Emergency first aid is the care that is given to an injured or sick person prior to treatment by medically trained personnel.
In this article we will look at the history of first aid, how it works and how to do it.
Here are some key points about first aid. More detail and supporting information is in the main article.
- First aid can be both simple and life-saving
- The Knights Hospitaller provided care to pilgrims and knights
- The aims of first aid are to preserve life, prevent harm and promote recovery
- In first aid, ABC stands for airway, breathing, and circulation
- The recovery position helps minimize further injury
- CPR stands for cardio-pulmonary resuscitation; it helps maintain the flow of oxygenated blood
- Whilst doing chest compressions, you may hear cracks: this is normal
- The term "first aid" was first used in 1863
- In 1877, St. John Ambulance was formed in England.
What is first aid?
Some self-limiting illnesses or minor injuries may only require first aid intervention, and no further treatment. First aid generally consists of some simple, often life-saving techniques that most people can be trained to perform with minimal equipment.
First aid usually refers to administration of care to a human, although it can also be done on animals. The aim of first aid is to prevent a deterioration of the patient's situation, to aid recovery, and to preserve life.
Technically, it is not classed as medical treatment and should not be compared to what a trained medical professional might do. First aid is a combination of some simple procedures, plus the application of common sense.
A brief history of first aid
First aid can be both simple and life-saving.
The history of first aid varies depending on what part of the world one is referring to. Around the 11th century in Europe the Order of St. John was created with the aim of training people to medically care for victims of battlefield injuries - these were laypersons who were formally trained in the administration of first aid.
Around this period the Knights Hospitaller provided care to pilgrims and knights - they also trained other knights in dealing with battlefield injuries.
During the Middle Ages in Europe first aid took a back seat and did not really resurface until the second half of the 19th century. In 1859 Henry Dunant, a Swiss businessman, trained and organized local village folk to administer first aid to battlefield victims of the Battle of Solferino, Italy.
In 1863, four nations met in Geneva, Switzerland, and formed an organization which became the modern Red Cross - during this meeting the term first aid was first used with its modern meaning.
The initial aim of the Red Cross was to administer aid to sick and wounded soldiers. During the industrial revolution Great Britain had a number of civilian ambulance crews who would come to the emergency aid of miners, railway workers and policemen.
Aims of first aid
The aims of first aid are:
- To preserve life: this is the main aim of first aid; to save lives. This includes the life of the first aider, the casualty (the victim, the injured/sick person), and bystanders
- To prevent further harm: the patient must be kept stable and his/her condition must not worsen before medical services arrive. This may include moving the patient out of harm's way, applying first aid techniques, keeping him/her warm and dry, applying pressure to wounds to stop bleeding, etc.
- Promote recovery: this may include applying a plaster (bandage) to a small wound; anything that may help in the recovery process.
First aid skills
ABC stands for airway, breathing, circulation.
ABC (and sometimes D)
The most common term referred to in first aid is ABC, which stands for Airway, Breathing, and Circulation. In fact, the term also is commonly used among emergency health professionals. The D stands for defibrillation.
- Airway - the first aider needs to make sure the casualty's airway is clear. Choking, which results from the obstruction of airways, can be fatal
- Breathing - when the first aider has determined that the airways are not obstructed, he/she must determine the casualty's adequacy of breathing, and if necessary provide rescue breathing
- Circulation - if the casualty is not breathing the first aider should go straight for chest compressions and rescue breathing. The chest compressions will provide circulation. The reason is time - checking circulation to a non-breathing casualty consumes time that could be used with chest compressions and rescue breathing. With less serious casualties (those that are breathing), the first aider needs to check the casualty's pulse
- Deadly bleeding or Defibrillation - some organizations have this fourth step, while others include this as part of circulation
How to evaluate and maintain the ABC of a patient depends on how well trained the first aider is. As soon as ABC has been secured the first aider can then focus on any additional treatments.
Some organizations use the 3Bs system, which stands for Breathing, Bleeding, and Bones, while others use 4Bs, which stands for Breathing, Bleeding, Brain, and Bones.
ABCs and 3Bs are taught to be carried out in order of sequence. However, there are times when the first aider may be performing two steps at the same time, as might be the case when providing rescue breathing and chest compressions to a casualty who is not breathing and has no pulse.
