3. RESPONSE: Shout and gently shake or tap the casualty.

FIRST AID If the casualty responds, find out what happened. Check
The Aims of first aid their signs and symptoms (how does the casualty feel or
Preserve life look? Try to work out what’s wrong), and determine a
This doesn’t just refer to the injured party, but yourself treatment (remember - if you are unsure, always seek
and anyone helping you. Far too often, a helper will medical advice). If there is no response, shout for help but
inadvertently put themselves in danger and subsequently be don’t leave the casualty just yet, and go to step 4.
another casualty for the emergency services to deal with. 4. CIRCULATION; Check for pulse carotid
Please take a moment to assess the situation, and make sure 5. AIRWAY: Open the casualty’s airway by lifting their chin
there are no threats to you before you step in. and tilting their head back.
Prevent the situation from getting worse 6. BREATHING NORMAL? Look, listen and feel for two
If you are in no danger yourself, try to stop the breaths in a maximum of ten seconds. If you can clearly
situation from becoming worse by removing any obvious determine the casualty is breathing, perform a secondary
dangers (such as stopping traffic, clearing people away from survey (check for bleeding, injuries and clues). Put the
the casualty, opening a window to clear any fumes, etc.). casualty into the recovery position, dial 999 if not already
Also, act as quickly as you can to stop the casualty’s done, monitor airway and breathing and keep the casualty
condition from worsening. warm. If you cannot determine if the casualty is breathing,
Promote recovery go to step 6.
Your role as a first aider is, after ensuring that the 7. CALL FOR HELP
situation cannot get worse, helping the casualty to recover from 8. RESUSCITATION: Give 30 chest compressions
their injury or illness, or stop their condition from getting followed by 2 rescue breaths, continue giving cycles of 30
worse. If the injury is severe, then the best you can do is try to compressions to 2 breaths. If there is more than one first
keep them alive until the emergency services arrive. aider on hand, change over every 2 minutes to prevent
An emergency action plan is important to have in place fatigue. Continue until the ambulance arrives.
should you be faced with a situation requiring first aid. Resuscitation
1. REMOVE DANGER: Make the scene safe, do not take To maintain life, we need our hearts to pump oxygenated
risks. blood to our vital organs. To achieve this we need to be
2. DANGER: Look for any further danger. If yes, go back a breathing and our hearts need to be pumping. Should either of
step, if no go to step 3. these functions stop, our brain and other vital organs will start

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to deteriorate (brain cells usually die within 3-4 minutes due • Try to get a response from the casualty. Gently shake their
to lack of oxygen) which will eventually lead to DEATH shoulders, shout and clap your hands in front of them, pinch
Have their heart ‘restarted’ with a defibrillator. These are their underarm or fingernail to get a pain response.
carried on all ambulances, and can also be found in some • If they do not respond, immediately shout for help, or call 999
public places (shopping centers, etc.). These days if you have a mobile phone on you. Whatever you do, do not
‘defibrillators are very sophisticated, and will talk you through leave the casualty alone.
the process, but you should be trained in the use of them • Circulation- check for pulse
before attempting to use one. However, even if you are trained Airway – clear the airway
to use one, you must call an ambulance first, as this will give  Clear the airway by placing your fingertips under the
the casualty the best chance of survival. casualty’s chin and lifting, so the front of the neck is
Even so, we need to keep the heart and brain oxygenated as best extended. Simultaneously placing your other hand on
we can while help is on the way; this is when we start Cardio their forehead to gently tilt the head back.
Pulmonary Resuscitation (CPR). B Breathing – is the casualty breathing normally?
Cardio Pulmonary Resuscitation (CPR) – Primary Survey: • When their airway is cleared, check if they are breathing
D Danger – ensure the area is safe and find out what has normally. You are looking for two breaths in ten seconds. Take
happened no longer than this to assess their breathing, as every second
• Make sure that it is safe for you to approach the casualty. Do counts.
not put yourself in any danger, because if you get injured you • Check whether their chest and abdomen are rising and falling.

