The ABC's of First Aid

The main aim of the first responder is to preserve and protect life, minimize the effects of injury, and call for medical help if needed. In order to do this the first-aider must be well prepared to react in the proper manner in a variety of situations. The primary requirement of a first responder is to assess the extent of the injury to the person as much as possible and respond immediately. The first responder should be well aware of their limitations, and if there is any question about the nature of an injury, call the emergency services immediately. In a severe injury the first responder should take charge, secure the scene, administer first aid, and call for medical assistance. Information about the person being aided should be gathered from relatives or bystanders, as well as by what you are able to observe from the accident scene. If the victim is conscious he or she should be questioned about what has happened and a quick assessment of the patient's condition should be made.

  The four most life threatening conditions are blocked air passages, respiratory arrest, circulatory failure, and bleeding. Death can take place in a few minutes in any one of the conditions so the first assessment should concentrate of these factors. The first thing to note is if the patient is conscious or unconscious by checking his or her responsiveness. The ABC's of first aid are checking the AIRWAYS, BREATHING, AND CIRCULATION. The assessment is done by making sure the airways are open and checking the breathing and the heart beat. If the victim is found crumpled up or laying face down, the first responder must turn the patient over. First check to see if there are any major broken bones or severe spinal injuries. Do not move a person with a spinal injury unless absolutely necessary. When rolling a victim over the greatest care must be taken in order not to injure the patient further.

Positioning the patient

1. Roll the victim over as a unit so that the head, neck, shoulders, and torso move together. Kneel next to the victim and raise the arm nearest the rescuer above the victim's head.

2. The rescuer's upper hand should be uses to stabilize the head and neck and prevent them from twisting.

3. The first-aider's other hand should be used to reach under the arm farthest away. This contact point will be used as the point where the rescuer pulls in order to roll over the body.

4. Carefully pull under the arm and guide the rotation of the hips and torso with a minimum of twisting. Be sure to keep the neck in line with the rest of the body. Turn the victim over flat on his or her back.

  Now that the victim is flat on his or her back, the first thing to do is clear and open the air passages of any mucus, blood, or other materials. If an unconscious person is lying on their back, the tongue is apt to fall against the back of the throat and block the air passages. Position the person on his or her back on a firm surface and use the head tilt/chin lift method.

Airways (A) -The head tilt/chin lift method

  If there are no neck injuries, tilt the head backward by placing one hand on the victim's forehead and the fingers of the other hand under the bony part of the chin. This will elevate the tongue thereby removing it from the back of the throat. The head of an infant or young child should not be tilted back too far as it may close off the airway. If there is a suspected neck injury do not tilt the person's head backwards. Use the modified jaw thrust instead. Place the victim on his or her back, kneel at the top of the victim's head, resting on your elbows. Reach forward and gently place one hand on each side of the chin, at the angle of the jaw and push forward with the index fingers to extend the jaw forward. Do not tilt or rotate the victim's neck or head. Opening the airways will sometime be all that is necessary to restore normal breathing patterns. Open the mouth and quickly clear the mouth and airways of foreign material with your fingers.

Breathing (B) - artificial respiration

  The first thing to do when a person is unconscious is to establish their responsiveness by tapping them on the shoulder and asking "Are you all right?". Immediately try to find out if they have a serious back injury, and if not, lay them on their back and use the head tilt/chin lift method to open the airways. Open the mouth and remove any foreign material or objects with your finger. Note what you have removed as it may give you clues to the cause of the problem. Is there any blood, vomit, foreign bodies, food, water, etc., in their mouth and throat? Assess the victim's breathing by LOOKING for the chest to rise and fall, LISTENING for the exhalation of the breath, and FEELING for the flow of air. If there is no chest movement, sound, or feeling of the breath moving in and out, the patient is not breathing.

Mouth-to-Mouth Resuscitation

  The best method of artificial respiration is mouth-to-mouth resuscitation. Time is of prime importantance as the percentage of those who recover drops rapidly with time. 98% of those who are given artificial respiration in the first minute survive, whereas only 50% recover after 4 minutes. After 5 minutes only 25% recover and after 10 minutes only 1% survive.

1. First open the airways as the most common cause of asphyxia in the unconscious patient is the tongue blocking the air passages. Kneel at the victim's side near the head opposite to the shoulders and use the head tilt/ chin lift to open the airways, clear the mouth and throat, and begin mouth-to-mouth resuscitation.

