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CHAPTER-4
FIRST AID & EMERGENCY MANAGEMENT

FIRST AID
1. Introduction First aid means first help. First aid consists of essential emergency
treatment of sick or injured person before sending to a medical officer or hospital for further
necessary action.

2. Definition First aid is the first help which is provided to victim or casualty at
the place of occurrence before attending by the medical officer.

3. Objectives of first aid:-

2 a. To save life.
3 b. To relieve pain.
4 c. To prevent injuries from becoming worse by treatment on the spot.

4. Golden rules of first aid.

5 a. Do first things quickly, quietly and without panic.

6 b. Re-assure the casualty and his relatives sympathetically.
7 c. Look for-
(1) Failure of breathing.
(2) Severe bleeding.
(3) Circulation.
8 d. Avoid handling the casualty unnecessarily.
9 e. Arrange for the safe removal of the casualty to the care of a doctor or
hospital as soon as possible.

DROWNING
1. Definition: Immersion of the body under the surface of water causing
infiltration of water into the respiratory tract, digestive system and the other spaces of the
body is called drowning.

2. Types:
a. Sea water drowning.
b. Plain water drowning.

3. Sea water drowning Sea water drowning means the development of

pulmonary oedema due to excess sodium chloride (NaCl) in the water and accumulation into
the lungs cavity.

b. Plain water drowning Plain water drowning causes circulatory over load and
haemolysis (destruction of RBC).

4. Sign & Symptoms.

a. Asphyxia (Blockage of airway).

b. Cyanosis (Bluish colouration of the lips, nails, tip of fingers ,tip of nose, and
skin due to lack of O2
c. BP-Low.
d. Pulse- Weak, thready and Feeble.
e. Body- Cold & pallor (Paleness).
f. Abdomen-Distended.
g. Unconsciousness.
h. Face, head and feet are swollen.

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5. Management of drowning

a. Victim to be rescued from the water immediately.

b. On approaching land respiratory passage to be cleared which may be blocked
by mud, weeds and tongue may be fallen back.
c. All wet and tight clothing to be removed.
d. After clearing the air passage, place the patient on the floor in prone position
head one sided on accross hand.
e. The lower part of the body of the victim to be elevated for removal of water.
f. Artificial respiration:- Hip lift, Hip roll and back pressure to be started and it is
to be continued until the normal respiration is started.
g. In case of cardiac arrest- CPR to be given.
h. Patient’s body to be massaged to promote circulation.
i. The body of the patient to be covered with the blanket to regain body heat.
j. Hot drink like Coffee, Tea or milk to be given if patient is conscious.
k. If the Patient’s body is hypothermic- stimulant drug like Inj-Oradexon to be
given.
l. Re-assurance for life.
m. I/V line set up.
n. Evacuation of the patient to the nearest hospital as soon as possible.

HAEMORRHAGE

1. Definition The escape of blood from the blood vessels due to injury, trauma or
any other physiological causes is called haemorrhage.
OR
Extravasation of blood from the circulatory system is known as haemorrhage.

2. Types of haemorrhage:
10
11 a. According to the source:

(1) Arterial haemorrhage.

(2) Venous haemorrhage.
(3) Capillary haemorrhage.

c. According to visibility or site:

(1) External haemorrhage.

(2) Internal haemorrhage.

d. According to duration:

(1) Primary haemorrhage.

(2) Reactionary haemorrhage.
(3) Secondary haemorrhage.

e. According to severity:

(1) Acute haemorrhage.

(2) Chronic haemorrhage.

3. Arterial haemorrhage Extravasation of blood from the artery due to cut or

injury is known as arterial haemorrhage. It is bright red in colour and forceful.

4. Venous haemorrhage Escape of blood from the vein. Blood is dark red in
colour and flow is steady.

5. Capillary haemorrhage Haemorrhage from the capillary is known as capillary

haemorrhage. In this haemorrhage colour of blood is bright red and bleeding is oozing
in nature.