won’t be able to help the casualty. • Listen for breath (more than a sporadic gasp).

• Remove any danger from the casualty, or if that is not • Use the back of your hand (lick the back of your hand if that

possible, and it is safe to do so, try to move the casualty away will help) or your cheek to feel for any breath from the
from the danger area. casualty.
• Try to find out what happened, making sure that you are safe This will all determine if the casualty is breathing normally.
doing so. DO If they are, you will need to place them in the recovery
NOT PUTYOURSELF INANY DANGER. position, which will be covered later in the notes.
• How many casualties are there? Can you cope with the If the casualty is not breathing normally:
situation? The first thing to do in this situation is to call for help. If
R Response – is the casualty conscious? someone is with you, get them to do this so you don’t have to
leave the casualty. If you are alone, and do not have a mobile
with you, you may need to leave the casualty to do this.
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However, it is vital that an ambulance is called, as the • Pinch the casualty’s nose closed; this will make sure the breath
casualty will stand a much better chance of survival with help you give them does not escape.
on the way. Once the ambulance is called, start CPR: • Take a breath and place your mouth over the casualty’s,
• Place the heel of one hand in the Centre of the casualty’s chest. forming a seal.
Place the other hand on top and interlink your fingers. • Steadily blow into the casualty’s mouth, making sure their head
• Take a position next to the casualty’s chest, kneeling at is tilted back and the airway is open. Keep your eyes down on
whichever side feels more comfortable for you. the casualty’s chest to make sure it rises (this should take about
• Press down firmly on the casualty’s breastbone current a second). This is known as a rescue breath.
guidelines suggest pushing down to a depth of 6cm) then • Remove your mouth from the casualty’s and leave enough
release the pressure, but try not to lose contact with the room for you to
casualty. This is known as a chest compression. When applying take a fresh breath of air. Keep the casualty’s airway open and
pressure, avoid doing so on the ribs, upper abdomen or the end watch for the chest deflating, as the air is expelled.
of the casualty’s breastbone. • Place your mouth over the casualty’s forming the seal again
• Each compression should take the same amount of time. and give another rescue breath. You need to do this twice.
• Carry out 30 chest compressions at a speed of 100-120 • Replace your hands on the casualty’s chest immediately and
compressions per minute. perform another 30 chest compressions, followed by 2 more
After 30 chest compressions, you must administer two rescue rescue breaths.
breaths (see images below). Continue swapping between 30 chest compressions and 2
In an ideal situation, the casualty will be on a flat hard surface to rescue breath should your rescue breaths not be effective,
be able to administer CPR. However, this isn’t always the case, follow the steps below:
and you may find that you need to perform CPR on a casualty • Give a further 30 chest compressions.
who is, for example, in bed. If this situation arises, try to get the • Remove any visible obstructions in the casualty’s mouth.
casualty onto the floor without hurting yourself or the casualty. • Make certain their airway is clear by tilting their head back and
If it is not possible, remove any pillows or cushions so the lifting the chin. If the airway is not clear, the breath you give
casualty is lying flat and attempt CPR. This is still better than will not fill their lungs.
doing nothing. Do not give the casualty more than two rescue breaths
Combining chest compressions with rescue breaths: before continuing with chest compressions.
• After chest compressions, make sure the casualty’s airway is If you have someone with you, take it in turns to administer
clear by tilting their head back. chest compressions. Every 1-2 minutes, change over so one
person administers chest compressions while the other gives
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the rescue breaths. Ensure there is as little delay in swapping as resuscitation. Although not ideal, it will still circulate the
possible, so the casualty is constantly receiving CPR. residual oxygen in their blood to their vital organs, so it is
Continue CPR until: better than no CPR.
