Provide An Emergency First Education and Care Setting
Provide An Emergency First Education and Care Setting
Provide An Emergency First Education and Care Setting
Thank you for choosing St John Ambulance Australia (VIC) Inc. for your First Aid training.
As Australia’s leading First Aid provider, we have developed this self-directed Pre-course Review
Pack to assist you to achieve the best possible First Aid training with St John. It is highly
recommended that you do work through this Review Pack before attending the course even if you
may have attended first aid course before.
Simply work through the Pack. It would work best if you read through the whole pack first and then
work your way through each section, answering the scenarios.
The scenarios are designed to assist you with assessing your understanding of the First Aid
principles of the section you have just reviewed. The correct answers are provided at the end of this
pack.
*This Pack is NOT a first aid text book. If you would like to refer to a reference book, you can
purchase the St John Australian First Aid textbook. Call St John on 1300 360 455.
V021213
stjohnvic.com.au
Things you should know
At the face-to-face session, the material covered in this pack will be assessed with:
Assessments conducted throughout the session through “Question and Answers” and
practical demonstrations methods.
A 45 multiple choice questionnaire, at the end of the session. You must achieve an 80%
score.
It is also important that you read the Terms and Conditions included on the First Aid Training
Confirmation letter. We recommend that you familiarise yourself especially with the training sections
highlighted below.
Training
The training offered by St John provides skills and knowledge in First Aid management but does
NOT constitute a medical qualification. St John accepts no responsibility for the subsequent actions
of participants. Training of this nature involves moderate physical activity, including kneeling and
bending. St John does not accept any responsibility for any harm suffered by you as a result of your
participation in your sessions.
If you have any special needs (including those in relation to language, literacy or numeracy), a
relevant disability or condition or any other concerns, you should raise these at the time of booking.
St John reserves the right to end your involvement in a course if you fail to follow the directions,
policies or procedures communicated to you by the trainer.
To gain your competency, you must fulfil both the following criteria:
1. You must attend all sessions and complete all assessments to a standard deemed to
be competent by your trainer. The assessment is based on interactive involvement in
all aspects of your course;
2. You are required to complete a questionnaire for which you must achieve at least 80%
accuracy.
First Aid skills are based on knowledge, training and experience. First Aid is the initial care of the ill
or injured, and usually is given by someone who is on the spot when a person becomes ill or injured.
The skills of First Aid are for all.
INFECTION CONTROL
Infection Control refers to a series of actions taken to minimise or control the spread of diseases. An
infectious disease is transmitted only by a specific kind of contact. Examples are measles, chicken
pox, and the common cold.
Good practice of Infection Control is even more important in a child care setting as children are very
susceptible to infection.
If a person in your care becomes injured or ill, you must do something, within the scope of your
training, to assist that person.
Negligence
An act of negligence may exist where it can be proven that:
A duty of care exists;
The First Aider breached their duty of care (i.e. did something that was outside the scope of
their training); and
The First Aider made the person worse as a result of their actions
A Duty of Care can be breached by either action or inaction (i.e. if you do nothing and the person
in your care gets worse).
An employer is vicariously liable for its employees’ acts “in the course of employment”.
Consent may be implied or expressed. It is implied when a person attends a First Aid room for
treatment and cooperates with the First Aider. For example, if a person attends the First Aid room,
holds their arm out and lets the First Aider apply a bandage. Consent is expressed when, for
example, the First Aider asks for permission to apply a dressing and the person verbally agrees to
treatment.
In some situations a person cannot give consent to treatment, for example when the injury or illness
has affected the ability to make an informed choice, or the person is unconscious, very young or
obviously confused. In these cases consent is not required and a qualified person may administer
any necessary treatment to save the person’s life or to prevent serious illness or injury.
If the casualty is a child, the parent/guardian should be asked for permission but if they are not
present and the injury/illness is life threatening, immediate first aid should be given. Often in an
organisation e.g. Child care centres, a pro forma consent is obtained on enrolment.
Ink
Clearly:
Casualty details - spelling, legal name
Details of the scenario
Summary of signs and symptoms
Summary of management
Summary of outcome i.e. what happened to the casualty
Signed off - usually a copy is to be provided to the casualty
If there are errors put a line through it and initial it
Storage
Confidentiality is a must when storing these reports. The only people who have access to this are
the casualty, the First Aider and in a workplace and the designated HR personnel. For any other
access, the casualty’s permission must be sought in writing.
Compliance
There are compliance requirements in various sectors. To complicate matters there can be state to
state variations as well to consider.
Under Section 183 of the Education Care Services National Regulations the following requirements
for keeping records in an education and care setting apply:
For an approved provider and family day care educator:
An incident, injury and illness record needs to be kept until the child turns 25.
A medication record must be kept until 3 years after the child’s last attendance.
Parents should be notified within 24 hours of an incident, injury or illness relating to their child.
The regulatory authority must be notified of a serious incident in an education and care
service within 24 hours.
