First aid

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Mamoon zboun
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Welcome to your:Welcome to your:
Emergency First AidEmergency First Aid
CourseCourse
Your Instructor is:

Operations Manual Chapter 6
Crew Health Precaution
Reference
Part A
Time Expected: 3 hours>> 1 hr is theory and 2 hrs is Training

Reference
Part A
Outlines
Responsibilities of first aider
The aim of first aid
Effect of altitudes on crew
Effect of flying on the body
Hygiene Standards
First aid and medical condition
Hypoxia
Respiratory condition
CPR
Types of Hemorrhage
Wound
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Reference
Part A
Outlines
Responsibilities of first aider
The aim of first aid
Effect of altitudes on crew
Effect of flying on the body
Hygiene Standards
First aid and medical condition
Hypoxia
Respiratory condition
CPR
Types of Hemorrhage
Wound
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Outline
• Shock
• Hysteria
• Unconsciousness
• Fractures
• Cardiac conditions and other medical
condition
• Child birth
• Conclusion
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Reference
Part A
Objective
At the end of this course all Cabinets team will be able to :
Identify the first aid course and their responsibility.
Deal with all medical condition that happen in the plan.
Apply the first aid in the plan effectively.
Identify CPR technique successfully.
Identify all medical cases that happen and deal with it.
Deal with the fractures and wound cases in the plan.
 define all medical cases related to first aid that happen in
the plan.
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Areas Covered in this Session
• Human Anatomy
• What is first aid
• Aims of first aid
• The Responsibilities of the First Aider
• Incident / Casualty priorities
• Multiple casualties
• Staying Safe during First Aid DANGER
• Call for Medical assistance ( Dr or nurse)
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Human Anatomy (remind/revise)
1. Trachea
2. Lungs
3. Heart
4. Liver
5. Stomach
6. Pancreas
7. Large intestine
8. Small intestine
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3
4
2
5
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© 2002 Abertay Nationwide Training

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Circulatory System
Aorta
Largest artery in the
body
Arteries
Strong muscular, elastic walls
enable arteries to expand with
each surge of blood away
from the heart and towards
tissues
Veins
Action of muscles around
these thin walled vessels
squeezes blood through
them, and one-way valves
keep it from flowing back
towards the heart
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Functions of the Blood
• Transportation of gases
• Nutrition
• Regulation
• Protection
• Excretion

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Pulse Points
Carotid
Brachial
Radial
Femoral
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Heart beat maximum checked 5-10 min

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The Respiratory System14
Respirtory
Centre
(Brain)
Bronchioles
Epiglottis
Trachea
Lung
Diaphragm
Alveoli
Tongue

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Respiration is the exchange of gases, oxygen
and carbon dioxide, which takes place in the
lungs and cells of the body.
Define Respiration
Take in oxygen
Remove carbon dioxide

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What is First Aid
• The treatment given for any injury, or
sudden illness before the arrival of an
ambulance, doctor or any other qualified
person.
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The Aims of First Aid
• To Preserve life
• To Prevent the condition
getting worse
• To Promote recovery
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Effect of attitude on crew due to lack of oxygen18
At cabin altitude of 8000 feet, O2 level in the blood
Is reduced under several condition so that it is lead to
body fatigue :
Heavy smoking.
Drugs.
No medication should be taken during on duty
Alcohol
General fitness
During the plan most of cabin they are still tired and
are not sleeping well, you should avoid late night and
fatigue.

Effect of flying on the body
• During the flying it is happen changes of the
atmospheric pressure causing collection of the air in
the body so that increase in the volume as decrease of
the atmospheric pressure
• Provided that the expanded gas can escape by normal
routes, but if can not escape due the blockage it
happened to the effect area.
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The method use in wear gloves20

Proper way to Remove Contaminated Gloves21

Hygiene Standards
Disease caused by bacteria can be spread by various routs :
Person to person
Animals
Through food and water ( typhoid and cholera)
the most factor is appropriate for bacterial growth :
Time
medium temperature
Moisture
Suitable food
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Personal health care and cleanliness should observe
 Hand washing
 Protective gloves
 Keep vaccination up to
date
 Eating regular meal
daily
 Minimize smoking and
alcohol assumption
 Exercise daily
 Take care of your skin
 Regular shower
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First aid kit and medical equipment
o The main purpose of FAK is to enable treatment for
injured passengers.
o It is containing materials that Is available in accidents
for emergent case.
o Kit contents are addressed by JAA’ S Acceptable Mean
of Compliance which recommended this items.
o Any doctor or nurse as well as qualified person should be
used this kit in any emergent case.
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Burning dressing
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First aid content
Bandage
Wound dressing
Adhesive
tape, safety
pins and
scissors
Antiseptic
wound
cleaner Disposable resuscitation aid
Simple analgesia

Antiemetic drug
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Nasal decongestant Handbook
GI antacid
Anti-diahrea
medication
Disposable Gloves
List of content in at least 2 language

