2. Contents
1. Introduction
2. The Basics:
• Airway, Breathing & Circulation (ABCs).
• Cardio-Pulmonary Resuscitation (CPR).
• Recovery position.
3. Anaphylaxis (Allergy)
4. Blood Loss
5. Choking
6. Diabetic Emergencies
7. Electricity
8. Heart Attacks
9. Seizures (Fits)
10. Stroke
11. Unconsciousness
12. References & Resources
21
Introduction
Emergency situations can occur at any time and result in
hundreds of thousands of deaths in the UK each year.
More often then not, a bystander with no first aid
knowledge or training will be the first person on the scene
to help.
It’s believed that many of the deaths seen due to accidents
and emergencies each year could be prevented if first aid
was given at the scene before medical help arrived.
Assistance should always be called for using 999 but whilst
waiting, there could be something that you could do to
improve a person’s chances of survival.
This booklet will provide information about basic first aid in
different types of emergencies.
This booklet is not:
• An alternative to calling 999.
• A substitute for professional medical assistance.
2
3-13
14-20
21-23
24-28
29-34
35-37
38-40
41-45
46-47
48-49
50
Page
3. The Basics
There are three major first aid principles that can be
applied to nearly any emergency situation and these will
be referred to throughout the booklet:
• Airway, Breathing & Circulation (ABCs).
• Cardio-Pulmonary Resuscitation (CPR).
• Recovery position.
An open airway, breathing and circulation are three things
that are immediately essential for life and so should
always be checked first in any emergency situation.
The ABCs are steps used by medical professionals and
can be done on conscious and unconscious people.
43
ABCs
Airway
If the person is unconscious or their breathing is noisy or
absent, their airway may be closed.
In this case, you need to do a ‘head tilt – chin lift’ to open it:
1. Lift their chin with one hand.
2. Place your other hand on their forehead.
3. Gently tilt their head back.
Holding the ‘head tilt – chin lift’ in place, look for a rise and
fall of the chest to check the person is breathing.
Place your ear close to the person’s mouth so that you can
hear and feel for breathing as well.
Remember:
• Always make sure it is safe for you to approach
someone in an emergency.
• Always check for medical alert jewellery (bracelets,
necklaces etc), this could provide vital information.
IMPORTANT:
• Do not ‘head tilt – chin lift’ someone if it is possible
they have a neck injury!
• Never move a person with a suspected neck injury
unless not doing so would be an immediate threat to
their life.
4. Breathing
If the person is not breathing or their breathing hasn’t
been improved by opening their airway with a ‘head tilt
- chin lift’ then artificial respiration needs to be started. To
do this:
1. Do a ‘head tilt – chin lift’ but pinch their nostrils
closed.
2. Take a deep breath and place you mouth over theirs
making a tight seal.
3. Exhale slowly into their mouth watching their chest as
you do. Their chest should rise, if it doesn’t, you may
need to reposition using step 1 and try again.
You may need to give artificial respiration as part of CPR
depending on if the person’s circulation is ok. (See
pages 6 & 7).
65
Circulation
Place your fingers on the person’s neck on either side of
the midline to feel for a pulse.
If you cannot feel a pulse during 10 seconds then begin
chest compressions:
1. Find the person’s sternum (the central vertical bone in
the middle of the ribcage).
2. Place the heel of your hand in the middle of their
sternum.
3. Put the heel of your other hand on top of the first.
4. Interlock your fingers press down firmly and quickly
keeping your elbows straight. You should be pressing
firmly enough to make the chest dip 4-5 centimetres
(1.5–2 inches).
5. After each compression, release the pressure on the
chest without lifting your hands off.
6. Compressions should be at a rate of 100 per minute.
(See CPR on page 7).
5. CPR
The aim of CPR is to create an artificial circulation for
someone whose circulation has stopped. This is to
maintain flow of oxygenated blood to vital organs such as
the brain and heart to prevent tissue death.
It is designed to buy time for a successful resuscitation
without the person’s organs suffering permanent damage
but is unlikely to help restart a person’s circulation itself.
Use your ABCs to assess a person; if they are not
breathing and have no signs of circulation (they are
in ‘cardiac arrest’) then they need CPR.
CPR varies slightly depending on the age of the person in
need; an adult, child or infant.
87
For an adult (puberty & older):
1. Assessed an adult as having no breathing or circulation
using your ABCs (see pages 4-6).
2. Call 999.
1. Do 30 chest compressions (as described on page 6).
2. Give 2 artificial respiration breaths (as described on
page 5).
3. Repeat steps 3-4 until the person recovers, help arrives
or you become too exhausted to continue.