An approved service must have a policy for managing medical conditions which sets out practices in
relation to the following:
The management of medical conditions
If a child enrolled has a specific health care need, allergy or relevant medical condition,
procedures requiring parents to provide a medical management plan
Requiring the development of a risk minimisation plan in consultation with the child’s parents
Requiring the development of a communications plan for staff members and parents.
Medical conditions that must be outlined in the service policy include asthma, diabetes, or a
diagnosis that a child is at risk of anaphylaxis.
Medication (including prescription, over-the-counter and homeopathic medications) must not be
administered to a child at a service without authorisation by a parent or person with the authority to
consent to administration of medical attention to the child.
In the case of an emergency, it is acceptable to obtain verbal consent from a parent, or a registered
medical practitioner or medical emergency services if the child’s parent cannot be contacted. In the
case of an anaphylaxis or asthma emergency, medication may be administered to a child without
authorisation. In this circumstance, the child’s parent and emergency services must be contacted as
soon as possible.
In the case of a family day care service, or a service that is permitted to have only one educator, a
second person is not required to check the dosage and witness the administration of the medication.
FOR FURTHER INFORMATION VISIT THE AUSTRALIAN EDUCATION AND CARE QUALITY
AUTHORITY
The following sections from the ‘Guide to the Education and Care Services National Law and the
Education and Care Services National Regulations 2011” cover the above topic:
Part 4.2: Children’s health and safety
Part 4.7: Leadership and service management
It should be where you start at any scenario and so it is very important that you are familiar with the
Action Plan. Your trainer will review the DRSABCD Action Plan further with you.
RESPONSE
1. Check for response by talking to the casualty (“What’s your name?”).
2. Gently squeeze the casualty’s shoulders looking for signs e.g. are there any facial
movements?
3. If there is no response to any of the above, the casualty is deemed as unconscious and you
move on to sending for help and checking that the airway is clear.
If there is a response you move on to collecting history, signs and symptoms and managing
the outcome of your investigations.
No response Response
Casualty deemed Casualty conscious
unconscious
Collect history, sign and
Send for help and check symptoms and manage the
the airway is clear outcome of your investigation
AIRWAY
Check the airway. Gently put pressure on the jaw which will open the mouth so you can look inside:
If it is clear and the casualty is lying on their back, tilt the head back (i.e.. lift the chin) and
check for breathing
If there is debris in the mouth and the casualty is lying on their back, roll the casualty into the
recovery position (see page 8), open their mouth and sweep the debris out with two of your
fingers. Then tilt the head to open the airway and check for breathing
1. Kneel beside casualty 6. Keep leg at right angle with knee touching
ground to prevent patient rolling onto their face
2. Place farther arm at right angle to the body
3. Place nearer arm across chest
4. Lift nearer leg at knee so it is fully bent upwards
BREATHING
Check for normal breathing using the “look, listen, feel” method
for at least 10 seconds. Look for consistent rise and fall of the
chest, and hear and feel consistent breaths.
Note: The position of the body, particularly the neck, contributes to the ability breathe.
For example, after a car accident and the driver, still in the seat, is slumped forward with their chin
on their chest. This will compromise the airway and their ability to breath and result in positional
asphyxia. The management is to open and clear their mouth. Then hold their chin in a “pistol” grip to
raise their chin to tilt their head, or from behind with each of your hand holding their head firmly on
both sides, tilt their head. This will open their airway.
1. Give 30 compressions
2. After 30 chest compressions, tilt head and lift chin
3. Give 2 breaths
4. Return your hands (fingers for infants) immediately to correct position on sternum.
5. Give a further 30 compressions
6. Continue compressions and breaths in a ratio of 30:2 at approximately 5 cycles in 2 minutes
until medical aid arrives
Note: If a First Aider is unwilling or unable to perform rescue breathing, compression-only CPR
will be better than not doing CPR at all.
Giving Compressions
Compressions should be performed with the casualty on a firm surface. In the case of an infant this
is best done on a table or similar surface.
1. Kneel beside casualty, one knee level with head and the other with casualty’s chest.
2. Locate lower half of sternum (breastbone) in the centre of chest.
Note: During CPR (combining chest compressions with rescue breathing), you would expect to
achieve 5 sets of 30 compressions and 2 breaths (30:2) in about 2 minutes
Breathing / respiration is achieved with the mouth/nose, trachea, lungs and diaphragm. Air enters
through the nose or mouth down the trachea (windpipe) which branches into two called bronchi, into
the lungs.
Each bronchus divides forming the bronchial tubes which in turn divide into many smaller tubes
which connect to tiny sacs called alveoli. The average adult's lungs contain about 600 million of
these spongy, air-filled sacs that are surrounded by capillaries. The inhaled oxygen passes into the
alveoli and then diffuses through the capillaries into the arterial blood. Meanwhile, the waste-rich
blood from the veins releases its carbon dioxide into the alveoli. This gaseous exchange is vital to
life. The carbon dioxide follows the same path out of the lungs when you exhale.