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6. Primary haemorrhage: When bleeding occurs at the time of injury or

operation, then it is called primary haemorrhage.

7. Reactionary haemorrhage: The bleeding which occurs with in 24 hrs of injury

or operation. It occurs due to dislodgement of clot, slipping of ligature or loosing of ligature
as a result of hypertension, sudden coughing, vomiting etc.

8. Secondary haemorrhage: The bleeding which occurs within 7 to 10 days of

injury or operation is called secondary haemorrhage.

9. Acute haemorrhage: It occurs due to –

a. Trauma or injury.
b. Abnormalities of blood vessels.
c. Rupture of vessels or vascular lesion by hypertension etc.

10. Chronic haemorrhage: The bleeding in which small continuous or intermittent

haemorrhage for prolong time due to haemorrhoids, chronic peptic ulcer disease and chronic
bleeding per-rectum etc.

11. Sign & Symptoms of haemorrhage

a. Acute haemorrhage
(1) Patient pallor or anaemic.
(2) Tachycardia.
(3) Restlessness.
(4) Air hunger.
(5) Skin cold & clammy.
(6) BP-low.
(7) Thirsty.
(8) Temp-subnormal.
b. Chronic haemorrhage:

(1) Patient pallor or anaemic

(2) General weakness.
(3) Headache,
(4) Dizziness etc.

12. Management of haemorrhage

12 a. Immediate first aid care

(1) To stop bleeding with pressure by means of bandage and pack.

(2) Position and rest-Patient’s injured part to be elevated if possible.
(3) Restore blood volume by I/V fluid.
13 b. Assesment and evaluation of the blood volume:

(1) History of patient to be taken.

(2) Clinical status of the patient.
(3) Investigation- Blood Hb%, PCV, CP, BT, CT, grouping with
crossmatching and other investigation's to be carried out according to the
disease.
14 c. Principle of management

(1) If the bleeding is not stopped by first aid measure then followings are to
be carried out:
(a) Hot fomentation (1300F-1500F)
(b) Ligation of blood vessels.
(c) Twisting and crushing of vessels by forceps.
(d) Electrocautery by diathermy & biopolar
(e) Repair of wound by suture (with catgut & silk)
(1) Restoration of blood volume by I/V fluid or blood transfusion.
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(2) Specific treatment of the disease.

(3) Associated diseases to be treated.
(4) Associated injury to be treated.

SHOCK
1. Definition: Shock is defined as a profound haemodynamic and metabolic
disturabance characterised by failure of the circulatory system to maintain adequate perfusion
of the vital organs.
OR
Failure of haemodynamic system is known as shock.

2. Types of shock: Mainly there are two types of shock. Such as

a. Hypovolumic shock.
b. Normovolumic shock.

3. Hypovolumic shock: The shock resulting from insufficient blood volume is

called hypovolumic shock. Such as: shock due to blood loss.

a. Causes of hypovolumic shock

(1) Haemorrhage.
(2) Loss of fluid and electrolytes (Diarrhoea).
(3) Loss of plasma (Due to burn).
(4) Severe vomiting.
(5) Profuse sweating.
(6) Prolonged fasting.
(7) Severe diabetes.

4. Normovolumic shock: Shock resulting from diseases like-IHD, MI, Massive

pulmonary embolism etc (when volume of the circulatory fluid is in normal)

5. Types of Normovolumic shock:

a. Cardiogenic shock.
b. Neurogenic shock.
c. Septicaemic/Toximic shock.
d. Vaso-vagal shock.
e. Anaphylactic shock.
f. Emotional shock.
g. Electric shock.

6. According to trauma:

a. Traumatic shock.
b. Non-traumatic shock.

7. According to severity:

a. Mild shock.
b. Severe shock.
c. Irreversible shock.