6. For a child (1 years old to puberty):
1. Assessed a child as having no breathing or circulation
using your ABCs (see pages 4-6).
2. Call 999.
3. Give 5 artificial respiration breaths. (Slight change: do
not tilt the child’s head back as far as you would in an
adult, they need a slightly less extended angle).
4. Check for a pulse in their neck again. If there is still
no pulse then continue with step 5.
5. Do 15 chest compressions. (Slight change: you do
not need the same amount of force as you would in
an adult. Just use the heel of one hand instead).
6. Give 2 artificial respiration breaths.
7. Repeat steps 5-6 until the child recovers, help arrives
or you become too exhausted to continue.
109
For an infant (under 1 years old):
1. Assessed an infant as having no breathing or
circulation using your ABCs (see pages 4-6. Slight
change: when assessing circulation in an infant it is
better to check for a pulse in the arm. Place your
fingers on the side of their elbow closest to their body to
check for a pulse).
2. Call 999.
3. Give 5 artificial respiration breaths. (Slight change: you
do not need to tilt their head back. Just ensure it is in
the neutral position and cover both their nose and
mouth with your mouth when giving breaths).
4. Check for a pulse in their arm again. If there is still no
pulse then continue with step 5.
5. Do 15 chest compressions. (Slight change: just use two
fingers to compress).
6. Give 2 artificial respiration breaths.
7. Repeat steps 5-6 until the infant recovers, help arrives
or you become too exhausted to continue.
12. 2221
Blood Loss
Serious blood loss can quickly result in death. There are
numerous ways and places on the body that blood loss
can occur and so it’s impossible to address every
scenario.
Remembering the main methods of reducing blood loss
will be useful in most situations.
1. Call 999.
2. Apply and maintain pressure directly on the wound.
3. If fracture is not a concern, raise the site of the wound
as gravity will decrease the blood flow to it.
4. If the blood loss is the result of a severed body part
(such as a finger), wrap it in plastic or clean material
and keep it cool.
Tourniquets
These are tightly tied bands that go around a limb to
reduce blood flow. Just like the band that gets tied around
your arm before having a blood test.
Improvised tourniquets such as items of clothing or
material tied tightly around bleeding limbs is portrayed
commonly in things like movies and TV shows but their
use in real emergencies is controversial because:
• Improvised tourniquets usually fail to compress
bleeding arteries well enough.
• They could result in the death of that limb and possible
amputation.
• Directly applying pressure at the point of bleeding is as
effective in reducing blood loss and does not run the
risk of limb death.
IMPORTANT:
• Tourniquets are therefore NOT recommended in First Aid.
IMPORTANT:
• Keeping the wrapped body part in a bag of ice is useful
but the body part should not directly touch any ice as this
may damage it and reduce the chances of a successful
reattachment.
13. 2423
Choking
This is most commonly caused by food (or foreign
objects in young children) getting stuck in the wind pipe
and blocking the airways.
The blockage could be mild in which the person will still
be able to speak, cough and breathe.
If it is severe they will not be able to do any of these
things and will soon become unconscious without help.
For children and adults (1 years old and older):
1. Encourage them to continue coughing and to try to
remove any blockage from the mouth if possible.
2. Give up to five back blows – using the flat of your
hand, firmly strike them between the shoulder blades.
Check for signs of removal of the obstruction
between each blow. If it is still there continue with
step 3.
Blood Loss – Further Information
• NHS information about managing blood loss as well
as numerous other first aid situations:
http://www.nhs.uk/Conditions/Accidents-and-
first-aid/Pages/First%20aid%20guide.aspx
• St John Ambulance comprehensive first aid
information for various types of blood loss:
http://www.sja.org.uk/sja/first-aid-advice/wounds-
and-bleeding/bleeding.aspx
If there’s no fracture, raise the limb
Blood Loss – Summary
Blood loss
Apply pressure
Seek immediate medical attention
& check ABCs
14. 2625
For infants (under 1 years old):
1. Give up to five back blows – lay them face down along
your forearm, dipping their head downwards. Using the
heel of your hand, firmly strike them between the
shoulder blades. Check for signs of removal of the
obstruction between each blow. If it is still there
continue with step 2.
2. Give up to five chest thrusts – turn them over so that
they are now laying face up along your forearm, still
dipping their head downwards. Place two fingertips on
their sternum, just below nipple level and push inwards
and upwards (towards their head). Check for signs of
removal of the obstruction between each thrust. If it is
still there continue with step 3.
3. Repeat steps 1-2 up to three times. If the obstruction
remains then call 999 and continue to repeat steps 1-2
until help arrives.