Dressing
 It is protective covering which is applied to a wound and used in :
o Prevent infection
o Absorb discharge
o Help control bleeding
o Avoid further injury
 You should follow sterile technique to eliminate all germs and
bacteria, material should be sterile and dry.
 When you applied dressing, you should not touch it or remove it.
 In some cases of bleeding, you should applying compression
technique to prevent blood loss, also it is normal to added new
dressing to it.
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Bandage
 In some cases, you should use the Bandage :
a. Keep dressing in place
b. Secure wire splint in fracture condition
c. To help control bleeding
 Do not Bandage too tightly why???
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Emergency Medical Kit (EMK)
 It is available on each aircraft in secure location, found
under aircraft specific information for each them
 All of the captain must ensure drugs are not administered
Except by qualified doctor or nursing.
 It contain life saving drugs and equipment that can be
opened under specific rules when announcement is
required requesting the medical assistance you should
notified by captain.
 EMK should be used by Doctor or nurse to administer
first aid necessary, if the doctor or nursing are not
available you should request any qualified person.
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Emergency Medical Kit (EMK)
 All needle and syringe after using it, they should but him
in SHARP BOX and labeled with small red label stating
that box has been used.
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 riabal
 Zantac
 Lasix
 Adrenaline
 Dexamethasone
 Flagyle
 Votrex
 Blood prsseure device
 Glucocheck machine
 Perfalgan
 Hydrocrtisone
 Capotine
 Water for injection
 Aspirin
 Isordile
 Eyepad
 Emergency bag
 Demo 5%-9%
 Medisol 5% 500ml
 R/L 500
 Pink/blue canula
 IV set
 Sterile step
 Gauze 2*2
 Steriel gloves
 Srynges 5, 10, 20 ml
 Needle 22, 23G
 Grepe bandage 2
 Confirming bandage 3 7.5*4
 Bandage 4 4*5 cm
 Mefix
 Tongue depressor
 Injection
 Allerfine
 Clopram
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Automated External Defibrillator
 It is available on every aircraft in secure location, the exact location of
the kit may found on the emergency equipment location diagram located
under aircraft.
 The physiological state of victim shall effect the like hood of successful
defibrillation,
Patient will exhibit muscle response during the energy transferee.
 It is recognized for successful resuscitation that related to the length of
time between onset of heart rhythm does not circulate blood, in this
cases you should take this step:
 Early access
 Early CPR
 Early defibrillation
 Early ACLS
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 The defibrillation is semi-automated and uses patented shock, it is
software analyze the patient ECG rhythm and indicate if it is or is not
detectable shockable rhythm.
 If patient recovers, placing him in recovery position with aid still
connected, patient will given oxygen and kept under observation.
 It should be used by doctor or nursing over airplane.
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Automated Defibrillation
o The operator control AED operation with 3 top buttons:
• ON/OFF
• Shock
• Analyze
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AED Operation
o To prepare for ECG and defibrillation :
 Confirm the patient with cardiac arrest, unconscious, not breathing
well, and not good pulse, no movement before use it
 Press ON to turn on the AED(green), then connected electrode
message and voice prompt will continue until patient is connected to
AED.
 Prepare patient for electrode connected:
 Place patient on hard surface (away from water and conductive
material)
 Remove clothes of patient from upper torso.
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CONTINU>>>>
o Apply electrode on the patient chest :
 First electrode on the lateral of left nipple with the center of the
electrode in med axillary.
 Place other electrode on the upper right chest lateral to the sternum
and below of the clavicles.
 Starting from one end, press electrode firmly into the patient skin.
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Special for electrode placement
o Using child pads from 1years to 8 years if not available using the
adult pads and AED.
o AED shouldn,t use for infant less than 1 years just CPR.
o For obese patient and large breast go on flat area on the chest
o In case of thin patient follow the contour of the rips and spaces
when passing the electrode this limit the air space and good
promotion of the skin contact.
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Shock Advised
 in case of detection of the shockable ECG rhythm it is
display SHOCK ADVISE message
 We will hear SHOCK ADVISE, the AED start for
charging first shock.
 When charging is complete the AED display two message
Stand clear and Push To shock following voice Shock.
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Contin>>>
 Ready tone (loud, high pitched, two toned sound), the
shock flashes:
o Check no any one is touching the patient
o Press shock to discharge the AID.
o If do not press shock, the shock will removed
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• in some cases you should not give shock :
 If AED detected non-shockable ECG rhythm, it is display
the no SGOCK ADVISED , the AID will not discharge
and no shock is given.
• After no shock advised the AED enter CPR time is 15 sec
or more, if CPR time is set to 0 AED display the
following sequences:
 Check for signs of pulse
 Check for signs of cerculation
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GENERAL
• If the AED used during the flight, an entry must made in
the ACL, line maintenance shall then inform in flight
product.
• In case of the pregnant if met criteria the of cardiac
arrest( not responsive, no breathing, no pulse)
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Portable oxygen cylinder
• Oxygen is provided for use by passenger or portable
cylinders for first aid purposes
• In cases of respiratory distress in any person require o2.
• Capacity: 120
• Outlet: 2l/l
• Procedure >>>
• Adult _ high 4L/m
• Infant and child_ low 2L
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• Passengers require oxygen for medical purpose to maintain
health during the flight.
• Each passenger used oxygen should be setting position
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Measure blood pressure
• Person should be quite for 3 – 5 minute.
• Cuff size appropriate to the wrist of person.
• Measurement should be taken alternative both wrist.
• Patient or passenger should be rest on his back.
• You should empty the bladder why??
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Responsibilities of First Aider
• Inform captain of plan and request for medical assistance or qualified
person.
• Documentation full detail of incident in log report
• Your first and number one concern for self
• Own safety if dangerous is happened.
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Continu>>
 Assess the situation
 Check The Area (CTA)
 Check your causality.
 Examine the causality
 Is this danger to the causality or other passenger
 Is the causality is conscious?
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Sequence of examination.
3. Chest
1. Head
8. Lower Limbs
2. Neck
7. Pelvis
Lower Back
6. Abdomen
5. Upper
Limbs
4. Shoulders
Top to Toe Survey50
/// no more than 15 second

