FA & BLS - Manual A4 Size v5
FA & BLS - Manual A4 Size v5
FA & BLS - Manual A4 Size v5
REFERENCE MANUAL
Inatructor’s Manual
SECOND EDITION 2014
Philippine Red Cross
CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
CHAPTER 1
Introduction to
First Aid
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CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
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Philippine Red Cross
CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
Definition
First aid is immediate help provided to a sick or injured
person until professional medical help arrives or becomes
available.
It is concerned not only with physical injury or illness,
but also with other forms of initial care, including psycho-
social support for people suffering emotional distress due to
traumatic events.
While Basic Life Support are emergency procedure that
consists of recognizing respiratory or cardiac arrest or both
and the proper application of CPR to maintain life until a
victim recovers or advanced life support is available.
Improvisation
Because emergencies are unexpected, first aid kits and other equipment may not always be
available at such time that they are needed. A first aider should therefore be able to “adapt,
improvise, and overcome!” He or she must have the ability to adapt to the situation and be able
to improvise materials and equipment until more help arrives.
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CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
Chain of Survival
Survival of cardiac arrest
depends on a series of critical
interventions. If one of these
critical actions is neglected or
delayed, survival is unlikely.
The chain has five
interdependent links: recognition of cardiac arrest and activation of emergency response
system; early cpr; rapid defibrillation; effective advanced life support; and integrated post-
cardiac arrest care.
Out of the five chains, three chains can be performed by the public; and most of the time,
would probably be carried out by the public as they are the ones who will most likely witness
the cardiac arrest on the scene. The emergency medical professionals cannot be in every place
every moment. If the public does not perform the first three chains properly, by the time the
patient reaches the hospital, even in the setting of best advanced life support care, and even if
the emergency team successful resuscitate the patient, the quality of life the patient would
probably be affected as he/she might have suffered brain damage due to lack of oxygen.
For best survival and quality of life, pediatric basic life support (PBLS) should be part of a
community effort that includes prevention, early cardiopulmonary resuscitation (CPR), prompt
access to the emergency
response system, and rapid
pediatric advanced life support
(PALS), followed by integrated
post– cardiac arrest care.
These 5 links form the
pediatric Chain of Survival, the
first 3 links of which constitute pediatric BLS.
This goes how vital public or community education and participation is to increase the
chance of survival of a cardiac arrest patient.
Legal Concerns
Consent
People have a basic right to decide what can and cannot be done to their bodies. They have the
legal right to accept or refuse emergency care. Therefore, before giving care to an injured or ill
person, you must obtain the person’s permission.
When a conscious person who understands your questions and what you plan to do gives
you permission to give care, this is called expressed consent.
Do not touch or give care to a conscious person who refuses care or withdraws consent at
any time. Instead, step back and call for more qualified medical personnel.
Sometimes, adults may not be able to give expressed consent. This includes people who are
unconscious or are unable to respond, are confused, mentally impaired, seriously injured or
seriously ill. In these cases, the law assumes that if the person could respond, he or she
would agree to care. This is called implied consent.
If the conscious person is a child or an infant, permission to give care must be obtained
from a parent or guardian when one is available. If the condition is life threatening and a
parent or guardian is not present, consent is implied. If the parent or guardian is present
but does not give consent, do not give care. Instead, call a local emergency number.
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CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
Duty to Act
This is the duty to respond to an emergency and to provide care. Failure to fulfill these duties
could result in legal action. This is an obligation that professional rescuers must observe
especially if they are officially on duty. Lay responders assume this accountability when they
start to give first aid care to a patient in an emergency.
Standard of Care
This is the public’s expectation that personnel summoned to an emergency will provide care
with a certain level of knowledge and skill.
Negligence
Pertains to the failure to follow a reasonable standard of care, thereby causing or contributing
to injury or damage. According to the Article 12 no.4 of Act No.3815 of the
A first aider can be held
Philippine Revised Penal Code Book One
liable for negligence
“any person who, while performing a lawful act with due care,
especially if his or her
causes an injury by mere accident without fault or intention of
actions were
causing it” is exempt from criminal liability.
deliberately negligent,
reckless or if the first aider abandons the person after starting care.
Currently, there is no legislation in the Philippines that specifically protects first aiders
from any legal actions that may arise from helping someone in an emergency, but for as
long as such person has acted the same way that a “reasonable and prudent person” would
in the same situation, that person may not be held criminally liable.
Abandonment According to the Article 275 no. 1 & 2 of Act No. 3815
This refers to discontinuing of the Philippine Revised Penal Code Book Two:
care once it has begun. “Abandonment of person in danger and abandonment
Care must continue until of one’s own victim”.
someone with equal or 1. Anyone who shall fail to render assistance to any person whom
more advanced training he shall in an uninhabited place wounded or in danger of
takes over. dying, when he can render such assistance without detriment
to himself, unless such omission shall constitute a more serious
Confidentiality offense.
This is the principle that 2. Anyone who shall fail to help or render assistance to another
information learned while whom he has accidentally wounded or injured.
providing care to a victim
is private and should not be shared with anyone except to those healthcare professionals
directly associated with the victim’s medical care.
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Philippine Red Cross
CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
o Demonstrate explicitly, through your actions, the humanity, neutrality and impartiality
of the International Red Cross and Red Crescent Movement.
Strengthen your moral standing to uphold the image of the Red Cross.
o You are the image that other people have of your National Society and of the Red Cross.
o You must earn the respect of your interlocutors at all times through your attitude and
actions.
o The perception by the population of the National Society, its leaders, staff and
volunteers – including you – at all levels and at all times, can be a key factor that
contributes to greater protection.
o You can easily understand that any “bad” behavior on your part will negatively
influence perceptions and thus undermine assistance programmes. It will also affect
your National Society and the other components of the International Red Cross and Red
Crescent Movement.
o This influence can have short- and long-term effects and can rapidly take on a
countrywide or even worldwide importance, especially where there is instant media
coverage.
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CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
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CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
Human Immune Deficiency Virus (HIV) is the virus that destroys the body’s ability to fight
infection. The resultant state is referred to as Acquired Immune Deficiency Syndrome
(AIDS).
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CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
Personal Safety
Your safety depends to a large extent on how you behave and how you assess actual and
potential dangers. Always protect yourself first, maintain self-control, observe before taking
any action, and proceed only if it really seems safe to do so. Be aware of and act in accordance
with the basic rules protecting individuals in situations of violence while being mindful of the
Fundamental Principles of the International Red Cross and Red Crescent Movement.
Be respectful of local culture, traditions, taboos, and dress codes. Be sensible in terms of the
clothing you wear and do not show off. Be tactful about personal matters (e.g. sex-related
issues).
Be disciplined, obey rules and follow the orders of your
team leader. Maintain a polite and respectful attitude In a hazardous situation,
whenever you enter into dialogue with people resorting to remember that the best
force or violence. Take time to listen, and explain what you option is often to stop what
are doing. Behave and act in an orderly and calm manner: you are doing.
“more haste, less speed.”
Security Assessment
The basic components of your security assessment are:
Assess hazards,
Check safe access and evacuation paths, and
Find safe shelters that you can use in case of danger.
Hazards specific to armed conflicts or other situations of violence have warning signs. You
must learn to pay attention to and assess what you hear and what you see.
Seek information from your team leader or other colleagues, people you meet on the way or in
the vicinity of the fighting (local residents, staff of local non-governmental organizations,
United Nations personnel, military or police personnel, etc.). Ask vital information on security
conditions to allow you to intervene safely, but be careful not to be mistaken for a spy.
At the scene, you must look and listen for the “sights and sounds of combat:”
Look for persons resorting to force or violence, or preparing to do so (taking an aggressive
posture, ready to open fire, etc.).
Look for smoke or tear gas.
Scan the environment for suspicious looking objects like bombs. Do not touch them!
Listen for screams, shots, explosions, etc.
Security conditions can change quickly. You must be prepared to adapt and be able to respond
to dangers that were not apparent earlier. Be ready for deployment to another location if
needed.
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CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
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CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
Remain calm and in control. If after an incident you are surrounded by an aggressive crowd of
bystanders, maintain your composure. This may create a calming effect on the situation and
people will then be more willing to help you.
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CHAPTER 1 – Introduction to First Aid and CPR First Aid and CPR Reference Manual
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CHAPTER 2
Emergency
Action
Principles
Philippine Red Cross
CHAPTER 2 – Emergency Action Principles First Aid and CPR Reference Manual
An emergency scene can be overwhelming. In order for the first aider to help effectively, it is
important that actions have to be prioritized and planned well. The Emergency Action Steps
serves as a guide for responders to follow in situations that demand immediate but careful and
calculated response. It has four parts:
Scene Size-up
Primary Assessment
Activating Medical Help
Secondary Assessment
The Emergency Action Steps generally involve both scene and patient assessment. Scene
assessment focuses on scene and rescuer safety. Patient assessment follows the ABCDE
approach which stands for
A – Airway
B – Breathing
C – Circulation
D – Disability (mental status and peripheral nervous system)
E – Extremities/Exposure (for further assessment)
Scene Size-up
Scene Safety
Before helping an injured or ill person, make sure
that the scene is safe for yourself and everyone else,
including bystanders.
To determine if the scene is safe, check for
hazards that may pose an immediate or potential
threat to life such as poisonous gases, toxic and
corrosive chemicals, explosive materials, downed
electrical lines, fire, water, traffic, weapons, and
other dangers.
If any of these are present, stay at a safe distance
and call the local emergency number
immediately.
Do not move a seriously injured person at the scene unless:
o There is an immediate danger, such as fire, lack of oxygen, risk of explosion or a
collapsing structure.
o There is a need to move a person with minor injuries to reach someone needing
immediate care.
o There is a need to move the injured person to give proper care.
If it is necessary to move the person, do it as quickly and carefully as possible and without
compromising your own safety.
If there is no imminent danger, tell the person not to move. Inform bystanders not to move
the same person as well.
Rushing in without being minding of the danger may often lead to fatal consequences.
Leave dangerous situations to professional responders who are better equipped to
handle them. Once they make the scene safe, you can offer to help.
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CHAPTER 2 – Emergency Action Principles First Aid and CPR Reference Manual
Knowing What
Happened
Careful evaluation of the
scene, including the possible
cause of injury and/or the
nature of the illness, along
with any other information
that you gather, will help
determine the condition of
the victim and what the next
possible action of the first
aider should be.
Knowing the cause of
injury allows you to predict
various injury patterns. Certain injuries are considered to be common to particular accident
situations. Injuries to bones and joints are usually associated with falls and vehicle collisions.
Burns are common to fires and explosions, while penetrating soft tissue injuries are often
associated with gunshot wounds.
Nature of illness is
often best described
by the patient’s chief
complaint: the reason
for providing care. In
order to quickly
determine the nature
of the illness, talk
with the patient,
family, or bystanders
about the problem.
But at the same time,
use your senses to check the scene for clues as to the possible problem.
Role of bystanders
The presence of bystanders does not often mean
that a patient is receiving help. They may have to
be asked to help. Bystanders may be able to tell
you what happened or make the call for help
while you provide care.
If a family member, friend or co-worker is
present, he or she may know if the person is ill or
has a medical condition and can also help to
comfort the person. The patient may be too upset
to answer your questions. Anyone who awakens
after having been unconscious may also be
frightened, especially if it’s a child.
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CHAPTER 2 – Emergency Action Principles First Aid and CPR Reference Manual
Number of casualties
Look carefully for more than one person who might be injured. You might not spot everyone
who needs help at first. If one person is bleeding or screaming, you may not notice someone
who is unconscious. It also is easy to overlook a small child or an infant. In an emergency with
more than one injured or ill person, you may need to prioritize care (in other words, decide
who needs help first).
Primary Assessment
The purpose of the primary assessment is to check for
immediate life-threatening condition which includes
unconsciousness, absence of breathing, absence of
pulse and severe bleeding. Primary assessment can be
done with the patient in the position in which you find
him or her, and begins with checking the patient’s
responsiveness.
Assessing Responsiveness
A patient’s response level can be summarized in the
AVPU mnemonic as follows:
A – Alert
V – Responsive to Voice
P – Responsive to Pain
U – Unresponsive/Unconscious
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CHAPTER 2 – Emergency Action Principles First Aid and CPR Reference Manual
If the person responds, leave the person in the position in which you found him or her,
provided there is no further danger, and then try to determine what is wrong with the person.
If the person does not respond in any way, assume that he or she is unconscious.
However, if the patient is found in a face-down position, you may have to position the
patient on his or her back to using log-roll technique facilitate opening of the airway and to
check for breathing.
Airway
An open airway allows air to enter the lungs for the person to breathe. If the airway is blocked,
the person cannot breathe. A blocked airway is a life-threatening condition: when someone is
unconscious and lying on his or her back, the tongue may fall to the back of the throat and
block the airway. To open an unconscious person’s airway, perform the procedure known as
the head-tilt/chin-lift technique. This moves the tongue away from the back of the throat,
allowing air to enter the lungs.
Sometimes you may need to remove food, liquid or other objects that are blocking the
person’s airway. These are called foreign-body airway obstructions and will be discussed in
detail in the next chapter.
But in cases of witnessed cardiac arrest, opening of airway is not a priority as the critical
initial element of BLS is chest compressions and early defibrillation.
