Standard First Aid

SINGAPORE RED CROSS SOCIETY
SINGAPORE
STANDARD FIRST AID

TRAINING NOTES
RED CROSS TRAINING CENTRE (RCTC). 15 Penang Lane, Level 3, Singapore 238486. TEL: 6336 0269 FAX: 6337 6435 Website: www.redcross.org.sg 20102011
Standard First Aid st Briefing by Instructor During 1 lesson
1.
IMPORTANT INFORMATION
Materials included in Course Fee per trainee SFA / CHFA / OFA / ROFA / WFA RFA / RCHFA BCLS / CPR+AED BFA Items for Purchase Face-shield, Triangular Bandage, Roller Bandage English First Aid Manual (9th Ed) Attendance Notes 1 1 1 1 Faceshield 3 2 1 1 Roller Bdg 1 1 1 Triangular Bdg 1 1 -
Price Per Unit (with GST) $2.50 each $35.00
100% attendance is compulsory to sit for the test. No make-up lessons will be arranged without submission of valid medical cert within 5 working days. Medically fit to perform CPR (resuscitation); have no underlying medical heart, lung conditions or any physical disabilities such as knee, spinal or joints injury history that prevents them from performing CPR effectively. Pregnant ladies not allowed for safety precaution. Declaration of Infectious diseases SRC is not responsible for injuries & medical conditions occurred during course Trainees must be able to speak & read in English for courses conducted in English. Stationery for note-taking. 1 NRIC-sized photograph (2.5cm by 3.5 cm) for card-size First Aid certificate. 2 photos required for OFA/ ROFA/ WFA trainees. Round-neck T-shirts & pants or jeans. For ladies, avoid applying lipstick. For classes conducted at Red Cross, please do not park your vehicle on Red Cross premises as they are strictly reserved for ambulances & staff only. For classes conducted at Red Cross, please walk to back of the building and enter through the back door
Medical Condition
English Proficiency Materials to Bring
Attire No Parking Weekend Classes
2.
ELIGIBILITY CRITERIA TO ATTEND REFRESHER COURSE

Refresher Standard First Aid (RFA Refresher First Aid for Infant-Child Care Personnel (RCHFA) Refresher Occupational First Aid (ROFA) Trainee must have a valid (not expired) Standard First Aid / Adult First Aid certificate issued by the Singapore Red Cross or St. John Ambulance. Trainee must have a valid (not expired) First Aid for Infant-Child Care Personnel certificate under NFAC approved training agencies. The list can be found in the Ministrys Child Care Link website: www.childcarelink.gov.sg. Trainee must have a valid (not expired) Occupational First Aid certificate accredited by OSD under the accredited Training Provider certification scheme. Link to list of Accredited Training Providers: http://www.mom.gov.sg/workplace-safety-health/training/trainingcourses/Pages/occupational-safety-and-health-personnel.aspx#fa
Red Cross reserves the right to reject the application if the certificate has expired. Singapore Red Cross Society / Red Cross Training Centre / 20102011
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Standard First Aid st Briefing by Instructor During 1 lesson
3.
TEST & ASSESSMENT

Comprises of Theory test (MCQ) & Practical assessment (2 scenarios) Course SFA / RFA : CHFA / RCHFA/ OFA / ROFA: BCLS / CPR+AED Theory Test Passing Mark MCQ (60% to pass) MCQ (70% to pass) MCQ (80% to pass) Duration 30 minutes 30 minutes 20 minutes
Trainees must pass the theory test to proceed to practical test. Trainees, who failed the theory at their 1st attempt, are allowed a 2nd attempt on same day. If they fail 2nd attempt theory, re-test (Theory & Practical) would be on another day (within one month from 1st attempt), after attending a revision class. Trainees who failed the practical station would have to re-take the entire test (theory and practical again). Trainees, who fail the test on the 3rd attempt (Theory or Practical), would have to re-take the entire course. Re-Test Fee (with GST) Certification Course Standard First Aid (SFA), Occupational First Aid (OFA), First Aid Training for Infant/Child Care Personnel (ChFA), Perform Workplace First Aid (WFA) Occupational AED (OAED), Workplace AED (WAED) Basic Cardiac Life Support (BCLS), CPR+AED (AED)
$20.00 $40.00
4.
CERTIFICATION
A card-size certificate (9cm by 5cm) will be awarded to trainees who have successfully passed the assessment. Certification Validity Period from date of Issue Certification Course Standard First Aid (SFA), Occupational First Aid (OFA), First Aid Training for Infant/Child Care Personnel (ChFA), Perform Workplace First Aid (WFA) Basic Cardiac Life Support (BCLS), CPR+AED (AED), Occupational AED (OAED), Workplace AED (WAED)
3 years 2 years
5.
ISSUANCE OF CERTIFICATE CARD (*New with effect 1-Jan-2012)

Certificate Collection Venue Cert Replacement Trainees can collect their card-size certificate on the spot from the examiner upon passing the assessment (unless requested by corporate class clients to send via registered mail within 14 working days) Red Cross Training Centre (RCTC) Office, Level 3 Opening Hours: Mon to Fri, 9am to 6pm (closed from 12.30pm to 2pm, Eve & PH) Reprint of cards for amendments not stated on the attendance or lost of card will be chargeable at a fee of $20.00. Issue an authorisation letter to a representative if you cannot collect personally.
Singapore Red Cross Society / Red Cross Training Centre / 20102011
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Standard First Aid Table of Contents
TABLE OF CONTENTS
LESSON 1:
Principles and Practice of First Aid Management of Medical Emergencies Introduction to Triangular & Roller Bandaging (Practical) Respiratory System Breathing Difficulties Adult Foreign Body Airway Obstruction (Choking) Circulatory System Perform Adult Cardiopulmonary Resuscitation Manage Shock Manage Bleeding Manage Different Types of Wounds Nervous System Manage an Unconscious Casualty Manage a Casualty with Chest, Spinal and Abdominal Injuries Musculoskeletal System Manage Fractures Manage Soft Tissue Injuries Manage Muscle Cramps Skin Manage Burn Injuries Manage Bites and Stings Manage Poisoning Manage Heat Disorders Transport a Casualty Types of Bandaging (Practical) - Triangular Bandaging - Roller Bandaging CPR (Practical) - CPR Checklist (for layperson) - One Man Adult CPR Practical Assessment Sheet Note Taking Page 4 to 9
LESSON 2:
Page 10 to 19
LESSON 3
Page 20 to 36
LESSON 4
Page 37 to 49
LESSON 5
Page 50 to 65
LESSON 6
Page 66 to 77
LESSON 7
Page 78 to 89
Page 90 to 92
Page 93 to 94
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Standard First Aid - Lesson 1 Principles and Practice of First Aid & Management of Medical Emergencies
STANDARD FIRST AID LESSON 1
Overview
This lesson looks at the principles and practice of first aid, its aims, the responsibilities and duties of a first aider, ways to protect yourself, the management of medical emergencies and how to use a first aid kit.
Topics Outline for Lesson 1

1 PRINCIPLES & PRACTICE OF FIRST AID
a) Definition of First Aid b) Aims of First Aid c) Role of a first aider d) Your limitations e) Ways to protect yourself
MANAGEMENT OF MEDICAL EMERGENCIES

a) Emergency Action Plan Primary survey Secondary survey Recovery position b) The First Aid Kit
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PRINCIPLES & PRACTICE OF FIRST AID
Definition of First Aid

First aid is immediate help given to a person who is injured or has suddenly taken ill before medical aid arrives.
a)
Aims of First Aid
The four aims of first aid are: 1. To preserve/save life - Prolong the life of a casualty by ensuring the airway is clear and rendering resuscitation when necessary. 2. To prevent the condition from worsening - minimise any complications by rendering first aid to the casualty 3. To promote recovery - to ensure that the casualty is comfortable by monitoring his conditions until the arrival of medical professional. 4. To provide comfort and relief.
b)

Role of a first aider

Sustain life Observe casualty Get help Organise care
Take note
1. Your knowledge and skills have limitations. 2. Your responsibilities begin when you arrive at the scene and continue until medical aid arrives or the casualty recovers. 3. Identify yourself, get permission to give care, and explain the help to be given. 4. Make sure you practice what you have been taught.
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c)
Ways to Protect Yourself
It is important for a first aider to ensure that there is no cross-infection when rendering first aid. As such, a first aider should avoid being in contact with a casualtys bodily fluids by: Knowing the dangers eg. blood-borne pathogens Covering open wounds Using Personal Protective Equipment ( PPE ) - latex gloves and pocket mask
2
a)
MANAGEMENT OF MEDICAL EMERGENCIES