8. Sign & Symptoms of shock:

a. Patient may be unconscious.

b. Appearance-pallor.
c. Skin-cold & clammy.
d. Faintness.
e. Restlessness.
f. Pulse-fast, thready and feeble.
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g. Fall of blood pressure.

h. Respiration-Shallow and rapid.
i. Sunken eyes.
j. Tongue-Dry and centrally coated.
k. Musles-Relaxes.
l. Thirsty.
m. Less quantity of urinary output.
n. Cyanosis.
o. Temp-Subnormal.
p. Irrelevant talking.

9. First aid treatment of shock:

a. Patient to be placed in comfortable position in the bed.

b. He is to be examined thoroughly.
c. Stop bleeding.
d. Head side to be lowered and foot side to be elevated at 450 angle.
e. All tight clothing to be loosen.
f. Avoid overcrowding.
g. ABC to be checked, if required artificial respiration and cardiac massage to be
started (5:1).
h. If possible, set up I/V line.
i. Body temperature to be maintained.
j. Relief of pain.
k. Assurance for life.
l. Patients to be transferred to nearest medical center as soon as possible.

FRACTURE
1. Definition Breach or break in the continuity of bone partial or completely due
to direct or indirect violence, muscular action or pathological cause is called fracture.

2. Causes of fracture

a. Direct violence.
b. Indirect violence.
c. Muscular action.
d. Fatigue or stress.
e. Pathological cause.

3. Types of fracture: Mainly there are two types of fracture.

a. Simple or closed fracture.

b. Compound or open fracture.

4. According to the fragment simple and compound fracture are as follows

a. Complete fracture.
b. Incomplete fracture.
c. Pathological fracture.
5. Complete fracture

a. Comminuted fracture.
b. Impacted fracture.
c. Complicated fracture.
d. Crushed fracture.
e. Depressed fracture.

6. Incompleted fracture

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a. Greenstick fracture.
b. Fissured or crack fracture.

7. Pathological fracture: This occurs when bones are abnormally fragile as a

result of associated disease at bone. When only slight violence is sufficient to cause the
fracture such as Osteoporosis, Osteo necrosis etc.

8. Fracture according to line

a. Transverse fracture.
b. Oblique fracture.
c. Short oblique fracture.
d. Spiral fracture.
e. Fissured fracture.

9. Fracture according to site

a. Head.
b. Ends.
c. Condyles.
d. Base.
e. Shaft.
f. Trochanter etc.
10. Sign & symptom of fracture

a. Severe pain.
b. Swelling.
c. Loss of function.
d. Deformity.
e. Tenderness.
f. Crepitation (cracking sound).
g. Irregular surface.
h. Shortening of the limb.
i. Bleeding (May or not).
j. Inability to move.
k. Unusual position.
11. First aid treatment of fracture

a. Place the patient in a comfortable position.

b. Toileting of the wound with antiseptic lotion and removal of the foreign body.
c. Stoppage of bleeding by applying pressure bandage.
d. Immobilization of fracture part by applying splint.
e. Establish I/V line.
f. Treatment of shock.
g. Relief of pain (By Inj: Morphine or Pethidine according to age and body
weight).
h. Nothing by mouth (Till further order).
i. Inj-TT –0.5ml I/m state.
j. Re- assurance.
k. Evacuation of the patient to nearest medical center or hospital immediately.

BANDAGE

1. Definition Bandage is a piece of cloth, calico, cotton, flannel, etc of various sizes
and shapes which is applied to some part of the body to retain a dressing or a splint to
support, compress, immobilize prevent or correct deformity.

2. Purposes of bandage Bandages are used in many purposes. They are as

follows.
a. To retain dressing and splints in position.
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b. To give rest and support to the affected part.

c. To arrest/stop/check bleeding by means of pressure.
d. To correct deformity.
e. To prevent oedema or swelling.
f. To restrict movement.
3. Types of bandages: Mainly there are three types of bandage such as:-

a. Triangular bandage.
b. Roller bandage.
c. Special types of bandage.
4. Roller bandage These are made from various materials such as:- Cotton, Calico,
Woven, Flannel, Muslin, and elastic wearing roller bandages are following types.
a. 1"-6"
b. Crep bandage (Elastic weaving)
c. POP (Plaster of Paris) Muslin.
5. Special types of bandages: There are four types of special bandages. These are
as under.
a. T- Shaped bandage.
b. Four tailed bandage.
c. Many tailed bandage.
d. Suspensor bandage.