Breathing
While maintaining an open airway, quickly check an unconscious person for breathing by doing
the LLF technique for no more than 10 seconds. Normal breathing is regular, quiet and
effortless. This means that when breathing normally, the person is not making noise, breaths
are not fast (although it should be noted that normal breathing rates in children and infants are
faster than normal breathing rates in adults) and it does not cause discomfort or pain.
If an adult is not breathing or is having irregular, gasping or shallow breath (also known as
agonal breath) and if the emergency is not the result of non-fatal drowning or other
respiratory cause such as a drug overdose, assume that the problem is a cardiac emergency. In
this case, the person needs CPR and chest compressions must not be delayed.
In some cases, the person may be unconscious but breathing normally. In such situations,
maintain an open airway by using the head-tilt/chin-lift technique as you continue to look for
other life-threatening conditions.
Generally, patients should not be moved from a face-up position, especially if there is a
suspected spinal injury. However, there are a few situations where you should move a person
into a recovery position whether or not a spinal injury is suspected, such as when:
You are alone and have to leave the person (e.g., to call for help), or
You cannot maintain an open and clear airway because of fluids or vomit.
There is no single recovery position that is perfect for all victims. The position should be stable,
near a true lateral position with the head dependent, and with no pressure on the chest to
impair breathing.
In an infant, this may require the support of a small pillow or a rolled-up blanket placed
behind his back to maintain the position.
The modified recovery or H.A.IN.E.S. (for High Arm IN Endangered Spine) position is designed
to reduce lateral cervical flexion for all unconscious patients suspected of spinal injury who
need airway and spinal protection, when there is a lack of spinal immobilization equipment
readily available. Placing a person in this position will help to keep the airway open and clear.
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CHAPTER 2 – Emergency Action Principles First Aid and CPR Reference Manual
Circulation
A. Bleeding
Quickly look for severe bleeding by looking over the person’s body from head to toe for signals
such as blood-soaked clothing or blood spurting out of a wound. Be meticulous. It is not always
easy to recognize severe bleeding. If there is a case of severe bleeding, it must be controlled as
soon as possible.
B. Shock
When someone becomes suddenly ill or is injured, normal body functions may be interrupted.
In cases of minor injury or illness, the interruption is brief and the body is able to compensate
quickly. With more severe injuries or illness, however, the body is unable to meet its demand
for oxygen.
The condition in which the body fails to circulate oxygen-rich blood to all the parts of the
body is known as shock. If left untreated, shock can lead to death.
Always look for the signals of shock whenever you are giving care. You will learn how to
recognize and treat a victim for shock in Chapter 4.
C. Skin color, temperature and moisture.
Assessment of skin temperature, color, and
condition can tell you more about the patient’s
circulatory system.
Normal body temperature is 98.6 °F (37 °C).
The most common way that a first aider takes
temperature is by touching a patient’s skin with
the back of the hand. This is called relative skin
temperature. It does not measure exact
temperature, but you can tell if it is very high or
low.
Skin color can tell you a lot about a patient’s heart, lungs, and other problems well. For
example:
Paleness may be caused by shock or heart attack. It also may be caused by fright, faintness,
or emotional distress, as well as impaired blood flow.
Redness (flushing) may be caused by high blood pressure, alcohol abuse, sunburn, heat
stroke, fever, or an infectious disease.
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CHAPTER 2 – Emergency Action Principles First Aid and CPR Reference Manual
Blueness (cyanosis) is always a serious problem. It appears first in the fingertips and
around the mouth. Generally, reduced levels of oxygen as in shock, heart attack, or
poisoning can be the cause.
Yellowish color may be caused by a liver disease.
Black-and-blue mottling is the result of blood seeping under the skin. It is usually caused by
a blow or severe infection.
If your patient has dark skin, be sure to check for color changes on the lips, nail beds, palms,
earlobes, whites of the eyes, inner surface of the lower eyelid, gums, and tongue. One way to
assess adequacy of circulation is by assessing capillary refill.
To assess capillary refill, you have to measure the time it takes for the color to return under
the nail. Two seconds or less is normal. If refill time is greater than two seconds, suspect shock
or decreased blood flow to that extremity.
Capillary refill is recommended only for children under six years of age. Research has
proven that it is not always accurate in adults. Capillary refill may be checked on infants by
squeezing the palm of the hand or sole of the foot and watching for color to return.
Call First (the local emergency number before giving care) for:
Any adult or child about 12 years of age or older who is
unconscious.
A child or an infant suddenly collapses in your sight or
presence.
An unconscious child or infant known to have heart problems.
Care First (give 2 minutes of care, then call the local emergency number) for:
An unconscious child (younger than about 12 years of age) who you did not see collapse.
Any drowning victim.
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CHAPTER 2 – Emergency Action Principles First Aid and CPR Reference Manual
One may call Patrol 117 during emergencies and life threatening situations that require
immediate response (ex: crime incidents, fire incidents, medical assistance, rescue operations),
public safety concerns, to report abusive officials and law enforcers, illegal activities and
crimes that do not require immediate assistance.
Information to be remembered in
activating medical help:
What happened?
Location of emergency?
Number of person injured or ill?
Cause and extent of injury and nature of illness and first aid given?
Telephone number from where call is made?
Name of person who called medical help (person must identify him/herself and hang
up the phone last).
If medical assistance is not available and if you decide to take the injured or ill person to a
medical facility,
Ask someone to come with you to keep the patient comfortable.
Be sure you know the quickest route to the nearest medical facility capable of handling
emergency care.
Pay close attention to the injured or ill patient and watch for any changes in his or her
condition.
Discourage an injured or ill person from driving himself or herself to the hospital.
Secondary Assessment
Secondary assessment involves the rest of the DE of the ABCDE If you determine that an
injured or ill person is not in an immediately life-threatening condition, you can begin to check
for other conditions that may need care. Checking a conscious person with no immediate life-
threatening conditions involves two basic steps:
Interviewing the person and bystanders
Checking the person from head to toe.
Interview
Ask the person and bystanders simple questions to learn more about what happened and to
learn more about the person’s medical history. Keep these interviews brief. Begin by asking for
the person’s name. This will make him or her feel more comfortable.
To gain essential information about the patient’s
medical history, ask the patient questions based on
the SAMPLE approach:
S – Signs and symptoms (How do you feel? Do
you feel pain or discomfort anywhere? )
o Signs are physical manifestations of the
injury or illness that can be observed by the
first aider, i.e. bruising, swelling, fever, open
wound, etc.
o Symptoms are indicators that only the
patient can feel or experience, i.e. pain,
dizziness, chills, weakness, etc.
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CHAPTER 2 – Emergency Action Principles First Aid and CPR Reference Manual
A – Allergies (Do you have any known allergies or allergic reactions? Has there been any
recent exposure?)
M – Medications (What medications are you taking? Are they over-the counter or
prescription? What is the medication for? When was it last taken? Can you tell me where
the medication is so we can keep it with you?)
P – Pertinent past medical history (Has anything like this happened before? Are you
currently under a health care provider's care for anything? Could you be pregnant (if a
woman)?)
L – Last intake and output (When did you last eat or drink? How much? Are you cold,
hungry or exhausted? When did you last urinate and defecate? Were they normal?)
E – Events leading up to the injury or illness (What led to the illness or injury? When did
it happen? How did it happen, in order of occurrence?)
Write down the information you learn during the interview or, preferably, have someone else
write it down for you. Be sure to give the information to advanced medical personnel when
they arrive.
If the person feels pain, ask him or her to describe it and to tell you where it is located.
Descriptions often include terms such as burning, crushing, throbbing, aching or sharp pain.
Ask when the pain started and what the person was doing when it began. Ask the person to
rate his or her pain on a scale of one to ten (one being mild and ten being severe).
Remember to question family members, friends or bystanders as well. They may be able to
give you helpful information or help you to communicate with the person. Children or infants
may be frightened. They may be fully aware of you but still unable to answer your questions. In
some cases, they may be crying too hard and be unable to stop. Approach slowly and gently,
and give the child or infant some time to get used to you. Use the child’s name, if you know it.
Get down to or below the child’s eye level.
Head-to-toe exam
Check the patient head to toe during the hands-on
physical exam, going by the following order: head,
face, ears, neck, chest, abdomen, pelvis, genitals,
each arm, each leg and back.
Look for DOTS, which stands for deformity,
open injuries, tenderness and swelling. Do not
move any areas where there is pain or discomfort,
or if you suspect a head, neck or spinal injury.
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4. Hold the shoulder and hip that are farthest from you then carefully roll the
person towards you.
5. Reposition the arms at each side of the body once the victim is now in the face-
up position.
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3. Ask the person to move his or her fingers, hands and arms; and then the toes,
legs and hips in the same way.
Watch the person’s face and listen for signals of discomfort or pain as you check for
injuries.
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CHAPTER 3
Cardiac
Emergencies
and
Cardiopulmonary
Resuscitation
(CPR)
CHAPTER 3 – Cardiac Emergencies and Philippine Red Cross
Cardiopulmonary Resuscitation First Aid and CPR Reference Manual
Heart Attack
Heart attack, also called myocardial infarction, occurs when the blood and oxygen supply to the
heart is reduced causing damage to the heart muscle and preventing blood from circulating
effectively. It is usually caused by coronary heart disease.
The effects of a heart attack depend largely on how much of the heart muscle is affected.
Often the person feels pain or discomfort in the center of the chest.
The pain or discomfort becomes constant.
It usually is not relieved by resting, changing position or taking medicine.
Some individuals may show no signals at all.
Discomfort in other areas of the upper body in addition to the chest. Discomfort, pain or
pressure may also be felt in or spread to the shoulder, arm, neck, jaw, stomach or back.
Trouble breathing. Another signal of a heart attack is trouble breathing. The person may be
breathing faster than normal because the body tries to get the much-needed oxygen to the
heart. The person may have noisy breathing or shortness of breath.
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Cardiopulmonary Resuscitation First Aid and CPR Reference Manual
Other signals. The person’s skin may be pale or ashen (gray), especially around the face.
Some people suffering from a heart attack may be damp with sweat or may sweat heavily,
feel dizzy, become nauseous or vomit. They may become fatigued, lightheaded or lose
consciousness. These signals are caused by the stress put on the body when the heart does
not work as it should. Some individuals may show no signals at all.
Differences in signals between men and women. Both men and women experience the most
common signal for a heart attack: chest pain or discomfort. However, it is important to note
that women are somewhat more likely to experience some of the other warning signals,
particularly shortness of breath, nausea or vomiting, back or jaw pain and unexplained
fatigue or malaise. When they do experience chest pain, women may have a greater
tendency to have atypical chest pain: sudden, sharp but short-lived pain outside of the
breastbone.
HEALTH STATISTICS
MORTALITY: Ten (10) LEADING CAUSES
NUMBER AND RATE/100,000 POPULATION
Philippines
5-Year Average (2001-2005) & 2006
5-Year Average
2006
CAUSES (2001-2005)
Number Rate Number Rate
1. Disease of the Heart 69,741 85.5 83,081 95.5
2. Disease of Vascular System 52,106 64.0 55,466 63.8
3. Malignant Neoplasms 39,634 48.6 43,043 49.5
4. Accidents** 33,650 41.5 36,162 41.6
5. Pneumonia 33,764 41.5 34,958 40.2
6. Tuberculosis, all forms 27,017 33.2 25,860 29.7
7. Chronic lower respiratory diseases 19,024 23.3 21,216 24.4
8. Diabetes Mellitus 15,123 18.5 20,239 23.3
9. Certain conditions originating in perinatal
13,931 17.2 12,334 14.2
period
10. Nephritis, nephritic syndrome and nephrosis 9,785 12.0 11,981 13.8
Note: Excludes ill-defined and unknown causes of mortality
*Reference year
**External causes of Mortality source: http://www.doh.gov.ph/node/198
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CHAPTER 3 – Cardiac Emergencies and Philippine Red Cross
Cardiopulmonary Resuscitation First Aid and CPR Reference Manual
Cardiac Arrest
Cardiac arrest occurs when the heart stops beating or beats too ineffectively to circulate blood
to the brain and other vital organs. The beats, or contractions, of the heart become ineffective if
they are weak, irregular or uncoordinated, because at that point the blood no longer flows
through the arteries to the rest of the body.
When the heart stops beating properly, the
body cannot survive. Breathing will soon stop,
and the body’s organs will no longer receive
the oxygen they need to function. Without
oxygen, brain damage can begin in about 4 to
6 minutes, and the damage can become
irreversible after about 10 minutes.
A person in cardiac arrest is unconscious,
not breathing and has no heartbeat. The heart
has either stopped beating or is beating
weakly and irregularly so that a pulse cannot
be detected.
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Cardiovascular disease is the primary cause of cardiac arrest in adults. Cardiac arrest also
results from drowning, choking, drug abuse, severe injury, brain damage and electrocution.
Causes of cardiac arrest in children and infants include airway and breathing problems,
traumatic injury, and a hard blow to the chest, congenital heart disease and sudden infant
death syndrome (SIDS).
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4. Then place the pads of the two fingers next to your index finger on the sternum. Raise the
index finger. If you feel the notch at the end of the infant’s sternum, move your fingers up a
little bit.