The emergency services If you are only giving chest compressions, the continuous
arrive to take over. You rate should be 100120 compressions per minute.
become too fatigued to If you have someone with you, take it in turns to administer
continue. chest compressions. Every 1-2 minutes, change over so one
Resuscitation for babies and children: person administers chest compressions while the other rests
Understandably, some people are reluctant to perform CPR on and maintains the casualty’s airway. Ensure there is as little
a child or baby for fear of causing further harm to them. delay in swapping as possible, so the casualty is constantly
However, a child in this state is likely to suffer far worse receiving chest compressions
consequences if CPR is not administered. Please keep that in Points of hygiene during resuscitation:
mind should the situation ever arise. • Use a cloth, or whatever you have to hand to wipe the
CPR on a child is very similar to CPR on an adult. There are casualty’s mouth clean.
only a few minor modifications to the process, which are • Face shields are useful to have on you, as they protect you
detailed below: from any serious infections such as TB, Hepatitis, etc.
Give the child 5 rescue breaths before starting CPR, then Always use one if you have it with you.
switch back to 30 chest compressions to 2 rescue breaths. • If you do not have a face shield to hand, a piece of plastic
 If you are alone, perform CPR for about a minute before going with a hole cut or torn into it will suffice, as will a
for help. handkerchief or any piece of material which will help to
Chest compressions on a child should be about one-third of prevent direct contact.
the depth of the chest. For a baby under 1 year old, only use • If you are in any doubt about the safety of giving rescue
two fingers to administer CPR. For a child over 1 year use breaths, you can perform ‘chest compression only’
either one or two hands to compress the chest, again one third resuscitation as a last means (this is described above).
of the depth of the chest • If you have protective gloves, use these. Always wash your
Resuscitation with chest compressions only hands afterwards to prevent any contamination
An adult cardiac arrest casualty will probably still have Responses in casualties
oxygen in their blood stream. If there is any reason you To correctly ascertain the level of consciousness in a
cannot give the casualty rescue breaths, you can still help the casualty you can use
casualty by giving them ‘chest compression only’ AVPU
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 A- Alert – the casualty is fully awake and alert to of their Head and neck
soruonding and will usually know the answer to general • Check for any signs of bruising, swelling or bleeding,
qestions like date ,time ,whwerethy are V-voice- casualty particularly from the ears.
may not be fully awake but can answer to verbal questions • Make sure to examine the whole of the head and face.
U-unresponsive – casualty is not conscious • Feel the back of the neck, as this is a hidden area.
altogether from responses. Try to ascertain if the casualty has been in an accident that is
Making sounds likely to damage the neck (for spinal injuries, see page 55).
The casualty is not able to respond verbally, but may make Shoulders and chest
grunts or moans in response to painful stimuli. • Check both shoulders by placing your hands on them to see if
No sounds there are any irregularities.
In this case the casualty will make no vocal sounds. • Run your fingers across the collarbones to check for any
P Pain damage.
Locating pain Run your hands over the ribcage, squeezing and rocking gently,
The casualty will be able to locate painful stimuli, and tell to make sure there are no breaks, as a broken rib could easily
you where it is being applied (pinch on the underside of the puncture a lung.
arm, pressing firmly on a finger nail, etc.). Abdomen and pelvis
Pain response (but not able to locate the pain) • Press the abdomen gently with the palm of your hand to see if
The casualty will respond to painful stimuli, but not be able to there are any irregularities or pain response.
locate where the pain is. • Gently put pressure on the pelvis to check for any fractures. 
U Unresponsive Check if the casualty is bleeding or is incontinent.
The casualty is not able to respond to pain or vocal stimuli. They Legs and arms
will remain unresponsive. • Run your hands down the legs gently, checking for any
You can perform primary and secondary surveys of the fractures or breaks.
casualty, which will help you to decide in which order to treat • Repeat the action with the arms.
the casualty, the most urgent first. You can then go on to Check the casualty for any clues to their condition (medic
assess the casualty further, which may help with diagnosis alert jewellery, needle marks, smell of alcohol, etc.).
and treatment. The more information you can give the Check the pockets
ambulance crew the better. • Check there is nothing in the pockets that will injure the
• Make sure to check any covered areas, such as the back.  Stop casualty further when you roll them into the recovery position.
or control any bleeding you find (see page 36).