6. Rules of bandage: The rules of bandage are the following.

a. Choice of bandage according to the part of the body.

b. Place the limb in position in which it is to remain after bandaging.
c. Don’t bandage two skin surfaces together; put some dressing in between to
prevent chafing.
d. Hold the head of the bandage for easy unrolling apply the outer surface of the
bandage of the part.
e. Always start from below and proceed upwards.
f. Take the turns from within outwards.
g. Fix the bandage first by taking two turns at the same level to prevent slipping.
h. Don’t unroll the bandage too much, it will be convenient.
i. Use equal pressure; all tight bandages should be loosen immediately after 24
hours.
j. Each turn should cover two thirds of the previous turn.
k. All the dressing to be covered.
l. Leave the tip of fingers and toes exposed unless it necessary to cover them, in
order to watch for the circulation.

ARTIFICIAL RESPIRATION & USE OF AMBU BAG

1. Definition: The act of re-establishing normal respiration in case of its failure

due to suffocation or asphyxia is known as artificial respiration. There are two main methods
of artificial respiration such as.

a. Manual artificial respiration method.

b. Mechanical artificial respiration method.

2. Manual artificial respiration method Apply by man such as mouth to mouth artificial
respiration, mouth to nose artificial respiration.

3. Mechanical artificial respiration method Apply by machine such as Ambu

bag.

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CARDIO PULMONARY RESUSCITATION

1. Definition: CPR is a procedure of reestablishing the function of heart and lungs by
external cardiac massage and artificial respiration simultaneously after a sudden stoppage of
both the system.

2. Causes of cardiac arrest

a. Myocardial infarction.
b. Hypoxia.
c. Acid base upset.
d. Electrolytes imbalance.
e. Drug.
f. Hypothermia.
g. Haemorrhage.
h. Electrocution.
i. Drowning.
j. Shock (Drug reaction).
k. Embolism.

3. Procedure of CPR

a. Place the patient on hard bed or floor in supine position with neck extended.
b. Primary breathing and circulation- check & clear.
c. Put on airway.
d. One first aider will take place on right side of the patient who will give
artificial respiration by Ambu bag or mouth to mouth.
e. Another first aider will sit in kneeling position on Lt side of the victim and put
his Lt palm on the sternum just above the xiphoid and right hand over the Lt hand.
f. Cardiac massage will be given with a pressure to depress the chest at least 1½''
–2''. At a time 15 massages to be given.
g. Soon after completion of cardiac massage one inspiration of artificial
respiration will be given by ambu bag (if ambu available).
h. If Ambu bag is not available mouth to mouth artificial respiration to be given
by the following method- keep right hand on the patient's chin to open the mouth and
Lt hand on the nose. Nose should be closed during artificial respiration and blowed by
mouth in the patient mouth to expand his chest. On completion close the mouth and
open the nose.
i. Ratio of cardiac massage and artificial respiration will be 15:2.
j. This process will continue till regain the normal function of heart and lungs or
declared death by the Medical Officer.

Gently shake shoulders and

shout. Are you OK? Activate
EMS by sending a bystander
Placetofingers
call theoflocal
other hand just
emergency
under chin
Open your mouth and gently
wide and
telephone lift. Do not
take
number aif
close victim’s mouth
deep breath.positioning completely.
Place yourismouth over
Check if conscious or unconscious Putsupport
victim’s ear
mouthclose to
making a
necessary
victim’s
fight
head and neck and mouth
seal.
androll
Give nose.
2 full LOOK
breaths
victim for
as a(1½-2 rise
unit and
seconds
onto fall
back
If not breathing.
105 of the chest. LISTEN and
each) with a pause between to take FEEL
GiveOpen
2 full airway.
breathsCheck
FIRST AID & EMERGENCY MANAGEMENT (1½-2 for
seconds
RESTRICTED each).
breathing. for breathing.
a breath
Keeping airway open, pinch nose using thumb and index finger.
Place palm of one hand on forehead and apply firm pressure backward.
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Check for Pulse.