5. Use the pads of two fingers to compress the chest. Compress the chest ½ to 1 inch, then let
the sternum return to its normal position.
6. When you compress, push straight down. The down-and-up movement of your
compressions should be smooth, not jerky.
7. Keep a steady rhythm. Do not pause between compressions. When you are coming up,
release pressure on the infant’s chest completely, but do not let your fingers lose contact
with the chest.
8. Keep your fingers in the compression position. Use your other hand to keep the airway
open using a head-tilt.
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Place your mouth over the stoma, making an airtight seal around the stoma. Blow into the
stoma until the chest rises. Then remove your mouth from the patient, allowing passive
exhalation.
2. Mouth-to-Mask
A transparent mask with or without a 1-
way valve is used in mouth-to-mask
breathing. The 1-way valve directs the
rescuer’s breath into the victim while
diverting the victim’s exhaled air away
from the rescuer. Some devices include
an oxygen inlet that permits
administration of supplemental oxygen.
Mouth-to-mask ventilation is
particularly effective because it allows
the rescuer to use 2 hands to create a
mask seal. There are 2 possible techniques for using the mouth-to-mask device. The first
technique positions the rescuer above the victim’s head (cephalic technique). A single rescuer
can use this technique when the patient is in respiratory arrest (but not cardiac arrest) or
during performance of 2-rescuer CPR. A jaw thrust is used in the cephalic technique, which has
the advantage of positioning the rescuer so that the rescuer is facing the victim’s chest while
performing rescue breathing.
In the second technique (lateral technique), the rescuer positioned at the victim’s side and
uses head tilt-chin lift. The lateral technique is ideal for performing 1-rescuer CPR, because the
rescuer can maintain the same position for both rescue breathing and chest compressions.
Automated External
Defibrillation (AED)
If the heart is damaged by disease or injury, its electrical system
can be disrupted. This can cause an abnormal heart rhythm that
can stop the blood from circulating.
The most common abnormal heart rhythm that causes sudden
cardiac arrest occurs when the ventricles simply quiver, or
fibrillate, without any organized rhythm. This condition is called
ventricular fibrillation (V-fib).
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In V-fib, the electrical impulses fire at random, creating chaos and preventing the heart from
pumping and circulating blood. The person may suddenly collapse unconscious, and stop
breathing.
Another abnormal rhythm found during sudden cardiac arrest is ventricular tachycardia, or
V-tach. With V-tach, the electrical system tells the ventricles to contract too quickly. As a result,
the heart cannot pump blood properly. As with V-fib, during V-tach the person may collapse,
become unconscious and stop breathing. In many cases, V-fib and V-tach can be corrected by
an electrical shock delivered by an AED. AEDs are portable electronic devices that analyze the
heart’s rhythm and deliver an electrical shock, known as defibrillation, which helps the heart to
re-establish an effective rhythm.
For each minute that CPR and defibrillation are delayed, the person’s chance for survival is
reduced by about 10 percent. However, by learning how to perform CPR and use an AED, you
can make a difference before EMS personnel take over.
Early CPR and defibrillation within the first 3-5 minutes after collapse, plus early advanced
care can result in high (greater than 50 percent) long-term survival rates for witnessed
ventricular fibrillation (VF). If bystander CPR is not provided, a cardiac arrest victim’s chances
of survival fall 7% to 10% for every minute of delay until defibrillation.
Defibrillation
Is the treatment of irregular, sporadic or absent heart rhythms by an electrical current to the
heart. It is the only definitive treatment for sudden cardiac arrest (SCA). Defibrillation
administered within 3-5 minutes after collapse is most successful. Every minute a victim is
unconscious translates to approximately a ten percent decrease in the likelihood of
resuscitation. After ten minutes, very few resuscitation attempts are successful. Thus, the most
important element in the treatment of SCA is providing rapid defibrillation therapy. CPR may
help prolong the window of survival, but it cannot reverse SCA.
The earlier defibrillation occurs, the higher the survival rate. When VF is present, CPR can
provide a small amount of blood flow to the heart and brain but cannot directly restore an
organized rhythm. Restoration of a perfusing rhythm requires immediate CPR and
defibrillation within a few minutes of the initial arrest.
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Without bystander CPR, the chance of survival from VF cardiac arrest declines by 7% to 10%
without defibrillation. Bystander CPR improves survival from VF cardiac arrest at most
defibrillation intervals. The use of AEDs increase the number of people (lay rescuers and
healthcare providers) who can perform CPR and attempt defibrillation, thus shortening the
time between collapse and defibrillation.
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You must be careful not to deliver the child shock dose for victims over 8 years of age because
the smaller dose may not be effective for the larger or older victim, you may use the adult pads
and deliver the adult dose. If an AED has optional child pads or a key or a switch to enable the
child dose to be delivered, it is important to select the pads and settings that are correct for the
victim.
Special Situations
The following 5 special situations may require the operator to take additional actions when
using an AED:
The victim is less than 1 year of age.
Currently there is not enough evidence to recommend for or against the use of AEDs in
infants less than 1 year of age.
The victim has a hairy chest.
If a teen or adult has a hairy chest, the AED pads may stick to the hair and may not stick to
the skin on the chest. If this occurs, the AED will not be able to analyze the victim’s heart
rhythm. The AED will then give a “check electrodes” or “check electrode pads” message.
The victim is immersed in water or water is covering the victim’s chest.
Water is a good conductor of electricity. Do not use an AED in the water. If the victim is in
water, pull the victim out of the water. If the victims’ chest is covered with water, water
may conduct the shock electricity across the skin of the victim’s chest. This prevents the
delivery of an adequate shock dose to the heart. If the water covers the victim’s chest,
quickly wipe the chest before attaching the electrodes. If the victim is lying on snow or in a
small puddle, you may use the AED. If the chest is covered with water, quickly wipe it first.
The victim has an implanted defibrillator or pacemaker.
Victims who have a higher risk for sudden cardiac arrest may have implanted
defibrillators/pacemakers that deliver shocks directly to the myocardium. You can
immediately identify these devices because they create a lump beneath the skin of the
upper chest or abdomen. The lump is half the size of a deck of cards, with a small overlying
scar. If you place an AED electrode pad directly over an implanted medical device, the
device may block delivery of the shock to the heart
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Occasionally the analysis and shock cycles of implanted defibrillators and AEDs will conflict. If
the implanted defibrillator is delivering shocks to the patient (the patient’s muscles contract in
a manner like that observed after an AED shock), allow 30 to 60 seconds for the implanted
defibrillator to complete the treatment cycle before delivering a shock from the AED.
The victim has a transdermal medication patch or other object on the surface of the
skin where the AED electrode pads are placed.
Do not place AED electrodes directly on top of medication patch (eg, a patch of nitroglycerin,
nicotine, pain medication, hormone replacement therapy, or antihypertensive medication).The
medication patch may block the transfer of energy from the electrode pad to the heart and may
cause small burns to the skin.
To prevent the medication patch from blocking delivery of energy, remove the patch and
wipe the area clean before attaching the AED electrode pad.
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Unresponsive
No breathing or no normal
breathing (only gasping)
Activate
Get
emergency
response Defibrillator
START
CPR
PUSH HARD
PUSH FAST
Check rhythm/
shock if indicated
Repeat every 2
minutes
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Unresponsive
No breathing or no normal
breathing (only gasping)
Activate
Get
emergency
response Defibrillator
Check PULSE
START
CPR
PUSH HARD
PUSH FAST
Check rhythm/
shock if indicated
Repeat every 2
minutes
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2. Give ventilation
Give 2 rescue breaths. If the breaths do
not make the chest clearly rise, repeat
cycles of chest compressions, and rescue breaths.
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CHAPTER 4
Airway &
Breathing
Emergencies
Philippine Red Cross
CHAPTER 4 – Airway & Breathing Emergencies First Aid and CPR Reference Manual
In breathing emergencies, the oxygen supply to the body is either greatly reduced or cut off
entirely. As a result, the heart soon stops beating and blood no longer moves through the body.
Without oxygen, brain cells can begin to die within four to six minutes. Unless the brain
receives oxygen within minutes, permanent brain damage or death will result.
Regardless of the reasons, it is important for the first aider to recognize when a person is
having trouble breathing or is not breathing at all. Signals of breathing emergencies include:
Trouble breathing or no breathing
Slow or rapid breathing
Unusually deep or shallow breathing
Gasping for breath
Wheezing, gurgling or making high-pitched noises
Shortness of breath
Dizziness or light-headedness
Pain in the chest or tingling in the hands, feet or lips
Unusually moist or cool skin
Flushed, pale, ashen or bluish skin
Apprehensive or fearful feelings
In a breathing emergency, air must reach the lungs. For any person, regardless of age, it is
important to keep the airway open when giving care.
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Types
Mild airway obstruction occurs when there is only partial
blockage of the airway.
Severe airway obstruction happens when there is complete
or total blockage of the airway.
Causes
The most common cause of choking in adults is airway obstruction caused by food, such as
when:
Trying to swallow large pieces of poorly chewed food;
Drinking alcohol before or during meals (Alcohol dulls the nerves that aid swallowing);
Wearing dentures (Dentures make it difficult to sense whether food is fully chewed before
it is swallowed);
Eating while talking excitedly, laughing, or eating too fast;
Walking, playing, or running with food or objects in the mouth;
In infants and children, choking occurs while eating or by putting non-food items such as
coins or toys inside the mouth while playing.
In all cases, recognition of airway obstruction is the key to successful prevention.
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CHAPTER 4 – Airway & Breathing Emergencies First Aid and CPR Reference Manual
A conscious
adult or child who
has a completely
blocked airway
needs immediate
care. Using more
than one technique
often is necessary
to dislodge an
object and clear a
person’s airway. A
combination of 5
back blows followed by 5 abdominal thrusts
provides an effective way to clear the airway
obstruction.
If a conscious choking adult or child
becomes unconscious, carefully lower the
person to the ground, open the mouth and look
for an object. If an object is seen, remove it with
your finger. If no object is seen, open the
person’s airway by tilting the head and try to
give 2 rescue breaths. If the chest does not
clearly rise, begin the modified CPR technique
used for an unconscious choking person.
If you determine that an adult or a child is
unconscious, not
breathing and the
chest does not rise
with rescue breaths,
retilt the head and
try another rescue
breath. If the chest
still does not rise,
assume that the
airway is blocked.
Caring for a
conscious choking
infant who cannot
cough, cry or breathe, you will need to give a combination of 5 back blows followed by 5 chest
thrusts.
If a conscious choking infant becomes unconscious, carefully lower the infant to the ground,
open the mouth and look for an object. If an object is seen, remove it with your little finger. If
no object is seen, open the infant’s airway by retilting the head and try to give 2 rescue breaths.
If the chest does not clearly rise, begin a modified CPR technique used for an unconscious
choking infant.
If you determine that an infant is unconscious, not breathing and the chest does not rise with
rescue breaths, retilt the head and try another rescue breath. If the chest still does not rise,
assume that the airway is blocked.
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Special Situations
If a conscious choking person is too large for you to reach
around, is obviously pregnant or is known to be pregnant, give
chest thrusts instead. Chest thrusts for a conscious adult are like
abdominal thrusts, except for the placement of your hands. For
chest thrusts, place your fist against the center of the person’s
breastbone. Then grab your fist with your other hand and give
quick thrusts into the chest.
If you are alone and choking, bend over and press your
abdomen against any firm object, such as the back of a chair, a
railing or the kitchens sink. Do not bend over anything with a
sharp edge or corner that might hurt you, and be careful when
leaning on a rail that is elevated. Alternatively, give yourself
abdominal thrusts, using your hands, just as if you were
administering the abdominal thrusts to another person. For a
choking person in a wheelchair, give abdominal thrusts.
Avoid use of a blind finger
sweep in adults and do not use
finger sweep in infants. Manually
remove solid material in the
airway only if it can be seen. If
advance medical help has not
arrived or been called, immediately
call for local emergency number.
Aftercare and referral for medical
examination:
After successful treatment for
FBAO, foreign material may
nevertheless remain in the
upper or lower respiratory
tract and cause complications
later.
Victims with a persistent cough, difficulty swallowing or the sensation of an object being
still stuck in the throat should be referred for a medical examination.
Another reason for medical examination is the possibility of serious internal injuries
resulting from abdominal thrusts or injury to the airway from the object that was lodged
and removed.
Asthma Attack
Asthma is an illness in which certain substances or conditions, called “triggers,” cause
inflammation and constriction of the airways (small tubes in the lungs through which we
breathe), making breathing difficult. Triggers of an asthma attack include exercise, cold air,
allergens or irritants, such as perfume.
People diagnosed with asthma can reduce the risk of an attack by controlling environmental
variables whenever possible. This helps to limit exposure to the triggers that can start an
asthma attack.
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Quick-Relief Medications
Quick-relief or rescue medications also called (short-acting
bronchodilators) are used to stop an asthma attack.
These medications work quickly to relieve sudden swelling in
the lungs. They lessen wheezing, coughing and chest tightness
which allows the person having an asthma attack to breathe
easier.
The most common way to take long-term control is through
the inhalation of quick-relief asthma medications. Inhalation
allows the medication to reach the airways faster and work
quicker. There also are fewer side effects.