AHA< 2016
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Primary Assessment
Breathing
Circulation
Responses of your casualty
Danger your present
environment
Airway

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IF NO PULSE PRESENT
COMMENCE CARDIAC MASSAGE !
Circulation52
NO MORE THAN 5 TO 10 SECOND

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Airway
OPEN
AIRWAY
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Airway
• Before opening the airway (check) for any
obstructions and remove (clear) them if
possible
• By tilting the head back and lifting the chin
forward, the tongue is drawn away (open)
from the back of the throat. Suspected
Spinal injuries will differ, majority are
conscious.
• In an unconsciousness casualty the tongue
may fall back to block the airway.

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IF ABSENT BREATHE FOR YOUR
CASUALTY !
Breathing55
Look, Listen & Feel up to 10seconds

SUPINE
* Check spine injury, and feel head and back if any
injury.
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Making a Diagnosis57

Give immediate care and treatment
• CARE is the continuous CABS and must carried out during first
aid.
• Communicate{talk to the causality} write down what care is given.
• Avoid harm_ be gentle, no food or drink until doctor is present
• Reexamine_ watch the causality and do not leave him alone, take
vital sign.
• Encourage_ give your causality support, watch him what say.
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• The three most vital sign you should taken :
 Consciousness
 Pulse{heart rate}
 Respiration{RR)
• The consciousness is the basic function of the brain
• You should remember the AMEGA:
 Assess
 Make area safer
 Examine and give treatment
 Get help
 After match clean and reporting
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Triage
• Is the process of prioritizing causalities based on the
severity of sign and symptoms and immediate
treatment.
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Secondary Survey
Complete Top to Toe Survey
Complete Definitive Treatments
Breathing
Pulse
Skin Colour
Temperature
Level of response
Monitor Vital Signs

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Treatment Priorities
• CABS
• Bleeding
• Maintain airway (Recovery position)
• Treat large wounds and burns
• Immobilise bone and joint injuries
• Other injuries / Conditions
• Regularly monitor casualty CABS
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Reporting
• Casualty’s name
• Casualty’s address
• History of the incident
• Description of any injuries
• Any unusual behavior
• Treatment given
• Breathing
• Pulse
• Response level
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Patient Interview
• S Symptoms
• A Allergies
• M Medications
• P Past Medical History
• L Last Meal
• E Events
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Dressings & Bandages: Uses
• Dressings
– Control bleeding
– Reduce infection
• Bandages
– Direct pressure
– Securing dressings etc
– Reduce swelling, support limbs
– Restrict movement
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Hypoxia
 Insufficient amount of oxygen to supply the body need for
physical and mental performance.
 Causes
 Failure of pressure control system
 Reduced cabin air flow
 Structural failure
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Sign and symptoms
 Increasing breathing rate
• Dizziness
• Poor coordination
• Impairment in judgment
• Reduced vision and sleepiness
• Cyanosis
• Unconsciousness and death
 If the captain increase the altitude of plan the TUC is
reduced
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Management
• * in this case you should be supply patient with oxygen
• Immediate supply patient with oxygen with o2 mask
• You should available o2 portable on the plan
• If the captain increase the altitude of the plan oxygen as
precaution.
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Respiratory Condition
 Most of people is inhaled and exhale air 12 to 20 per
min
 Depending on the nature and medical condition
 The airway : passage of the air from mouth to lung
 Respiratory disorder
 Asthma
 Sever acute respiratory syndrome
 Lung cancer
 Difficulty breathing
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Chocking
Is caused by food or object stuck
in the throat , if the passenger
cough, speak and normal skin
encourage him to cough
If the passenger is choking sign are
Cannot speak, blue face, clutching
neck between thumb and index
finger, an loss of conscious