Keeping head tilted place 2 fingers on Adam’s apple slide fingertips into
groove at the side of the neck nearest you.

PULSE FOUND
Give 1 breath every 5-6 seconds until NO PULSE
breathing resumes Landmark and begin chest compressions
(DO NOT GO TO STEPS 5 AND 6) (GO TO STEPS 5 AND 6

Landmark for
hand position.
Run fingers up lower edge of rib cage to
notch where ribs meet breast bone.
Place middle finger on
notch, index finger next to it.
Put heel of other hand next
to fingers. Place hand you
located notch with on top or
interlace fingers. Keep
fingers up off chest.

Chest compressions.
Place shoulders and weight directly over hands, keeping elbows
movements, compress chest cavity 1½-2 inches at a rate of 80-100

Compressions per minute.

Give 15 compressions
counting: “ one and two
and three and.....” Follow
15 compressions with 2
breaths and repeat.

15 2
compressions breaths

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HEAT STROKE
1. Definition Heat stroke is a condition developed on man due to exposure to heat
in which the body temperature may be dangerously elevated. It is followed by dry skin
vertigo, headache thirst, nausea and muscular cramp.
or
Heat stoke is hyperpyrexia due to inhibition of heat regulating mechanism in conditions of
high temperature or high humidity or because of sweating interfered with.

2. Sign & Symptoms

a. Skin- Hot dry and redness.

b. Cessation of sweating.
c. Frequently desire to micturation.
d. Flashed face.
e. Temp – Hyperpyrexia even in some cases it rises up to 1080 F or above.
f. Pulse- Fast and thready.
g. BP- High.
h. Severe headache.
i. Thirsty.
j. Nausea.
k. Vomiting.
l. Vertigo
m. Muscular cramps.
n. Finally unconscious.

3. First aid management of heat stroke

a. Remove the patient from the place of occurrence to a well ventilated or in a

cool room.
b. His whole body is to be exposed and temperatures to be reduced by cool
sponging under a running fan.
c. Ice cap on the forehead and pieces of ice wraped with cotton to be applied in
the axilla and groin.
d. If the temperature does not come down the patient to be wraped by bed sheet,
towel or blanket dipped in ice water.
e. He may be given ice water enema if the temperature is not reduced.
f. Temperature should be checked frequently and if it dose not come down below
1020F, otherwise he may be collapsed.
g. On recovery he is to be given plenty of fluid by adding 2-4 TSF of salt in a
glass of water.
h. I.V line with 0.9% sodium chloride or dextrose saline.
i. Assurance of the patient.
j. Evacuation to nearest medical center immediately.

HEAT EXHAUSTION

1. Definition: It is a condition developed due to working in confined spaces like

engine room, boiler room, where excessive heat and ventilation is failed to supply fresh air
followed by excessive sweating, subnormal temperature and muscular cramps.

2. Sign & Symptoms

a. Profuse sweating.
b. Absence of micturation.
c. Skin- Pale, body cold & clammy.
d. Temp- Subnormal.
e. Pulse- Rapid and thready.
f. BP-Low.
g. Painful muscular cramp.
h. Vertigo.
i. Breathing shallow.
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j. Faint.
k. Unconsciousness.
l. Thirsty and severe dehydration.
m. Restlessness.

3. First aid of heat exhaustion

a. Remove the patient from the place of occurrence in well a ventilated area
either by stretcher or manually.
b. All wet wearing are to be removed.
c. Patient’s body to be covered with blanket to regain his body temperature.
d. TPR and BP to checked frequently and recorded.
e. To promote circulation throughly his body to be massaged.
f. O2 Inhalation to be given if the patient is cyanosed.
g. I.V line to be established to maintain electrolytes balance.
h. On recovery plenty of fluids to be given by mouth.
i. Stimulant drug- Inj.- Nikethamide to be given according to the severity of the
patient.
j. Assurance for life.
k. Evacuate the patient to nearest medical center immediately.