A metered dose inhaler (MDI) sends a measured dose of
medicine in mist form directly into the person’s mouth. The
person gently presses down the top of the inhaler. This causes a
small amount of pressurized gas to push the medicine out
quickly. Sometimes a “spacer” is used to control the amount of
medication that is inhaled. The medicine goes into the spacer
and then the person inhales the medication through the mouthpiece on the spacer.
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CHAPTER 4 – Airway & Breathing Emergencies First Aid and CPR Reference Manual
Hyperventilation
Hyperventilation occurs when a person’s breathing is faster and more shallow than normal.
When this happens, the body does not take in enough oxygen to meet its demands.
Hyperventilation is the body’s way of compensating when there is a lack of oxygen. The
result is an excess of carbon dioxide which alters the acidity of the blood.
Causes
Hyperventilation often results from fear or anxiety and usually occurs in people who are tense
and nervous. However, it also can be caused by head injuries, severe bleeding or illnesses, such
as high fever, heart failure, lung disease and diabetic emergencies. Asthma and exercise can
also trigger hyperventilation.
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3. If five back blows fail to relieve the airway obstruction, give up to five
abdominal thrusts as follows:
Stand behind the victim and put
both arms around the upper part
of the abdomen.
Lean the victim forward.
Clench your fist and place it
between the umbilicus and
xiphisternum.
Grasp this hand with your other
hand and pull sharply inwards
and upwards.
Repeat up to five times.
If the obstruction is still not
relieved, continue alternating five
back blows with five abdominal
thrusts.
4. If the patient becomes unconscious:
Support the victim, while carefully lowering him or her to the ground.
If advance medical help has not arrived or been called, immediately call for local
emergency number.
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4. Note the time of administration and any change in the person’s condition.
The medication may be repeated once after 1 to 2 minutes.
Have the person rinse his or her mouth out with water to reduce side effects.
Stay with the person and monitor his or her condition and give CARE for any other
conditions.
Keep the person from getting chilled or overheated.
Call the local emergency number if trouble breathing does not improve quickly.
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CHAPTER 5
Bleeding and
Shock
Philippine Red Cross
CHAPTER 5 – Bleeding and Shock First Aid and CPR Reference Manual
Bleeding
When bleeding occurs, a complex chain of events is triggered in the body. The brain, heart and
lungs immediately attempt to compensate for blood loss to maintain the flow of oxygen-rich
blood to the body tissues, particularly to the vital organs. As the brain recognizes a blood
shortage in the body, it signals the heart to circulate more blood as it constricts blood vessels in
the extremities. The brain signals the lungs to work harder to provide more oxygen.
Other important reactions to bleeding occur on a microscopic level. Platelets collect at the
wound site in an effort to stop blood loss through clotting. White blood cells prevent infection
by attacking microorganisms that enter through breaks in the skin. Over time, the body
manufactures extra red blood cells to help transport more oxygen to the cells.
Blood volume is also affected by bleeding. Normally, excess fluid is absorbed from the
bloodstream by the kidneys, lungs, intestines and skin. However, when bleeding occurs, this
excess fluid is reabsorbed into the bloodstream as plasma. This re-absorption helps to
maintain the critical balance of fluids needed by the body to keep blood volume constant.
Bleeding that is severe enough to critically reduce blood volume is life threatening. This can
cause tissues to die from lack of oxygen. Life threatening bleeding can be either external or
internal. External bleeding occurs when a blood vessel is opened from the outside such as
through a tear in the skin.
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CHAPTER 5 – Bleeding and Shock First Aid and CPR Reference Manual
Pressure bandage
Pressure on a wound can be maintained by applying
a bandage to the injured area. A bandage applied to
control bleeding is called a pressure bandage. If
blood soaks through the bandage, do not remove the
blood-soaked bandages. Instead, add more dressings
and bandages and apply additional direct pressure.
Shock
Shock is a condition in which the circulatory system fails to deliver enough oxygen-rich blood
to the body’s tissues and vital organs. The body’s organs such as the brain, heart and lungs do
not function properly without enough blood supply. This triggers a series of responses that
produce specific signals known as shock. These responses are the body’s attempt to maintain
adequate blood flow.
Causes
Shock is a spontaneously deteriorating process mainly caused by any of the following:
Loss of blood volume
Blood or fluid loss from blood vessels decreases blood volume, usually as a result of
bleeding, and results in adequate perfusion. Common causes are trauma to vessels or
tissues, severe burns, and fluid loss from the GI tract. Vomiting/diarrhea can also lower the
fluid component of blood.
Pump failure
Poor pump function occurs when disease or injury damages the heart. The heart does not
generate enough energy to move the blood through the system. This usually happens
during heart attacks or when there is profound trauma to the heart.
Dilation of peripheral blood vessels
Even though the blood vessels dilate normally, it is inadequate to fill the system and
provide efficient perfusion. This can be due to infection, drug overdose (narcotics), or
spinal cord injury.
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For victims experiencing shock without evidence of spinal injury, the legs may be raised 6
to 12 inches. If unsure, leave him or her lying flat.
Help the person maintain normal body temperature. If the person feels cool to the touch,
cover him or her with a towel or blanket to avoid chilling.
Do not give the person anything to eat or drink even though he or she is likely to be thirsty.
The person’s condition may be severe enough to require surgery, in which case it is better if
the stomach is empty.
Reassure the person every so often.
Continue to monitor the person’s breathing and for any changes in the person’s
condition. Do not wait for signals of shock to develop before caring for the underlying
injury or illness.
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CHAPTER 6
Soft Tissue
Injuries
Philippine Red Cross
CHAPTER 6 – Soft Tissue Injuries First Aid and CPR Reference Manual
Soft tissues make up the inner layers of the skin. These are the fat and muscles beneath the
skin’s outer layer. Soft tissue damage may occur at the skin’s surface or deep within If this
happens, severe bleeding may occur either on the skin’s surface or underneath it, where
detection is hardest. Germs can also enter the body through wounds and become the cause of
infection.
The skin is composed of many layers. The two primary layers of the skin are the outer layer,
the epidermis, that provides a barrier to bacteria and other organisms which cause infection;
and a deeper layer, called the dermis, that contains the nerves, hair roots, sweat and oil glands
and blood vessels. Because the skin is well supplied with blood vessels and nerves, most soft
tissue injuries are likely to bleed and be painful. The hypodermis, located beneath the
epidermis and dermis, contains fat, blood vessels and connective tissues. This layer insulates
the body to help maintain body temperature. The fat layer also stores energy.
The muscles lie beneath the fat layer and comprise the largest segment of the body’s soft
tissues. Although the muscles are considered soft tissues, muscle injuries are discussed more
thoroughly in Chapter 8.
Wounds
A wound is any physical injury involving a break in the layers of the skin. Wounds are
generally classified as either closed or open.
Complications
Wounds have the following complications:
Bleeding (external and internal) and shock.
Infection - Open injuries have a potential for serious bacterial wound infections or even
fatal illnesses.
Tetanus is a severe infection that can result from a puncture or a deep cut. Tetanus is a
disease caused by bacteria. These bacteria produce a powerful poison in the body. The
poison enters the nervous system and can cause muscle paralysis. Once tetanus reaches the
nervous system, its effects are highly dangerous and can be fatal. Fortunately, tetanus often
can be successfully treated with medicines called antitoxins.
Rabies is a disease caused by a virus transmitted commonly through the saliva of diseased
mammals, such as dogs and cats. If not treated, rabies is fatal. Anyone bitten by a wild or
domestic animal must get professional medical attention as soon as possible.
Closed Wound
A closed wound is a wound Signs and Symptoms
where the outer layer of the skin Tender, swollen, bruised or hard areas of the body,
is intact and the damage lies such as in the abdomen
below the surface. It is usually Rapid, weak pulse
caused by the application of Skin that feels cool or moist or looks pale or bluish
external force, such as in motor Vomiting of blood or coughing up blood
vehicle accidents, falls or from Excessive thirst
blunt objects, resulting in An injured extremity that is blue or extremely pale
contusions or bruises. A closed Altered mental state, such as the person becoming
wound may bleed internally. confused, faint, drowsy or unconscious
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CHAPTER 6 – Soft Tissue Injuries First Aid and CPR Reference Manual
Open Wound
In an open wound, the outer layer of skin is broken. The break in the skin can be as minor as a
scrape of the surface layers or as severe as a deep penetration. External bleeding is often a
factor when treating open wounds. The amount of bleeding depends on the location and
severity of the injury.
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Special Considerations
Open chest wound
Call the local emergency number.
Put on disposable gloves.
Help the patient sit down properly. Encourage him to
lean towards the injured side and cover the wound
with the palm of his hand.
Place a sterile dressing or clean non-fluffy pad over
the wound and surrounding area. Cover with an
occlusive dressing (plastic bag, foil or kitchen film).
Secure firmly with adhesive tape on three edges only
so that the dressing is taut. A taped-down dressing
keeps air from entering the wound when the person inhales. See that there is an open
corner which allows air to pass through when the person exhales.
Take steps to minimize shock.
Monitor the person’s breathing.
An open chest wound is a life-threatening injury that occur when an object, such as a
knife or bullet, penetrates the chest wall, or when a fractured rib breaks through the
skin.
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Avulsion
If the victim has an avulsion in which a body part has been completely severed;
Call the local emergency number.
Put on disposable gloves.
Wrap the severed body part in sterile gauze or any clean material, such as a washcloth.
Place the wrapped part in a plastic bag. Keep the body part cool by placing the bag on ice.
Do not place the bag on dry ice or in ice water.
Make sure the part is transported to the medical facility with the victim.
Embedded object
If the victim has an embedded object in the wound:
Call the local emergency number.
Put on disposable gloves.
Do not remove the object yourself.
Use bulky dressings to stabilize the object.
Any movement of the object can result in further tissue damage.
Control bleeding by bandaging the dressing in place around the object.
If the object is lodged in the airway of the injured party, transport the patient immediately
to the hospital if there is no medical help available.
Wash your hands immediately after giving care.
Bullet wounds
Military assault rifles and handguns shoot bullets at high speed. Under International
Humanitarian Law, all bullets used by armies must be manufactured to prevent exploding or
fragmenting when these hit a human body. However, due to various factors such as ricocheting
off a wall, a tree, or the ground, some bullets do break up into fragments in the body.
Characteristics of bullet wounds:
The amount of tissue damage varies according to the size and speed of the bullet, its
stability in flight, and the bullet’s construction.
It is usually single.
It is usually a small entry wound.
There may or may not be an exit wound but, if there is, the size is variable.
Blast injury
The detonation of high-energy explosives creates a blast wave in the air that can travel around
objects such as buildings or walls. The wave causes rapid and large changes in atmospheric
pressure. As this blast of air circulates around the area where someone is passing through, this
action may affect parts of the body that normally contain air.
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Things to Remember:
A blast victim may not have any external injury.
A single, large explosion may injure many people at the same time. Some injuries are due
to the blast wave itself, others are due to burning and fragments sent off by the explosion.
The blast wave may also throw people against walls which may result in blunt injuries.
The secondary fragments from broken glass and debris caused by the blast wave may also
cause penetrating wounds.
Finally, a blast may cause a building to collapse and people caught inside may suffer crush
injuries.
Burns
Burns are injuries to the skin and to other body tissues that is caused by heat, chemicals,
electricity, or radiation.
Prevention
Heat burns can be prevented by following fire safety practices. Being careful around
sources of heat is also a good deterrent against injury.
Chemical burns can be prevented by following safety practices on the use of chemicals and
following manufacturers’ guidelines when handling them.
Electrical burns can be prevented by following safety practices around electrical lines and
equipment. Vacating outdoor areas where lighting could strike may also help.
Sunburn can be prevented by wearing appropriate clothing and applying sunscreen to the
skin. Sunscreen should have a sun protection factor (SPF) of at least 15.
Classification
Generally, burns are classified according to its depth:
Superficial (first-degree) burns
o Involve only the top layer of skin
o Cause skin to become red and dry
o Usually painful and swollen
o Usually heal within a week without permanent scarring
o Sunburn is a good example of a superficial burn.
Partial-thickness (second-degree) burns
o Involve the top layers of skin
o Cause skin to become red
o Usually painful
o Have blisters that may open and weep clear fluid, making the skin appear wet
o May appear mottled and may often swell
o Usually heal in 3 to 4 weeks and may scar
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Critical burns
Critical burns are those burns that require immediate medical care. These are based on factors
such as depth, area and location. The following are considered critical burns:
Full thickness burns that cover more than five percent of the body’s surface area. The Rule
of Nine and The Rule of Palm is used to determine the extent of injury of the affected area.
o The Rule of Nine assigns a percentage value to each part of an adult body and is modified
taking into account the different bodies of small children and infants.
o The Rule of Hand considers the victim’s hand proportions, with the exclusion of the
finger and thumb; to represent about one percent of his or her total body surface.
Partial thickness burns that covers more than 10 percent of the body’s surface area or those
that can be found in multiple locations.
Burns to the face, genitals, and injuries that completely encircle the hands or feet which
may cause possible constriction and prevent circulation.
Burns caused by chemicals, electricity and explosives.
Burns involving someone under five years old or older than five who have thinner skin and
often burn more severely.
Burns involving people with chronic medical problems such as heart or kidney ailments.