4. If they become unconscious you will need to need to
assess their ABCs and perform CPR if needed (see
‘The Basics’ section).
3. Give up to five abdominal thrusts (also known as the
Heimlich Manoeuvre, illustrated below) – from behind
the person, place one closed fist below their rib cage
in the centre of their stomach, grasp this fist with your
other hand and pull upwards and inwards sharply.
Check for signs of removal of the obstruction
between each thrust. If it is still there continue with
step 4.
4. Repeat steps 2-3 up to three times. If the obstruction
remains then call 999 and continue to repeat steps 2-
3 until help arrives.
5. If the person becomes unconscious you will need to
aassess their ABCs and perform CPR if needed (see
‘The Basics’ section).
15. Continue to check ABCs
& await medical assistance
Call 999
Seek medical advice if
necessary
Repeated back blows &
chest/abdominal thrusts up to
three times or they have
become unconscious
Obstruction resolves Obstruction remains
5 Abdominal thrusts (Aged 1+)
Or
5 Chest thrusts (Under 1 years old)
5 Back blows
Encourage coughing & remove any visible/obvious
obstruction
Choking
2827
Choking - Summary
Choking – Further Information
NHS information choking as well as numerous other first
aid situations:
http://www.nhs.uk/Conditions/Accidents-and-first-
aid/Pages/First%20aid%20guide.aspx
For more comprehensive guidelines on choking, full
guidelines are available online in PDF format:
• For adults: http://www.resus.org.uk/pages/bls.pdf
• For children:
http://www.resus.org.uk/pages/pbls.pdf
16. 3029
Diabetic Emergencies
Diabetes is a disease in which people are unable to keep
their levels of blood sugar (glucose) under control by
producing enough insulin (a hormone) or they produce
insulin that is unable to work properly.
This results in people having too high a blood sugar level
and they then need to take injections of insulin or other
medications to lower this, depending on the type of
diabetes they have.
People with diabetes are normally well informed on how to
manage their own blood sugar levels but they can run into
problems such as;
• Taking too much medication and/or not ingesting
enough food and drink, resulting in low blood sugar
(hypoglycaemia).
• Taking too little medication and/or ingesting too many
sugary foods and drinks, resulting in high blood sugar
(hyperglycaemia).
Remember:
• If in doubt when dealing with a person who is not a
diagnosed diabetic then it is best to stick to ABCs
and to call 999 for help.
Hypoglycaemia
If the person knows they are diabetic, they will probably be
able to recognise their own symptoms of hypoglycaemia.
Symptoms may include the following:
• Behaviour changes such as feeling confused and
deteriorating levels of response.
• Shallow breathing.
• Strong, bounding pulse.
• Muscle tremors.
• They may look pale, sweaty and be cool to the touch.
• Feeling weak or faint.
1. Give the person something to raise their blood sugar
quickly like a sugary juice, chocolate etc.
2. If they improve quickly, continue to offer food and drink
until they recover and advise them to discuss this
episode of hypoglycaemia with their doctor if nothing
obvious such as skipping a meal or too much
medication provoked it. They may need their
medication regime adjusted.
17. 3231
3. If they do not improve quickly, call 999 and assess their
ABCs until help arrives (see ‘The Basics’ section).
4. If they become unconscious place them into the
recovery position.
Hyperglycaemia
It’s less common for people who know they have diabetes
to get to such a high level of sugar in their blood for this to
cause them to be so unwell that it would be considered a
hyperglycaemic emergency.
This normally takes a while of either not taking enough
medication or eating inappropriate types and amounts of
foods/drinks, in which time a high blood sugar level would
normally be picked up by their doctor.
Symptoms may include the following:
• Behaviour changes such as deteriorating levels of
response.
IMPORTANT:
• Do not attempt to feed sugary foods and drinks to an
unconscious person as this could result in airway
obstruction and choking.
• Deep laboured breaths. (Their breath may have a faint
but characteristic smell of acetone, similar to pear drop
flavoured sweets or nail varnish remover).
• Rapid pulse.
• Signs of dehydration such as increased thirst, drinking
and urination or dry skin.
1. Do not give the person any additional foods or drinks as
this may further raise their blood sugar level.
2. If they are conscious and well enough, seek medical
attention immediately.
3. If they are severely unwell, call 999 and keep checking
their ABCs until help arrives (see ‘The Basics’ section).
4. If they become unconscious place them into the
recovery position.
IMPORTANT:
• If someone is wrongfully thought to be hyperglycaemic
when actually they are hypoglycaemic, treating this
person with an insulin injection could be lethal.