Management
 Check the patient is choking
 If the patient is conscious you should use the Heimlich
maneuver {abdomen thrust} that force air up and out to
clear airway.
 If patient unconscious stand behind the passenger are
your arm around his waist, if standing place one of your
feet between his leg to support patient body
 Make fist one hand and put him against abdomen above
navel button
 Give upward quickly to out of an object
 On pregnanet just downward and used chest thrust
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Unconsiousness adult or child
• AMMGA
• Check for responsive if not responsive
• Check pulse for 5 second if no pulse start CPR
• If yes pulse, check the airway if patient not breathing give
breathing if choking >>
• If unconscious but good breath with pulse but him in the
recovery position
• Do not do chest or abdomen thrust
• If infant you should do hold infant and but him toward the
earth then with palm hit him until the object is out
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Rules for Applying Dressings
• Wear disposable gloves
• If possible, wash hands
• Correct size
• Place pad directly onto wound
• Avoid touching wound
• Try not to cough or sneeze
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General Rules for Bandaging
• Explain and reassure
• Posture
• Support
• Your positioning
– Natural hollows
– Apply bandages firmly
– Exposure of digits
– Check circulation
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Preventing Cross Infection
• Always wash your hands
– Before dressing a wound
• Wear disposable gloves
• Avoid touching the wound
• Do not sneeze or cough
– When treating a wound
• Place soiled dressing in suitable bag
– Seal and destroy by incineration
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Carbon monoxide
Vehicle exhausts, chimneys
– headache, confusion
– aggression, nausea
– vomiting, incontinence
– dusky skin, red tinge
– unconsciousness
Smoke
Fires
– coughing
– swollen air passages
– unconsciousness
– soot around nose
– burns
Carbon dioxide
Deep enclosed spaces
– Breathlessness
– headache
– Hypoxia
– confusion
– unconsciousness
Solvents & Fuels
Glues, lighter fluid
– headache, vomiting
– stupor
– unconsciousness
– death
Effects of Fume Inhalation

Asthma
• condition in which your airways narrow and swell and produce extra mucus.
This can make breathing difficult and trigger coughing, wheezing and shortness
of sign and symptom
• Difficulty breathing, wheezing sound and Blueness of lips
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Treatment for Asthma
• Ensure C, A, B,S
• Reassure the patient.
• Position patient up-right
– Leaning forward.
• Ensure a good air supply.
• Monitor vital signs.
• Assist with medication.
• History
• Inform captain and called medical
• assisstance
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Medical Assistance for Asthma
Seek medical assistance if:
• First attack or is severe
• Inhaler has no effect after 5-10 minutes
• Casualty is getting worse
• Breathlessness makes talking difficult
• Exhaustion
• Unconsciousness
– CABS, Resuscitate if necessary
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Causes of Shock
• Blood loss
• Heart attack
• Allergic reaction
• Loss of body fluids
• Massive infection
• Damage to spinal nerves
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Shock - First Signs
RECOGNITION:
– (adrenaline causes)
• Rapid pulse
• Pale gray skin
• Cold clammy skin
• Sweating
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Treatment for Shock85

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MODERATE LOSS
2 to 3 pints (20% - 30%)
slightly raised
cold and sweaty
pale
dilating, but equal
slightly raised
light headed, faint
constant observation and monitoring of vital signs to determine medical progress
cool
becoming unstable
Pulse
Skin
Colour
Pupils
Breathing
Consciousness
History
Peripheral Temp.
General Condition
Blood Loss 2-3 pints

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SEVERE LOSS
over 3 pints (30% and over)
fast, light, thready
cold and clammy
pale - cyanosed
dilated and equal, slow to react to light
deep sighing - air hunger
apathetic, low pain threshold
may become thirsty and suffer from blurred vision
cold
poor, could prove fatal
Pulse
Skin
Colour
Pupils
Breathing
Consciousness
History
Peripheral Temp.
General Condition
Blood Loss over 3 pints

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Causes of Fainting
• Temporary reduction of blood flow
to the brain
• Reaction to pain or fright
• Emotional upset
• Exhaustion
• Lack of food
• Long periods of standing
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Recognition of Fainting
• Brief loss of consciousness
• Fall to the floor
• Slow pulse
• Pallor
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If unconsciousness persists
Call for the ambulance
Treatment for Fainting
• Raise and support lower limbs
• Fresh air, open window
• As they recover reassure casualty
• Assist casualty to sit up
• Treat any injuries

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Anaphylactic Shock91

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Anaphylactic Shock
The name given to a major Allergic reaction
within the body;
Causes:
• Specific drugs
• Stings
• Ingestion of certain foods (peanuts)
• Chemical released into the blood stream
causing the blood vessels to dilate thus
restricting the airway.

Allergy
• Hypersensitivity disorder of the immune system
• It is happened when the person immune system is reacted to
harm substance in the environment { food, dust, animals,
insects}
• Also it is considered life threatening
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Severe Allergies
• Anxiety
• Blotchy skin
• Swelling of face
• Swelling of neck
• Puffiness around eyes
• Breathing difficulties
• Rapid pulse
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Treatment of Severe Allergies
• Relieve Breathing
• Inform captain of the plan
• call the doctor or nurse
• Continue CABS if unresponsive
• Some of passenger know their Self it is
• Allergy with epi pen.
• Take history
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Sign and symptoms
• Sweating
• Rapid and weak pulse
• Shock
• Nausea
• Rapid and shallow breathing
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Heart Attack Treatment
Your aims are;
• Make casualty comfortable
• Take history
• Monitor vital signs
• Reassure
• Prepare to resuscitate
if necessary
• Inform captain
• Announcement medical help
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Sign and symptoms
• Sever pain in the in the chest
• Face become pale and blue
• Pulse rapid and slow
• Irregular breathing
• Casualty is motionless
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First aid priorities
• Control blood loss
– Pressure, Elevation
• Minimise shock
• Protect from infection
• Hospital
The nature of the
wounding force
determines the type of
wound and influences
its treatment.
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Always
wear protective gloves and
goggles when dealing with
blood and body fluids
Types of Bleeding
• Arterial
• Venous
• Capillary
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Wound Types
LacerationContusion
Incised Puncture
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Bleeding Control
EElevation
Shock
IInfection
Pressure
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Internal Bleeding
• Bruising / Rigid abdomen
• Tender abdomen
• Guarding stomach
• Symptoms of shock
• Bleeding from orifices
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Internal Bleeding
• Lungs
• Stomach
• Kidneys
• Upper / Lower Bowel
• Fractured base of skull
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Treatment - Internal Bleeding
• C, A, B, S
• Treat for shock
– Elevate lower limbs if
possible
– Place in the recovery
position if patient becomes
unconscious
– Reassure
– Monitor vital signs
– Urgent removal to hospital
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Lots of blood, Possible underlying
injury
Scalp & Head Wounds
Treatment;
• Displace skin flaps (Split wounds)
• Apply direct pressure (Sterile dressing, secure)
• Lay casualty down slightly raised head &
shoulders
• Unconscious ABC (Recovery position)