People who may be undernourished. People who are exposed to burn sources who may not
be able to leave the area.
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Chemical Burns
Remove the chemical from the skin as quickly as possible. It is important to remember that
the chemical will continue to burn as long as it is on the skin. If the burn was caused by dry
chemicals, brush off the chemicals using gloved hands or a towel and remove any
contaminated clothing before flushing with tap water (under pressure). Be careful not to
get the chemical on yourself or on a different area of the person’s skin.
Flush the burn with large amounts of cool running water. Continue flushing the burn for at
least 20 minutes or until advanced medical personnel take over.
If an eye is burned by a chemical, flush the affected eye with water until advanced medical
personnel take over. Tilt the head so that the affected eye is lower than the unaffected eye
as you flush.
If possible, have the person remove contaminated clothes to prevent the spread of infection
while you continue to flush the area. Be aware that chemicals inhaled can be potentially
damaging to the airway or lungs.
Electrical Burns
Never go near the person until you are sure that he or she is no longer in contact with the
power source.
Turn off the power at its source and be aware of any life threatening conditions.
Call the local emergency number. Any person who has suffered from an electrical shock
needs to be evaluated by a medical professional.
Be aware that electrocution can cause cardiac and respiratory emergencies. Therefore, be
prepared to perform CPR or use an automated external defibrillator (AED).
Care for shock and thermal burns.
Look for entry and exit wounds and give appropriate care.
Remember that anyone suffering from electric shock requires advanced medical attention.
Radiation Burns
Care for a radiation burn, i.e. sunburn, as you would for any thermal burn.
Always cool the burn and protect the area from further damage by keeping the person away
from the burn source.
Bandaging
Definitions and Types
Dressings are pads placed directly on the wound to absorb blood and other fluids and to
prevent infection. They need to be kept sterile. Most dressings are porous which allow for
better air circulation. This helps promote healing. Larger dressings cover very large
wounds and even multiple wounds in one body area.
An occlusive dressing is a bandage or dressing that closes a wound or damaged area of the
body. It prevents the injury from being exposed to air or water.
A bandage is any material that is used to wrap or cover any part of the body. Bandages are
used to hold dressings in place, apply pressure to control bleeding, protect a wound from
dirt or infection, and to provide support to an injured limb or body part. Any bandage
applied snugly to create pressure on a wound or an injury is called a pressure bandage.
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Square Knot
A square knot (or reef knot) is used to tie the ends of a triangular
bandage. It is easy and quick to tie and untie.
It is formed by tying a left-handed overhand knot and then a
right-handed overhand knot, or vice versa. A common mnemonic
for this procedure is "right over left, left over right, makes a
knot both tidy and tight."
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2. Use bulky
dressings to
stabilize the
object.
3. Control
bleeding by
bandaging
the dressing
in place
around the object.
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2. Bring both
ends up again.
3. Pass the left
end over and
under the right
end.
Untying
1. Pull one end
and one piece
of bandage
apart.
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2. Then fold
lengthwise
along the
middle.
3. To make it
narrower, fold it
again until you
obtain the
desired width.
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6. Pick up the point and tuck it in where the bandage ends cross.
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Forehead or Eye
1. Place the center of the cravat over the
dressing that covers the wound.
2. Carry the ends around to the opposite
of the head and cross them.
3. Bring them back to the starting point
and tie them.
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Chest
1. Place the center of the bandage on the
dressing with the point resting on the
shoulder at the side of the injured chest and
its base parallel to the ground.
2. Fold a hem about 2 inches outward along the
base then carry both ends firmly around the
body and tie them at the back.
3. Twist both ends together and bring them up
to the shoulder
where the point is
and tie them as
well.
4. Be sure to fold
outside hems at
each side of the
bandage before
tying the point.
Shoulder
1. Using a wide cravat, place a third of its length
on the dressing with the short end towards
the front.
2. Carry the other end passing down the armpit
and back to the shoulder, crossing the short
end and covering the dressing.
3. Continue bringing the same end around the
back, then the other armpit, and back to the
front where it is
tied with the short
end.
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Arm or Leg
1. With a cravat, place
it diagonally along
the arm or leg with
a third of its length
on the dressing.
The short end
should be towards
the upper part.
2. Starting below the
dressing, wrap the
other end around
the arm or leg.
Use overlapping
spiral turns upward
until it covers the
dressing and the
end reaches the
other end.
3. Fold the short end
back and wrap it
around the
extremity.
To reverse its direction, go opposite that of the other end.
4. Tie the ends as a square knot.
Elbow or Knee
1. Bend the elbow or
knees at a right
angle unless this
movement produces
pain.
2. Use a rather wide
bandage.
Start with the
middle of the
bandage over the
dressing at the
elbow or knee.
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Palm
1. Place the center of
the cravat over the
dressing.
The palm should be
facing upward.
2. Starting with the end
on the thumb side of
the hand, carry this
end under and
around the hand.
3. Next, pass on the
wrist side of the
other end, and then
back to same side
where it started.
4. Carry the other end
under and around the hand twice, with the first wrap passing behind the
thumb and the second one between the thumb and the first end.
5. Cross both ends at the wrist and tie them.
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Hand or Foot
1. Place the hand or foot
on the center of the
bandage with the
point towards the
fingers or toes and
the base towards the
wrist or heel.
2. Bring the point
towards the wrist or
ankle to cover the
hand or foot in the
process.
3. Fold an outward hem
along the base then
bring and cross the
ends on top of the
hand or foot.
4. Cross the ends in
opposite directions
around the wrist or
ankle then tie them.
5. Draw the point
towards the wrist or
ankle and tuck it in
the folds where the
ends cross each other.
Anchoring
1. Place the end of the
bandage on a bias (or
offset) at the starting
point.
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Tying off
(if without adhesive tape, retainers or clips)
1. Take the bandage end
in a direction away
from the body part
being covered.
2. Loop around the
thumb or finger and
continue back to the
opposite side of the
body part.
3. Encircle the part with
the looped end with
the free end and tie.
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Turns
Circular – This is done by simply encircling the part with each layer of
bandage superimposed on the previous one. Its use is limited to covering parts
of uniform width such as the head, chest or abdomen.
Spiral (open or closed) – This method is used to encircle body parts with
varying diameters
such as the limbs. It
may be applied as
temporary bandage,
like a splint or as a
holder, to put a large
burn dressing in
place. It may be
closed simply by
encircling the part
until all gaps are
closed.
Figure-of-eight –
This is useful for
bandaging body
joints such as the
wrist, shoulder, knee
or ankle.
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CHAPTER 7
Poisoning
Philippine Red Cross
CHAPTER 7 – Poisoning First Aid and CPR Reference Manual
A poison is any substance that can cause injury, illness or death when introduced into the body.
Poisons include solids, liquids, gases and vapors. A poison can enter the body through four
ways – ingestion, inhalation, injection and absorption.
I. Ingested Poisons
Ingestion means swallowing. Poisoning by ingestion may include any of the following:
Food poisoning
Food poisoning occurs when food or water that has been contaminated with certain types of
bacteria, parasites, viruses, or toxins is swallowed.
Most cases of food poisoning are due to common bacteria such as Staphylococcus or
Escherichia coli (E. coli). Another rare but deadly type of food poisoning is botulism which is
caused by the bacteria Clostridium botulinum. Even common root crops such as cassava
(kamoteng kahoy or balinghoy), which contains cyanide, taro (gabi) and yam (ube) can be toxic
if not properly processed and cooked. Another type of poisoning prevalent in the Philippines is
red tide or paralytic shellfish poisoning (PSP) caused by eating contaminated mussels
(tahong) and other shellfish. Eating puffer fish (butete) is also equally fatal as it also contains a
very potent neurotoxin (tetrodotoxin) that can cause paralysis of the breathing muscles and
instantaneous death.
Prevention
Carefully wash your hands before cooking or cleaning. Always wash them again
after touching raw meat.
Promptly refrigerate any food that will not be eaten. Keep the refrigerator set to 4.4
°C or below.
DO NOT use outdated foods, packaged food with broken seals, or cans that have
bulges or dents.
DO NOT consume foods that have an unusual odor or a spoiled taste.
Only drink water that has been treated or chlorinated.
DO NOT eat wild mushrooms.
DO NOT eat fish that are known to be toxic or shellfish that have been exposed to
red tides.
Caustics
Strong acids and alkalis when swallowed can burn the tongue, mouth, esophagus, and stomach.
These burns may cause perforation (piercing) of the esophagus or stomach. Food and saliva
leaking from a perforation can cause severe infection within the chest or abdomen. This can
prove to be deadly.
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Common sources of caustics include solid and liquid drain and toilet bowl cleaners, muriatic
acids, car battery fluids, rust removers, bleaches, detergents and ammonia-containing
products.
Industrial products are usually more concentrated than household products and thus tend to
be more dangerous.
Hydrocarbons
Hydrocarbons include gasoline, diesel fuel, kerosene, lighter fluids, paints, lacquer, glue and
solvents. Swallowed hydrocarbons can enter and irritate the lungs and can lead to severe
pneumonia (chemical pneumonitis).
Dancing Firecracker (Watusi)
Watusi is usually reddish in color, about 1 ½ inches in length and 1/10 inch in width. It is
usually ignited by friction to produce a dancing movement and a crackling sound.
Watusi is often mistaken by children for sweets. The firecracker when ingested may
explode in the gastrointestinal tract. This results in burns or even ruptures of the stomach
or intestines. More commonly, it causes serious and fatal chemical poisoning.
Watusi is made of yellow phosphorus, potassium chlorate, potassium nitrate and
trinitrotoluene (TNT). All these substances are toxic. Yellow phosphorus does the most
damage.
The symptoms of phosphorus poisoning include abdominal pain, vomiting, diarrhea,
garlic breath odor, burns in the mouth and throat, yellowing or jaundice of the skin (due to
liver damage), and heart rate irregularities. It also impairs the central nervous system,
causing restlessness, drowsiness, stupor, or coma.
Pesticides
Pesticides, especially those that contain organophosphate and carbamate, can also be
deadly to humans when swallowed accidentally or used in suicide attempts. These
examples of organophosphates include malathion, parathion, diazinon, dichlorvos,
chlorpyrifos, and sar in. Some of these compounds are derived from nerve gases.
Organophosphate and carbamate insecticides make certain nerves “fire” erratically. This
causes many organs to become overactive and eventually to stop functioning.
The symptoms of Organophosphates and carbamates cause eye tearing blurred vision,
over salivation, sweating, coughing, vomiting, frequent bowel movements and urination.
There is difficulty in breathing. Muscles can twitch uncontrollably and weaken
considerably.
Drug overdose
Drug overdoses are sometimes caused intentionally to commit suicide or to inflict self-harm.
Intentional or unintentional misuses of medication also result too many drug overdoses. These
may involve the use of stimulants, sedatives, pain relievers, and even vitamins.
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Prevention
Keep all toxic chemicals and medicines locked up. Ensure that they are in their original
containers and are out of children’s reach.
Use personal protective equipment when handling toxic chemicals.
Use chemicals only for their approved and intended purpose. Dispose empty containers
promptly and properly.
Carbon monoxide
Carbon monoxide (CO) is a by-product of incomplete combustion and is found in fumes such as
those produced by small gasoline engines, stoves, generators, lanterns, and gas ranges. This
can also be produced by burning charcoal and wood.
The gas is colorless, odorless and non-irritating. It is highly lethal and can cause death after
only a few minutes of exposure.
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Prevention
Never use a charcoal grill, hibachi, lantern, or portable camping stove inside a home, tent,
or camper.
Never leave the motor running in a vehicle parked in an enclosed or partially enclosed
space such as a garage.
Never run a motor vehicle, generator, pressure washer, or any gasoline-powered engine
outside an open window, door, or vent where exhaust fumes can enter into an enclosed
area.
Cyanide
Cyanide is used in manufacturing paper, textiles, and plastics. It is present in chemicals used to
develop photographs. Cyanide salts (NaCN or KCN) are used in metallurgy for electroplating,
metal cleaning, and removing gold from its ore.
Breathing cyanide gas (HCN) causes the most harm, although ingesting cyanide can be toxic
as well. When cyanide is inhaled, its composition can prevent the cells of the body from getting
oxygen. When this happens, the cells die.
Cyanide is more harmful to the heart and brain than to other organs because the heart and
brain use a lot of oxygen.
Prevention
First, get fresh air by leaving the area where the cyanide was released. Moving to an area
with fresh air is a good way to reduce the possibility of death from exposure to cyanide
gas.
If the cyanide release was outside, move away from the area where the cyanide was
released. If the cyanide release was indoors, get out of the building.
If leaving the area that was exposed to cyanide is not an option, stay as low to the ground
as possible.
Chlorine
Chlorine (Cl) is an element use d in industry and is found in some household products. It can
also take the form of a poisonous gas.
It’s most important use is as a bleach in the manufacture of paper and cloth. Chlorine is
mostly found in drinking water which can kill harmful bacteria. It is also used as part of the
sanitation process for industrial waste and sewage. Household chlorine bleach can release
chlorine gas if it is mixed with other cleaning agents.
When chlorine gas comes into contact with moist tissues such as the eyes, throat, and the
lungs, an acid is produced that can damage these tissues.