The process of breathing (respiration) is divided into two distinct phases, inspiration (inhalation) and
expiration (exhalation). During inspiration, the diaphragm contracts and pulls downward while the
During expiration, the diaphragm relaxes, and the volume of the thoracic cavity decreases, while the
pressure within it increases. As a result, the lungs contract and air is forced out.
The ambient air we breathe in consists of about 20.8% oxygen. The gaseous exchange uses up
about 5%. Therefore the expired air has about 15% oxygen in it. This amount of oxygen breathed
into the casualty’s lungs, combined with compressions during CPR will preserve the circulation of air
and blood around the body while waiting for medical aid to arrive.
Note: If the chest does not rise, recheck the mouth and remove any obstructions, ensure adequate
head tilt and chin lift and ensure there is an adequate seal around the mouth (or mouth/nose).
DEFIBRILLATION
What is a defibrillator?
It is a machine that can analyse the heart rhythm and decide to deliver a jolt of biphasic electricity to
stop the arrhythmia. This in turn will allow normal sinus rhythm to resume. A fully automated external
defibrillator is known as an AED and a semi- automated as an SAED but the term AED is most
commonly used.
Defibrillating a casualty
1. Follow DRSABCD
2. Establish that the casualty is unresponsive, not breathing
and not moving
3. Call Triple Zero (000) for an ambulance
— ask bystander if present
4. Commence CPR, and continue during following steps
5. Expose casualty’s chest
Note: If implant is identified, place pad at least 5 cm away from site— do not place pad on top of
pacemaker or implant site.
CHILDREN
Non- cardiac arrest causes such as drowning or suffocation are more likely to occur in children and
therefore defibrillation is unlikely to be of assistance as heart activity from such causes are unlikely.
However in case it is feasible to defibrillate, there are a number of AEDs that can be used. The
principles are the same. As almost all infants and young children who require resuscitation is in
respiratory arrest and therefore CPR should not be interrupted during the preparation for
defibrillation.
A standard AED may be used on a child eight years or older (weight over 25 kg approximately).
If the child is under 8 years old or weigh less than 25kg, use child / infant pads but do not delay to
determine exact age or weight. These pads are placed front and back of chest.
You will be required to demonstrate implementing the DRSABCD Action Plan which includes:
Management of an unconscious breathing casualty including:
The Recovery Position
Management of an unconscious non-breathing casualty including:
Performing CPR at 30 compressions to 2 breaths at 5 cycles in 2 minutes for 4
minutes with seamless changeover on an adult and infant manikin.
Application of an AED
CHAIN OF SURVIVAL
The Chain of Survival is a series of interlinked actions which when followed is the key to improving
the survival rate of casualties in cardiac and/or respiratory arrest.
It is a proven fact that the Chain of Survival can improve survival rate up to 80%.
The danger here is people jump in to rescue the drowning person and end up drowning themselves.
Once the person is out of the water CPR would most likely need to be commenced.
Note:
There is a better than 50% chance of saving an apparently drowned infant or child by giving
CPR.
Even in the case of a successful rescue the casualty still need to be assessed and monitored.
Hence the need to call Triple Zero (000).
CHOKING
A person chokes when the airway is partly or completely blocked. The person usually has trouble
breathing, but if the blockage is a complete blockage they cannot breathe at all.
The First Aid aim is therefore to dislodge the object obstructing the airway, because if this is not
done the person could die.
Causes:
The most common causes of choking are:
Eating or drinking too quickly or together
Not chewing the food sufficiently
Swallowing small bones
Swallowing small objects
The simplest way to assess the severity of an airway obstruction is to check whether a cough is
effective or ineffective.
If an effective cough is present, the casualty is encouraged to keep coughing to expel the object.
The casualty should be monitored until recovery but if deteriorating, call Triple Zero 000, ask for an
ambulance and commence CPR if necessary.
Scenario 1
You are supervising meal time. Suddenly one of the children is coughing, gagging and
wheezing.
Management
1. DRSABCD
2. Reassure the casualty
3. Call Triple Zero (000) for an ambulance
4. Raise the casualty’s legs (unless fractured or a snake bite) above the level of the heart -
place head flat on the floor
5. Treat any wound or burn and immobilise any fractures
6. Loosen any tight clothing at neck, chest and waist
7. Maintain casualty’s body warmth with a blanket or similar
(DO NOT use any source of direct heat)
8. Give small amounts of clear fluid (preferably water) frequently to the conscious casualty who
does not have abdominal trauma and unlikely to require an operation in the immediate
future. If in doubt, do not give fluid
9. Monitor and record breathing, pulse and skin colour at regular intervals
10. Place the casualty in the recovery position if there is breathing difficulty, the casualty
becomes unconscious or is likely to vomit
Scenario 2
The casualty you are managing has progressively become quieter and anxious. Their skin is now
pale and feels cold and clammy. They are also complaining of “the room is spinning” / feeling
dizzy.