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Minor Wounds
• Minor wounds may need medical help
– Dog bite,
– Infected
– Embedded object etc.
• Minor bleeding
• Foreign bodies
• Bruises
HYGIENE

Nois bleeding
• Vessls rupture due to the aire pressure is changed
• Emotional stress, physical blow, more common in
elderly because weaker and thinner blood vessls,
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Bleeding from Orifices
• Mouth
• Ear
• Nose
• Anus
• Urethra
• Vagina
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Chemical splash in eye
• Splash of flash, tinner and hydraulic in eye
• You should lay him or stand and washing affected area
• And cover affected eye
117

Forigen body of the eyes
• Irritation of eye and become red and irritated
• What to do>>
I. Look up and down
II. Using moistened wool check(under lid, pull upper lid
back look for the center of eye), check left corner of
eye
III.If forigen body seen in lower lid using splash eye
water and may use the wool moistened
IV.If stuck in the eye do not remove it cover eye with pad
V. Call medical assistanse,.
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What to do
• Upright position.
• Pinch the lower part of noise and cold compression
• Breathing through mouth
• Spilt blood into sick bag

120
Eye Injury
• Provide support for the casualty’s
head
• Give the casualty a sterile dressing to
hold on the eye
• Arrange removal to hospital
120

Air sickness
• Most common in flight, usually happen by fear and
motion of flight
• S&s
 Nausea, pale, dizzy, perspiration
o What to do
1. Offer clean sickness air bag
2. Put seat in reclined position and open fresh air
3. Bathe of face and neck with cold compressor
4. Cover with blanket
5. Fix vision on any object a/c
6. If seated rear of a/c, move to over wing area
121

dehydration
• Lack of water in the body due to :
 Insuffcient of fluid
 Excessive sweating
 Working in heating area
 Diarrhea and vomiting
 Hemorrage and burns
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What to do
• Drink plenty of water
• At least every half hour or 1 hour drink water
• Do not drink caffeine, tea and fizzy drink that stimulate
kidney and cause an increase loss of fluid
• In internal bleeding do not give fluid
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Tooth ache
• Decayed tooth and made worse by eating or drinking yhis
induse infection
• Adminster just paracetamol tablet
• In cases of bleeding palced cotton over socket and bit on it,
ice may be given.
124

Headache
• Tension or imagraine and the degree of severity
• If tension just give paracetamol tab, in imagrine if
person handeled his medication advised take him
125

GI condition
• Abdomen pain
• It is symptom need treatment, if without fever,
vomiting fainting, or other seious illness improve
without treatment
• If pain persistnat need medical team
126

treatment
• Using heating pad relive pain
• Warm chamomile tea will ease discomfort
• Using antacid medication
• Pain killer such as revanin
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indigestion
• Pain in the upper abdomen
Mild to sever pain between the breastbone to the navel
• Burning in in the upper abdomen
• Heat or burning between the breast bone and naval
128

What to do
• Antiacid medication
• Walking around the cabin alleviate the pain
• Inform captain
• Call medical team
129

Acute appendecitis
• Sever abdomen pain
• Nausea and vomiting
• Increase pulse and increase temprature
130

What to do
• Nothing is giving by mouth
• Paracetomol tab is given
• Make comfortable for passenger draw his knee up to
ease this pain
131

Renal colic
• It is stones passed down the urinary tract to the
kidney in bladder
o Sudden pain in low back, nausea and vomiting, pass
small amount of urine, blood in urinr, history from
previous attack
 What to do ??
1. Reassurance and take history, drink plenty of water,
inform medical team, inform captain, treat shock
132

133
Types of Head Injury
All Head Injuries Are Serious;
• Wounds to the scalp
• Fracture of the skull
• Concussion
• Cerebral compression

134
Fractured Skull134

135
Recognition of Concussion
• Brief or partial loss of consciousness
• Nausea,
• Dizziness on recover
• Memory loss

136
Cerebral Compression
• Noisy slow respiration's
• Slow, full and bounding pulse
• Flushed face
• Diminished level of response
– going into unconsciousness
• Unequal or dilated pupils
• Intense headache

137
Fractured Skull137

138
Fainting
Infantile convulsion
Shock
Head injury
Stroke
Heart Attack
Asphyxia
Poison
Epileptic Fit
Diabetes
Causes of Unconsciousness
FF
II
SS
HH
SS
HH
AA
PP
EE
DD