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Prevention
Leave the area where the chlorine was released and get to fresh air. Quickly moving to
an area where fresh air is available is highly effective in reducing exposure to chlorine.
If the chlorine release was outdoors, move away from the area where the chlorine was
released. Go to the highest ground possible. Chlorine is heavier than air and will sink to
low-lying areas. If the chlorine release was indoors, get out of the building.
Tear gas
Tear gas (or lachrymatory agents) is the common name for substances that even in low
concentrations cause temporary incapacitation. This may result in painful eye irritation and
difficulty in breathing.
Tear gas is usually shot off through grenades. When thrown into a closed space, the gas
concentration can cause asphyxia and suffocation.(ref.1)
Prevention
If you see a tear gas coming or receive a warning that it is headed your way, try to move
away or get upwind. Put on protective gear, if available. Minimize skin and face exposure by
covering up as much as possible. A gas mask, if properly fitted and sealed, provides the best
respiratory protection. A bandanna soaked in water and tied tightly around the nose and
mouth may prove adequate.
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Snakebites
Snakebite is considered as an occupational disease among food producers in the Philippines as
w ell as in Southeast Asia. Many deaths from snakebite are not recorded because treatment is
usually done by traditional healers.
As such, there are no reliable estimates of mortality in the Philippines. Figures of 200 to 300
deaths each year have been suggested. Fatal envenoming can only be caused by cobras.
Over 98 percent of bite sites occur on the limbs, 85 percent of which can be found mainly on
the lower limbs. These are mostly "startled" bites or "defensive" bites where the victim does
not receive a full-fanged bite. “Full-fanged bites” are those which have a full load of venom
injected into the body of the victim.
There are two important families of venomous snakes in the Philippines: Elapidae and
Viperidae.
Elapids have short permanently erect fangs. This family includes the cobras (ulupong,
agwason), king cobra (banakon), kraits, coral snakes and the sea snakes (sigwalo, walo-
walo). Common Philippine species are: the Northern Phillipine Cobra (Naja philippinensis)
found in Luzon, Mindoro, Catanduanes and Masbate; Southeastern Philippine Cobra (Naja
samarensis) in Mindanao, Samar, Leyte, Bohol, Camiguin, and in other nearby islands;
Equatorial Spitting Cobra (Naja sumatrana) in Palawan and Calamianes; King Cobra
(Ophiophagus hannah); Banded or Yellow-lipped Sea Krait (Laticauda colubrine); Striped
Coral Snake (Calliophis intestinalis) in Mindanao and Palawan and the Garman's sea snake
(Hydrophis semperi) found only in Taal Lake in southern Luzon.
Vipers have long fangs which are normally folded up against the upper jaw, but when the
snake strikes these become erect. Vipers include the typical vipers (Viperinae) and the pit
vipers (Crotalinae). The crotalids have a special sense organ, the pit organ, to detect their
warm-blooded prey. Among the local species are the Philippine Pit Viper (Parias
flavomaculatus), found almost all over the country; the North Philippine Temple Pit Viper
(Tropidolaemus subannulatus) in Luzon and Visayas; and the South Philippine Temple Pit
Viper (Tropidolaemus phillipinensis) in Mindanao.
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Prevention
Educate yourself. Know your local snakes. Know where they like to live and hide. Know
the times of the year, what kinds of weather, and what times of the day they are most
likely to be active.
Avoid snakes or be away from them as much as possible. Avoid watching “live” snake
shows from street snake charmers.
Wear protective clothing such as proper boots and trousers. Prepare clothing beforehand,
especially when travelling to areas which are dark and steeped in grass and undergrowth.
Be especially vigilant after rains, during flooding, harvest times in the fields, and when
travelling at night. Bring a light source such as a torch, flashlight or lamp during your
walk.
Never handle, threaten or attack a snake.
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Ideally, a broad elastic roller bandage should be used for the person. If this is not available,
long strips of material can be substitutes. The bandage is bound firmly around the entire
bitten limb, startingdistally around the fingers or toes and moving as high up the extremity
as possible. Ideally, this is up to the groin.
Do not remove the trousers as the movement of doing so will only assist the venom into
entering the blood stream. Keep the bitten leg still. The bandage is bound firmly, but not so
tightly that the peripheral pulse is occluded or that the patient develops severe pain in the
limb. Check the snugness of the bandaging—a finger should easily, but not loosely, pass
under the bandage. Apply a splint to the leg which will immobilize joints on either side of
the bite. Bind it firmly to as much of the leg as possible. Walking should be restricted. If
there are bites on the hand and forearm: bind to the axilla, use a splint to the elbow and
make e a sling.
As far as the snake is concerned - do not attempt to kill it as this may be dangerous.
However, bring the snake to along to the hospital if it has been killed. Do not handle the
snake with bare hands as even a severed head can still bite!
Bee Stings
Most of the time, bee stings are harmless. If the person is allergic however, it can lead to
anaphylaxis (severe allergic reaction), a life-threatening condition.
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Stingrays (pagi) tend to be partially buried in sandy or silty bottoms in shallow inshore waters.
Up to six venomous spines in their tails can stab unwary swimmers who happen to tread on or
unduly disturb them. All stingray wounds, no matter how minor, should receive medical
attention to avoid the risk of secondary infection. Some injuries caused by venomous stingrays
can be fatal for humans if the spine pierces the victim’s trunk.
Prevention
Always wear suitable footwear when exploring intertidal area or wading in shallow
water.
Avoid handling sea urchins.
First aid management
Immerse the wound in 45ºC water, or as can be tolerated, for 30 to 90 minutes.
Many marine toxins are proteins which are destroyed by heat. A hot soak can
dramatically reduce the pain and the amount of damage caused by a sting.
Soak the affected area in vinegar. This inhibits bacterial infection and dissolves the spine
skeleton which is made of calcium carbonate––the same basic material as human bones.
This material fizzes and dissolves readily in any acid such as vinegar.
Leave an inaccessible spine alone and only if it hasn't penetrated a joint, nerve or blood
vessel.
Cleanse the wound with an antiseptic solution.
Washing out remaining venom and pieces of spine will help minimize damage, speed
healing and prevent infection.
Jellyfish Sting
Jellyfish (dikya, salabay) are usually found in shallow waters. They have a transparent bell or
cube-like body with a pale blue color. They move through gentle pulsations of the bell but are
frequently driven ashore and stranded by wind and currents. The true jellyfish are typically
pelagic and exist for the greater part of their life as medusae. Species of some genera may occur
in large groups or swarms.
All jellyfish are capable of stinging but only a few species are considered a significant hazard
to human health. The box jellyfish Chiropsalmus quadrigatus is known to cause a number of
deaths every year in the Philippines.
A box jellyfish can have many tentacles that can grow to a length of three meters or 10 feet
and are covered with stinging cells or nematocysts. Each tentacle on a box jellyfish can have up
to 5,000 of these nematocysts where the potent venom is stored. The box jellyfish uses these
tentacles to catch their prey which are usually small fish and crustaceans.
Prevention
Avoid swimming in waters where jellyfish are concentrated. These are often indicated
by beached specimens.
Wear protective clothing such as a wet suit and a full length rash guard when swimming
in areas where jellyfish are prevalent.
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To care for a victim who has come into contact with a poisonous plant:
Remove contaminated clothing and jewellery which may constrict circulation when
swelling occurs.
Rinse the affected area immediately. Do it thoroughly.
Seek medical advice if a rash or weeping lesion (oozing sore) develops.
Soothe the area with medicated lotions.
Stop or reduce itching with antihistamines that will dry up the lesions.
Advice the victim to see a physician if the condition worsens and large areas of the body or
the face are affected. .
Give care for severe allergic reactions if it does develop.
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CHAPTER 8
Head and
Spine Injuries
Philippine Red Cross
CHAPTER 8 –Head and Spine Injuries First Aid and CPR Reference Manual
Head, neck and spinal injuries are not very common, but these may cause the most long-lasting
damage to the body. Paralysis, speech impairment, and brain trauma are just some of the
possible effects of these injuries. Not only are these disabilities permanent, but they may also
be life-threatening.
Types
Head injury
Any head injury is potentially dangerous. If not properly treated, injuries that seem minor
could become life threatening. Head injuries include scalp wounds, skull fractures, and brain
injuries.
Skull fractures belong to two categories: open or closed. An open head injury has an
accompanying scalp wound, while a closed head injury does not have an accompanying scalp
wound.
A brain injury is trauma to the brain which causes bleeding inside the skull. Blood build-up
causes pressure, resulting to more damage to the brain.
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Concussion
A concussion involves a temporary loss of brain function from a blow received by a victim to
the head. Loss of consciousness may not always occur, but its aftereffects can be easily
recognized. These can range from sleep and mood changes to increased light and noise
sensitivities. Cognitive disturbances may also be present. Some effects may not appear for a
long period of time, and this is why observation of the victim is needed.
Spinal injury
Spine injuries often fracture the vertebrae and sprain
the ligaments. These injuries usually heal without
problems. In severe injuries, the vertebrae may shift
and compress or may even be severed from the spinal
cord. Both occurrences may cause temporary or
permanent paralysis and may even lead to death. The
areas where paralysis may occur depend on the area
where the spinal cord was damaged.
Spinal motion restriction is the procedure for early
treatment of spinal injuries. Spinal motion restriction is
the limiting of spinal motion through manual spinal
stabilization.
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Scan and look for any swollen or bruised areas when you are checking a victim with suspected
head, neck or back injuries. Do not apply direct pressure on any area that is swollen, depressed
or soft. You may also find certain signals that indicate a serious injury.
These signs and symptoms may be obvious or may develop at a later time. Head, neck or back
injuries should not be taken lightly, even when the victim seems to function in a normal
manner. Regardless of the situation, it is best to alert medical professionals of head, neck, back
and injury cases.
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Try to keep the person from moving his or her lower body. This helps prevent movement that
may change the position of the head and neck causing more injury. Keeping the head in the
position where you find it helps prevent further damage to the spinal column. The way by
which you perform this technique depends upon the position in which you find the victim.
Manual stabilization can be performed while victims are lying down, sitting or standing.
DO NOT attempt to align the head and lower body. If the head is sharply turned to one side,
DO NOT move it. Support it in the position found. Place the person in a modified recovery or
H.A.IN.E.S. position if you are unable to maintain an open airway. Do this also if you have to
leave to get help.
Removal of Helmet
Helmets are worn to protect the head in the event of
impact from a fall during sports or activities involving
motorcycle use.
The helmet is a vital accessory. It decreases the severity of
head injuries, lessens the likelihood of death, and even
prevents possible medical care. They are designed to
cushion and protect riders' heads from the impact of a
crash. Helmets can’t provide total protection against
injury, but they do help minimize the occurrence of both.
The NHTSA in the U.S. estimates that motorcycle helmets
reduce the likelihood of crash fatalities by thirty seven percent.
The Motorcycle Helmet Act of 2010 requires all motorcycle riders, including drivers and
back riders in the country, to wear standard protective helmets.
There are different kinds of helmets. Sport helmets are typically open in front and offer easier
access to the airways. Motorcycle helmets are either half or full-faced and may have a face
shield for added protection. Check that this does not impede airway assessment.
First aiders should be able to quickly assess whether or not patients need to have their
helmets removed. Leave the helmet in place if the following conditions exist:
Little or no movement of the patient's head within the helmet;
Obstructions or impediments to airways and breathing are not present;
Removal would cause further injury to the patient;
Proper spinal immobilization may be performed even with the helmet in place;
There is no interference with the first aider’s ability to assess and reassess airway and
breathing.
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3. The first aider at the side of will extend the arm over victim’s head.
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6. Reposition the arms at each side of the body once the victim is now in the face-
up position.
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3. At the command, place the patient onto the board. Use the logroll and slide
technique or a proper lift to maintain in-line immobilization.
This limits patient movement to the minimum.
The best method to
use must be decided
based upon the
situation, scene and
available resources.
Pad voids between
the patient and the
board, taking care not
to make unnecessary
movements.
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Pad under the head and under the torso in the case of adult victims. Pad under the
shoulders and up to the toes in the case of infants and children in order to establish a
neutral position.
4. Use cravats to immobilize the torso.
Use cravats to immobilize the victim’s legs, thigh, hip, chest then the head to the board.
Support the head by using a blanket roll.
Can also use a commercial strap in securing the victim to the board.
5. Reassess the patient’s pulse, motor and sensory functions.
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3. Removal of Helmet
The first aider who is
stabilizing the helmet
pulls the sides of the
helmet apart and gently
slips the helmet
halfway off the
patient’s head.
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CHAPTER 9
Bones, Joints
and Muscle
Injuries
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Components
Muscles and Tendons
Muscles are made of special tissue that can contract and relax. When muscles are used, this
results in movement. Tendons are tissues that attach muscles to bones.
Bones and Ligaments
The body has over 200 bones. A Bone is a dense, hard tissue that forms the skeleton. The
skeleton makes up the framework that supports the body. Where two or more bones join,
they form a joint. Bones are usually held together at the joints by fibrous bands of tissue
called ligaments.
Types
A strain or pulled muscle is caused by the overstretching and tearing of muscles or
tendons. This usually involves muscles in the neck, back, thigh or the back of the lower leg.