External Bleeding
Management
1. DRSABCD
2. Lay casualty down if the bleeding is severe
3. Remove or cut clothing to expose the wound
4. Apply firm direct pressure or instruct casualty to do so if possible
5. If casualty is unable to apply pressure, apply pressure using a
pad or your hands (use gloves if available)
6. Raise and rest the injured part when possible
7. Apply a pad over the wound if not already in place and secure
with bandage - ensure pad remains over the wound
8. If bleeding continues, leave initial pad in place and apply a
second pad over the first and secure with a bandage
9. If bleeding continues replace second pad only
10. Seek medical aid
You will be required to demonstrate the management of a bleeding wound including that of
uncontrolled bleeding following the initial bandaging.
Scenario 3
You have just stepped into the kitchen startling the person who was chopping onions at the
kitchen sink. They cut the palm of their left hand, dropped the knife and the onions have gone
everywhere.
NOTE: The constrictive bandage must be visible at all times and must be mentioned in the
handover.
The aim of the basic wound care is to prevent infection in a minor wound. The casualty should be
advised to keep the dressing dry and to change the dressing at least once a day or if the dressing is
compromised in any way e.g. gets wet, dirty.
The casualty should also be advised of the signs and symptoms of infection including localised pain,
redness, swelling, offensive discharge, not healing. In this case they should seek medical aid.
1. 2. 3.
Create a clean area in Apply a non-adherent Tape dressing securely on all
which to work e.g. a clean dressing covering the whole sides
paper towel wound Discard sealed rubbish bag
Wash your hands and put Discard gloves into rubbish appropriately
on gloves bag
Wet the gauze swabs with
the normal saline and clean
the wound
© St John Ambulance Australia (VIC) Inc. 19
There are three separate actions in cleaning the wound:
1. With a wet gauze, wipe the furthest section of the wound from you from top to bottom once
only and discard used gauze into rubbish bag.
2. With another wet gauze, clean the middle section using the same method.
3. Then with a third gauze swab, wipe the portion nearest to you, again, using the same
method.
Embedded Object
If you need to control the bleeding, you should apply pressure to the
surrounding areas, but not actually on the foreign body.
You can do this by placing pads around the object, and securing the pads
with a bandage taking care not to put pressure on the object.
Amputations
Internal Bleeding
Severe internal bleeding usually results from injuries caused by a violent blunt force such as a car
accident or falls from a height. It can also occur when an object, such as a knife, penetrates the skin
and damages internal organs. Some conditions such as stomach ulcers can also result in internal
bleeding.
Management
1. Lay casualty down or if casualty is coughing up frothy blood half sitting will be more
comfortable
2. Raise the legs or bend the knees
3. Loosen tight clothing
4. Call Triple Zero (000) for an ambulance
5. DO NOT give the casualty anything to eat or drink
6. Reassure the casualty, manage shock
CRUSH INJURIES
A crush injury results when something large and heavy strikes or falls on a person. The damages
that these injuries may cause include internal bleeding, fractures, rupture of internal organs and
impair blood supply and therefore are potentially life-threatening.
Management
1. Follow DRSABCD. Ensure your OWN safety. If safe and able to do so, remove the crushing
object as soon as possible
2. Call Triple Zero (000) for an ambulance
3. Control bleeding then mange other injuries
Factors triggering an asthma episode may include exercise, respiratory infections, allergies (to
pollen, foods, bee stings etc.), exposure to sudden changes in weather conditions especially cold
air, anxiety, smoke. Although asthma is treatable and usually can be managed, there is no known
cure. There are two types of medication – relievers and preventers.
Relievers reduce the muscle spasm and open the narrowed airways. Common brands are Ventolin,
Asmol, and Bricanyl. This is the medication First Aiders are likely to assist the casualty to self -
administer in an asthma attack OR in Victoria; State regulation permits the administration of the
reliever medication. It also permits the use of another person’s reliever or one from the First Aid kit.
Ventolin puffers can also be purchased without a prescription in Victoria. In an acute asthma attack,
the reliever is best administered with a spacer.
Preventers reduce the inflammation in the airways and reduce symptoms and exacerbations.
Examples are Pulmicort and Flixotide.
There are also combination medications like Seretide and Symbicort which is a preventer plus a
symptom controller.
Management
1. Follow DRSABCD
2. Assist the casualty, if conscious, into a comfortable position - usually sitting upright.
3. Be reassuring and ensure adequate fresh air
4. Assist with prompt administration of medication - give 4 puffs of a reliever inhaler (puffer) with
breaths in between puffs. Stop for 4 minutes
5. If no improvement after 4 minutes, give another 4 puffs with 4 breaths in between puffs
6. If still no improvement, call Triple Zero (000) for an ambulance
7. Keep giving 4 puffs with 4 breaths in between puffs, and 4 minutes breaks until the
ambulance arrives (For adults with severe asthma attack, you may give up to 6-8 puffs every
5 minutes)
8. If the casualty becomes unconscious, follow DRSABCD
Scenario 5
It is a hot, windy and dusty day. One of the children in the playground is wheezing and having
breathing difficulties. The child is a known to have asthma.