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• Try to have a witness present if you need to remove any items damage to their right lung for example, place them on their
from the casualty who can vouch for you. right to protect the one working lung.
• Be wary, there may be sharp objects in the casualty’s pockets Step 1
such as needles or a knife. • Remove any dangers from the casualty (remove glasses, check
• Be sure to loosen any restrictive clothing, such as ties and belts. pockets for anything that will cause further injury) and
Recovery straighten the legs.
• Gently place the casualty in the recovery position (see page • Preferably move the left arm out, with their elbow bent and
12). palm face up.
• If you have any suspicion that the casualty may have an injured Step 2
neck, try to get someone to hold the head in line with the body Now bring the far side leg into a bent position, with the foot on
while you turn the casualty the floor, tuck their foot under the near side leg to keep it up.
(see spinal injuries, page 55) to lessen the risk offurther Step 3
damage. • Bring the far side arm across the chest, with the back of the
• Be careful not to cause further injury to the casualty or hand against the casualty’s cheek, and hold it there.
exacerbate suspected injuries. Now using the bent knee as leverage and holding the back of
The recovery position the hand against the cheek, pull the knee towards you, rolling
When an unconscious casualty is lying on their back, their the casualty onto their side.
breathing can be hampered by them ‘swallowing their tongue’ Make sure their knee is touching the ground so that they don’t
(the tongue slides back in their throat, cutting off the airway). roll back.
Or, the person can vomit while unconscious, and are not able Step 4
to reflexively heave or expel the vomit, which can suffocate Make sure that the upper leg is bent at both the hip and the

them. By placing the casualty on their side (the recovery knee, as though the casualty is in a ‘running’ position. Keep
position), this ensures the airway is clear by stopping the their hand under their cheek and tilt their head back to clear
tongue sliding back in the throat and allowing vomit to drain the airway.
Check the casualty’s back for any hidden injuries, and if
from the mouth.
you have anything to hand, cover them for warmth and their
Try, if possible, to move the casualty onto their left, as this
dignity.  request an ambulance.
will keep any contents in the stomach from escaping.
Monitor the casualty’s breathing every 30 seconds
However, always place breathing first, so if a casualty has any
while awaiting the ambulance. If the casualty stops

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 breathing, return them to their backs and commence Signs and symptoms of a stroke:
CPR. A stroke must be treated immediately. If you suspect a stroke,
Things not to do: carry out the following FAST test:
• Never put anything into an unconscious casualty’s mouth. F Facialweakness
• Never move a casualty without performing the checks Can the casualty smile? Has their mouth or eye drooped?
mentioned first. A Arm weakness
• Never place anything under the head of a casualty who is on Can the casualty raise both arms?
their back. This could obstruct the airway. S Speech problems
• Never unnecessarily move a casualty as this could cause further Can the casualty speak clearly? Do they have problems
injury. understanding you?
Head injuries T Time to call for help
Treat any suspected head injury with the utmost caution, as If the casualty fails any of these tests, call ambulance as a
they have the potential to be very serious. Head injuries often stroke isa medical emergency.
lead to unconsciousness and all the attendant problems. Also, There may be other signs to look for, but the FAST check is
head injuries can cause permanent damage to the brain the quickest and may save time. However, please note the
Stroke following may occur:
• One side of the face or body becomes suddenly numb.
Strokes must always be treated as a medical emergency, and
• Loss of balance.
an ambulance called immediately. Any delay in the
• Lack of co-ordination.
treatment of a stroke can have a dramatic effect on the
• Suddenly developing a severe headache.
casualty’s recovery. If you suspect a stroke, CALL AN
• Sudden confusion.