A sprain is the tearing of ligaments at a joint. The joints most easily injured are the ankle,
knee, wrist and fingers.
A dislocation is the movement of a bone at a joint away from its normal position. This
movement usually is caused by a violent force tearing the ligaments that hold the bones in
place.
A fracture is a complete break, a chip or a crack in a bone. In general, fractures are not life
threatening. However, a breakage in the large bones, a severed artery, and difficulties in
breathing are dangerous signals to look out for. A fracture is either closed or open.
In a closed fracture the skin is not broken. Closed fractures are the most common
injuries. Open fractures are more dangerous than closed fractures due to its exposure to
infection. An open fracture can also cause severe bleeding.
An open fracture involves an open wound. It occurs when the end of a bone tears
through the skin. An object that goes into the skin and breaks the bone, such as a bullet,
can also cause an open fracture.
Causes
Musculoskeletal injuries may occur from several specific causes and are categorized as follows:
Direct force – A direct force is the force of an object striking the body and causing injury at
the point of impact. An example is a fist striking the chin, which can break the jaw. The
penetration of objects such as bullets or knives can injure structures beneath the skin at the
point where they penetrate.
Indirect force – Indirect force is a force that travels through the body and causes injury to
a body part away from the point of impact. An example is a fall on an outstretched hand
resulting in an injury to the shoulder or collarbone.
Twisting force – One part of the body twists while another part of the body turns. This may
force a bone or a joint beyond its normal range of motion, leading to injury.
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Splinting Rules
Splinting is a method of immobilizing an injured part to minimize movement and prevent
further injury. It should be used ONLY IF there is a need to move or transport the person to the
hospital, and only if it does not cause more pain. Leave the victim in the position found with
the injured part supported by the ground if splinting is not possible.
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CHAPTER 10
Medical
Emergencies
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Stroke
A Stroke is a disruption of blood flow to a part of the brain which may cause permanent
damage to the brain tissue. This is also called a cerebrovascular accident (CVA).
According to Philippine Health Statistics, stroke incidents killed some 61.8 per 100,000
people in the country in 2004. It is the second leading cause of mortality in the Philippines after
heart disease.
The World Health Organization estimates that 15 million people worldwide will suffer from
strokes each year while five million will die and another five million will be permanently
disabled.
Causes
Most commonly, a stroke can be caused by the following:
A blood clot, called a thrombus or embolus, that forms or lodges in the arteries that supply
blood to the brain.
Bleeding from a ruptured artery in the brain caused by a head injury, high blood pressure
or an aneurysm, which is a weak area in the wall of an artery that balloons out and can
rupture.
Fat deposits lining an artery (atherosclerosis) may also cause stroke.
Less commonly, a tumor or swelling from a head injury may compress an artery and cause
a stroke.
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Assessment
For stroke assessment, think F.A.S.T., which stands for the following:
F – Face. There is weakness, numbness or drooping on one side of the face. Ask the person
to smile. Does one side of the face droop?
A – Arm. There is weakness or numbness in one arm. Ask the person to raise both arms.
Does one arm drift downward?
S – Speech. Slurred speech or difficulty speaking. Ask the person to repeat a simple
sentence. Are the words slurred? Can the person repeat the sentence correctly?
T – Time. Try to determine when the signals first began. Time is critical if these signals
suddenly occur. Call the local emergency number right away.
Diabetic Emergencies
Diabetes is the inability of the body to change sugar (glucose) from food into energy.
The cells in your body need glucose as a source of energy. The cells receive this energy
during digestion or from stored forms of sugar. The sugar is absorbed into the bloodstream
with the help of insulin. Insulin is a hormone produced in the pancreas and is necessary for the
proper utilization of sugar by the muscles, fat and liver.
For the body to properly function, there has to be a proper balance between insulin and
sugar. Diabetes occurs when the pancreas does not adequately produce insulin. It also happens
when the body cannot properly use insulin.
Diabetes can lead to other medical conditions such as blindness, nerve disease, kidney
disease, heart disease, and stroke. In fact, it is the ninth leading cause of death in the
Philippines. According to the Department of Health, an estimated four million Filipinos are now
afflicted with the disease, and about five hundred new Filipino diabetic patients are identified
per day. If the disease is not properly managed, serious complications may arise.
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Too little sugar in the blood (hypoglycemia): The person may have taken too much insulin,
eaten too little, or has suffered from overexertion. Extremely low blood sugar levels can
quickly become life threatening.
Seizures
When the normal functions of the brain are disrupted by injury, disease, fever, poisoning or
infection, the electrical activity of the brain becomes irregular. This irregularity can cause a
loss of body control known as a seizure.
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Anaphylaxis
An allergy is caused by the over-activity of the immune system against specific antigens. An
antigen is a foreign molecule that enters the body and triggers the production of antibodies by
the immune system.
Allergies are relatively common. Yet, an emergency situation can arise in a small proportion
of people with allergies. Anaphylaxis is a severe allergic reaction that is usually life-
threatening.
Causes
The most common antigens that often cause reactions for allergic people are the following:
Bee or insect venom
Pollen
Animal dander
Latex
Certain antibiotics and drugs
Certain foods like nuts, peanuts, shellfish and dairy products
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Monitor the person’s breathing. Look for any changes in their condition.
Assist the person with the use of a prescribed epinephrine auto-injector. Give this to the
individual if available. Do this only when permitted by local and national regulations.
Give care for life-threatening emergencies.
Document any changes in the person’s condition over time.
Fainting
Fainting is a partial or complete loss of consciousness
resulting from a temporary reduction of blood flow to the
brain.
Fainting usually is a harmless self-correcting
condition. When the victim collapses, the normal
circulation to the brain resumes and the person usually
recovers quickly with no lasting effects. However, what
appears to be a simple case of fainting may also actually
be a symptom of a more serious condition.
Causes
Fainting can be triggered by:
An emotionally stressful event;
Pain;
Specific medical conditions such as heart disease;
Standing for long periods of time or overexertion.
Pregnant women and the elderly are more likely than others to faint when suddenly
changing positions. This could occur when moving from a sitting or lying position or when
standing up.
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CHAPTER 11
Environmental
Emergencies
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Exposure to extreme heat or cold can make a person seriously ill. The likelihood of illness
also depends on factors such as physical activity, type of clothing, wind flow, humidity,
working and living conditions, and a person’s age and state of mind.
Heat-related Emergencies
Heat Cramps
Heat cramps are painful involuntary muscle cramps that can occur
during and after exercise or work in a hot environment.
Causes
Heat cramps result from the loss of large amounts of salt and water
from heavy sweating through exercise or work. This commonly
happens when water in the body is restored without replacing the
lost salt or potassium.
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Heat Exhaustion
Heat exhaustion is a milder form of heat-related illness that can develop after exposure to high
temperatures. This may also be a result of inadequate fluid intake or the insufficient
replacement of fluids.
Heat Stroke
Heat stroke is a form of hyperthermia. Prolonged
exposure to high temperatures can contribute to failure
of the body’s temperature control system. Since the body
is incapable of dissipating heat in the entire system, the
body temperature goes up. Body temperatures could rise
up to 41.1 ºC (106 ºF) or even higher.
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Cold-related Emergency
Hypothermia
Hypothermia is the general cooling of the entire body. In hypothermia,
body temperature drops below 35º C. As the body cools, an abnormal
heart rhythm (ventricular fibrillation) may develop and the heart
eventually stops. The victim will die if not given prompt care.
The air temperature does not have to be below freezing for people
to develop hypothermia. Elderly people and those with medical
conditions, such as an infection, insulin reaction, stroke or a brain
tumor, are more susceptible to hypothermia.
Certain substances such as alcohol and barbiturates can also
interfere with the body’s normal response to cold. This causes
hypothermia to occur more easily. Anyone remaining in cold water or
wet clothing for a prolonged period of time may also be susceptible to
hypothermia.
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CHAPTER 12
Special
Situations
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Disasters and emergency may strike quickly and without warning. These events can be
frightening for adults, but they are traumatic for children if they don’t know what to do. During
a disaster and emergency, your family may have to leave your home and daily routine. You and
your family will probably be in a state of panic when disaster happens. It is important that you
have already prepared the things that you and your family will need to survive.
Emergency Preparedness
Emergency Evacuation Drill
A physical or mental exercise aimed at perfecting facility or skill especially by regular practice.
One good example of earthquake drill is performed by children in grade school.
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Patients who have injuries with open skull fractures and are unconscious, those with extensive
and deep burns and people with imminent cardiac arrest and major torso trauma are
examples. The dead or the dying are part of this group.
This is the order of priority for the treatment and transport of patients in a multiple casualty
situation.
Triage Types
Primary Triage
Primary triage is the initial triage done in the field. It aims to determine which patients
are prioritized for treatment.
Secondary Triage or Retriage
Secondary triage is often done at the designated treatment area to reassess all remaining
patients, to upgrade the triage category, and to decide which patients are prioritized for
evacuation.
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Emergency Childbirth
The following information is provided only for the very rare occasion when delivery occurs
unexpectedly and you cannot get medical help in time. During childbirth, the contractions of
the uterus dilate (open) the cervix and help the mother as she pushes the baby down the
vagina (birth canal) and out of the vaginal opening. Usually the baby is born head first, facing
down. After the baby is delivered, the placenta (after birth) detaches from the uterus and is
also expected.
The early stages of labor can last many hours. During this time, the cervix expands and the
baby begins to move down the birth canal. Once the mother is actively pushing out the baby,
delivery proceeds quickly.
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Aquatic Emergencies
An emergency can happen to anyone in, on or around water. Regardless of how good a person
is at swimming, anyone can get into trouble because of a sudden illness or injury. Skilled or not,
a person playing even in shallow water can be knocked down by a wave or pulled into deeper
water by a rip current. In such situations, drowning often occurs as a result.
Causes of Drowning
The major causes of drowning include the following:
Panic
Exhaustion in the water
Losing control and getting swept into water that is too
deep
Losing support (as in a sinking boat)
Getting trapped or entangled in the water
Using drugs or alcohol before getting into the water
Suffering from a medical emergency while in the water
Using poor judgment while in the water
Hypothermia
Trauma
Having a diving accident.
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An active drowning victim is vertical in the water but unable to move forward or tread
water. The victim’s arms are at the side pressing down in an instinctive attempt to keep the
head above water to breathe.
All energy is going into the
struggle to breathe, and the
victim cannot call out for help.
Such a person has only about
20 to 60 seconds before
submerging.
A passive drowning
victim is someone who is not
moving and may be floating
face down in the bottom or near the surface of the water.
Follow these general guidelines whenever you are swimming in any body of
water (pools, lakes, ponds, rivers or oceans):
Always swim with a buddy; never swim alone.
Read and obey all rules and posted signs.
Swim in areas supervised by a lifeguard.
Children or inexperienced swimmers should take extra precautions, such as wearing
approved life jackets when near bodies of water. Adults should keep an eye on children
at all times.
Watch out for the “dangerous too’s”—too tired, too cold, too far away from safety, too
much sun, too much strenuous activity.
Be knowledgeable of the water environment and the potential hazards (deep and shallow
areas, currents, depth changes, and obstructions) and know where the entry and exit
points are located.
Know how to prevent, recognize and respond to emergencies.
Use a feet-first entry when entering the water.
Enter headfirst only when the area is clearly marked for diving and has no obstructions.
DO NOT mix alcohol with swimming, diving or boating. Alcohol impairs judgment,
balance and coordination. It affects swimming and diving skills and reduces the body’s
ability to stay warm.
Emergency Actions
Near-Drowning
Make sure that the scene is safe. DO NOT rush into a dangerous situation where you too
may become a victim.
Always check first to see whether a lifeguard or other trained professional is present before
helping someone who may be having trouble in the water.
DO NOT swim out to a victim unless you have the proper training, skills and equipment.
If the appropriate safety equipment is not available and there is a chance that you cannot
safely help a person in trouble, call for help immediately.
If you must assist someone who is having trouble in the water, you must have the
appropriate equipment both for your own safety and the victim’s.
Send someone else to call the local emergency number while you start the rescue.
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Submerged Victim
If a victim is at or near the bottom of the pool in deep water, call for trained help immediately.
If the victim is in shallow water that is less than chest deep, carefully wade into the water
with some kind of flotation equipment.
Reach down and grasp the victim.
Pull the victim to the surface.
Turn the victim face-up and bring him or her to safety.
Remove the victim from the water.
Provide emergency care.
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4. The next step is to assess the hemodynamic status of the patient by checking
for bilateral radial pulses.
An absent radial pulse implies that the patient is
hypotensive and should be triaged as an immediate
priority.
If the radial pulse is present, go to the next
assessment.
5. The final assessment in the START triage is to assess the patient's neurologic
status.
This simply means assessing the patient's ability to
follow simple commands, such as "show me three
fingers."
This assessment establishes that the patient can
understand and follow commands.
A patient who is unconscious or cannot follow simple
commands is an immediate priority patient.
A patient who complies with a simple command
should be triaged in the delayed category.
If the woman is having her first child and the exposed area of the baby’s head is smaller
than 1 peso coin, proceed to the nearest hospital, if it is not more than 20 minutes away.
Encourage the woman not to bear down or strain with contractions but instead to
breathe in and out rapidly with short, panting breath.