Anaphylaxis
Anaphylaxis is potentially life threatening and therefore needs urgent management and medical
attention. The First Aid management is the administration of a bolus dose of adrenaline. This is
usually given with an auto-adrenaline device which is a predosed, one use only device which can be
administer by a lay person.
There are two brands of adrenaline auto injector (AAI) currently in Australia – EpiPen and Anapen.
Each has two doses – an adult dose and a junior dose. The junior dose is usually prescribed for a
child less than 20kg.
Scenario 6
During lunch a child’s eyes are puffy and a rash is appearing on their skin. Apparently the child
had a taste of someone else’ sandwich. This child has an anaphylactic history with peanuts.
1. ANAPEN
Used/Fired Anapens:
Pull off black needle shield. Pull off grey safety cap from
red button.
Remove EpiPen©.
Push down hard until a
Massage injection site for
click is heard or felt and
10 seconds.
hold it in place for 10
seconds.
You will be required to demonstrate the administration of an AAI.
The damaged heart muscle may initiate an uncontrolled disorganised rhythm that may stop the heart
beating effectively. This is the most common cause of a Sudden Cardiac Arrest. This could occur
within minutes of the first symptoms of a heart attack.
So, the First Aider must act quickly and call Triple Zero (000) for an ambulance immediately.
If the casualty has chest pain or discomfort similar to angina, but is not relieved by medication and
rest, the First Aider should manage the casualty as having a heart attack
There are two types of diabetic emergencies – very high blood sugar and very low blood sugar.
The more common and immediately dangerous emergency is hypoglycaemia. It can develop quickly
and some people may not be aware of the early signs. Commonly caused by a missed or delayed
meal after diabetic medication but could be due to too much medication and not enough food or
incorrect type of food or unaccustomed exercise. Alcohol consumption increases the likelihood of a
“hypo”.
Management
1. Low blood sugar: Give sugar, glucose or a sweet drink (e.g. soft drink, but NOT ‘diet’ soft
drinks). Continue giving sweet drinks every 15 minutes until the casualty recovers. Follow up
with a sandwich or other food. If no improvement call Triple Zero (000) for an ambulance
2. High blood sugar: The casualty may need assistance to check their sugar level and to self-
administer insulin. DO NOT administer it yourself. Seek medical aid if required. If help is
delayed, encourage the casualty to drink sugar-free clear fluids
If unsure whether it is high or low blood sugar scenario, give the casualty a sugar drink.
Note: If the casualty is unconscious:
Follow DRSABCD, GIVE NOTHING BY MOUTH
Ensure Triple Zero (000) is called and an ambulance is on its way
Scenario 8
Just before Morning Tea time, bright, bubbly, chatty Betty was seen to be behaving very
aggressively and seemed to be unco-ordinated, fighting with her best friend.
Scenario 9
You are at a meeting when you suddenly realise the speaker’s speech is slurring and not within the
context of the meeting. The speaker also seems to be losing their balance and appears confused.
Seizures are the result of sudden, usually brief, excessive electrical discharges in a group of brain
cells involving part or the whole brain. Therefore the signs and symptoms vary. Transient symptoms
can occur, such as loss of awareness or consciousness and disturbances of movement, sensation
(vision, hearing and taste), mood or mental function and behaviour.
Not all seizures are epilepsy. Some seizures can be caused by head injury, high fever, brain tumour,
poisoning (including drug overdose), serious infections or severe impairment of oxygen or blood to
the brain.
Epileptic seizures
Epileptic seizures are caused by a disturbance of the brain. They can be a result of chemical
imbalance, a previous injury or an unknown cause. This section is concerned with convulsive type
seizures caused by epilepsy, which can affect people of any age. These can last from 1 to 3
minutes.
Management
During seizure
• DO NOT try to restrain the person
• DO NOT put anything in the mouth
• Protect person from obvious injury
• Place something under head and shoulders
After seizure
1. Follow DRSABCD
2. Place in the recovery position
3. Manage all injuries
4. DO NOT disturb if the casualty falls asleep but continue to check airway and breathing
5. Seek medical aid if the casualty does not recover
Seek medical aid if seizure continues for more than 5 minutes, another seizure quickly follows, the
casualty has been injured, there is no history of epilepsy, there is a history of a head injury, or when
in doubt.
Scenario 10
You are at a party where strobe lights are flashing. One of the dancers falls to the ground and is
exhibiting jerky movements and frothing at the mouth.
What are some of the actions you can carry out to help the casualty?
A. Nothing as you do not know the casualty;
B. Make it safe for the casualty to have their seizure;
C. Call Triple Zero (000) for an ambulance immediately and leave;
D. Call the casualty’s family to come and manage the casualty.
Note: DO NOT cool the child by sponging or bathing but remove excess clothing or wrapping.
Scenario 11
You are cuddling a toddler who has a fever. The child suddenly begins to convulse.
HYPERVENTILATION
Hyperventilation is a result of involuntary over-breathing due to excitement, hysteria, stress or other
emotion.