GUN SHOT/ PENETRATING INJURY

1. Definition Breach of continuation of the tissue due to any force or violence is

called injury.

2. Types of injury: Mainly there are two types of injury

a. Aseptic injury Which is made by surgeon where there is less possibility

of presence of infective agents.
b. Septic injury Which is occurred due to any cause where there are
presence of infective agents.

3. Types of septic injury: There are six types of septic injury.

a. Abrasion:- Damage of superficial skin.
b. Lacerated injury:- Superficial skin are crushed.
c. Incision:- Cutting with sharp instrument where edge of wound will be fine.
d. Punctured/stab injury: penetration of foreign body stabbing by dagger.
e. Shell injury:- Punctured by shell
f. Gun shot injury:-Punctured by gun shot.

4. First aid /management of gun shot injury

a. Place the victim in supine position with shoulder and legs side raised which are
supported by pillows or roll of blanket.
b. This process will relax body muscles and prevent to come out of abdominal
contents.
c. If abdominal contents come out that should not push back or replace. Injured
area to bed covere with large dressing or clean bed sheet
d. Inj- Morphine/Pethidine to be given to prevent pain, shock.
e. Nothing by mouth.
f. I.V line to be established.
g. Crowding or gathering to be avoided.
h. Inj- TT. 0.5 ml to be given IM state.
i. Re-assurance for his life (if conscious).
j. Evacuate the casualty to hospital.
k. Inform surgical spl and also Anesthesiologist immediately.

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HYPERPYREXIA
1. Definition: High temp or temp above 105 0 F of the human body is called
hyperpyrexia.

2. Signs & Symptom

a. Temperature- 1050 F and above

b. Pulse- Rapid.
c. Respiration – Rate high.
d. Vomiting
e. Nausea.
f. Severe headache.
g. Restlessness
h. Convulsion.
i. Thirst.
j. Skin-dry.

3. Management of hyper pyrexia

a. Patient to be placed in a comfortable position.

b. Whole body to be exposed keeping privacy.
c. All tight clothing should be loosen & open.
d. The patient is to be given drink cold water.
e. Put ice cap on forehead.
f. He is to be placed under the running fan.
g. If required Napa suppository is to be given by rectum.
h. Frequently check of temperature.
i. If the temperature does not come down then he is to be warped with a bed
sheet or blanket dipped in ice water.
j. Even to reduce body temperature, he may be put on a tube of cold water up to
neck.
k. He may be given ice water enema also.
l. Frequent check of temperature - It should not be reduced below 101 0 F other
wise he may be collapsed.
m. On recovery he is to be given plenty of fluid by adding 1-2 TSF of salt in a
glass of water.

SNAKE BITE
1. Management of snake bite

a. Victim is to be placed at rest on the spot.

b. Movement to be restricted.
c. Site of bite to be found out.
d. Two tourniquets to be applied above the site of bite. Where there is single bone
and another is in double bone. It should be relaxed every after 20 minute for few
seconds other wise gangrene may occur.
e. Wash the bitten area to remove the venom.
f. Bleeding is to be encouraged from the bitten area by sucking or by squeezing.
g. Patient is not to be allowed to sleep.
h. Set up I/V line.
i. No sedative to be given.
j. Inj TT 0.5 ml IM stat.
k. Assurance.
l. Evacuation to nearest medical center as soon as possible.

CHEMICAL BURN OF EYE

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1. Definition Chemical burn of eye causes due to contact with chemicals in the
form of solid, Liquid, Powder or dust in home, industry or Lab.

2. Chemicals cause injury & treatment.

a. Acid burn:
(1) Wash the injured eye by normal saline or distilled water which is available.
(2) Then send the patient to Medical Officer for further management.
b. Alkali burn:
(1) Wash the affected eye by normal saline or distilled water to neutralize
the alkali.
(2) If particle left behind, remove by swab sticks.
(3) Necrotic tissues of conjunctiva should be removed and
(4) Atropine/ steroid/ antibiotic drop should be given as directed.

