First Aid/Emergency First Aid & Initial Action Steps
First aiders are never required to place themselves in a situation which might put them in danger. Remember, you cannot help a victim if you become a victim yourself. When a first aider is called upon to deal with a victim, they must always remember to safeguard themselves in the first instance and then assess the situation. Make sure the scene is safe, and remember that your own personal safety is above all else. Before you enter a scene, put on personal protective equipment, especially impermeable gloves. Only after these steps are completed can treatment of the victim begin.
As you approach a scene, you need to be aware of the dangers which might be posed to you as a first aider, or to the victim. These can include obviously dangerous factors such as traffic, gas or chemical leaks, live electrical items, buildings on fire or falling objects. While many courses may focus on obvious dangers such as these, it is important not to neglect everyday factors which could be a danger. (ex. Gas fires, where in getting close to a victim could result in burns from the heated vapor.)
There are also human factors, such as bystanders in the way, the victim not being co-operative, or an aggressor in the vicinity who may have inflicted the injuries on the victim. If these factors are present, retreat until the police are able to control the situation.
Once you have assessed the scene for danger, you should continue to be aware of changes to the situation or environment that could present danger to you or your victim until you have left the scene.
If there are dangers which you cannot mitigate by your actions (such as falling masonry, an assailant, or a structure fire), then STAY CLEAR and call the emergency services. Remember to never put yourself in harm's way.
What has happened?
As you approach the scene, your goal to gain as much information as possible about the incident. Try and build a mental "picture" of the situation in your head. Details you observe can help you care for your victim, especially if the injury or illness is not obvious.
Assess the Scene - Where are you? What stores, clubs, public buildings, etc. are nearby? Has anything here caused the injury? Does this area have motor vehicle traffic? Is this area known for violent crime? What time of day is it? What are the weather conditions?
Look for Clues - Things that could help you determine the reason for the patient's illness or injury may be obvious (such as an empty pill bottle between the patients legs) or subtle (shellfish - which many people are allergic to - in the victims food).
Get some History - If there are witnesses, ask them what's happened "Did you see what happened here?" and gain information such as how long ago it happened "How long have they been like this?", but be sure to start your assessment and treatment of the victim simultaneous with your history taking.
Be sure to Listen - While working on a victim you may overhear information from witnesses in the crowd. An example of this would be an old man falling on the sidewalk, as you approach the scene you can hear someone say "He was just walking and his legs went out from under him." But you may not see the person saying this. Everything should be taken into account should no witnesses want to become involved or you cannot ask questions. Note what is said and continue treatment.
Once you are confident that there is minimal danger to yourself in the situation, the next step is to assess how well (if at all) your victim responds to you.
This can be started with an initial responsiveness check as you approach the victim. This is best as a form of greeting and question, such as:
"Hello, I'm here to help you. Are you alright?"
The best result would be the victim looking at you and replying. This means that the victim is alert at this time.
In an emergency setting, the level of responsiveness is categorized by using what is called the AVPU scale, AVPU stands for the four possible categories they can fit into. They are either "Alert", "Verbal", alert to "Pain", or "Unresponsive"'
If the victim looks at you spontaneously, can communicate (even if it doesn't make sense) and seems to have control of their body, they can be termed Alert.
Key indicators on the victim are their:
- Eyes - Are they open spontaneously? Are they looking around? Do they appear to be able to see you? Do they look "glassed over"?
- Response to voice - Do they reply? Do they seem to understand? Can they obey commands, such as "Open your eyes!"? Do they know where they are or what happened to them?
If the victim is not alert, but you can get them to open their eyes, or obey a command by talking to them, then you can say that they are responsive to Voice - that is, they became alert upon you speaking to them.
If a victim does not respond to your initial greeting and question, you will need to try and get a response from them by carefully delivering pain.
The word "pain" is a bit misleading - it refers to anything physical you do to elicit a response from your victim. The first, and most gentle stimulus to use is a tap/shake of the shoulder. There are other, more painful stimuli that can be employed should this be unsuccessful, but all of these have their downsides, especially if overused.
Of these, the three most commonly used ones are:
- Sternal rub - This is performed by grinding the knuckles of your clenched fist vertically up and down the victim's sternum (or breastbone).
- Nail bed squeeze - Using the flat edge of a pen or similar object, squeeze in to the bottom of the victim's fingernail or toenail.
- Ear lobe squeeze - using thumb and forefinger, squeeze or twist the victim's ear.
If any of these provoke a reaction (groaning, a movement, fluttering of the eyes), then they are responsive to pain. It is important to note that different trainers have different opinions on the efficacy of these, so ask your trainer before employing any of these on a first aid course.
Any of the responses A, V or P, mean that the victim has some level of consciousness. If they are not alert, you should always summon professional help - call an ambulance.
If they are only responsive to Voice or Pain, then consider using the Recovery position to help safeguard them if they need to vomit.
If they do not respond to voice or pain, then they are Unresponsive and you must urgently perform further checks on their key life critical systems of breathing and circulation (informally known as the ABCs). A victim who is unresponsive will often require special attention, both due to the injury or illness causing their unconsciousness, and the fact that they are unable to provide any reason for them being sick or injured.
To this stage the first aider, on approaching a victim should have:
- GO - Put their gloves on
- D - Checked for danger
- R - Checked for responsiveness
- S - Looked at the scene for clues about what has happened
- H - Gained history on the incident
- AVPU - Assessed to see how responsive the victim is.
This can be remembered as the mnemonic "GO DR SHAVPU" (Go Doctor Shavpu)
If the victim is unconscious, the first aider should immediately call an ambulance - you will need professional help regardless of whether they are breathing or not. Waiting would endanger the victim's life unnecessarily, and any time wasted in summoning help is time lost. If you are alone with an adult victim, call immediately, even if you must leave the victim. Placing them into the recovery position will help prevent them from choking if they should vomit while you are calling the ambulance. If you are alone with an unconscious child, continue your primary assessment; you will call once you have confirmed that the victim is breathing, or after 2 minutes of CPR. If you are not alone, have a bystander call the ambulance immediately while you continue your assessment and care of the victim.
If there is more than one person injured the rescuer must determine the order in which victims need care. In general, rescuers should focus on the victim with the injury that is the greatest threat to life. Simple triage techniques should be applied to make sure that those in greatest need of care receive support quickly.
The last step is to actually provide care to the limits of the first aider's training -- but never beyond. In some jurisdictions, you open yourself to liability if you attempt treatment beyond your level of training.
Treatment should always be guided by the 4Ps:
- Preserve life
- Prevent further injury
- Promote recovery
- Protect the unconscious
Treatment will obviously depend on the specific situation, but some situations will always require treatment (such as shock). The level of injury determines the level of treatment required.
The principles first, do no harm and life over limb are essential parts of the practice of first aid. Do nothing that causes unnecessary pain or further injury unless to do otherwise would result in death.