THE EMERGENCY ACTION PLAN
Primary survey Secondary survey Recovery position
Primary Survey
[I] Assess the scene for Danger.
A first aider must be aware of any surrounding dangers and remove danger immediately if possible. Remove the casualty from the danger as an alternative. Ask yourself these questions before rendering assistance.
Priority of Treatment
Is there any danger to me? Can I rescue the casualty from danger? How do I deal with the danger? How many casualties are there? Who to treat first? Follow the priority of treatment. 1. Life threatening emergencies. 2. Bleeding wounds and fractures. 3. Minor injuries.
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[II]
Assess casualty for Responsiveness
A first aider needs to determine the level of responsiveness by Gently tapping the casualty at the shoulder, and Asking if the casualty is alright.
[III]
Observe the casualtys level of responsiveness as follows:
Alert able to respond to simple questions and give answers. Voice able to respond to voice by moving body. Pain able to respond to pain. Unresponsive no response or movement.
Shout for help
[IV]
If there is no response from the casualty, shout for help and contact emergency service, call the ambulance 995 immediately. Pass relevant information such as: [V] Your name and telephone Casualty location and location landmarks Briefly what happened Number of casualties Casualtys condition Other information e.g. traffic condition Open and check the Airway Head tilt chin lift, a technique to ensure clear airway. Check for Breathing
[VI]
Look at the chest, listen to the air and feel the warm air for up to 10 seconds. If no breathing, commence CPR Commence CPR
[VII]
Commence CPR and continue until casualty begins to breathe, ambulance arrives, AED is available, rescuer gets exhausted or someone takes over. If breathing is present, check for signs of injuries.
# Footnote :
During your initial assessment, check also for severe bleeding, head and spinal injuries before ABC.
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Secondary Survey
Once breathing is maintained, the first aider needs to conduct a head to toe secondary survey to check whether there is any injury. The technique is perform in a systematic way :
C H E C K
Recovery Position
Check for pain, any discomfort. History ask briefly what happened. Examine head to toe for any missed injuries. Compare opposite side for abnormality. Keep monitoring vital signs.
Once there is no injury, the first aider needs to place the casualty to the recovery position or rest the casualty in the most comfortable position, depending on the condition of the casualty. Purpose 1. Prevents casualtys tongue from falling back and blocking his airway. 2. Prevents any vomitus or secretions from choking the casualty During recovery Monitor the Vital Signs Breathing Level of response / level of consciousness
The Recovery Position

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b)
Every home should have a First Aid Kit
Every home or workplace should have a first aid kit that must be readily available and accessible to all. A well-maintained first aid kit will make the first aider more confident when rendering first aid. A first aider must check for expiry dates on the items and replenish the items immediately.
Quantity
10 pieces each 4 packets 6 pieces 1 bunch 2 pairs 1 pair 1 roll 2 packets 1 packet 1 piece 5 tubes 2 rolls each 1 set
Basic Items
Adhesive dressing plasters in assorted sizes Sterile gauze of various sizes Triangular bandages Safety pins Disposable gloves Scissor Micropore or zinc oxide tape Cotton balls Antiseptic cleaning wipes ( 10 pieces/packet) Face mask with one way valve Normal saline (10 cc) Crepe bandage ( 2.5, 5, 7.5, 10 cm ) Tweezers or forceps ( plastic or stainless steel )
Quantity
1 each 1 each 2 packets 1 each
Useful Addition Items

Notepad and pen Torch and whistle Instant cold pack Thermometer ( clinical or digital )
* This is only a suggested list. END OF LESSON 1

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Standard First Aid - Lesson 2 Breathing Difficulties & Adult Foreign Body Airway Obstruction
Overview
This lesson looks at the respiratory system, the mechanism of breathing, recognition of breathing difficulty, specific causes of breathing difficulty and how to clear foreign body airway obstruction of a conscious to an unconscious adult.

1 THE RESPIRATORY SYSTEM
a) The Structure of the Respiratory System b) Its Functions c) The Mechanism of Breathing
RESPIRATORY DISTRESS OR BREATHING DIFFICULTY

a) Recognition of Respiratory Distress b) Some Causes of Breathing Difficulty Choking abdominal and chest thrust Unconscious choking Drowning Hyperventilation Bronchial Asthma
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1
a)
THE RESPIRATORY SYSTEM

Structure
The respiratory system comprises of the: Nasal passage Larynx Trachea ( windpipe ) Bronchial tubes Pleura Alveoli Diaphragm
b)
Function
The functions of the respiratory system are: To provide oxygen for use in the body. To excrete carbon dioxide.
Respiration is the process in which the body takes in oxygen and expels carbon dioxide (a waste product from body tissues). The breathing process comprises the actions of breathing in (inspiration / inhalation), breathing out (expiration / exhalation) and a pause.
c)

Mechanism of Breathing
During inspiration (breathing in) the chest cavity is enlarged, 21% of oxygen is inspired. During expiration (breathing out) the lungs contract, the cavity returns to normal size and air is forced out, 16 % of oxygen is expired. Only 5% of oxygen is absorbed by the body. The exchange takes place in the lungs at the alveoli (air sacs); the oxygen that we breathe in is taken into the pulmonary capillaries; at the same time, carbon dioxide is released and expelled as we breathe out. The breathing rate of an adult is between12 to 18 breaths per minute.
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Mechanism of Breathing
RESPIRATORY DISTRESS OR BREATHING DIFFIFULTY
While normal breathing is effortless, steady, rhythmic, and occurs with little or no noise, abnormal breathing is noisy and requires much effort. The brain will suffer permanent damage if deprived of oxygen for more than four minutes. Breathing difficulty is a condition where the casualty is having laboured breathing or respiratory distress.
a)

Recognition
Difficulty in breathing and gasping for breath Anxiety, restlessness, confusion, disorientation Casualtys skin is bluish in colour (cyanose) Leading to unconsciousness
b)

Causes of breathing difficulty are:

Choking Fumes inhalation Drowning Hyperventilation Bronchial Asthma
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Respiratory Arrest
Respiratory arrest means absence of spontaneous breathing. It is a life-threatening condition requiring immediate medical attention. Common causes
Actions to take
Choking Heart attack Drug overdose Prolonged asthmatic attack DRSABC
ADULT FOREIGN BODY AIRWAY OBSTRUCTION (CHOKING)

Choking is a respiratory distress that occurs when the airway is partially ( mildly ) or totally ( severely ) obstructed by a foreign object or commonly the tongue when the victim becomes unconscious.
Causes
Foreign body Tongue (when unconscious)
Recognition
Difficulty in speaking, breathing & coughing Universal sign Cyanosis
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Actions to take for a Conscious casualty (not pregnant or obese)

Encourage the victim to cough until condition worsens.
STEP 1.

ASSESS WHETHER VICTIM IS CHOKING
Ask, Are you choking? Are you pregnant?(for female casualty only). If the victim is choking, the victim will not be able to speak, breathe or cough but may nod his head.
STEP 2.

POSITION OF RESCUER
If the victim is standing, the rescuer stands behind the victim. If the victim is sitting, the rescuer kneels down and positions himself behind the victim
STEP 3.
LOCATION OF LANDMARK
Put your arms around the victims abdomen. Place 2 fingers breath above the navel and well below the tip of the xiphoid process. Make a fist with one hand. Place the thumb-side of the fist against the abdomen, midline and above the 2 fingers spacing.
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STEP 4.

THE HEIMLICH MANOEUVRE
Lean the victim forward with one hand, while maintaining the fist against the abdomen. Grasp the fist with the other hand. Give quick inward and upward thrusts in one motion into the victims abdomen until the foreign body is expelled or the victim becomes unconscious.
Actions to take for a Conscious casualty (pregnant or obese)

Encourage the victim to cough until condition worsens. STEP 1. ASSESS WHETHER VICTIM IS CHOKING STEP 2. POSITION OF RESCUER STEP 3. LOCATION OF LANDMARK Place arms under the victims armpits, encircling the chest. Make a fist with one hand. Place thumb-side of fist on the middle of the victims breastbone.
STEP 4. CHEST THRUST Grasp fist with the other hand and give quick backward thrusts. Deliver each thrust firmly and distinctly with the intent of relieving the obstruction until the foreign body is expelled or the victim becomes unconscious.
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Actions to take for an Unconscious casualty

STEP 1. CHECK FOR DANGER
STEP 2. ASSESS UNRESPONSIVENESS
STEP 3. SHOUT FOR HELP. ACTIVATE THE EMERGENCY MEDICAL SERVICE (EMS) Shout loudly for help and immediately call 995 for an emergency ambulance.
STEP 4. PERFORM CHEST COMPRESSIONS Commence 30 chest compressions using the same location and technique used as chest compression (refer to Adult CPR).
STEP 5. OPEN THE AIRWAY Perform a Head-Tilt Chin-Lift maneuver
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Remove visible foreign body if seen by using the index finger Do not perform blind sweeping.
STEP 6. CHECK BREATHING

Look, Listen and Feel for signs of breathing (up to 10sec).
STEP 7. MOUTH TO MOUTH BREATHING