STRETCHER, TYPES AND ITS USE

1. Definition Stretcher is an appliance which is used to carry patient from one place
to another.

2. Types of stretcher: There are four types of stretcher, these are as follows.

a. Neil- Robertson stretcher.

b. Four handed army pattern field stretcher.
c. Transport type stretcher.
d. Helicopter stretcher.

3. Uses:

a. Patient is carried from one place to another.

b. Patient is transfered from one ship to another ship.
c. Patient is carried from any backward place.
d. Patient is transfered from sea to hospital by transport type of stretcher.
e. Patient is transfered from ship to helicopter.

METHODS OF CARRYING WOUNDED PARSONNEL WITH OR WITHOUT

ASSISTANCE

1. There are several ways of handling a casualty in the confined spaces of a ship.
The two main methods are manual and by stretcher. Both methods of transport require
practice if they are to be carried out correctly without discomfort and anxiety to the injured
man and with the least amount of exertion on the part of the bearers

2. Methods of carrying the wounded patient are as follows.

a. Fireman’s lift.
b. Pick-a-back.
c. Human crutch.
d. Fore and aft carry.
e. Two-handed seat.
f. Three-handed seat.
g. Four-handed seat.
h. Ordinary manhandling.
i. Manhandling down a gangway.
j. Drag carry.

STRETCHER DRILL PROCEDURE

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pwMÉ¡ 1 Lcj ¢fRe Hhw 1 Lcj X¡e ¢Nu¡ ¢hS¡s pwMÉ¡l ¢fRe c¡s¡Ch z
6z Hi¡h Bjl¡ HMe 4 cm c¡s¡h z
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8z aMe p¡jel p¡¢l Nee¡ Llh 1, 2, 3, 4, CaÉ¡¢c z
9z JXÑ¡l qh ®hu¡l¡l pwMÉ¡ aMe (1, 2, 3, 4) (1, 2, 3, 4) qh z
10z aMe hm¡ qh -----¢Vj ®VÊQ¡l A¡e Hhw ----S¡uN¡ ®bL ®l¡N£
ÙÛ¡e¡¿¹¢la Ll z
11z avre¡v Q¡l Se ®øÊQ¡l ¢eu Bph Hhw 1 J 3 eð c¡s¡h ®øÊQ¡ll h¡j
¢cL Hhw 2 J 4 eðl c¡s¡h X¡e ¢cL z
12z 1 eðl hÉ¡¢š² cmea¡ ¢qp¡h AXÑ¡l ¢ch ®øÊQ¡l dl, ®øÊQ¡l EW¡J
Hhw Sm¢c Qm z
13z Q¡l Se HL pwN ¢iall f¡ fÊbj ¢cu Qma öl¦ Llh z
14z Hl fl ®l¡N£l f¡nÄÑ ®øÊQ¡l l¡M¡l pju cmea¡ hmh ¢mgV ®øÊQ¡l
¢ae Se ®l¡N£l HLC f¡nÄÑ HhC f¡u qy¡V¥ hy¡L¡ Ll hph Hhw Qa¥bÑ Se
a¡q¡cl p¡q¡kÉL¡l£ ¢qp¡h AeÉ f¡nÄÑ c¡s¡hz

Loading/ unloading of patient from stretcher to vehicle/Ambulance/ Boat/ Craft.

1. Place a casualty correctly on a stretcher to reduce movement and discomfort to a

minimum.
2. Four bearers are required all through in a modified form; it can be carried out by three.
3. Three bearers kneel on their left knees on one side of the casualty and a fourth bearer
kneels on the other side facing the center man of the three.
4. Their hands are passed under the casualty’s body. Those of the bearers opposite to
each other being joined below the buttocks the other two supporting the head and
shoulders and lower limbs respectively on the word lift.
5. The casualty is raised gently from the deck and place on the ledge formed by the knees
of the three men kneeling side by side
6. Great care to be taken to support any injured part of the body.
7. The fourth bearer then leaves the others and places the stretcher in position below the
casualty.
8. Then joint hands once more with the centre man of the three and on the word lower.
9. The casualty is lowered gently on to the stretcher.