2. With the hand that is placed on the victim's forehead pinch the victim's nose using your thumb and index finger.

3. Open your mouth and take a deep breath and get ready to blow.

4. Place your open mouth tightly over the victim's mouth and give the patient two full breaths that last around 1 to 1 and 1/2 seconds. After each breath remove your mouth, take a deep breath, and watch to see if the chest is moving. If the victim is an infant place your mouth over the nose and mouth of the child and give a softer breath than you would in an adult. If the victim's mouth can not be used due to injury place your mouth over the nose.

5. After giving these two breaths check the pulse at the carotid artery on the neck. Keep your upper hand on the victim's forehead to keep the airways open while you use your lower hand to locate the pulse at the neck. Place your fingertips on the victim's wind pipe then slide them toward yourself until you reach the groove in the neck between the wind pipe and the neck muscles. Press down gently on this area to check the pulse for at least five seconds but no more than 10 seconds. If you feel the victim's pulse, continue to give artificial respiration once every 5 seconds (12 times a minute) in an adult. If there is no pulse begin cardiopulmonary resuscitation immediately (Refer CPR).

6. When you blow into the victim's mouth you should feel a moderate, giving resistance. If you feel a strong resistance check the patient's chest to see if it is moving. If it is not, the airways are blocked. Place your hands under the victim's chin and thrust the jaw farther out. If this does not work check the person's mouth and throat for foreign objects again. If nothing can be removed the victim may have a foreign object in the throat and be choking. Use the "Heimlich maneuver" to try and force the object from the air passages (refer to choking). Once the throat is free from obstructions resume mouth-to-mouth resuscitation.

7. Give an adult approximately 12 breaths a minute, a child around 15 breaths a minute, and an infant around 20 breaths a minute. The quantity of air is important so make sure you work rhythmically and give full breaths to the victim. Do not make yourself breathless by becoming over excited or blowing too rapidly.

8. Continue to give artificial respiration until the patient can breathe on their own. Once their breath is stable, place them in the recovery position . If they do not respond on their own continue mouth-to-mouth resuscitation until help arrives.

9. If a drowning victim's stomach is bloated with swallowed water, place them on their stomach with their head turned to the side. Place both hands under the stomach and lift upward. This will drain the water out. After 10 seconds if there is no water draining out resume artificial respiration. Do not take more then 10 seconds as the first priority is to maintain the victim's breathing.

Circulation (C) - Cardiopulmonary Resuscitation (CPR)

  CPR is a technique that uses mouth-to-mouth resuscitation combined with external heart compression done by rhythmic pressure on the breastbone. This technique is best done by individuals who have been trained in its application. Courses in CPR are available with the American Heart Foundation and the American Red Cross. Take one! The American Medical Association (AMA) suggests, however, that the instructions given in a first aid book should be applied in emergency situations as it is a question of survival for the victim. The information given below is merely a study guide, and should not be used to replace a first aid manual, or treatment by medically trained personnel. The reader should refer to complete first aid books on the subject.

  Sudden death is the immediate cessation of the respiration and the heartbeat. This can happen for a variety of causes including heart attack, asphyxiation, drowning, stroke, choking, electric shock, allergenic reactions, or severe injuries, etc.. A person is clinically dead once the heart stops beating but there is a 4 to 6 minute grace period where the victim can be resuscitated without brain damage and other complications. Most victims will not survive after 6 minutes so time is of the essence in such a situation. Nevertheless, it is important to continue CPR after 6 minutes until help arrives.

1. If the victim is laying face down or crumpled up use the proper method of rolling the patient over (refer to positioning the patient). Place the victim carefully on his or her back on a firm, flat surface and raise the legs slightly, if possible. Use the head tilt/chin lift technique (or the modified jaw thrust if there is any chance of a spinal injury) to open the airways. Clear the mouth of any obstructing material with your fingers, if necessary. Look, listen and feel for the flow of air in and out of the lungs. If the victim is not breathing give them 2 breaths of mouth-to-mouth respiration and then check the victim's heartbeat at the neck. Take no more than 10 seconds to check the pulse. If there is no heartbeat, begin CPR immediately, and send someone to call the emergency services. If there is no one present, begin CPR and call emergency services after you have reestablished the breathing and heartbeat.