Management
1. Follow DRSABCD
2. Calm casualty - remove to a quiet, private place
3. Encourage slow, regular breathing - slowly count
breaths aloud
4. Seek medical aid
A person experiencing this effect will feel dizzy and may lose consciousness for a brief period of
time. People usually faint from a standing position and injuries may result.
Management
1. Lay the casualty down with legs raised, with the head and body flat
2. Ensure plenty of fresh air
3. Loosen tight clothing such as belts or ties
4. Check for injury or illness
5. After recovery, let the casualty rest for some minutes before moving
Note: DO NOT sit the casualty down on a chair with their head between their knees.
Scenario 12
A friend is complaining they are feeling dizzy and seeing stars.
FRACTURES
A fracture is a break in the continuity of bone and is defined according to the type and extent.
Fractures can be caused by either direct or indirect force. Other indirect fractures can occur when a
muscle pulls violently on a bone, separating a fragment.
Complications
Any fracture can be complicated by injury to adjoining muscles, blood vessels, nerves and organs.
Fractures of large bones usually result in considerable blood loss and shock.
Management
1. Apply the DRSABCD action plan
2. Assist casualty to remain as still as possible
3. Control any bleeding and cover any wounds
4. Observe casualty carefully
5. Manage shock
6. Seek medical aid
Note: NO attempt should be made to force the fracture back into place.
So for example packaging cardboard, newspaper, magazines can be used. It should be neatly
folded so that it does not unravel or catch anywhere. The procedure is usually finished off by
supporting the splinted limb with a full arm sling.
Method:
1. Place the forearm length wise on the improvised splint with the fingers wrapped over the
edge of the splint and so the splint protrudes slightly beyond the elbow
2. Firmly apply a narrow bandage before and beyond the fracture site, try not to pull or jerk
3. The procedure is usually finished off by supporting the splinted limb with a full arm sling
You will be required to demonstrate splinting of a forearm fracture and the application of a
full arm sling.
Scenario 13
A young child has fallen off their bicycle. They landed on their right lower arm. It is now painful
and has a slight swelling.
Management
Follow DRSABCD and apply RICE:
If the application of the ice pack does not help, seek medical aid.
Scenario 14
A group of children is playing football when one of them rolled their ankle.
When a casualty has a serious head injury, the neck or spine may also be injured.
The skull gives the head its shape and protects the brain. The skull may be fractured by either a
direct force (a blow to the head) or indirect force such as a fall from a height and landing heavily on
their feet. Severe injuries may cause multiple cracking (an ‘eggshell’ fracture) which may extend to
the base of the skull.
Concussion is an altered state of consciousness, usually caused by a blow to the head or neck. The
casualty may become unconscious but this is often momentary.
Compression is excess pressure on part of the brain. It may be caused by a depressed skull fracture
where the broken bones put pressure on or directly damage the brain, or by a build-up of blood
inside the skull. If a blow to the head causes bleeding in the brain or on the surface of the brain and
the blood cannot drain from the closed space, it builds up and puts pressure on the brain.
This is life-threatening.
• Headache
• Loss of memory, particularly of the event
• Confusion
• Altered or abnormal responses to commands and touch
• Wounds to the scalp or to face
• Nausea or vomiting
• Dizziness
Management
1. Follow DRSABCD
2. If casualty is conscious:
• Place casualty in a comfortable position with head and shoulders slightly raised
3. If casualty is unconscious:
• Place in recovery position
• Clear and open airway
• Monitor breathing
4. Support casualty’s head and neck during any movement; avoid twisting movement
5. Keep casualty’s airway open with a chin lift
The spine is a flexible column with the spinal column housing the spinal cord. The spinal cord is
encased entirely within the spine, surrounded by the cerebrospinal fluid which cushions the spinal
cord against the stresses of movement. Injuries to the spine may impact on the spinal cord which
can result in complete and permanent loss of feeling and paralysis below the point of injury. The
casualty may become a paraplegic or a quadriplegic.
Causes of spinal injuries include falls from a height, a direct blow to the spine, diving or surfing
accidents, high speed car/motorcycle accidents or sudden acceleration or deceleration (such a
whiplash).
Management
1. Immobilising the spine is the priority for any casualty with a suspected spinal injury
2. Support the head and neck in a neutral position by placing your hands on either side of the
casualty’s head
3. If the casualty is unconscious, the airway must be kept open
4. Calling Triple Zero (000) is urgent
5. DO NOT move the casualty unless you have to
Scenario 15
At your child care centre, a child fell off the monkey bar and hit their head on the frame of the
set - up 10 minutes ago. The child has a “lump and bump” on their forehead There are no other
visible injuries.
General rules:
Start with DRSABCD
Do not put pressure on the eye i.e. if applying cover, it should be loose.
Only cover the injured eye
Advice the casualty not to rub their eye, try not to blink hard, move their eyeball. Ask casualty
not to move eyes by e.g. focusing on an object directly in front of them
Nosebleeds
There are various causes of nosebleeds ranging from trauma to simple excessive blowing to no
obvious causes.
