victim
has more than one seizure per hour, or in case the seizure lasts
more than two minutes, call “Emergency”.
Seizures, while frightening, are usually not life threatening. You
should be more concerned about the seizure’s cause, so be
sure to determine if the victim is wearing a Medic Alert tag or if
he is suffering from another injury.

137. SEIZURES
SYMPTOMS
Tingling sensation
Twitching, muscle spasm
Body stiffening
Drooling
Loss of bladder or bowel control
Unconsciousness
FEBRILE SEIZURES
Seizures in young children or infants are often caused by
sudden high fevers. If the child has such a fever take off
his clothes and sponge his body with lukewarm, not
cold, water.
Call your doctor for further advice.
CAUTION: Do not give the child a bath.

138. BITES and STINGS
Bite - Dog
1. The most common bites are from dogs, with children
and elderly people being the most frequent victims.
2. causing wounds to the skin and deeper tissues,
3. bites tend to result in infection
4. prompt medical treatment is needed
5. A tetanus injection and a course of antibiotics may be
prescribed by the doctor.
Action
For a small wound
1. Wash the area which has been bitten as thoroughly
as possible with soap and warm water.
2. Dry the area with a clean towel or blot it dry with
clean tissues.
3. Apply a sterile adhesive dressing over the wound.

139. BITES and STINGS-2
For a large wound
Where there is obvious skin damage and some bleeding
• Stop bleeding by pressure with your hand or fingers
• When the bleeding is under control, apply a bandage to
maintain pressure and keep the dressing in place.
• Always roll bandages from the inside of the limb outwards.
Take the victim to a hospital or get professional medical help.
Dog Bite
1. Wash the bite wound with soap and water.
2. Apply alkaline based antiseptic lotion, like ‘Savlon’ or cover
the wound with soda-by-carb ( Normal cooking soda) powder.
3. Leave the wound open.
4. Apply “Rabipure Spray”
CAUTION:
If bitten by an unknown dog or a stray dog DO NOT TAKE
CHANCES. GET VACCINATED.

140. BITES and STINGS-3
Sting - Bee & Wasp
• Bee and wasp stings can be very painful but are usually
harmless.
• After stinging, the bee leaves a single sting, which is barbed
and contains a single sack in the skin
WHAT THE VICTIM MAY COMPLAIN OF:
* Immediate pain at the sting sites, * Itching,
* Swelling inside the throat (If allergic to the venom),
* Wheezing and breathing difficulties (If allergic to the venom)
WHAT TO LOOK FOR
* Swelling and redness at the sting site
* Swelling of the face and eyelids with a rash (If allergic to the venom)
* Vomiting (If allergic to the venom)
* Rapid pulse and wheezy breathing (If allergic to the venom)
Action
1. For a bee sting, scrape the barb off the skin immediately with a fingernail
or by brushing the barb off sideways.
2. DO NOT pull the barb out.
3. Help the victim to lie down in the most comfortable position possible.
Raise the area which has been stung.

141. Heat & Cold Emergencies

142. Hyperthermia
• General name given to a variety of heat-related
illnesses
• In hot weather or intense activity, body
perspires.
• Perspiration evaporates, cooling skin
• If it happens for long periods, body loses ability
to respond efficiently
• Two forms:
– Heat exhaustion: warning that body is getting hot
– Heat stroke: malfunction of the heat-control centers
in the body life-threatening – high body temperature

143. Heat Exhaustion
– Cool, clammy skin
– Excessive perspiration
– Dilated pupils
– Rapid pulse
– Headache
– Nausea or vomiting
– Abdominal or limb
cramps
– Dizziness
– Move to cooler site
– Make victim lie or sit
down, an elevate feet
– Place cool, wet cloth
on forehead and torso
– Wrap in wet towels or
sheet
– Fan with electric fan or
hair dryer set to cool
– Give CONSCIOUS
victim a cool drink
– If condition does not
improve, move to
DO NOT use alcohol rub to cool victim
DO NOT force to drink
DO NOT give anything caffeinated or
alcoholic
• Symptoms • Action