AMBULANCE IMMEDIATELY.
• Problems seeing with one or both eyes.
There are two types of stroke:
• Pupil size becomes unequ
1. Ablood clot blocks a blood vessel that supplies part of the
brain. This is the most common. Choking
2. Aruptured blood vessel in the brain. The build-up of Choking is a very common occurrence, and is probably one of
blood ‘squashes’an area of the brain. the most useful skills you can have as a first aider. Choking can
With either type of stroke the signs are similar, with the result lead to tragedy if not dealt with properly.
that a part of the brain dies. There is no age definition of a stroke Signs and symptoms
casualty; anyone of any agcan have a stroke. • Casualty is unable to talk, breath or cough.
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• They may be gasping and clutching their throat. If the back slaps and abdominal thrusts do not appear to be
• They may appear distressed. working, shout for someone to help, but do not stop
• They may become pale and show signs of cyanosis in later administering the treatment if the casualty is conscious.
stages.  Becoming unconscious. Choking in a baby under 1 year
Treatment of an adult or child over 1 year: The baby may attempt to cough on their own. If the choking
Ask the casualty if they are choking firstly to establish this is not serious, this will clear the obstruction. The baby may
is the case. If they are not doing so already, ask them to cry which indicates they are now breathing properly.
cough as this will usually dislodge minor obstructions. If the obstruction is not cleared by coughing, follow the steps
However, if this doesn’t work, follow the steps below: below:
1 – Back slaps 1 – Back slaps
• If there is no help around, shout for help. Do not leave the • Shout for help immediately, but do not leave the baby alone.
casualty alone. • Lay the baby over your arm facing downwards with their legs
• Bend the casualty forward at the waist so their head is lower either side of your elbow with their head below their chest.
than the chest. If the casualty is a young child, you can place • Administer up to five slaps firmly between the shoulder blades
them over the knee to help with this. with the palms of your fingers, not your open hand.
• Find the hollow spot between the shoulder blades and • Check between each slap if the obstruction has dislodged.
administer five firm slaps with your open hand. Make sure to • If this does not work go to step 2.
check between blows if the obstruction has dislodged. 2 – Chest thrusts
• If this does not work, go to step 2. Turn the baby over, so they are laying chest up on your other
2 – Abdominal thrusts (Heimlich Manoeuvre) arm, keep their head below their chest.
• Stand (or kneel if it is a child) behind the casualty and place Using two fingers on the baby’s chest give up to 5 chest
both your arms around their waist. thrusts. This is a similar manoeuvre to chest compressions
• Make a fist and place it just below the casualty’s ribs with in CPR, but sharper and administered at a slower rate.
your thumb facing inwards (as if you’re looking at a watch).  Check between each thrust if the obstruction has dislodged.
• Grasp your fist with your free hand and pull in sharply. Do If this does not work, repeat step 1 and follow with step 2
this up to five times, making sure you check between each until the obstruction is
thrust if the obstruction has dislodged. If the casualty becomes unconscious make sure they are
• If this does not work, repeat step 1 and follow with step 2 laying on the ground (or on a flat firm surface for a baby)
until the obstruction is dislodged. and commence CPR. Make sure there is an ambulance on

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the way. Continue CPR until help arrives or you become • Anxiety, a feeling of impending doom.
fatigued. Treatment of
Anaphylactic shock anaphylactic
Anaphylaxis is an extreme allergic reaction which can be shock  Call
fatal. This is trigged by a massive over reaction by the ambulance
immune system. Severe anaphylactic reaction is a rare immediately.
occurrence, usually triggered by drugs such as penicillin, • Lay the casualty in as comfortable position as possible. If the
insect stings, nuts such as peanuts and shellfish such as casualty is having problems breathing, they may want to sit up
prawns, latex, dairy produce, etc. to ease this.