139
Voluntary
Biceps etc.
Tendons
Types of Muscles
Involuntary
Operate vital organs
Heart etc.
139

141
Soft Tissue Injuries - Sprains
Sprains are injuries due to:
• Stretching or tearing
ligaments or other tissues at
a joint.
• Caused by a sudden twist or
stretch of a joint beyond it’s
normal motion
141

142
Soft Tissue Injuries - Sprains
The Symptoms of a Sprain are:
• Pain on movement
• Swelling
• Tenderness
• Discoluration
142

143
Soft Tissue Injuries - Strains
• A strain is an injury to a muscle or tendon
caused by over-exertion.
• In severe cases muscles or tendons are torn
and the muscle fibres are stretched.
143

144
Soft Tissue Injuries - Strains
The Symptoms of a strain are;
• Intense pain
• Moderate swelling
• Painful movement
• Difficult movement
• Sometimes, discolouration

145
IF IN DOUBT - TREAT AS A
FRACTURE !
Soft Tissue injuries
Treatment (RICER)
• Rest the injured part.
• Apply Ice or cold compress.
– (15-20mins)
• Compress the injury.
• Elevate the injured part.
• Rehabilitate / Recuperation
145

146
Rehabilitation
Stop moaning I haven’t started yet…

147
Functions of the Skeleton
• Support
• Movement
• Protection
• Produce blood cells
147

148
CAUSES:
Direct force
Indirect force
Muscular action
Disease
TYPES
Open/Closed
Stable/Unstable
Greenstick
Definition of a Fracture
Definition;
• A broken or cracked bone
148

149
Simple:
This is a clean break or
crack in the bone
Simple Fracture149

150
Comminuted:
This is a type of fracture
that produces multiple bone
fragments
Comminuted Fracture150

151
Green stick:
A split in a young, immature
bone. Most common in children
Green-Stick Fracture151

152
Open:
In a open fracture, part of
the bone breaks through the
skin causing bleeding
The exposed bone is
Vulnerable to contamination
Wound
Open Fracture152

153
Closed:
The surrounding skin is
unbroken.
Closed Fracture153

154
Open Fractures
• Cover wound, apply dressing
• Place padding over and around the wound
• Secure dressing and padding
• Immobilise injured part
• 999
• Treat casualty for shock
• N.B. Nothing to eat or drink
154

155
Closed Fractures / Dislocations
• Support injured part
• Secure injured part
• 999
• Circulation
– (10 minutes)
• N.B. Traction in extreme locations
155

156
Assessment of Injuries
• History: (Ask the casualty what happened)
– Violent blow or fall
– Snapping sound
– Sharp pain
• Compare:
– One side of the body against another
• Visualise:
– Try and imagine what happened
• X-ray:
– Injury may not be obvious
156

157
Assessment of injuries
Recognition;
• Difficulty moving limbs
• Pain made worse by movement
• Distortion
• Coarse grating at bone ends
• Shock (Femur, Ribcage, Pelvis)
• Shortening, bending or twisting
157

158
Dislocations
• Partial or full displacement of bones at a
joint
• Tears ligaments
• Associated fracture
• External wrenching force
• Violent muscle contraction
• Do not attempt to replace joint
158

159
Injuries to the face and jaw
• Maintain airway
• Possible spinal injury
• Possible head injury
• Reduce swelling
• Hospital treatment

160
Cervical 7
Thoracic 12
Lumbar 5
Sacrum
5 (fused)
4 coccyx (fused)
• Intervertebral discs
– Padding or cushioning
– Gristle
The Human Spine
• Spinal Cord
– Composed of nerve
fibres
160

161
Spinal Injuries
Three things are required;
• A high index of suspicion.
• Acute observation.
• Dexterous and gentle handling.
161

162
Spinal Injury
Your aims are;
• To prevent further injury
• Arrange removal to hospital
162

163
IF IN DOUBT
TREAT AS A SPINAL INJURY
Treatment of Spinal Injuries
• Call for an medical team.
– do not attempt to treat casualty on your own
• Support head and neck.
• Instruct casualty not to move.
• Reassurance.
• Do not move casualty unless in extreme
danger.

164
“LIFT WITH THE
LEGS”
Principles of Lifting
• Assess the Task - Area - Load
• Bend the knees
• Broad stable base
• Back straight (Not necessarily vertical)
• Firm grip with palm of hand
• Arms in line with trunk
• Weight close to center of gravity
• Turn feet in direction of movement

165
Types and Causes of Burns
• Dry Burn
• Scald
• Electrical Burn
• Chemical Burn
• Radiation
• Friction Burn
• Cold Burn
• Fire- Domestic appliances
• Hot liquids - Steam
• Low and high voltage - Lightning
• Industrial & Domestic chemicals
• Sunburn - Exposure to radiation
• Fast moving belts – Machinery
• Bare skin contacting ice etc.