If breathing is absent, attempt one ventilation. If chest does not rise, this indicates that the airway is still blocked. Reposition the victims head and re-attempt to ventilate. If 2nd ventilation fails, suspect that the victim is still choking.
STEP 8. CONTINUE CHEST COMPRESSIONS
If no foreign body seen, repeat Steps 4 to 7 until able to give two successful ventilations, help arrives, or victim starts breathing, coughing, moving or talking. If breathing is present, check for injuries. Position the victim in the recovery position if no injuries. Continue to monitor the victims breathing and level of response every few minutes.
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Drowning
Death by drowning usually occurs not because the lungs are full of water, but because throat spasms prevent breathing. Causes Fatigue Poor swimming skills Strong currents and waves
Actions to take DRSABC Keep casualty warm Seek medical attention
Hyperventilation
Hyperventilation is a condition of over-breathing, which causes an excessive loss of carbon dioxide from the blood, leading to a tingling sensation and numbness of the hands and legs. Recognition Unnaturally fast, deep breathing. Dizziness, faintness, trembling or tingling in the hands. Cramps in the hands and feet. Seek medical attention
Causes Anxiety Hysteria Panic attack Fright
Actions to take Lead casualty to a quiet place. Ask casualty to breathe slowly. Let him re-breathe his own expired air covering mouth and nose.
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Bronchial Asthma
Bronchial asthma is a condition where there is difficulty in breathing due to the muscles of the air passages going into spasm Causes Environmental triggers like cold air, pollen, cigarette smoke and perfumes. Occupational exposures such as dust, fumes and industrial smoke.
Recognition Difficulty in breathing. Wheezing during expiration. Blueness of the skin (cyanosis). Distress and anxiety. In severe attacks, the effort of breathing will tire out the casualty.
Actions to take Let the casualty adopt the position that he finds most comfortable, which is often sitting up. Do not lie down. Ask him to breathe slowly and deeply. Ask him about any asthma medication. Assist him to use the inhaler. If condition worsens, rush victim to the nearest doctor or hospital or call ambulance 995.
END OF LESSON 2
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Standard First Aid Lesson 3 The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
Overview
This lesson covers the circulatory system, shock, bleeding, wounds and cardiopulmonary resuscitation.

1 THE CIRCULATORY SYSTEM
a) Structure of the circulatory system b) The Heart c) Blood Pressure d) The Pulse
MANAGEMENT OF SHOCK
a) Causes of Shock b) Recognise the signs and symptoms of shock and how to manage shock.
ADULT CARDIOPULMONARY RESUSCITATION (CPR)

a) b) c) Heart Attack and Cardiac Arrest Importance of the Chain of Survival Concept Steps in performing CPR
MANAGEMENT OF BLEEDING
a) Recognise and manage different types of bleeding.
MANAGEMENT OF DIFFERENT TYPES OF WOUNDS

a) Recognise and manage different types of wounds including nose bleed. b) Recognise and manage special types of wounds - embedded foreign body.
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THE CIRCULATORY SYSTEM
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a)
Structure
The circulatory system is made up of the heart and blood vessels. Four to six litres of blood circulate around the body to distribute oxygen and nutrients to the tissues and carry waste products away.
Blood Vessels
There are three types of blood vessels: arties, veins and capillaries.
Arteries Strong, muscular, elastic-walled vessels which carry blood away from the heart
towards the tissues.
Veins Thin-walled vessels which carry blood back to the heart. Blood is squeezed through the
veins by action of the surrounding muscles, and is kept flowing towards the heart through oneway valves.
Capillaries Arteries subdivide to form a dense network of fine, thin-walled vessels called
capillaries within the body tissues. The thin capillary walls allow for exchange of gases and other materials between cells of the body and the blood. The capillaries then rejoin to become veins.
b)
The Heart
Pulmonary artery carries deoxygenated blood to Pulmonary vein carries oxygenated blood from lungs The functions of the heart are to pump:
Deoxygenated blood to the lungs for oxygenation. Oxygenated blood to all parts of the body.
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c)
Blood pressure
The hearts pumping action makes the blood exert pressure against the walls of the artery. This is called blood pressure. As the artery walls are elastic, they can expand or contract to maintain blood pressure at normal levels. Blood pressure is a measurement of your risk for hypertension and heart disease. Blood Pressure (BP) is described by two numbers, for example, if your BP is 120/80, the systolic BP is 120mmHg and the diastolic BP is 80mmHg. The systolic range for adult is Hg 100 140 mm
The diastolic range for adult is 60 90 mm Hg
d)
The Pulse
This is the pressure wave along arteries, generated by the contraction of the heart. It can be felt where the artery is close to the surface of the body. Pulse rate for a normal adult Pulse rate for an infant 1 yr is Pulse rate for a child is = 60 to 100 beats per min. = 100 to 160 per minute = 80 to 120 per minute
The pulse for an adult can be felt at the: 1. Wrist (radial pulse) 2. Neck (carotid pulse).
Pulse Normal versus Abnormal Normal 60 to 100 beats per min regular strong Abnormal > 100 ( fast heart rate or tachycardia ) < 60 ( slow heart rate or bradycardia ) irregular weak ( in shock )
Rate Rhythm Strength
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MANAGEMENT OF SHOCK
Shock may be defined as failure of the circulatory system to perfuse tissues of the body. Shock is defined as a life-threatening condition which may be progressive and may lead to the collapse of the circulatory system. Life in danger
Causes
Severe blood loss eg. bleeding Fluid loss eg. burns Severe pain Infection or poisoning Heart attack or heart failure Severe allergic reaction
Types
Hypovolemic shock ( volume failure ) Hypovolemic shock ( volume failure ) Neurogenic shock ( spinal injuries ) Septicaemia shock ( vasodilation ) Cardiogenic shock ( pump failure ) Anaphyalactic shock ( vasodilation )
Recognition Extreme thirst Anxiety Mental state changes Rapid & shallow breathing Rapid & weak pulse
Pale cold & moist skin
The signs and symptoms vary with the degree of severity of shock. Table below illustrates the response of the body to blood loss. Volume 300 to 500 ml of blood loss 1500 to 2000 ml of blood loss Signs & Symptoms Little or no effect 1. 2. 3. 4. 5. 6. 7. Increased pulse rate Shallow and rapid breathing Sweating Cold and clammy skin Pallor Nausea Drowsiness
More than 2000 ml of blood loss
1. Pulse becomes undetectable 2. Loss of consciousness 3. Breathing may cease and heart may stop, impending death.
Actions to take
Reassure the casualty. Call ambulance 995. Lay casualty down or put him in a comfortable position. Elevate legs above level of heart (unless fractured). Treat cause (e.g. stop bleeding). Loosen visible tight clothing. Monitor vital signs breathing & response.
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3 a)
ADULT CARDIOPULMONARY RESUSCITATION (CPR) Heart attack
A heart attack occurs when there is an insufficiency of blood supply to the heart muscle.
Recognition
Chest pain / discomfort Shortness of breath Sweating Nausea
Action to take
Reassure the victim. Call ambulance 995 and get the Automated External Defibrillator (AED) if available. Ask him if he has any medication to relief the pain. If so, ask him to take the medicine. Monitor the victim. Perform CPR if victim is not breathing and is unconscious.
b)
Cardiac Arrest
Cardiac arrest is a sudden cessation of heartbeat. When this occurs, the heart will stop pumping and the circulation will also stop. The casualty may have chest pain and may collapse suddenly, or he may be found unconscious because his heart has stopped
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c)
The Importance of the Chain of Survival Concept

Early CPR Early Defibrillation Early Advanced Cardiac Care
Early Access
The chain of survival concept highlights the importance of understanding the four interconnected links that lead to the rapid recovery of cardiac arrest casualty.
The four links are:
Early Access the first aider must recognise the symptoms and signs of life-threatening
conditions, such as chest pain and shortness of breath, which warrants a call to 995 before the casualty collapses.
Early Cardio Pulmonary Resuscitation it is a temporary intervention that provides

oxygen to the heart, brain and other vital organs. If no oxygen reaches the brain for 4 minutes, the casualty may become brain dead.
Early Defibrillation the external electric shock defibrillation will restore regular heart
rhythm. It improves survival rates for out-of-hospital cardiac arrest casualty.
Early Advance Cardiac Life Support medical care provided by the ambulance medical
personnel that includes supporting ventilation, establishing intravenous access, administering drugs, controlling arrhythmias and preparing the casualty for transport to hospital.
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d)
Steps in performing CPR
STEP 1. CHECK FOR DANGER
STEP 2. ASSESS UNRESPONSIVENESS

Call, tap or gently shake the person Hello! Hello! Are you OK?
STEP 3. SHOUT FOR HELP. ACTIVATE EMERGENCY

MEDICAL SERVICE (EMS) If victim does not respond, shout for help. Call ambulance 995 and get the first aid kit and AED if available.
STEP 4. POSITION THE CASUALTY

For CPR to be effective, the victim must lie on a firm, flat surface. If the casualty is lying face down, or on his / her side, you will need to roll the casualty over onto his /her back.
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STEP 5. OPEN THE AIRWAY

Perform a head-tilt chin-lift manoeuvre.
Airway blocked
Tongue falls back
With head-tilt chin lift, the airway is clear.
STEP 6. CHECK FOR BREATHING LOOK at the chest movement LISTEN for breathing sounds, and FEEL for warm air against your cheek for signs
of breathing (up to 10sec). Gasping is considered not breathing.
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STEP 7. COMMENCE CPR. LOCATE HAND

POSITION FOR CHEST COMPRESSIONS Maintain head tilt-chin lift. Run your middle finger from the lower margin of victims rib cage to sternal notch. Place index finger next to middle finger ( landmark is lower half of the breastbone ).
Sternal Notch
STEP 8. PERFORM CHEST COMPRESSIONS