• Therefore, use of insulin injections during first aid is NOT
advised.
18. Seek medical advice if
no obvious cause
Give more food/drinks
Continue to check ABCs
& await medical assistance
Continue to check ABCs
& await medical assistance
Seek medical advice
Call 999
Call 999
Condition improves
quickly
Condition does not
Improve quickly
Conscious & well enough Unconscious or
clearly unwell
Hyperglycaemia
Give them something sugary to eat/drink
Hypoglycaemia
3433
Diabetic Emergencies - Summary
Diabetic Emergencies – Further Information
For more information about diabetes, how to recognise it and
what to do in an emergency please see the following links:
• NHS information about diabetes:
http://www.nhs.uk/Conditions/Diabetes/Pages/Intro
duction.aspx
• St John Ambulance first aid information for diabetic
emergencies:
• http://www.sja.org.uk/sja/first-aid-advice/other-
medical-emergencies/hypoglycaemia.aspx
• http://www.sja.org.uk/sja/first-aid-advice/other-
medical-emergencies/hyperglycaemia.aspx
• Support and information for diabetes sufferers:
http://www.diabetes.org.uk
19. 3635
Most electrical accidents occur at home but can occur
industrially, by power lines or very rarely, by lightning.
Someone being electrocuted may or may not have an
obvious electrical source near them.
They may be; in spasm, burnt, having breathing problems,
or in a deadly heart arrhythmia.
1. Call 999.
2. Switch off the electrical current safely, at the mains if
possible.
3. If you aren’t able to do this, stand on an insulation
material to protect yourself (a phone book is a good
example) and use something that wont conduct
electricity to push/pull the person the electrical source
away from each other.
4. Check the person’s ABCs (see ‘The Basics’ section).
5. If they do not need CPR, you may be able to begin
treating any burns whilst awaiting medical help. (see
‘Fire & Burns’ section).
Electricity
Check ABCs
& await medical assistance
Use a non-conductor to
separate the person &
electrical current
Stand on insulation material
Unable to switch off
electrical current safely
Switch off the electrical current
Call 999
Electrical shock
IMPORTANT:
• Do not put yourself at risk when trying to help in this
situation. If you are in doubt of your safety, await help.
Electricity - Summary
20. 3837
Heart Attacks
The arteries that supply blood to the heart (coronary
arteries) can become blocked and this leads to heart cell
death. The collection of symptoms that this blockage
causes is what we call a heart attack and these include:
• Chest pain – this is normally described as an
uncomfortable feeling of pressure or squeezing in the
centre of the chest.
• Pain in other body areas – this can include one or both
arms, the jaw, the neck, the back or even the stomach.
• Shortness of breath.
• Breaking out in a cold sweat.
• Nausea.
• Light-headedness.
Electricity – Further Information
For more information about electricity and what to do in an
emergency please see the following links:
• NHS information about electrocution (although this
resource specifically talks about children, the
information is applicable to adults as well):
http://www.childrenfirst.nhs.uk/families/first_aid/ele
ctrocution.html
• British Red Cross first aid information about
electrocution:
http://www.redcross.org.uk/What-we-do/First-
aid/First-aid-tips-and-videos/Electrocution
• BBC health information about electrocution:
http://www.bbc.co.uk/health/treatments/first_aid/pr
ocedures/electrocution.shtml
21. 4039
If you think someone is having a heart attack:
1. Call 999.
2. Check their ABCs (see ‘The Basics’ section). They may
become unconscious, they may have pulse but aren’t
breathing or they may not have a pulse or be breathing.
3. Start CPR (see ‘The Basics’ section). If possible, raise
their legs allow more blood flow towards the heart.
Check ABCs, perform CPR if needed &
await medical assistance
Call 999
Heart attack
Heart Attacks - Summary
Heart Attacks – Further Information
For more information about heart attacks, how to recognise
them and what to do in an emergency please see the
following links:
• NHS information about coronary artery disease and
heart attacks:
http://www.nhs.uk/Conditions/Coronary-heart-
disease/Pages/Introduction.aspx
• St John Ambulance first aid information for heart
attacks: http://www.sja.org.uk/sja/first-aid-
advice/heart-attacks-and-shock/heart-attack.aspx
• Information and charity for heart disease:
http://www.bhf.org.uk/default.aspx
22. 4241
Seizures (Fits)
There are numerous causes of seizures including; head
injury, fever, withdrawal, sleep deprivation and strokes.
When someone suffers from recurrent, unprovoked
seizures, they are said to have the medical condition;
epilepsy.