Some Don’ts:
Don’t try to hold back the baby’s head or tell the woman to cross her legs to delay
delivery.
Don’t place your hands or fingers into the birth canal at anytime, because of the danger
of infection.
Don’t interfere by not allowing the delivery to proceed until the baby’s head has
emerged fully.
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CHAPTER 13
Lifting and
Moving
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Lifting and carrying are dynamic processes. A patient can be moved to safety in many different
ways, but no one way is best for every situation. The objective is to move a patient to safety
without causing injury to either the patient or the first aider.
Emergency Move
Is the movement of a patient to a safe place before initial assessment and care is provided,
typically because there is some potential danger. Emergency moves are usually done by one or
two people and without any equipment.
Non-emergency Move
Is the movement of a patient when both the scene and the patient are stable. Carrying devices
are often used and the procedure is not necessarily urgent.
Limitations
The manner and technique by which patients are moved and carried depends on certain
limitations that are prevalent during any given situation. Considering these limitations before
lifting or moving a patient will help the first aider decide what method is best and how to
proceed safely with the transfer. These limiting factors are:
Dangerous conditions at the scene
The size and weight of the victim
Physical ability of the first aider
Presence of other rescuers
The victim’s condition
Available carrying device
Terrain and distance to travel.
Generally, DO NOT move an injured or ill person while giving care except in
the following situations:
When faced with immediate danger such as fire, lack of oxygen, risk of explosion or a
collapsing structure. Give care only when it can be done safely.
When there is a need to get to another person who may have a more serious problem.
In this case, a person with minor injuries may be moved to reach someone needing
immediate care.
When it is necessary to give proper care. For example, if someone needs CPR, he or
she might have to be moved from a bed because CPR needs to be performed on a firm,
flat surface. If the surface or space is not adequate for giving the necessary care, the
person should be moved.
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Rescuer Distribution
To ensure that no individual suddenly bears an unexpectedly dangerous weight and to reduce
the risk of injury to the rescuers and the patient, it is important to position the rescuers
accordingly:
When a patient is in a horizontal position, between 68 and 78 percent of the patient’s
weight is in the torso. Therefore, the strongest rescuers should be positioned at the
head area of the carrying device.
However, remaining
rescuers should still
position themselves in
such a way that each
person, including the
rescuers at the patient's
head, bears an equal
amount of the patient's
weight.
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Commands
To safely lift and carry a patient, rescuers must anticipate and understand every move, with
each move being executed in a coordinated manner:
The team leader should indicate where each team member is to be located and rapidly
describe the sequence of steps that will be performed to ensure that the team knows what
is expected of it even before any lifting is initiated.
Orders that will initiate the actual lifting or moving or any significant changes in movement
should be given in two parts: a preparatory command and a command of execution. For
example, if the team leader says "All ready to lift. LIFT!" The "All ready to lift" will get the
rescuers’ attention, identify who should act, and prepare them to act, while the declarative
"LIFT!" will indicate the exact moment for execution.
Other commands may include “KNEEL!”, “STAND!”, “WALK!”, “STOP!” and “LOWER!” As
much as possible, other rescuers should acknowledge the team leader’s preparatory
command by saying “READY!”
Commands of execution should be delivered in a louder voice. Often, a countdown is helpful
when you need to lift a patient. To avoid confusion when performing a countdown, always
clarify whether "three" is to be a part of the preparatory command or whether it is to serve
as the order to execute. You can say "We're going to lift on three. One-two-THREE!" or "I'm
going to count to three and then we're going to lift. One-two-three-LIFT!”
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1. Grasp the person’s armpit or clothing behind the neck (gathering enough to
secure a firm grip).
2. Pull the person (headfirst) to safety.
3. During this move, the person’s head is cradled by clothing. It can also be
protected by the responder’s arms.
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4. The next rescuer on the opposite side slides an arm under the victim's back
and the other arm just below the victim's buttocks.
The hands should be alternated from the two sides.
5. The rescuer close to the patient’s legs at the opposite side slides his arm under
the victim's thighs and the other arm under the victim's legs below the knees.
NOTE: The rescuers with hands that are under the patient’s body should place their
hands only about halfway under the victim at this stage.
6. The command "All ready to lift!" is followed by the command "LIFT!" and the
patient is lifted to the rescuers' knees.
It is rested there while their hands are slid far enough under the victim to allow rotation
of their hands inward so that they can create two interlocking grips by holding each
other’s wrists.
7. The command "All ready to stand!" is followed by the command "STAND!" and
all carriers stand erect with the victim.
8. To lower the victim to the ground or unto a carrying device, reverse the
procedure.
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CHAPTER 14
Psychological
First Aid
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CHAPTER 14 – Psychological First Aid First Aid Reference Manual
Stress
Is a normal response to a physical or emotional
challenge and occurs when demands are out of balance
with resources for coping.
A stressor is an event or condition that triggers the
stress response.
Types of stress
Day-to-day stress
Cumulative stress
Critical stress
Causes of Stress
Stressors may be as varied as taking a test, speaking
in public, experiencing poverty, feeling loneliness, Some of the physical indicators
thinking poorly of the self, being stuck in traffic or of negative stress include:
even when winning a prize. A stressor for one person
may not be a stressor for another, although some Severe headaches
stressors, such as injury or loneliness, tend to create Sweating
stress for everyone. Lower back pain
Positive or “good” stress is productive. Good stress Weakness
is the force that produces, among other things, Sleep disturbance
enhanced thinking abilities, improved relationships Shortness of breath
with others, and a greater sense of control. It can be part of the experience of being in a play,
making a new friend, or succeeding at a difficult task. Good stress can help you perform better
and be more efficient. Stress judged as “bad’’ (distress) can result in negative responses, such
as sadness, fatigue, guilt and disease.
Most stressful situations involve harm and loss, threat or challenge. Harm and loss
situations may include the death or loss (end of
relationship) of a loved one, physical assault or physical Becoming aware of how the
injury, illness or disability, and loss of property or body reacts to stress can help in
livelihood. Threat situations, real or perceived, can be recognizing stressful situations
frightening or menacing and make it more difficult to and conditions.
deal with life. Losses can be sudden and occur without
any warning.
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CHAPTER 14 – Psychological First Aid First Aid Reference Manual
Self-care
Looking after one’s self means remaining fit to help others and to keep on doing so. Self care
techniques include:
Remembering that you may have a quite normal and unavoidable reaction.
Taking good care of one’s self by eating well, limiting the intake of alcohol and tobacco, and
exercising to relieve tension.
Remembering that it takes time to process things that have happened.
Not trying to self-medicate, and seeking professional advice if reactions are still difficult to
deal with after a few weeks.
2. Listen attentively
It is important to take time to listen carefully in order to help someone who is going through a
difficult time, listening without hurrying him or her, and showing active listening by asking
questions to clarify what the affected person is talking about. There may not be much time at
the scene of an accident, but it is still important to listen and be there for the person until the
ambulance personnel take over. For many people, interference can seem intrusive. It is,
therefore, important to maintain a balance and listen carefully without intruding.
3. Accept feelings
Keep an open mind about what is being said and accept the affected person’s interpretation of
the events. Acknowledge and respect feelings. Do not correct factual information or the
affected person’s perception of the sequence of events. Be prepared to encounter violent
outbursts of feelings. The person might even shout or reject help. It is important to be able to
see beyond the immediate facade and maintain contact in case the person needs to talk about
what has happened. At the scene of an accident this could mean moving away slightly, while
keeping an eye out for any signs that the person might need help.
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Appendix
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Appendix 1 – Basic First Aid Kit Supplies First Aid and BLS-CPR Reference Manual
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Appendix 2 – Basic Family Survival Kit First Aid and BLS-CPR Reference Manual
Survival Kit
It is a 72-hour survival kit which contains basic materials and life saving measures that can be
used whenever families have no access to basic goods because of a disaster or an emergency.
Store these in a location that’s easily accessible but safely out of reach for young children.
Remember to get the entire family involved in preparation because disaster preparedness is
everybody’s business. The following are basic contents:
Battery powered/crank radio (1pc.) – for gathering information on the updated news and
events.
Flash lights (2pcs.) – for signal purposes during night and power failures.
Whistle (1pc. per person) – for emergency signals to call attention
Pocket knife/multi-purpose tool – for cutting and opening of pack food items.
Lighter or box of matches (1pc.) – for starting fire for boiling; cooking or lighting.
Extra clothes for each member of the family – for change of clothes especially under
garments.
Dust mask – for protection against dust, dirt and bad stench.
Spare batteries – for support in times of power failure for radios & flashlights, etc.
Blankets and mats – protection from the weather. Keeps the person warm.
Trash bag – for disposal of waste materials or also can be used as rain cover.
Spon, fork, plates, cup – for food preparation.
Utility rope and cord – for tying of materials and equipment
Potable water (5gallons/bottle) – water enough for your family that can be used for
drinking and cooking. Water should be stored in a plastic sealable container.
Ready to eat food & food with long shelf life – this minimizes foods that take a long time to
prepare.
o 10 kilos of rice
o 10 cans canned goods (2 cans meatloaf, 2 cans corned beef, 6 can sardines)
o 7 pouches instant noodles
o 1 kilo sugar
o ½ kilo of salt
o 1 liter vegetable oil
o 1 pack assorted biscuits
o 1 pack candies or chocolates
Hygiene kit items
o 2 bars soap
o 5 pieces toothpaste (225 grams)
o 2 pieces sanitary napkin
o 5 pieces personal towel (14”x27”)
o 2 rolls toilet paper
o 1 pack cotton buds
o 1 bar detergent soap
First aid kit –for treatment or immediate care of injured individuals. (refer to first aid
appendix 1)
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Appendix 2 –Basic Family Survival Kit First Aid and BLS-CPR Reference Manual
Also include special items for family members, infants and elderly or physically
challenged individuals:
Diaper, toys
Extra eye glasses, contact lenses and supplies, denture needs.
Prescription medications
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Appendix 2 – Road Safety First Aid and BLS-CPRReference Manual
Road Safety deals with reducing traffic accidents. It is also about arresting
injuries sustained during those accidents.
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Appendix 2 – Road Safety First Aid and BLS-CPRReference Manual
Causes Number
Drive Error 4,222
Speeding 2,908
Overtaking 2,042
Mechanical Defects 2,003
Turning 1,543
Overloading 1,174
Self Accident 806
Road Defects 783
Hit and Run 673
Drunk Driving 94
Using Cellular Phones 47
Reference: 2003 Asian Development Bank Report
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Appendix 2 – Road Safety First Aid and BLS-CPRReference Manual
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Appendix 3 – Occupational Safety and Health First Aid and BLS-CPR Reference Manual
Occupational Safety and Health (OSH) is the promotion and maintenance of the
highest degree of physical, mental and social well-being of workers in all
occupations. It calls for the prevention of any impairment in the health and well-
being of workers caused by their working conditions or work environment. OSH
stands for the protection of workers from risks and hazards that could adversely
affect their health and well-being and for their placement in an occupational
environment adapted to his/her physiological ability. (ref: National Profile on
Occupational Safety and Health, Occupational Safety and Health Center (OSHC),
Manila, September 2006)
For the year 2009-2010, the Institute for Occupational Health and Safety
Development (IOHSAD) recorded at least 511 deaths and 791 injured in work-
related incidents in the Philippines.
(ref:http://bulatlat.com/main/2011/04/29/neglect-of-occupational-health-and-
safety-results-in-death-injuries-of-workers/) Most of these deaths and injuries can
be prevented if workplace safety is adequately promoted and rules are strictly
observed and enforced.
According to Article 156 of the Labor Code, “every employer shall keep in his
establishment such first-aid medicines and equipment as the nature and
conditions of work may require, in accordance with such regulations as the
Department of Labor and Employment shall prescribe” and that “the employer
shall take steps for the training of a sufficient number of employees in first-aid
treatment.” This ensures that trained personnel will be available and can
immediately respond when an emergency arises, and thus prevent unnecessary
deaths and disabilities due to possible neglect and delays in obtaining medical
help.
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Appendix 3 – Occupational Safety and Health First Aid and BLS-CPR Reference Manual
Article 157 further specifies that “it shall be the duty of every employer to furnish
his employees in any locality with free medical and dental attendance and
facilities consisting of … the services of a full-time registered nurse when the
number of employees exceeds fifty (50) but not more than two hundred (200)
except when the employer does not maintain hazardous workplaces, in which
case, the services of a graduate first-aider shall be provided for the protection of
workers, where no registered nurse is available.”
The Labor Code’s implementing rules and regulations define the following in the
context of OSH:
"First aid treatment" means adequate, immediate and necessary medical
and dental attention or remedy given in case of injury or sudden illness
suffered by a worker during employment, irrespective of whether or not
such injury or illness is work-connected, before more extensive medical
and/or dental treatment can be secured. It does not include continued
treatment or follow-up treatment for any injury or illness.
"First-aider" means any person trained and duly certified as qualified to
administer first aid by the Philippine National Red Cross or by any other
organization accredited by the former.
This implies that only PRC has the legal mandate in the country to train and
certify employees in first aid. Its Occupational First Aid course is designed to
provide workers with basic first aid competencies that address the need of any
and most common workplace emergencies.
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Appendix 4 – Poison Control Center First Aid and BLS-CPR Reference Manual
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