Interlace fingers, and lift fingers off the chest wall. Straighten and lock elbows. Position you shoulder directly over the casualtys chest Use your body weight to compress down to a depth of at least 5 cm and count loudly; 1 and 2 and 3 and 4 and 5 and, 1 and 2 and 3 and 4 and 10 and, 1 and 2 and 3 and 4 and 15 and, 1 and 2 and 3 and 4 and 20 and, 1 and 2 and 3 and 4 and 25 and, 1 and 2 and 3 and 4 and 30 and followed by 2 ventilations.
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STEP 9. FOLLOWED BY MOUTH TO MOUTH BREATHING Followed by 2 ventilations. Maintain a head-tilt chin-lift. Pinch nose and give 2 quick ventilations ( 400600 ml/sec per breath ). Watch chest rise and release the pinch after each breath. Continue good quality CPR.
Guidelines recommended by National Resuscitation Council ( NRC )

For layperson, no reassess. To give effective chest compressions, rescuer should push hard and push fast. Locating the correct hand position for chest compression should be done quickly. The ratio of compression and ventilation is 30 : 2 Perform chest compression rate at 100 per minute. Continue CPR till ambulance arrives or until AED is attached to casualty or the victim starts breathing or rescuer becomes exhausted. If breathing is present, check for injuries and position the victim in the recovery position ( if no injuries ). Continue to monitor victims vital signs every few minutes.
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RECOVERY POSITION STEP 1. POSITION THE VICTIM
STEP 2. ROLL THE VICTIM TOWARDS

THE RESCUER
STEP 3. FINAL RECOVERY

POSITION
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MANAGEMENT OF BLEEDING
Types of Bleeding
Recognition
Arterial
1. Bright red, oxygenated blood. 2. Spurts out, flowing under pressure
Venous
1. Dark red, deoxygenated blood 2. Gushes profusely
Capillary
1. Blood loss usually slight 2. Causes a bruise if bleeding is into tissues 3. Slow ooze
External Bleeding
1. Protect yourself. Use disposable rubber or plastic gloves.
2. Control bleeding with direct pressure.
3. Elevate affected part.
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4. Do not apply a tourniquet. 5. When bleeding cannot be stopped by direct pressure, apply Indirect Pressure. Brachial pressure point
Femoral pressure point
6. Rest the affected part. Elevation slows bleeding.
1. 2. 3. 4. 5. 6.
Internal Bleeding Reassure casualty Lay casualty down Elevate legs above level of heart (unless fractured) Loosen visible tight clothing Give nothing by mouth Monitor vital signs breathing & response
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MANAGEMENT OF WOUNDS
Types of Open Wounds Recognition and Actions To Take Abrasions (Graze) Superficial wound resulting from a sliding fall or a friction burn. Often embedded with dirt that may result in infection. Remove debris. If dry, leave open; if wet cover with dry gauze dressing (not cotton wool ).
Incised Wound A clean cut by a sharp edge. Vessels may be cut. Control bleeding. Seek medical attention.
Laceration Tear in skin from example a barbed wire. Edges are irregular. Often contaminated and danger of infection is high. Control bleeding. Seek medical attention.
Puncture / Stab Wound A deep wound caused by a nail or a sharp pointed object. Risk of infection is high. Do not remove any impaled object. Seek medical attention.
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Avulsion (Tearing Wound) Caused by machinery or explosive devices. Skin and underlying tissue torn off or left hanging. Severe bleeding may occur. Control bleeding. Seek medical attention.
Amputation Body part is cut or torn off and bleeding may be severe. Control bleeding Take all amputated parts to the doctor. Preserve amputated body parts correctly
Preservation of an amputated finger
1. Wrap amputated part in clean dry gauze to absorb moisture.
2. Put wrapped amputated body part in plastic bag.
3. Place bag with the wrapped part in another bag of ice.
Nose bleed
Causes Spontaneous bleeding After an injury, sneezing or blowing hard on the nose Spontaneous bleedi Actions to take Casualty to be seated Pinch soft part of nose and lean forward Breathe through the mouth Release after 10 minutes If bleeding has not stopped, reapply pressure for two further periods of 10 minutes each Seek medical attention if bleeding persists
After
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Special types of wounds: Embedded Foreign Body Recognition: Gravel, broken glass, plastic, metal / wooden splinters or a sharp metal object may be embedded in the skin. Actions to take: 1. Do not attempt to remove a penetrating foreign body. 2. Place padding around the object or place a ring pad over the object, and bandage over the ring pad.
End of Lesson 3
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Standard First Aid Lesson 4 Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries

Overview
This lesson covers the brain and the nervous system, disorders of consciousness including head, orofacial, chest, spinal and abdominal injuries

1 MANAGEMENT OF AN UNCONSCIOUS CASUALTY
a) The Nervous System b) Structure of the Brain c) Definition of Unconsciousness d) Recognize the different causes of Unconsciousness - Head and Facial Injuries - Fits - Fainting - Stroke - Diabetes
MANAGEMENT OF CASUALTY WITH CHEST, SPINAL AND ABDOMINAL INJURIES

a) Recognize spinal injuries b) Recognize a penetrating chest injury c) Recognize an abdominal injury
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1
a)
MANAGEMENT OF UNCONSCIOUS CASUALTY

THE NERVOUS SYSTEM
The Nervous System consists of the: 1. Central Nervous System, mainly the
Brain Spinal cord
2. Peripheral Nervous System, consisting of the motor nerve moving from the spinal cord sensory nerve going into the spinal cord
3. Autonomic nervous system which carries signals to and from the internal organs (e.g. heart, stomach, intestines) and the brain.
b)
Structure of the Brain
Function of the brain is to control bodily functions. Disorder of the brain results in unconsciousness. The brain and spinal cord are covered by protective membranes (meninges). The brain and spinal cord are bath in cerebrospinal fluid (CSF).
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c)
Definition of Unconsciousness
Unconsciousness is defined as impairment of awareness. It can range from drowsiness and confusion to total lack of response. It is a total or partial loss of ability to respond to external stimulus like voice or pain. The main causes of impaired consciousness are structural damage to the brain or a lack of nutrients, oxygen and glucose (sugar) from reaching the brain. The first aider can assess consciousness by checking the casualtys level of responsiveness as follows: a. b. c. d. Alert able to respond to simple questions and give answers Voice able to respond to voice by moving body Pain able to respond to pain Unresponsive no response or movement
d)
Causes of Unconsciousness Alcohol intoxication Epilepsy Insulin coma Overdose of drugs eg. sedatives Ureamia ( renal failure ) Trauma ( head injury ) Infection Psychiatric condition eg. Hysteria Stroke / Shock
Action to take
Apply Emergency Action Plan DO NOT
Give anything by mouth. Move the casualty unnecessarily. Leave an unconscious casualty unattended at any time.
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HEAD INJURY
A head injury may be caused by a direct or indirect force resulting in a scalp laceration, brain concussion, brain compression, or skull fracture.
Types of head injuries

Scalp laceration .
Recognition & Its First Aid
1. Apply direct pressure if underlying skull fracture is not suspected. 2. If a skull fracture is suspected, apply pressure round the edges of the wound. Use a ring pad to do this. 3. Secure the dressing with a scalp bandage. 4. Seek medical attention
Concussion A concussion is a shaken brain resulting in a partial loss of consciousness. 1. Brief or partial loss of consciousness 2. Dizziness, nausea or vomiting 3. Loss of memory 4. Generalised headache
Compression ( Contusion ) Compression is pressure exerted on the brain e.g. by a blood clot.
1. Headache intensifies. 2. Breathing slow & noisy 3. Vomiting 4. Pupils unequal or dilated 5. Some weakness or paralysis
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Types of head injuries