2. Give the patient a sharp thump to the chest about 1/2 way down the breastbone and slightly to the left over the heart. This will sometimes start the heart beating again. If the heart begins to beat, follow this maneuver with 6 to 10 breaths by mouth-to-mouth resuscitation and the victim should regain his or her color. If not, locate the bottom of the person's rib cage with the index and middle fingers of the hand closest to the patient's feet. Locate the xiphoid process and the notch where the ribs meet the sternum by running your index finger upward. Place your middle finger in the notch and the index finger on the sternum.

3. Place the heel of the other hand (the one closest the victim's head) above the index finger on the patient's sternum. Keep the fingers on the chest by interlocking them. Keep your arms in a straight line and your elbows locked. Position your shoulders directly over your hands so that the pressure is exerted straight downward.

4. Press straight downward on the chest for about 1 & 1/2 to 2 inches. This should squeeze the heart between the sternum and the spine forcing the blood into circulation.

5. Release the pressure in order to allow the heart to completely refill with blood. Keep the heel of your hand in contact with the victim's chest at all times. Make the movements up and down in a smooth and rhythmic fashion so that compressions can pump the blood throughout the body.

6. Perform 15 cardiac compression at a rate of approximately 80 to 100 a minute. Count out loud "one and, two and, three and"....... up to fifteen.

7. Then use the head/tilt chin/lift technique and give two full breaths of mouth-to-mouth resuscitation to the victim. This completes one cycle of CPR..

8. After the fourth cycle, recheck the carotid pulse in the neck for a heartbeat. Take only 5 to 10 seconds to do this maneuver. If the heartbeat has not begun to beat continue CPR. Stop and check for a heartbeat every few minutes. Never interrupt CPR for more than 5 seconds unless you are checking the pulse or moving a victim.

  In a child between the ages of one and eight do not press downward more than 1 and 1 & 1/2 inches. Give the child one breath after every five compressions. Check an infant's pulse at the brachial artery, located on the inside of the upper arm between the elbow and shoulder. If the victim is an infant place the index finger just under an imaginary line between the nipples and place the middle and ring fingers on the center of the chest. Do not extend an infant's head too far back as this may close the airways. Compress no more than 1/2 to 1 inches downward. Give an infant 100 compressions a minute and one breath of mouth-to-mouth resuscitation every five compressions. Keep giving CPR until help arrives.

The Recovery Position

  Anytime a victim is drowsy, stuporous, or in a coma there is a need to place them in the recovery position. When they are drowsy they can be easily roused but again fall in and out of consciousness. In stupor a person responds only to pain or other strong stimulation. Coma is when the victim is completely unconscious and does not respond at all. There is always a danger that such persons will choke on their own discharges or from their tongue blocking their airways. The recovery position is designed so that the patient is comfortable, the airways are open, and discharges such as vomit can drain out easily. The patient is laid on their side with the body slightly rotated toward the front. The face is turned to one side with the jaw pointing up and out to open the airways. The arms and the legs are placed in such a manner that they support the body. If there are spinal injuries do not place a person in recovery position unless they are vomiting or in danger of choking.

1. Kneel next to the victim's side and turn the head toward the side and tilt the head upward keeping the jaw forward.

2. Place the arm nearest you by the victim's side under the buttocks with the palm upward, if possible. Bring the opposite forearm in front of the patient's chest. Hold the far leg by the knee or ankle and bring it toward you crossing it over the near leg.

3. Support the victim's head with your upper hand and take your lower hand and grasp the victim by the clothing at the opposite hip. Then quickly pull and rotate the person on their side resting them against your knees.

4. Place the head carefully to ensure the airways are open and bend the patient's nearest arm and place it above the victim's head to support the upper body.

5. Bend the victim's uppermost leg at the knee, drawing the thigh well forward to support the lower body.

6. Carefully remove the lower arm from under the victim's body by working it outward from the shoulder downward. Leave it parallel to the side of the body to prevent the victim from rolling on their backs.

  If you suspect broken bones or spinal injuries move the unconscious victim only if necessary. Place them in a position that approximates the recovery position without putting weight on the broken bones. Use rolled up blankets, or other suitable things, to support the person in the recovery position, if necessary. Anyone who has been unconscious should be examined by a medical professional. To review the methods for controlling bleeding, refer to the chapter specifically on bleeding. Do that now as it is of vital importance.