Management
1. Ask the casualty to breathe through mouth and not to blow nose
2. Sit the casualty up, head slightly forward
3. Apply pressure by pinching the soft part of the nostril (below the bridge) together for at least
10 minutes
4. Loosen tight clothing around neck
5. Place cold wet towels around neck
6. If bleeding persists seek medical aid.
Management
1. Look in the ear to identify the object
2. Do not attempt to remove the object
3. Seel medical aid
Management
1. Follow DRSABCD
2. Place casualty in a sitting position with affected side down
3. Cover the wound – use the casualty’s or your own hand to stop air flowing in and out of chest
cavity
4. Cover wound with a dressing such as plastic sheet or bag or aluminium foil. If not available,
use a sterile dressing or pad
5. Seal with tape on three sides (not bottom)
6. Call Triple Zero (000) for an ambulance
Scenario 16
A child has had a sharp exposed branch puncture their chest when they fell hard into a bush.
When the child exhales you can see blood stained bubbles around the wound and on inhalation
a sound of air being sucked in is heard.
Management
1. Follow DRSABCD
2. Place casualty on back with knees slightly raised and supported (a pillow may be used under
the head to increase comfort)
3. Loosen clothing
4. Cover protruding organs with aluminium foil or plastic food wrap, or a large, non-stick sterile
dressing, soaked in sterile saline (clean water if saline is not available)
5. Secure with broad bandage (not tightly)
6. Call Triple Zero (000) for an ambulance
Scenario 17
A child has managed to eviscerate themselves and their intestine is protruding from their
abdomen.
What First Aid action would you take in managing the injury?
A. Apply the DRSABCD Action Plan and decide it is too dangerous to approach so just wait
for the arrival of an ambulance;
B. Immediately apply firm pressure with your bare hands to push the intestines back into the
abdomen;
C. Apply the DRSABCD Action Plan and include covering the protruding organs with plastic
food wrap soaked in clean water;
D. Leave the child where they are and after calling Triple Zero (000) get the other children out
of the way.
Although there is no bleeding, burn injuries result in fluid loss, loss of temperature control and
damage of varying degrees of underlying layers of tissue and nerves. Damage may include the
respiratory system and eyes. The probability of the casualty going into shock is very high. Besides
the obvious physical damage, burns also cause psychological damage as they can disfigure and
disable resulting in an altered body image.
General Management
1. Follow DRSABCD
2. Remove the source of the burn
3. Cool the burnt area with cool running water
4. Cover burn for example with a non-adhesive burns dressing, or
plastic food wrap
5. Manage shock
The purpose of the cool running water is to return the burnt area to
normal temperature. It can take up to 20 minutes. With bitumen burns
continue the cooling for 30 minutes but no longer.
Clothing, jewellery and rings may be removed unless stuck. If a person’s clothing is on fire, manage
by applying the action of STOP-DROP-ROLL.
General management
1. DRSABCD
2. Call Triple Zero (000) for an ambulance
3. Call fire services if atmosphere is contaminated with smoke or gas
4. With a conscious casualty - listen to history and give reassurance
5. Call Poisons Information Centre 13 11 26
Note: DO NOT try to induce vomiting, but if the casualty does vomit, you
should send as much of the vomit as possible to the hospital with them.
• Wash corrosive substance off mouth and face with water or wipe it off
• With inhaled poisons - move casualty to fresh air if possible
Scenario 19
A child tells you that the lemonade in the kitchen tastes awful. The child is not showing any
signs or symptoms of poisoning.
Management
Pressure Apply ice pack or
Immobilisation cold pack Hot Fluid Vinegar
Bee
Snakes Box Jellyfish
Wasp Stonefish
Funnel Web & Mouse Irukandji Jellyfish
Centipedes Bullrout
Spiders
Scorpions Stingray
Blue Ring Octopus
Red-Back Spider Bluebottle
Cone Shell
Ant & Tick
Remove sting Apply ice Apply ice pack Apply ice pack Remove whole Apply ice pack Apply pressure
– scrape pack or cold or cold pack. or cold pack. tick using fine or cold pack. immobilisation
sideways side pack. tip forceps. bandage.
of a sharp Apply ice pack Apply ice pack
object. Apply or cold pack. or cold pack.
ice/cold pack
Snakes
The venom travels in the lymphatic system of the body. Applying a
pressure immobilisation bandage reduces the speed of the
circulation. Commence the applicationwith a non-adhesive dressing to
the site of the bite and bandage firmly with a crepe badage (refer to
how to apply a pressure immobilisation bandage below).
Apply hot Flood the Apply hot Apply hot fluid. Apply hot Apply pressure Flood the Apply pressure
fluid. entire stung fluid. fluid. immobilisation. entire stung immobilisation.
area with area with
vinegar for vinegar for at
at least 30 least 30
seconds. seconds.
Scenario 20
You will be required to demonstrate the application of a pressure immobilisation bandage
You are on a bush walking excursion with a group of children. One of the accompanying adults
called out that they have been bitten by a snake.
Heat cramps - Result from losing too much water and salt through sweating causing painful muscle
cramps, usually in legs and abdomen.