Skull fracture A fracture of the skull is the break, either partly or completely of a skull bone. A large force is necessary to cause such as injury e.g. road traffic accidents or a fall from a height.
Recognition
1. Progressive deterioration in LOC 2. Blood & CSF coming out from nose or ears usually indicates a base of skull fracture. 3. Vomiting 4. Blood shot eyes
FACIAL INJURIES
Cheekbone and Nose fracture
Causes Trauma Fights Regconition Bloodshot eyes Deformity and swelling around cheek, jaw or nose. Pain Severe bruising Loose or missing teeth
Actions to take Apply cold compress Pinch nose foe nose bleed Seek medical treatment
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Eye Injury Injuries to the eye by trauma, fall, cut , flying objects or foreign body can lead to pain, tearing, irritation, bleeding redness or loss of vision
Recognition Pain, visual loss and bleeding may be present.
Actions to take Foreign body in the eye - Do not rub your eye Cuts of the eye and lid -Cover with a sterile, dry pad over the affected eye and bandage. Tell the casualty to keep both eyes still. Seek medical help immediately Chemical burns - Flood the eye with water immediately
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FITS ( Seizures/Convulsions )
A fit is a sudden loss of consciousness followed by uncontrolled movements of the limbs. It generally lasts a few minutes and it cannot be stopped.
1. Tonic phase (stiffening of the body)
2. Clonic phase (the body jerks)
3. Post-convulsive phase (exhaustion)
Causes
Head injury High fever Stroke Brain tumour Infection High/low blood sugar Epilepsy ( recurrent seizures ) Actions to take
Recognition 1. Sudden loss of consciousness 2. Shaking of limbs 3. Clenching of teeth, up-rolling of eyes 4. Foaming around the mouth 5. Drowsy, dazed or confused
DO NOT
1. If your casualty is falling - support or ease 1. Move the casualty his fall. unless there is immediate danger 2. Make space around him - ask bystanders to move away. Prevent self-injury. 2. Use force to restrain him 3. Loosen tight clothing around the neck. 3. Put anything in his 4. Roll casualty onto his side to drain mouth secretions. 5. After the fit is over, if casualty is drowsy, place in the recovery position. 6. Call the ambulance 995.
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Fainting ( Syncope )
Fainting is a brief loss of consciousness due to a temporary reduction in the blood flow to the brain. Recovery is usually rapid and complete.
Causes
1. 2. 3. 4. 5. 6.
Actions to take 1. Lay the casualty down. 2. 3. 4. 5. 6. Loosen tight clothing. Check ABC. Raise the casualtys legs. Ensure plenty of fresh air. Advise the casualty to seek medical attention.
Fright Hunger Exhaustion Severe pain Emotional upset Prolonged standing
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Stroke
A stroke is a condition in which the blood supply to part of the brain is suddenly impaired by a blood clot ( blockage ) or a ruptured vessel. Blood clot Ruptured vessel
Recognition 1. Altered level of consciousness. 2. Slurred or garbled speech. 3. Loss of movement, weakness and feeling, usually on one side of the body. 4. Severe headache.
Actions to take 1. Call for an ambulance 995. 2. Reassure the casualty. 3. Ensure the ABC is present if he is unconscious. 4. Monitor vital signs every five minutes till the ambulance arrives.
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Diabetic coma ( diabetes mellitus )

Insulin is a hormone produced by the pancreas that allows your body cells to use blood glucose (sugar) for energy. Food is converted into glucose before it is absorbed into our bloodstream. The pancreas then releases insulin to move the glucose from the bloodstream into the body cells for use or storage. People with diabetes are unable to fully use the glucose in their bloodstream due to: - lack of insulin in the body - insulin is ineffective Loss of consciousness in diabetes can be due to low blood sugar or hypoglycaemia or excessive blood sugar or hyperglycaemia.
HYPOGLYCAEMIA
Recognition 1. Rapid loss of Consciousness. 2. The casualty has not taken any food following diabetes medication or injection. 3. Overdose of insulin injection.
HYPERGLYCAEMIA
1. The casualty has been unwell over the last few days. 1. Dry mouth and lips. 2. Undiagnosed diabetes mellitus. 3. Failure to take medications or insulin.
Actions to take
Give a sweet drink if the casualty is able to drink.
Seek medical attention immediately.
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2
a)
MANAGEMENT OF SPINAL, CHEST AND ABDOMINAL INJURIES

Spinal Injuries Causes: Falling from a height. Diving into shallow waters. Being thrown off a horse or a motorcycle. Sudden deceleration in a motor vehicle. A hit across the back by a heavy object or force. An injury to the head or face
Recognition 1. Inability to move the lower limbs. 2. Abnormal / loss of sensation. 3. Limb weakness / paralysis. 4. Difficulty in breathing if the injury is high up in the neck.
Actions to take: Do not move the casualty unless there is presence of danger. For a conscious casualty: 1. Reassure the casualty and advise him not to move. 2. Steady and support his head in the neutral position (head injury). 3. Call for an ambulance 995.
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b)
Penetrating Chest Wound Actions to take: 1. Call for an ambulance dial 995. 2. Cover the wound immediately with the casualtys own hand or the palm of your gloved hand. 3. Place a sterile dressing or clean pad over the wound, and cover the pad with a plastic bag or cling wrap film. 4. Secure firmly with adhesive strapping on four sides. Leave a gap at the fourth side untapped to allow air under pressure during expiration to escape. 5. Support the conscious casualty in a comfortable position, inclined towards the injured side.
Recognition: A wound with or without a penetrating injury (entrance and/or exit). A crackling feeling may be felt in the skin around the wound.
Position of the casualty after treatment Keep the uninjured lung uppermost
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c)
Abdominal wounds Actions to take: 1. Call for ambulance 995. 2. Lay the casualty down, bending and supporting his knees if possible. 3. Put a large dressing over the wound, and secure it lightly in place with a bandage or adhesive strapping. 4. Cover any exposed abdominal contents with a polythene bag or cling wrap film. 5. Alternatively, use a sterile dressing. 6. Treat for shock and monitor the vital signs.
Recognition: An open or closed wound to the abdomen. The intestines or other organs may be exposed.
Raising and supporting the knees may ease strain on the injury
End of Lesson 4
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Standard First Aid Lesson 5 The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
Overview
This lesson covers the musculoskeletal system, fractures and soft tissue injuries.

1 THE SKELETAL SYSTEM
a) b) Structure Joint
MANAGEMENT OF FRACTURES
a) b) c) d) Definition of fracture Types of Fracture Open and Closed Fracture Specific Bone Fractures
MANAGEMENT OF SOFT TISSUE INJURIES

a) Sprain and Strain
MANAGEMENT OF MUSCLE CRAMPS

a) Causes and Actions
Singapore Red Cross Society / Red Cross Training Centre / Oct 2011
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1
a)
THE SKELETAL SYSTEM

Structure
The skeleton consists of 206 bones.
Functions Protection Locomotion Support Formation of blood cells
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b)
A JOINT
A joint is the place where two bones come together. There are three types of joints classified by the amount of movement they allow: immovable, slightly movable, and freely movable. The structure of a movable joint consists of: Ligament Capsule Bone Cartilage Synovial fluid (joint fluid)
An example of a slightly movable joint of the spine.
An example of a freely movable joint is a ball-and-socket joint of the shoulder.
Another example of a freely movable joint is a hinge joint of the elbow.
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MANAGEMENT OF FRACTURE
The human body contains more than 650 individual muscles which are attached to the skeleton, which provides the pulling power for us to move around. The main job of the muscular system is to provide movement for the body.
a)
Definition of a fracture
Fractures are breaks or disruptions in bone tissue. These can be complete or partial breaks in the bone.
b)
Types of Fractures
All fractures can be broadly described as:
1. Closed (Simple) fractures are those in which the skin is intact
2. Open (Compound) fractures involve wounds that communicate with the fracture.
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Other types of fracture Complicated Greenstick Comminuted Spiral Transverse
Causes Direct force Indirect Muscular contractions
Recognition Deformity or shortening of the affected limb. Open injuries or internal bleeding, (manifested as shock if severe). Pain and tenderness of the injury site. Swelling and bruising from internal bleeding. Loss of function of the limb.
Footnote : The signs and symptoms of fractures can also be summarise as PLASTICS Pain, Loss of Function, Abnormality, Swelling, Tenderness, Infection, Crepitus and Shock.
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Actions to take: 1. Lay the casualty down and minimise movement 2. Support the injured limb until it is immobilised. 3. Cover the wound ( for open fractures ) with a clean pad and apply pressure with a bandage. 4. Immobilise the injured part with a splint or to the body. 5. Elevate the injured part, if possible. 6. Seek medical attention.
DO NOT Press down directly on a protruding bone. Move the casualty until the injured part is secured and supported. Let the casualty eat or drink anything.
Types of splints Splints can be made from many different materials. 1. 2. 3. Improvised splint: folded newspapers, magazines Commercial splint: SAM splint (moldable splint), air splint, wooden splints Self splint: The injured part is tied to an uninjured body part
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c)
Specific Bone Fracture
Upper limb
Collar bone (Clavicle) fracture
Recognition 1. History of fall ( direct or indirect ) 2. Pain, swelling and deformity 3. The casualty supports the elbow on the injured side to relieve pain 4. Head inclined to injured side
Actions to take: 1. Support the arm of affected collar bone in an elevation sling. 2. Secure the arm to the chest with a broad bandage. 3. Seek medical attention.
Upper arm (humerus) fracture
Recognition 1. History of fall directly on to the shoulder or on to the outstretched hand 2. Pain and swelling 3. Difficulty in raising the arm
Actions to take: 1. Support the injured arm in an arm sling. 2. Secure the arm to the chest with 2 broad bandages.
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Dislocations Displacement of a bone at a joint caused by strong force wrenching the bone out of its joint, or by a violent muscle contraction is called a dislocation.
Dislocated shoulder
Recognition 1. History of fall 2. Acute pain, swelling and flattening of shoulder. 3. The casualtys head inclined to the injured side. 4. Inability to raise the arm.
Actions to take: 1. Sit casualty down. 2. Apply a large arm sling to the affected arm. 3. Immobilise the sling with a broad bandage. 4. Seek medical attention.
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Fracture elbow Actions to Take: For an elbow that can be bent: 1. Treat as for a fracture of the upper arm. 2. Check for sensation at the affected wrist every 10 minutes. 3. If no sensation, gently straighten the elbow until it returns and immobilise it in that position. 4. Seek medical attention. For an elbow that cannot be bent: 1. History of fall on elbow. 2. Severe pain, swelling and deformity, unable to bend elbow. 3. Do not attempt to forcibly bend or straighten the elbow. 4. Lay the casualty down and place the injured limb on his trunk. 5. Secure arm to the trunk of the body with 3 broad bandages. 6. Seek medical attention.
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Fractures of the forearm and wrist
Recognition History of fall on outstretched hand. Pain, swelling and dinner fork deformity.
Actions to take: SPLINT METHOD ( Picture A ) 1. Place a splint on the injured side. 2. Or use a newspaper / magazine as an improvised splint. 3. Secure the splint with a narrow bandage. 4. Support the arm in an arm sling. 5. Secure the arm to the chest with a broad bandage. 6. Seek medical attention. SPLINTLESS METHOD ( Picture B ) 1. Place a soft padding around injured wrist/forearm 2. Support the arm in an arm sling. 3. Secure the arm to the chest with a broad bandage.
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Fracture of the hand and fingers
Recognition 1. Pain and tenderness at the fracture site. 2. Swelling and bruising. 3. Deformity.
Actions to take: 1. Place soft padding around the hand. 2. Support the injured arm in an elevation sling. 3. Secure the arm to the chest with a broad bandage. 4. Seek medical attention.
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Lower limb
Fracture of the thigh (femur)
Recognition 1. Severe pain, pallor and sweatiness. 2. 3. 4. 5. 6. Bruising and swelling of fracture area. An outward turning of the knee and foot. Shortening of the leg. Inability to stand. Signs of shock.
Actions to take: 1. Lay the casualty down. 2. Call ambulance 995. 3. Bring the sound leg alongside the injured leg. 4. Place soft padding between the legs. 5. Slide 4 broad bandages under the legs and secure both legs at the ankle, knee, below and above the fracture. 6. Tie the knots at the uninjured side. 7. Seek medical attention.
Fracture of the pelvis Recognition 1. History of road traffic Injury with a direct force on the pelvis 2. Pain and inability to stand Actions to take: same as a fracture femur
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Fracture of the lower leg (tibia/fibula)
Recognition 1. Deformity and shortening of the limb. 2. An open injury. 3. Severe pain and tenderness at the fracture site. 4. Swelling and bruising.
Actions to take: 1. Lay the casualty down. 2. Call ambulance 995. 3. Bring the sound leg alongside the injured leg. 4. Place soft padding between the legs. 5. Slide 4 broad bandages under the legs and secure both legs at the ankle, knee, above and below the fracture. 6. Tie the knots at the uninjured side. 7. Seek medical attention.
Fracture of the Ankle Recognition 1. History of severe twisting force 2. Pain and inability to put weight on injured foot 3. Swelling 4. Deformity if there is a displaced fracture Actions to take: 1. Help casualty to lie down 2. If a fracture is not suspected, apply the RICE procedure 3. If a fracture is suspected, immobilise the fracture 4. Seek medical attention
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Fracture of the jaw - Injuries to the face may break the jaw. Recognition 1. Pain when moving the jaw and swallowing. 2. Distortion of the teeth and dribbling. 3. Swelling, tenderness and bruising. 4. A wound or bruising within the mouth. Actions to take: 1. Sit the casualty up. 2. Place a soft pad to support the jaw. 3. Secure the jaw with a broad bandage or roller bandage as shown. 4. Call ambulance 995.
Fracture of the Ribcage Causes Direct or indirect force. May be complicated by a penetrating wound or a flail chest injury where breathing may be severely impaired.
Recognition 1. Pain at the fracture site. 2. Pain on taking deep breaths or coughing. 3. Shallow breathing. 4. Air being sucked into the chest cavity. 5. Shock.
Actions to take: 2. Reassure the casualty. 3. Place a soft padding on the injured rib and secure with a broad bandage. 4. Support the limb on the injured side in an elevation sling. 5. Secure the sling with a broad bandage.
6. Call ambulance 995.
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MANAGEMENT OF SOFT TISSUE INJURIES