Many organizations have other acronyms (similar to abbreviations) that remind people of their sequence of steps. First Aid Works, an organization that trains people in the UK uses DRAB to remind first aiders what to do during their Primary Survey:
Primary Survey - DRAB (danger, response, airway, breathing)
- Danger- check for dangers to the casualty and to you as a first aider. If there is danger present, can you get rid of the danger, or move the casualty from the danger? If there is nothing you can do, stay away and get professional help. The worst thing a rescuer can do is become another victim
- Response- if safe to approach, is the casualty conscious? See if the patient is alert, ask questions and see if you get a response, find out whether he/she responds to your touch. Very well trained first aiders will know how to find out whether the casualty responds to pain
- Airway- is the casualty's airway open and clear? If not try to clear it. Trainers advice first aiders to have the casualty lying on their back, and then to place one hand on his/her forehead and place two finger from the other hand on the casualty's chin and gently tilt the head back while slightly raising the chin further upwards. Any obstructions need to be removed from the casualty's mouth, including dentures. First aiders are trained only to put their fingers in the casualty's mouth if they can see an obstruction there
- Breathing- is the casualty breathing effectively? The first aider should look at the chest for movement, his/her mouth for signs of breathing (e.g. sounds), and get close to the casualty and see if air exhalation can be felt on the first aider's cheek.
The Secondary Survey - DOMS (deformities, open wounds, medic alert tags, swellings)
If the casualty is breathing adequately, then it is possible to carry out a Secondary Survey. This is a rapid whole body check. As soon as this has been done, the casualty should be placed in a recovery position. At this point the first aider should call for an ambulance.
The recovery position can be a vital part of first aid.
- Remove glasses if the casualty is wearing them
- Place the arm that is nearest to you at right angles to the casualty's body (you are kneeling next to him/her)
- Bring the other arm across their chest; hold the back of his/her hand against his/her nearest cheek
- With you other hand, hold the casualty's thigh that is furthest from you and pull up the knee. Make sure his/her foot is flat on the ground
- Slowly pull down on the casualty's raised knee and roll him/her over towards you
- Move the upper leg slightly so that the casualty's hip and knee are bent at right-angles. This makes sure they do not roll back onto their face
- Gently tilt the head back so that the airway is kept open.
Cardio-pulmonary resuscitation (CPR)
If the casualty is not breathing the first aider will need to perform CPR (cardio-pulmonary resuscitation). In 2008 the European Resuscitation Council and the American Heart Association, in a reversal of policy, subscribed to the effectiveness of just chest compressions, without artificial respiration, for adults who suddenly collapse in cardiac arrest.
It is unlikely that CPR will start a heart. Its purpose is to maintain the flow of oxygenated blood to the brain and heart, and thus preventing or at least delaying tissue death. CPR can extend the brief window of time during which successful resuscitation may occur without permanent brain damage.
In 2005 ILCOR (International Liaison Committee on Resuscitation) agreed on new guidelines. The new guidelines make it simpler for both lay rescuers and healthcare professionals to make the most of the potential for early resuscitation.
The new guidelines stated that rescuers should go straight to CPR if there is no breathing, rather than then checking for a pulse. It also added that rescue breathing without chest compressions must not be performed.
Research indicates that a sizeable percentage of lay personnel cannot detect a pulse when one is there, and some detect a pulse when one is not there.
30 chest compressions - the first aider should be kneeling next to the casualty who should be lying on his/her back. Place the heel of one hand in the middle of the casualty's chest, and place your other hand on top of your first hand and interlace the fingers. Push the chest down (compress the chest) to about 1.5 to 2 inches (4 to 5 cm).
If the casualty is a child aged 1 to 8 years compress to a maximum of 1.5 inches (4 cm). Then let go and wait till the chest recoils (comes back up) completely before repeating. Elbows need to be kept straight throughout.
Push the breastbone up and down to a depth of about 5 cm - do this 30 times at a pulse rate of 100 per minute. If the casualty is a child aged from 1 to 8 years, use just one hand for the compressions
- Give 2 breaths - Make sure airway is open and pinch the nose so it closes. Gently raise the chin upwards with the two fingers of your other hand. Take a deep breath and seal your mouth over the casualty's mouth and breathe out into the casualty's airway. You should see the casualty's chest rise and fall. To get another breath lift your head and breathe in deeply. Perform the whole procedure again.
Repeat the 30 chest compressions followed by two breaths about five times and then check to see whether the casualty has started to breathe normally. If not, carry on performing CPR. If breathing starts normally, stay with the casualty until help arrives.
If you feel uncomfortable about giving rescue breaths, remember that chest compressions alone are life savers - do not just stand there doing nothing. It is important not to let your hands bounce when you are performing chest compressions - make sure the heel of your hand is touching the casualty's chest all the time during the chest compressions. You may hear some pops and snaps during chest compressions; this is normal, so do not stop.