166
Burns
Superficial
Partial
Thickness
Full
Thickness
166

167
Treatment of Minor Burns
Your Aim Is;
• Halt the burning process
• Relieve the swelling
• Relieve the pain
• Minimise risk of infection
• Seek medical advice
167

168
Treatment of Severe Burns
Your Aim Is To Ensure;
• Scene safety
• cabs
• Halt the burning
process,
• Relieve pain
• Treat for shock
– Resuscitate if necessary
– Treat associated injuries
– Minimise the risk of
infection
– Arrange urgent removal to
hospital
168

169
Heat Exhaustion
• Recognition
– Wet / sweaty appearance, Fatigue / Pale look
– Headaches with possible cramps
• Treatment
– Remove from offending environment
– Fan / cool patient
– Provide cool drink
– Advise to see doctor or dial
999 if they
deteriorate
169

170
Heat Stroke
• Recognition
– Hot dry red skin
– Rapid Lowered level of consciousness
– Nausea and/or vomiting
– Body temperature above 40ºC (104ºF)
• Treatment
– Remove from offending environment
– Dial 999 for an Ambulance
– Cool patient with cold, wet sheets
– Nothing by mouth

171
Hypothermia
General cooling of body
Mild Hypothermia
– Shivers - Cool body
– < 98.6 temperature
Severe Hypothermia
– No Shivers
– Sluggishness
– Lowered level of
consciousness
171

172
Hypothermia
• Treatment
– Remove from offending
environment
– Remove wet clothing
– Insulate with blanket or
covers
• Mild
– Offer hot drink
• Severe
– Activate EMS
– Provide source of heat
172

173
Define Diabetes
• A condition in which the body fails to
regulate the concentration of sugar in the
blood.
• Diabetics are prone to two main problems:
– Hypoglycemia
– Hyperglycemia

hysteria
• Psychological condition that falls in nervous disorder
and triggered by anxiety
• S& s
• Rapid heart beat
• Respiratory problem
• Salivation, swelling in the muscle and redness of eye
• Diffculty speak and breathing
• Clenching of teeth and paralyzed of limp
174

Treatment
• Reassurance
• Do not give alcohol or caffeine
• Call medical help
175

176
Hypoglycemia - Low blood glucose
pale
profuse sweating and cold
irritable, confused or may be unconscious, fits may
be present in later stages
rapid and weak
sudden, may be minutes
sugar
normal to rapid
Colour
Skin
Consciousness
Pulse
Onset
Treatment
Breathing
Signs and Symptoms

177
Hyperglycemia - high blood glucose
flushed
dry
restless, drowsy or lethargic
behaviour
rapid and full
gradual, hours to days
insulin
deep and sighing, possible
sweet smell - acetone
Colour
Skin
Consciousness
Pulse
Onset
Treatment
Breathing
Signs and Symptoms

178
Hypoglycaemia - Treatment
Conscious Patient;
• Establish C, A, B
• Help patient to lie or sit down
• Give sugary foods, drinks etc.
• Advise to See their Doctor
178

179
Hypoglycaemia - Treatment
Unconscious Patient
• Establish A, B, C
• Place patient in recovery position
• Monitor vital signs
• Prevent chilling
• Look for other causes
• Urgent removal to hospital
179

180
Hyperglycaemia - Treatment
• Establish CABS
• Place patient in recovery position
• Monitor vital signs / Prevent chilling
• Look for other causes
• Urgent removal to hospital
180

181
Define Epilepsy
Definition:
• A condition that causes brief
disruptions in the normal electrical
activity of the brain.
181

Stages of epilepsy
• It is 4 stages:
 Sometimes person has fit it is happen, headache, blurred
vision
 May have peculiar cry and stiff also rigid, eye become
staring and becom blue
 Convulse and injury himself, foaming on the mouth, urine
may passed
 At the end person deep sleep.
182

What to do ??
• The fit can not be prevented, so that prevent person from
injury himself
• If seated, loosely fasten seat belt, but do not attempt to
restrict movement.
• If person on the floor, pad around with pillow
• Check CABS
• Allow him to sleep and wake
183

stroke
• It obstruction in blood vessels that supply brain (cereral
thrombosis), symptoms depend on the area of the
damaged area
• S&s
 Headache
 noisy breathing
 Numbness in face, arm, leg
 Slurred speech
 Dizzy
 Loss of vision
 Puipls of eyes is unequal
 Irregular pulse
184

What to do ???
• Maintain open airway
• Comfortable position, raising of the shoulder and arm
• Do not give food or anything
• Inform captain
• Call medical assistance
• If he take chronic medication give it
185

DVT
• Blood clot in the lower limb, booling or stasis
• Factor increase risk of the DVT:
 Immobility
 Family history
 Recent surgery
 Pregnancy
 Dehydration
 Cancer
 Athletic person
 Blood condition that increase the blood clot
186

Sign and symptoms
• Suuden swelling in the lower limb
• Tenderness in the lower limb
• SOB
• Sweating
• pain
187

treatment
• Take history and assess situation
• Elevated the affected limb and reassure
• Call medical assistance and inform captain
• If swelling do not massage
188

prevention
• Avoid setting with legs crossed
• Walk periodically in flight
• Drinking of water and juice to prevent dehydration
• Avoid alcohol and alcohol is recommended
• Do not sleep in cramping position, napping just 30min
• Exercises
189

Pulmonary embolism
• Blockage of artry the lung secondary of DVT.
 Sign and Symptoms
 Usuaally after 2-4 day it is appeared
 Shortness of breath
 Chest pain
 Fever
 Coughed of blood
 Coma
 Cramp on side
190