Strain
Sprain:
A sprain is the over- stretching and / or tearing A strain is an over stretching and / or tearing of ligaments of a joint. of muscle or tendons attached to the muscle.
Recognition: 1. Acute pain and tenderness at the joint. 2. Swelling around the joint. 3. Limited movement.
Recognition: 1. Sudden sharp or severe pain 2. Tenderness when the area is touched.
Actions to take - R.I.C.E. PROCEDURE
Support & elevate the Injured part
An ice pack helps relieve pain
Compression counteracts swelling, and gives the injured part support
Elevation reduces swelling.
Rest
1. Rest injured area.
Ic e
Compress
Elevate
2. Ice area for 15 min @ 2-3 hr for first 24-48 hr. 3. Compress area for 24-48 hr. 4. Elevate area for first 24-48 hr. 5. Seek medical attention if pain and swelling persist.
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Cramps
A cramp is a sudden and very painful contraction of a muscle or a group of muscles. Cramps in legs are very common.
Causes Exercise soon after a meal Chilled muscles Sudden vigorous activity Poor muscular coordination Loss of body fluids and salt During pregnancy
Actions to take Gently stretch the contracted muscles e.g. cramp in the calf Straighten knee and pull the foot up towards the shin.
End of Lesson 5
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Standard First Aid Lesson 6 Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty

Overview
This lesson covers the Integumentary system or the Skin, bites and stings, poisoning, heat disorders and transportation of casualties.

1 MANAGEMENT OF BURN INJURIES
a) b) c) d) e) f) g) Structure and Function of the Skin Classification of Burns Causes of Burn Injuries Depth of Burn Severity of Burn Extent of Burn Burns in Special Areas Burns to the Mouth and Throat Chemical burn Electrical Burn
MANAGEMENT OF POISONING
a) Common Routes of Poisoning b) First Aid for Poisoning
MANAGEMENT OF BITES AND STINGS

a) b) c) d) e) Bee and Wasp Sting Scorpion Sting Jellyfish and other marine stings Dog and cat bites Snake Bites
MANAGEMENT OF CASUALTY WITH HEAT DISORDERS

a) b) c) d) Types of Heat Disorder Heat cramp Heat exhaustion Heat stroke
TRANSPORTATION OF CASUALTY
a) b) c) One first-aider method Two first aiders method Three first aider methods
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1
a)
MANAGEMENT OF BURN INJURIES

Structure of the Skin
Epidermis
Dermis
Subcutaneous
Functions
1. 2. 3. Protects from injury Protects from infections. Regulates body temperature.
b)
1. 2. 3. 4.
Burns can be classified by:

Causes ( types ) of burn Depth of burn Severity of burn Area of burn
Scalds
c)

Causes ( Types ) of burn injuries

Dry burns Scalds Cold burns Chemical burns Electrical burns Radiation burns
Chemical
Electrical
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d)
Depth of Burn
Recognition
Depth of Burn
Superficial burn 1. Injury involves only the outer layer of the skin. 2. Redness, swelling, tenderness and pain are present.
Depth of Burn
Recognition
Partial-thickness burn 1. Injury affects the deeper layers of the epidermis. Formation of blisters. Pain is present.
2. 3.
Full-thickness burn 1. Injury involves all layers of the skin; damage may extend to nerve, muscle and fat. 2. The skin appears pale, waxy and sometimes charred. 3. Pain free.
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e)
Severity of burn
The severity of a burn depends on:

Burn depth Burn size Burn site Infant, child or adult
f)

Extent of burn
The extent of a burn is expressed in terms of a percentage of the bodys total surface area. The rule-of-nines.
Immediate Medical Attention for severe burn injury
A partial-thickness burn of 9% or more may lead to shock. A full-thickness burn of any size. Burns to the neck, nose or mouth. Burns to the eye. Any partial-thickness burn of 1% or more (covering an area approximating to that of the casualtys palm).
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Superficial and Partial Thickness Burn Actions to take

1. COOL the burn - Do not apply anything to the burn. 2. CONSTRICTORS remove if any. 3. COVER the burnt area.
Full-thickness burn Actions to take:

1. Cover the burnt area with a clean cloth for protection. 2. Treat the casualty for shock if present. 3. Perform DRABC. Watch for breathing difficulty involving burns on the face and neck. 4. Call for ambulance 995.
Important points to note

DO NOT 1. Apply butter or oils on a burn. 2. Apply ice or cool to near-freezing temperatures. 3. Neutralise a chemical burn with a reciprocal chemical. 4. Disregard an electrical burn.
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g)
Burns in Special Areas BURNS TO THE MOUTH AND THROAT Actions to take:
1. Call for ambulance 995 2. Take steps possible to facilitate the casualtys breathing. 3. Be prepared to resuscitate!
CHEMICAL BURN
This occurs when caustic or corrosive substances come into contact with the skin.
Actions to take:
1. Flush the area immediately with copious amounts of water for 15 20 minutes or longer. 2. Remove the casualtys contaminated clothing whilst flushing. 3. Cover the burned area with a dry clean dressing. 4. Seek immediate medical attention.
ELECTRICAL BURN Actions to take:

