FIRST AID

By: Amandeep Kaur

Definition: It is the immediate treatment given to casualty of trauma or sudden illness in absence of medical help.

History: The bandaging of battle wounds is shown on Classical Greek pottery from circa 500 BCE, whilst the parable of the Good Samaritan includes references to binding or dressing wounds.[1] There are numerous references to first aid performed within the Roman army, with a system of first aid, supported by surgeons, field ambulances, and hospitals.[2] Roman legions had the specific role of capsarii, who were responsible for first aid such as bandaging, and are the forerunners of the modern combat medic.[3] Further examples occur through history, still mostly related to battle, with examples such as the Knights Hospitaller in the 11th century CE, providing care to pilgrims and knights in the Holy Land.[4] During the late 18th century, drowning as a cause of death was a major concern amongst the population. In 1767, a society for the preservation of life from accidents in water was started in Amsterdam, and in 1773, physician William Hawes began publicizing the power of artificial respiration as means of resuscitation of those who appeared drowned. This led to the formation, in 1774, of the Society for the Recovery of Persons Apparently Drowned, later the Royal Humane Society, who did much to promote resuscitation.[5][6] Napoleon’s surgeon, Baron Dominique -Jean Larrey, is credited with creating an ambulance corps (the ambulance volantes), which included medical assistants, tasked to administer first aid in battle. In 1859 Jean-Henri Dunant witnessed the aftermath of the Battle of Solferino, and his work led to the formation of the Red Cross, with a key stated aim of “aid to sick and wounded soldiers in the field”.[2] The Red Cross and Red Crescent are still the largest provider of first aid worldwide.[5] In 1870, Prussian military surgeon Friedrich von Esmarch introduced formalized first aid to the military, and first coined the term “erste hilfe” (translating to ‘first aid’), including training for soldiers in the Franco-Prussian War on care for wounded comrades using pre-learnt bandaging and splinting skills, and making use of the Esmarch bandage which he designed.[1] The bandage was issued as standard to the Prussian combatants, and also included aide-memoire pictures showing common uses.

In 1872, the Order of Saint John of Jerusalem in England changed its focus from hospice care, and set out to start a system of practical medical help, starting with making a grant towards the establishment of Britain’s first ambulance service. This was followed by creating its own wheeled transport litter in 1875 (the St John Ambulance), and in 1877 established the St John Ambulance Association (the forerunner of modern day St John Ambulance)” to train men and women for the benefit of the sick and wounded”.[7]

 Purpose:     

  1. To save life
  2. To prevent further injury
  3. To make medical aid available as early as possible.

Golden rules of first aid

  • Stay relaxed and check the surroundings.
  • Never put yourself or others at risk
  • Take decisions wisely; ask for advice if not sure.

Reassure the casualty and keep them warm

  • Do not move the casualty if there is risk of injury to back or neck.
  • Wash your hands before applying first aid dressings, or wear disposable gloves to prevent infection
  • Clean wounds thoroughly before applying dressings
  • Wash away foreign objects such as grit or glass
  • Do not remove embedded objects, leave that to the medical experts
  • Always use the right dressing for the injury
  • Don’t forget to replace any items you use from your first aid kit

Qualities of first aider

  1. Good observer
  2. Alert
  3. Calm and comfortable
  4. Methodological Approach
  5. Knowledgeable
  6. Soft spoken

Getting medical help

  • Unconsciousness
  • A suspected heart attack
  • Breathing problems
  • A deep wound
  • A severe burn
  • A suspected fracture or broken bone
  • A severe allergic reaction
  • A snake or animal bite
  • Poisoning
  • Severe shock
  • Any condition which turns rapidly worse