Heat exhaustion - Results from being physically active in a hot environment without taking the right
precautions.
Heat stroke – A potentially life threatening condition. Water levels in the body become so low that
sweating stops and body temperature rises because the body can no longer cool itself.
Management
The basic principle of managing exposure to heat is immediate cooling. However, you must take
care to ensure that the casualty is not over cooled.
General management
• DRSABCD
• Move the casualty to a cool environment
• Give fluids to drink in small amounts
Which of the following actions would you take in managing the casualty?
A. Call Triple Zero (000) for an ambulance and wait with the casualty;
B. Give the runner a bottle of water to drink and tell them to continue the run;
C. Lie the casualty down in the shade, give fluids and sponge with cold water;
D. Massage the casualty’s limbs for 15 minutes and make them drink 2 litres of water.
EXPOSURE TO COLD
To conserve body heat, blood vessels in the skin shut down to prevent the body’s core heat
escaping. Wind and skin wetness increases the effects of cold air.
The body loses heat by radiation especially from the head, evaporation, breathing, conduction and
convection. Certain groups of people are particularly prone to cold-induced conditions. These
include the elderly, babies and young children, and anybody weakened by disease/illness,
starvation, fatigue, injury etc.
Management
Hypothermia occurs when the body’s warming mechanisms fail, or is overwhelmed, and the body
temperature drops below 35°C.
The aim is to stabilise core temperature rather than attempt rapid rewarming:
1. DRSABCD
2. Move the casualty to a warm, dry place
3. Protect casualty from wind, rain, sleet, cold and wet ground
4. Handle gently, avoid activity or movement
5. Remove wet clothing
6. Wrap casualty in blanket
7. Cover head to maintain body heat
8. Give casualty warm drinks if conscious
Note: Add hot water bottles or heat packs to casualty’s neck, armpits and groin if managing
hypothermia
9. Call Triple Zero (000) for an ambulance if hypothermia is severe and when in doubt
FROSTBITE
Frostbite occurs when the skin and underlying tissues become frozen
as a result of exposure to below zero temperatures.
Management
1. DRSABCD
2. Move the casualty to a warm, dry place and prevent further heat loss
3. Rewarm the frostbitten part with body heat (e.g. place frostbitten fingers in armpit)
4. Handle the frozen tissue very gently to prevent further tissue damage
5. Call Triple Zero (000) for an ambulance
6. If possible remove any jewellery
Scenario 22
In a group of bushwalkers you notice that one of them does not have rain protection. The person
is staggering, has slurred speech, is shivering and complains of feeling cold.
First Aid, like all other skills that are practical by nature, needs the necessary tools to be effective. In
First Aid, the tools include:
1. You booking into a course! Training is the first stage in achieving the skills and knowledge
2. Having the right equipment i.e. a First Aid kit to suit your needs in the workplace, in your home
and in your car. How about other aspects of your life e.g. your sports club?
A centre-based service must provide an appropriate number of suitable first aid kits that are easily
recognisable and readily accessible to adults.
A family day care educator must provide a suitable first aid kit at the residence or family day care
venue that is easily recognisable and readily accessible to adults.
First aid kits should also be taken when leaving the service premises for excursions, routine outings
or emergency evacuations.
Improvising
There may be occasions where you need to give First Aid but there is no First Aid kit available.
If a kit is not available, you will need to improvise First Aid equipment, by using whatever you can
find but, sort out the pros and cons of using the item before applying it.
For example, using a plastic bag for gloves, and a folded face cloth wrapped in cling wrap as a non-
adhesive pad are feasible and has positive outcomes. But using a plastic bag as a mask is not, as
there is no substitute for a face mask.
However, you should not let the absence of a First Aid kit prevent you from offering First Aid to a
casualty.
_____________________________________________________________________________
Scenario Answers
1. D 9. A 17. C
2. C 10. B 18. A
3. D 11. A 19. D
4. B 12. D 20. A
5. B 13. B 21. C
6. D 14. C 22. D
7. B 15. A
8. C 16. B
CONGRATULATIONS
You have completed the self-directed pre-course learning pack.
Again, thank you for choosing St John. We look forward to seeing you at the course.
References:
Many businesses believe they are First Aid READY for a First Aid emergency
BUT this is not necessarily the case.
First Aid When did your workplace last undertake a First Aid
Assessment?
Ready Is your organisation a high or low risk workplace?
Assessment Do you have workplaces that are remote or where access to
emergency services is limited?
When your First Aiders are away from the workplace - sick, at
lunch or on leave, who’s looking after you?
Enough Do all First Aiders in your workplace have current First Aid
qualifications and up-to-date skills obtained in the last 12
Trained
months?
First Aiders Does everyone know who the First Aiders are in your
workplace?
Accessible, Does your workplace have visible First Aid Kits and Signage?
How often is your First Aid Equipment checked so it is ready for
visible a First Aid emergency?
First Aid Does your workplace require a First Aid Room and/or
Equipment Equipment?