1. Check DRSABC. 2. Check for fractures and spinal injury. 3. Treat the casualty for shock. 4. Cover entry and exit burns. 5. Seek immediate medical attention.
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2
a) 1. 2. 3. 4.
MANAGEMENT OF POISONING
Common routes of poisoning : Ingestion Inhalation Absorption Injection taken by mouth breathed in through skin needles, stings & bites
Actions To Take : If swallowed, do not induce vomiting. If inhaled, move to well-ventilated and open spaces. If absorbed, wash with lots of water. Seek medical treatment immediately. Identify the poison if possible.
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MANAGEMENT OF BITES AND STINGS

Actions to take: 1. If the stinger is in the wound (this applies to a bee sting only), flick it out with the edge of a card or knife. 2. Apply a cold compress. 3. For a sting in the mouth, give the casualty ice to suck on or cold water to sip. 4. Seek medical attention.
Bee and wasp sting They are dangerous in these cases: 1. People who are allergic to stings. 2. Stings in the mouth and throat. 3. Multiple stings can result in death.
Scorpion sting This causes severe pain and burning sensation around the site, followed by numbness or tingling from the neurotoxin in the sting
Actions to take: 1. Apply cold compress to relieve pain. 2. Immobilise the injured part. 3. Monitor for difficulty in breathing. 4. Seek medical attention.
Jellyfish and other marine stings The venom is contained in special stinging cells of the jellyfish that stick to the skin. The aim is to inactivate the stinging cells before they release their venom.
Actions to take: 1. Sit the patient down. Pour copious amounts of vinegar or sea water to stop the stinging cells from releasing venom. 2. Dust a dry powder over the affected skin. The stinging cells stick to the powder. 3. Then brush off the powder with a clean pad. 4. Monitor the casualty for difficulty in breathing. 5. Seek medical attention.
Dog and Cat Bites
Actions to take: For superficial bites 1. Wash wound. 2. Cover with a clean dressing 3. Seek medical attention. For deeper bites 1. Control bleeding - direct pressure. 2. Cover the wound. 3. Seek medical attention.
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Snake Bites
Actions to take:
Some poisonous snake venoms causes bleeding in tissues and organs (anticoagulant toxin eg viper ) and paralysis of muscles ( neurotoxin eg cobra, krait). Poisonous snakes usually bite only in defense.
1. 2. 3. 4. 5. 6. 7.
8. 9. 10.
Call ambulance 995. Lay casualty down Tell the person to keep calm and still. Not all bites from poisonous snakes contain venom (called dry bites). If there are no symptoms of poisoning, roller bandaging is not needed. A dry dressing over the wound will be enough. If it is a suspected poisonous bite then apply a roller bandage above the wound with the same tightness as for a sprained ankle. Do not use a tourniquet. Immobilise the bitten leg. Monitor vital signs.
Recognition 1. Look for fang marks (pair of puncture marks) 2. Symptoms that may suggest poisoning: 3. Redness and swelling, oozing of blood (viper). 4. Nausea and vomiting, laboured breathing and disturbed vision (cobra, krait). 5. Muscle aches and blood in urine (sea snake).
Fang marks
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MANAGEMENT OF CASUALTY WITH HEAT DISORDERS
Three stages of progressive severity:
Disorder
Symptom
Actions to Take
a.
HEAT CRAMP is painful cramps due to excessive sweating from a strenuous activity. If the person continues, heat exhaustion may result.
1. Muscle cramp. 2. Excessive sweating.
1. Sit in cool place. 2. Drink enough water. 3. Seek medical attention
2. HEAT EXHAUSTION is severe tiredness due to loss of body fluid through excessive sweating from strenuous activity. If the person continues, heat stroke may result.
1. Tiredness. 2. Excessive sweating.
1. Lay casualty in a cool place. 2. Elevate the legs.
3. Muscle cramps. 3. Give plenty of water 4. Rapid pulse and breathing. 4. Monitor vital signs. 5. Seek medical attention.
3. HEAT STROKE occurs when the body is unable to control its temperature. When temperature rises, the sweating mechanism fails, and the body is unable to cool down. It is a life-threatening condition.
1. Confused. 2. Hot flushed and dry skin. 3. Body temp more than 40 degree Celsius.
1. Check DRABC. 2. Call ambulance 995. 3. Move the casualty to a cool place. 4. Cool the casualty rapidly with water.
HEAT CRAMP
HEAT EXHAUSTION
HEAT STROKE
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TRANSPORTING A CASUALTY
Introduction Move the casualty ONLY if the casualty is in immediate danger. Do not move the casualty unnecessarily. Do not leave the casualty alone. Principles of lifting Know your capabilities. Keep your back straight and bend your knees. Apply a safe grip. Use as much of the palms as possible. Position your feet, shoulder width apart for balance, with one foot in front of the other. When lifting, do not twist your back; pivot with your feet.
Methods of transportation Support Hand seats Chair Blanket Stretcher Wheelchair
Methods of Carrying
Shoulder drag
a)
ONE FIRST AIDER METHOD Shoulder Drag Crouching Drag Blanket Pull Human Crutch Cradle Carry Firemans Lift Pick-A-Back Carry
Blanket pull Crouching drag
Pick-A-Back
Firemans Lift
Cradle Carry
Human Crutch
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b)
TWO FIRST AIDERS METHOD Two- Handed Seat Carry Four-Handed Seat Carry Fore-and-Aft Carry Chair Carry
Chair Carry
Fore-and-Aft Carry
Four- Handed Seat Carry
Two- Handed Seat Carry
c)
THREE FIRST AIDERS METHOD Three-person Carry
(i)
(ii)
(iii)
End of Lesson 6
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Practical Types of Bandaging
TYPES OF BANDAGING
Triangular Bandaging
Broad and Narrow Bandage Use as a ring pad For dislocation of shoulder For upper arm fracture For wrist / lower arm fracture For collarbone fracture For finger fracture For elbow fracture
Roller Bandaging Applying on a wound Hand, Foot, Elbow (for holding dressing or supporting sprains) Knee Eye Head
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TRIANGULAR BANDAGING
All Rights Reserved. This document belongs to the Singapore Red Cross Society / Red Cross Training Centre (RCTC) 15 Penang Lane / Level 3 / Singapore 238486 / Website: www.redcross.org.sg / Tel: 63360269 / Fax: 63376435.
1
1
Apex
Side
2nd Fold
BROAD BANDAGE
Side
Base
1st Fold
3rd Fold
NARROW BANDAGE
Storing and folding to a pressure pad
Narrow Bandage
Use as a ring pad
Wrap a narrow bandage round your fingers a few times to form a loop.
Weave remainder of bandage around and around the loop.
Finished ringpad. Used over an embedded foreign body.
Place the triangular bandage against the chest with Apex towards the elbow
Bring the other end of the bandage to the other shoulder
Secure the sling with a knot on the opposite side of the injury
Twist the end to secure the elbow region
5
Immobilize the Open Arm Sling with a broad bandage to prevent movement
DISLOCATION OF SHOULDER (OPEN ARM SLING)

5
Apply an Open Arm Sling and immobilize it with two broad bandages : 1 - below the Fracture 1 - above the Fracture
FRACTURE SITE
FRACTURE UPPER ARM

6
Place a splint on the injured site
Secure the splint with a narrow bandage
FRACTURE WRIST / LOWER ARM (WITH SPLINT)

SPLINTLESS METHOD
5
Immobilize the fracture with a Broad Bandage OPEN ARM SLING AND IMMOBILISATION WITHOUT USING A SPLINT
Place the arm on the uninjured site
Place a Triangular bandage on the elevated arm, with Apex towards the elbow
Tuck in the hand first
Tuck in the rest of the bandage
6
Bring the rest to the back of victim and secure a knot and a immobilization
9
Do a fold to secure the elbow region Twist at the elbow region
COLLARBONE FRACTURE
8
Place a pad over the affected finger
Elevate the affected arm
Tuck in the hand first
Tuck in the rest of the bandage
Do a fold to secure the elbow region
Twist at the elbow region
Bring the rest to the back of victim and secure a knot and a immobilization
FRACTURE FINGERS
Place a Broad Bandage across the chest
Place a 2nd Broad Bandage below the elbow
Place a 3rd Broad Bandage around the wrist region
ELBOW FRACTURE (UNABLE TO BEND)

10
11
1. APPLYING ON A WOUND
STEP 1 STEP 2
STEP 3
STEP 4
STEP 5
13
2. HAND / FOOT ( for holding dressing or supporting sprains )

STEP 1 STEP 2
STEP 3
STEP 4
14
STEP 5
15
FOOT
16
3. ELBOW ( for holding dressing or supporting sprains )

STEP 1 STEP 2
STEP 3
STEP 4
17
4. KNEE
18
5. EYE
STEP 1 STEP 2
STEP 3
STEP 4
19
STEP 5
20
6 .HEAD
STEP 1 STEP 2
STEP 3
STEP 4
21
STEP 5
22
GENERAL RULES OF APPLYING A ROLLER BANDAGE