 Conditions that require first aid

  • Altitude sickness, which can begin in susceptible people at altitudes as low as 5,000 feet, can cause potentially fatal swelling of the brain or lungs.[8]
  • Anaphylaxis, a life-threatening condition in which the airway can become constricted and the patient may go in to shock. The reaction can be caused by a systemic allergic reaction to allergens such as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine.
  • Battle field first aid—this protocol refers to treating shrapnel, gunshot wounds, burns, bone fractures, etc. as seen either in the ‘traditional’ battlefield setting or in an area subject to damage by large-scale weaponry, such as a bomb
  • Bone fracture, a break in a bone initially treated by stabilizing the fracture with asplint.
  • Burns, which can result in damage to tissues and loss of body fluids through the burn site.
  • Cardiac Arrest, which will lead to death unless CPR preferably combined with an AED is started within minutes. There is often no time to wait for the emergency services to arrive as 92 percent of people suffering a sudden cardiac arrest die before reaching hospital according to the American Heart Association.
  • Choking, blockage of the airway which can quickly result in death due to lack of oxygen if the patient’s trachea is not cleared, for example by the Heimlich Maneuver.
  • Cramps in muscles due to lactic acid build up caused either by inadequate oxygenation of muscle or lack of water or salt.
  • Diving disorders,drowning or asphyxiation.[9]
  • Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.
  • Heat stroke, also known as sunstroke orhyperthermia, which tends to occur during heavy exercise in high humidity, or with inadequate water, though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the victim has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads to permanent disability. Emergency treatment involves rapid cooling of the patient.
  • Heat syncope, another stage in the same process as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from the latter by some authorities.
  • Heavy bleeding, treated by applying pressure (manually and later with a pressure bandage) to the wound site and elevating the limb if possible.
  • Hyperglycemia(diabetic coma) and Hypoglycemia (insulin shock).
  • Hypothermia, or Exposure, occurs when a person’s core body temperature falls below 33.7 °C (92.6 °F). First aid for a mildly hypothermic patient includes rewarming, which can be achieved by wrapping the affected person in a blanket, and providing warm drinks, such as soup, and high energy food, such as chocolate.[10]However, rewarming a severely hypothermic person could result in a fatal arrhythmia, an irregular heart rhythm.[11]
  • Insect and animal bites and stings.
  • Joint dislocation.
  • Poisoning, which can occur by injection, inhalation, absorption, or ingestion.
  • Seizures, or a malfunction in the electrical activity in the brain. Three types of seizures include a grand mal (which usually features convulsions as well as temporary respiratory abnormalities, change in skin complexion, etc.) and petit mal (which usually features twitching, rapid blinking, and/or fidgeting as well as altered consciousness and temporary respiratory abnormalities).
  • Muscle strains and Sprains, a temporary dislocation of a joint that immediately reduces automatically but may result in ligament damage.
  • Stroke, a temporary loss of blood supply to the brain.
  • Toothache, which can result in severe pain and loss of the tooth but is rarely life-threatening, unless over time the infection spreads into the bone of the jaw and starts osteomyelitis.
  • Wounds and bleeding, including lacerations. incisions, and abrasions, Gastrointestinal bleeding, avulsions and Sucking chest wounds, treated with an occlusive dressing to let air out but not in.

REFERENCES:      

  1. Pearn, John (1994). “The earliest days of first aid”. The British Medical Journal(309): 1718.
  2. Eastman, A Brent (1992). “Blood in Our Streets: The Status and Evolution of Trauma Care Systems”. JAMA Surgery 127 (6): 677–681.
  1. Jump up^ Efstathis, Vlas (November 1999). “A history of first aid and its role in armed forces”(PDF). ADF Health.
  2.  “First Aid: From Witchdoctors & Religious Knights to Modern Doctors”.
  3. New Scientist, Vol. 193 No. 2586 (13–19 Jan 2007), p. 50
  4.  Price, John (2014). Everyday Heroism: Victorian Constructions of the Heroic Civilian. Bloomsbury: London. p. 203. ISBN 978-1-4411066-5-0.
  5.  “Event first aid and ambulance support”. British Red Cross.
  6.  Cymerman, A; Rock, PB. “Medical Problems in High Mountain Environments. A Handbook for Medical Officers”. USARIEM-TN94-2. US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report. Longphre, John M.; Petar J. DeNoble; Richard E. Moon; Richard D. Vann; John J. Freiberger (2007). “First aid normobaric oxygen for the treatment of recreational diving injuries.”. Undersea and Hyperbaric Medicine 34 (1): 43–49. ISSN 1066-2936.OCLC 26915585. PMID 17393938.
  7.  “Everyday First Aid – Hypothermia”. British Red Cross.
  8.  Sterba, JA (1990). “Field Management of Accidental Hypothermia during Diving”. US Naval Experimental Diving Unit Technical Report. NEDU-1-90.
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