Marine (Sea) Animals Bite

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With the exception of sharks and barracuda, most marine animals will not deliberately
attack. The most frequent injuries from marine animals are wounds by biting, stinging, or
puncturing. Wounds inflicted by marine animals can be very painful, but are rarely fatal.

a. Sharks, Barracuda, and Alligators. Wounds from these marine animals can involve
major trauma as a result of bites and lacerations. Bites from large marine animals are
potentially the most life threatening of all injuries from marine animals. Major wounds from
these animals can be treated by controlling the bleeding, preventing shock, giving basic life
support, splinting the injury, and by securing prompt medical aid.

b. Turtles, Moray Eels, and Corals. These animals normally inflict minor wounds. Treat by
cleansing the wound(s) thoroughly and by splinting if necessary.

c. Jellyfish, Portuguese Man-of-War, Anemones, and Others. This group of marine

animals inflicts injury by means of stinging cells in their tentacles. Contact with the tentacles
produces burning pain with a rash and small hemorrhages on the skin. Shock, muscular
cramping, nausea, vomiting, and respiratory distress may also occur. Gently remove the
clinging tentacles with a towel and wash or treat the area. Use diluted ammonia or alcohol,
meat tenderizer, and talcum powder. If symptoms become severe or persist, seek medical
assistance.
d. Spiny Fish, Urchins, Stingrays, and Cone Shells. These animals inject their venom by
puncturing the skin with their spines. General signs and symptoms include swelling, nausea,
vomiting, generalized cramps, diarrhea, muscular paralysis, and shock. Deaths are rare.
Treatment consists of soaking the wounds in hot water (when available) for 30 to 60 minutes.
This inactivates the heat sensitive toxin. In addition, further first aid measures (controlling
bleeding, applying a dressing, and so forth) should be carried out as necessary.
e. Sea Snakes. Sea snakes are found in the warm water areas of the Pacific and Indian oceans,
along the coasts, and at the mouths of some larger rivers. Their venom is VERY poisonous,
but their fangs are only 1/4 inch long. The first aid outlined for land snakes also applies to sea
snakes.
CAUTION
Be careful not to scald the casualty with water that is too hot because the pain of the wound
will mask the normal reaction to heat.

TRIAGE
Definition: It is a system of evaluation and classification of casualty for the purposes of
treatment and evacuation.
Or
Triage: A system where by a group of causalities or other patients are sorted according to the
seriousness of their injuries or illness so that treatment priorities can be allocated between
them.
In emergency situation it is designed to maximize the number of survivors.
Triage consists of:
a. The immediate sorting of casualty according to their types, seriousness and
likelihood (M¤h pñha) of survival.

b. The establishment of priorities for treatment and subsequent evacuation to

ensure that medical care is provided of the greatest benefit to the largest number.
Classification of Triage:
Group-1: Casualty who require treatment to save life or limb.
Group-2: Casualty who after emergency care have little addition risk by delay further
treatment.

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Group-3: Category includes casualty who may require self aid or from a comrade
(comrade=pqLjÑ£,p¡b£,A¿¹l‰ pwN£) Patients in this category are not evacuated
to a medical treatment facility.
Priorities of evacuation:
Evacuation means conveying the casualty after first aid to the nearest medical treatment
center using the safest, quickest and the most comfortable means available.
.

Priority-I: Urgent evacuation is required as soon as possible but not later than 2hrs so
save life. This category includes treatable casualty where condition can not be considered.
Priority-II: Evacuation is required within 4 hrs or the casualty medical condition could
worsen.
Priority-III: Evacuation within 24 hrs casualty require additional care but evacuation is not
immediate critical.

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