Choose the appropriate and correct size of bandage, different parts of the body require different widths of a roller bandage. 5.0 cm ( 2 ) Head, ear, eye 7.5cm ( 3 - 4) Forearm, arm, hand, foot, leg 10.0cm ( 4 ) Thigh, knee 15.0cm ( 6 ) Trunk Always position yourself towards the front of the casualty at the injured side. Support the injured part in the position in which it will remain after bandaging. Hold the head or barrel of the bandage facing up. Place the tail of the bandage below the injury. Work from inside of the limb outwards. Make two straight turns with the head of the bandage to anchor it in place. Make a series of spiraling turns. Wind from inside to outside of the limb. Make sure that each turn covers between a half and two-thirds of the previous layer of bandaging. Finish off with one straight turn and secure the ends. Check circulation to extremity of the injured limb regularly. If there is swelling and bandage becomes too tight, undo the bandaging again. 23 Do not use bandaging around the neck.
Practical CPR
CPR Checklist
For Lay Person a. Adult Foreign Body Airway Obstruction (Conscious) b. Adult Foreign Body Airway Obstruction (Unconscious) c. One-Man Adult CPR
One-Man Adult CPR Practical Assessment Sheet
Page 90
CPR CHECKLIST (FOR LAYPERSON)

(A) Adult Foreign Body Airway Obstruction CONSCIOUS 1. Ask: Are you choking? 2. Position: Stand behind victim, arms around abdomen; Perform abdominal thrust; Place thumbside of fist against abdomen in the midline, 2 finger above the navel, grasp fist with the other hand; 3. Perform inward & upward thrusts (5 sets) until foreign body is dislodged or victim becomes unconscious. (B) Adult Foreign Body Airway Obstruction UNCONSCIOUS Once the victim become unconscious: 1. 2. 3. 4. 5. 6. 7. Pregnant or Obese Person 1. Ask: Are you choking? 2. Position: Stand behind victim, arms around victims chest; Place thumb-side of fist inwards on mid sternum; Grasp fist with the other hand and press with quick backward thrust; 3. Give successive backward thrusts (5 sets), repeat thrusts until effective or victim becomes unconscious. Place victim on his/her back on a flat firm surface. Check Response, gently shake and tap the shoulder of victim and Shout: Are you OK? No response: Call ambulance 995. Commence 30 chest compressions. Open the Airway, head tilt-chin lift. Remove visible foreign body by using the index finger. Check for Breathing: look, listen and feel (up to 10 seconds). If NO BREATHING, attempt 2 ventilations. (1 sec / breath) st - If 1 attempt unsuccessful: nd - Re-position head, attempt 2 ventilation. nd If 2 ventilation unsuccessful SUSPECT CHOKING. Commence 30 Chest compressions Repeat ( 5 ) to ( 9 ). If breathing is present, check for external injuries. No injuries, place victim in Recovery Position. 1. 2. 3. 4. 5. 6. (C) One-Man CPR
Check scene for Danger. Check Response, gently shake and tap the shoulder of victim and Shout: Are you OK? No response: Call ambulance 995. Place victim on his/her back on a flat firm surface. Open Airway, use head tilt-chin lift. Check for Breath!ng: look, listen and feet (up to 10
8. 9. 10. 11. 12.
seconds) 7. If NO BREATHING 8. Commence Cardiopulmonary Resuscitation (CPR) Correct body & hand position, compress vertically at least 5cm downwards. Say 1&2&3&4&5 &1&2&3&4&10 &1&2&3&4&15, 1&2&3&4&20 &1&2&3&4&25 &1&2&3&4&30 follow by 2 breaths (1 sec / breath) 30 Compression : 2 Ventilation 8. Continue CPR till ambulance arrives, the victim starts breathing or rescuer becomes exhausted.
9. If breathing is present, check for external injuries, no injuries, place victim in recovery position.
PULSE CHECK FOR TRAINED HEALTHCARE PROVIDERS ONLY.

All Rights Reserved. This document belongs to the Singapore Red Cross Academy (SRCA) Red Cross Training Centre / 15 Penang Lane / Level 3 / Singapore 238486 / Website: www.redcross.org.sg / Tel: 66640500 / Fax: 63376435.
CPR PERFORMANCE PRACTICAL ASSESSMENT

SINGAPORE RED CROSS SOCIETY / RED CROSS TRAINING CENTRE (2011 Aug)
CPR PERFORMANCE PRACTICAL ASSESSMENT

SINGAPORE RED CROSS SOCIETY / RED CROSS TRAINING CENTRE (2011 Aug)
Name:
Course Ref No:
NRIC/Passport No:
Signature:
Critical Performance 1
Attempt 2
Remarks 3
One Man Adult CPR

Critical Performance 1 Check for Danger, if no danger approach casualty. Attempt 2 Remarks 3
6.
Demonstrate proper technique of compression Correct body and hand position Compression depth at least 5cm vertically downwards Say mnemonic (1-5, 1-10, 1-15, 1-20, 1-25, 1-30)
1.
Assess Responsiveness Call, tap or gently shake the person & shout Hello! Hello! Are you Ok?
7.
2.
No response - Shout for help, Call for ambulance 995 Get AED Open the Airway Perform a head-tilt chin-lift manoeuvre. Check for Breathing Look, Listen and Feel for up to 10 seconds. Gasping is considered not normal breathing.
Followed by 2 mouth to mouth breathing Maintain a head tilt-chin lift. Pinch nose and give 2 quick ventilations (400-600ml per sec/breath) and Watch chest rise and Release the pinch after each breath. The ratio is 30 compressions and 2 breaths per cycle ( 30:2 )
3.
8.
4.
Continue CPR till ambulance arrive or the victim starts breathing If breathing is present perform secondary survey. Place victim in the recovery position and monitor the vital signs.
Results : [P] = Pass 5. Commence CPR. Locate landmark for chest compression for CPR Maintain head-tilt chin-lift Run your middle finger from the lower margin of victims rib cage to sternal notch. Place index finger next to middle finger.
1
[F] = Fail
PASS / FAIL
Name of Examiner :
Signature of Examiner :
Date:
Notes
Notes
Page 93
Notes
Notes
Page 94

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SINGAPORE RED CROSS SOCIETY

STANDARD FIRST AID

Standard First Aid st Briefing by Instructor During 1 lesson

Price Per Unit (with GST) $2.50 each $35.00

English Proficiency Materials to Bring

Attire No Parking Weekend Classes

ELIGIBILITY CRITERIA TO ATTEND REFRESHER COURSE

Standard First Aid st Briefing by Instructor During 1 lesson

TEST & ASSESSMENT

ISSUANCE OF CERTIFICATE CARD (*New with effect 1-Jan-2012)

Singapore Red Cross Society / Red Cross Training Centre / 20102011

Standard First Aid Table of Contents

Singapore Red Cross Society / Red Cross Training Centre / 20102011

STANDARD FIRST AID LESSON 1

Topics Outline for Lesson 1

MANAGEMENT OF MEDICAL EMERGENCIES

Singapore Red Cross Society / Red Cross Training Centre / 20102011

PRINCIPLES & PRACTICE OF FIRST AID

Definition of First Aid

Aims of First Aid

Role of a first aider

Singapore Red Cross Society / Red Cross Training Centre / 20102011

Ways to Protect Yourself

MANAGEMENT OF MEDICAL EMERGENCIES

Singapore Red Cross Society / Red Cross Training Centre / 20102011

Assess casualty for Responsiveness

Observe the casualtys level of responsiveness as follows:

Singapore Red Cross Society / Red Cross Training Centre / 20102011

The Recovery Position

Every home should have a First Aid Kit

Useful Addition Items

* This is only a suggested list. END OF LESSON 1

STANDARD FIRST AID LESSON 2

Topics Outline for Lesson 2

RESPIRATORY DISTRESS OR BREATHING DIFFICULTY

Singapore Red Cross Society / Red Cross Training Centre / 20102011

THE RESPIRATORY SYSTEM

Singapore Red Cross Society / Red Cross Training Centre / 20102011

RESPIRATORY DISTRESS OR BREATHING DIFFIFULTY

Causes of breathing difficulty are:

Singapore Red Cross Society / Red Cross Training Centre / 20102011

ADULT FOREIGN BODY AIRWAY OBSTRUCTION (CHOKING)

Singapore Red Cross Society / Red Cross Training Centre / 20102011

Actions to take for a Conscious casualty (not pregnant or obese)

ASSESS WHETHER VICTIM IS CHOKING

Singapore Red Cross Society / Red Cross Training Centre / 20102011

THE HEIMLICH MANOEUVRE

Actions to take for a Conscious casualty (pregnant or obese)

Singapore Red Cross Society / Red Cross Training Centre / 20102011

Actions to take for an Unconscious casualty

STEP 2. ASSESS UNRESPONSIVENESS

STEP 5. OPEN THE AIRWAY Perform a Head-Tilt Chin-Lift maneuver

Singapore Red Cross Society / Red Cross Training Centre / 20102011

STEP 6. CHECK BREATHING

Look, Listen and Feel for signs of breathing (up to 10sec).

STEP 7. MOUTH TO MOUTH BREATHING

STEP 8. CONTINUE CHEST COMPRESSIONS

Singapore Red Cross Society / Red Cross Training Centre / 20102011

Actions to take DRSABC Keep casualty warm Seek medical attention

Causes Anxiety Hysteria Panic attack Fright

Singapore Red Cross Society / Red Cross Training Centre / 20102011

Singapore Red Cross Society / Red Cross Training Centre / 20102011

STANDARD FIRST AID LESSON 3

Topics Outline for Lesson 3