There are numerous types of seizures but for first aid
purposes they can be divided broadly into two categories:
Tonic-clonic (formally; Grand mal)
• The most recognisable type of seizure.
• The person loses consciousness and fall to the ground.
• They make jerking movements.
• They breathe irregularly and may turn blue around the
mouth.
• They may lose bladder and/or bowel control.
Other seizures
• These various types are more subtle and harder to
recognise.
• Bodily signs can vary from twitching, partial body jerks
and sudden loss of muscle tone.
• The person may begin peculiar behaviours, or they may
appear to suddenly switch off and day dream.
• They may or may not be conscious.
General first aid principles remain the same for all types of
seizures:
1. Protect the person from injuring themselves. Remove
objects they could bash into if having a tonic-clonic
seizure. Guide them away from danger if they are
having another type of seizure.
2. Protect their head, don’t let them strike it against
anything.
3. After a few minutes, any jerking movements should
stop and they may begin to slowly regain
consciousness. At this stage, place them into the
recovery position (see ‘The Basics’ section).
4. Reassure them and stay with them until they recover.
5. Only call 999 if;
• You know it’s the person’s first seizure.
• The seizure lasts longer then 5 minutes.
• Another seizure follows the first without the person
regaining consciousness in between.
• The person is injured during the seizure.
• You have any reason to believe they need urgent
medical attention.
23. 4443
IMPORTANT, DO NOT:
• Restrain them.
• Attempt to bring them round from the seizure.
• Put anything in their mouth – commonly done out of
worry someone will bite or swallow their tongue but doing
this may cause more harm then good.
• Try to move them – unless not doing so would be an
immediate threat to their life.
• Give them anything to eat or drink until they have fully
recovered.
Stay with them & offer
reassurance until they
recover
Check ABCs
& await medical assistance
Recovery position
Call 999
They begin to recover • Seizure longer then 5
minutes
• Another seizure
follows the first
without
consciousness in
between
• The person is injured
Protect the person’s head
Protect the person from injury
Seizure
Seizures (Fits) - Summary
24. 4645
Seizures (Fits) – Further Information
For more information about seizures, how to recognise them
and what to do in an emergency please see the following
links:
• NHS information about epilepsy:
http://www.nhs.uk/epilepsy
• Member-led organisation providing information about to
epilepsy:
http://www.epilepsy.org.uk/info/seizures/index.html
• Information and charity for epilepsy:
http://www.epilepsysociety.org.uk/AboutEpilepsy
Stroke
When there is a lack of blood supply to a part of the brain
this is called a ‘stroke.’ This can either be caused by
blocked blood vessels (similar to what happens during a
heart attack) or it can be caused by a burst blood vessel.
The quicker that someone receives medical attention after
a stroke, the greater their chances of a good recovery and
so it’s important to recognise the signs of a stroke:
• The person’s face may fall on one side, ask them to
smile to see if both sides of their face move
symmetrically.
• They may experience weakness in one arm, ask them
to raise both arms and to hold them up to test for this.
• Their speech may begin to slur when they try to speak.
1. If you have any reason to think someone may be
having a stroke, call 999 immediately.
2. If they become unconsciousness; check their ABCs,
use these to assess their need for CPR.
3. If they lose consciousness but are still breathing place
them into the recovery position and keep checking their
ABCs until help arrives.
25. 4847
Stroke – Further Information
For more information about strokes, how to recognise them
and what to do in an emergency please see the following
links:
• NHS information about stroke:
http://www.nhs.uk/Conditions/Stroke/Pages/Introdu
ction.aspx
http://www.nhs.uk/actfast/Pages/stroke.aspx
• Organisation, information and charity for stroke:
http://www.stroke.org.uk/
• Comprehensive information about strokes including
treatment:
http://www.patient.co.uk/health/Stroke.htm
Check ABCs
& await medical assistance
Call 999
Stroke
Stroke - Summary Unconsciousness
There are many causes of unconsciousness (most of
which are covered more specifically else where in this
booklet) such as:
• Drugs
• Alcohol
• Head trauma
• After a seizure (a fit)
• Diabetic emergencies
• Lack of oxygen (choking, anaphylaxis, drowning, smoke
inhalation during a fire etc)
• Circulation problems (blood loss, heart attacks, strokes
etc)
General approach
Despite there being many different causes of
unconsciousness, initial first aid remains the same:
1. Be sure it is safe for you to approach.
2. Check the person’s ABCs (see ‘The Basics’ section).
3. If they are in cardiac arrest then call 999 and continue
with CPR (see ‘The Basics’ section).
4. If they are not in cardiac arrest then call 999 and place
them into the recovery position (see ‘The Basics’
section).