What to do
• Assessment situation and CABS
• Inform captain and administer oxygen
191

Food poisoning
• Eating food contaminated by bacteria and toxins
o Sign and symptoms
 Nusea and vomiting
 Abdomen pain and cramping
 Diarrhea
 Headache
 shock
192

What to do
• Rest
• Call medical team and inform captan
• Give plenty of fluid
• Do not give solid food
• Air sickness bag in case casually vomitus
• Save of food/ drink which is suspected to be contaminated
193

Prevention
• Hand washing before prepare food
• Protective gloves
• Keep hair tidy to prevent loosen hair fall in food
• Use plastic gloves when handling food
• Never keep lukewarm for long periodtime
194

Drug overdose
• It is taking medication excess mount recommendation
 In this cases if patient conscious ask what happened, do
not induce vomitus, call medical team
 If unconscious, put patient in recovery position, if no
pulse CPR
195

Ingestion chemical material
• It is causing tissue injury, the vast of this chemical is acidic or
alkaline substance, by adults or neonatal( suicidal attempt).
• Sign and symptoms is difficulty swallowing, pain,vomiting,
bleeding in throat, chest.
• What to do
 If conscious give small amount of water benefit 30 minute
after exposure to solid alkaline, call medical team, check LOC
 If unconscious, no breathing and pulse, give artificial
repiration, cardiac massage, CPR
 If breathing and pulse is present call medical team,recovery
position, oxygen if needed.
196

Impairment due to alcohol
• Excessive drink alcohol find in beer, wisky, wine
• It is CNS depressant, rapidly absorbed by body,
metabolized by liver then diffuse in the blood stream.
• Indvidulas affected in alcohol vary:;
• Age, gender, race, physical condition, family history,
use of drug, amount of food befor drunk
197

Risk of your body
• Impaired in brain function
• Violence
• Damage to develop of fetus
• Feeling of warmth
• ** for men heavy drink is consuming over 2 drink per
day, woman more than 1 drink
198

Laws on the flight
• Passenger do not drink wine or their own liqure
• One alcohol is permitted per time
• You should discontinued for passengers if heavy
drink
• Over coffee
• Advise sleep
199

Childbirth
• Called emergency birth
• In any case any happen outside of the hospital called
emergency
• In the flight do not deleveries baby mother do
• Baby is born full term 40 wks
• During the flight if any pregnant informed you it is
labored start to prepare the board
200

mechanism of labor
1. Cotraction {pain in lower back/abdomen}
Blood stained with mucus, sac of fluid around baby
At the end baby enter birth canal ( fill dilatation of cervix
10cm
2. Baby in the canal birth until is born
3. Baby born until afterbirth
201

What to in first stage
• Introduce yourself to the mother
• Assess labor pain 4 or 5
• Minutes apart then the birth is very near
• Evaluation the mother, inform captain
• Call medical assistance
• Ask mother go to lavatory and empty bladder
• Reassure
• Privacy, if no area off with blanket
202

Collect and prepare
• Oxygen and first aid mask
• Put anything under the mother
• 2 boiled bowls of boiled water for clean mother and
baby
• First kit
• Sterlize scissors with boiled water to cut cord
• Gauze bandge to tie the cord
• Sick bag for the soild dressing, and using gloves
203

Second stage delivery
• Instruct mother to push and rest between them
• Any bowled action take place must be cleaned to
prevent infection
• Place pad over rectum
204

Third stage
• Baby born slowly to prevent mother torn muscle of
vagina so you should
• Mother not to bear down during the pains
• Assisstance cover back passage with clean with clean
pad and apply gentle pressure over baby head during
the contraction
205

Care of baby
• Lay baby downward over the mother thigh head
lower than body
• Clear gentle baby mouth and noise
• If baby is not breathing well so that clean mouth well
206

Dealing with umbilical
• Do not quick cut the cord
• Feel cord and wait pulse cease
• Tie the cord firm with gauze bandge made first tie 15
cm and then second tie stripe 7.5 cm from the first
• Between them cut cord with sterile
• Ensured the cord attached to the baby well
207

Third stages
• Examination by doctor or midwife
• Place receptacle between mother thigh to hold baby
after birth
• Never pull the cord of baby
208

To control bleeding
• Place bad over vaginal bleeding
• Elevate the feet
• Have mother lower legs and put them togather
• Gentely massage the mother abdomen
 Care of mother
o Check pulse
o After cleaning of mother comfortable position and
warm drink
209

Emergent case captain landing
• Placenta is not deliverd withen 30 min
• Sever hemorrhage
• Presentation of arm or leg do not pull
 In cases of of the breech birth buttocks or both feet
are deliverd first, baby manage born without
complication
 If buttocks and trunks are delivered requiring put on
hand and forearm under the baby trunk
210

Miscarrage condition
• Treat shock
• Save all blood clot clots passed
211

Uncondtional landing for
medical emergency
• Stop breathing and pulse
• Unconsciousness
• Uncontrolled bleeding
• Internal bleeding
• Heart attack
• Retained placenta
• Recurrent epileptic fit
212

Medical clearnance carriage
• For blind or deaf no medical clearance required
• Medical clearnance required
 Medical condition aggravated during of the flight
 Require medical attention
 potential hazards to the safety of the flight
 Certain disease that causing adverse effect
213

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