144. Heat Stroke
– Body temp above120 f
– Flushed, dry, hot skin
– Constricted pulse
– Confusion
– Rapid pulse
– Seizures
– Unconsciousness
– Cool victim
– Move to cooler site
– Place cool, wet cloth
on forehead and torso
– Wrap in wet towels or
sheet
– Fan with electric fan or
hair dryer set to cool
DO NOT use alcohol rub to cool victim
DO NOT give anything to eat or drink
• Symptoms • Action

145. Cold Injuries
• Generally caused by exposure to cold
• Two forms:
– Hypothermia: condition in which the body’s
temperature drops below normal
– Frostbite: condition in which the skin freezes,
initially causing pain and redness in the
affected area, which may develop into
numbness and whiteness

146. Hypothermia
– Shivering
– Uncoordinated
movements
– Drowsiness, weakness
– Confusion
– Unconsciousness
– Cardiac arrest
– Check airway, breathing –
no breathing ->CPR
– Gently lead or take victim
to warm, dry shelter
– Change victim to dry
clothing
– Warm slowly – place warm
compresses to neck, groin
and chest (loss of heat
maximum)
– Conscious victim, can
swallow: give sips of warm,
sweetened, non-alcoholic
beverages
Very slow and weak pulse - take extra time
and care to check pulse
DO NOT use any form of direct heat
e.g. electric blanket
• Symptoms • Action

147. Frostbite
– Numb, cold skin
– Pink skin that
becomes pale, then
blackened or hard and
frozen
– Blisters
– Move victim out of cold to
shelter
– Remove any tight clothing or
jewelry
– Slowly thaw skin; place
frostbitten hands or feet in
bowl of warm not hot water for
30 mins. Add more warm
water as it cools.
– No water available: use your
skin, blankets or newspaper to
warm skin
– Dry thawed skin and keep
warm: use clean, dry cloth; dry
cloth between frostbitten toes
and fingers
– Do not let victim smoke or
drink alcohol
If there is chance of skin refreezing, DO
NOT thaw it. The more often the tissue
freezes and thaws, the deeper the damage.
DO NOT use heating devices, stoves (victim
can’t feel frostbitten tissue and can be
burned)- warms too quickly (skin can get
permanently damaged).
DO NOT rub or massage frostbitten tissue.
• Symptoms • Action

148. SEIZURES
CAUTION :
If you suspect a head, neck or back injury refer to relevant
Chapter.
1. If the victim suspects that he is going to have a seizure
or if he begins to lose his balance, help him to the
ground.
2. Lay the victim on his side to prevent any vomit from
entering his lungs.
CAUTION :
Do not put your hands in or near the victim’s mouth during
the seizure.
3. Loosen any tight clothing on the victim.
4. Prevent the victim from injuring himself. Remove
eyeglasses. Push away any objects or furniture that might
injure the victim if he collides with it.

149. Asthma
– History of the condition
– Difficulty in breathing,
especially breathing out
– Wheezing, or noisy
breathing
– Inability to speak
– Pale skin and potential
blueness, particularly
around the lips, caused
by lack of oxygen
– Distress, dizziness and
confusion – as it
becomes harder to get
oxygen into body
– Unconsciousness
–Reassure the casualty
–Help into a sitting
position, leaning
slightly forwards
–If medication is on
hand, help the casualty
use it (usually inhalers)
–Usually tired after an
attack, so get them to
rest
–If breathing or hear
stops due to a severe
attack, resuscitate
Asthma attacks cause the muscles of the air passages to go into
spasm, making it very difficult the sufferer to breathe.
• Symptoms • Actions

150. Asthma

151. Title: Right to Emergency Care –
Supreme Court.
Date of Judgment : 23/02/2007.
Case No. : Appeal (civil) 919 of 2007
• The Supreme Court has ruled that all injured persons
especially in the case of road traffic accidents, assaults, etc.,
when brought to a hospital/ medical centre, have to be offered
first aid, stabilized and shifted to a higher centre/ government
centre if required.
• It is only after this that the hospital can demand payment or
complete police formalities.
• In case you are a bystander and wish to help someone in an
accident, please go ahead and do so.
• Your responsibility ends as soon as you leave the person at
the hospital.
• The hospital bears the responsibility of informing the police,
first aid, etc.
• Please do inform your family and friends about these basic
rights so that we all know what to expect and what to do in the
hour of need.

152. THANK YOU
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