• Constricts the bronchioles in lungs. • If the casualty is feeling faint, do not let them sit up. Keep
• Makes blood capillary walls weaken and leak, which causes them lying flat and raise their legs.
severe swelling and shock. • If the casualty is aware of their condition, they may be carrying
• Weakens the heart’s contractions. an adrenaline shot. This can save the casualty’s life if
• Makes the skin itchy and come out in a rash. administered promptly.
Signs and symptoms • The casualty can usually give themselves the adrenaline shot,
An allergic reaction can occur in seconds, so recognising the but if they are unable you may have to help them.
problem is essential: • If the casualty becomes unconscious, check their airway and
• Casualty’s face, tongue, neck, lips and eyes may suddenly breathing and resuscitate as necessary.
swell up. Asthma
• Their voice may become hoarse, developing a ‘lump in the Asthma is a fairly common allergic reaction in the lungs,
throat’ which may lead to loud, noisy breathing which may stop usually caused by pollution, dust, pollen or traffic fumes. The
altogether. muscles surrounding the bronchioles spasm and constrict
• Tightness in the chest, difficulty breathing, wheezing (the which makes it very difficult for the casualty to breathe.
casualty may have Asthma sufferers normally carry around medication in the
the equivalent of an asthma attack, with the addition of a form of an inhaler which when breathed in dilates the
swollen airway). bronchioles helping to relieve the condition.
• Weak, rapid pulse. Asthma attacks can be very traumatic for the casualty,
• Nausea, stomach cramps, vomiting, diarrhoea. especially children, so be sure to reassure them and keep
• Itchy, red or blotchy skin. them as calm as possible. This is best achieved by being calm
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yourself and let them know you are a first aider. If the oxygen exchange in the alveoli (known as wet drowning). The
casualty is not calmed in a timely manner, their attack may other 10% are caused by spasms in the muscles near the
lead to ‘hyperventilation’ after the inhaler has been used and epiglottis and larynx which blocks the airway (known as dry
their breathing has eased. drowning). The casualty will have swallowed a large amount of
• Use of muscles in the upper chest and neck help the casualty to water, which may be vomited during resuscitation.
breath. Please remember that drowning can have many factors such
• If it is a severe attack, the casualty may become exhausted. as alcohol, hypothermia or a medical condition such as heart
• If the attack is prolonged, the casualty may become attack or epilepsy.: When a small amount of water is taken
unconscious and stop breathing. into the lungs it causes irritation and fluid is drawn from the
Treatment of an asthma attack blood into the alveoli. This reaction could happen several
• Sit the casualty upright, with their back to a wall, table or chair hours after a near drowning, the casualty may relapse after
for support. appearing to have recovered fully and have difficulty
• Help the casualty to use their inhaler (usually a blue inhaler for breathing later on. This is why any drowning casualty who
an attack). has been resuscitated should be taken to hospital as a matter
This can be administered every few minutes, if the attack does of urgency. mnx
not abate. Firstly, do not endanger yourself as you getting in trouble
• Keep talking to the casualty, reassuring them and keep them won’t help the casualty. Try not to enter the water yourself
calm. Ask them simple questions; keep their mind off the unless you have been trained to do so. If possible, try to
attack. reach the casualty with a stick, rope or a floating object
• Should the attack be severe, prolonged, appears to be getting (lifesavers or similar).
worse or the casualty is becoming exhausted • Do not put yourself at risk. Try to reach the casualty with a
• Frigid, winter air can worsen an attack, so do not take the rope, stick or float.
casualty outside for fresh air. • Try to keep the casualty horizontal during the rescue as they
• Keep the casualty sitting upright while they are conscious, even may go into shock.
if they become too weak to sit upright on their own. Only ever • Check their airway and breathing. Perform CPR if necessary.
lay a casualty having an asthma attack down if they become Heart attack
unconscious, then place them in the recovery position and be A heart attack (myocardial infarction) is usually caused when
prepared to carry out resuscitation. the surface of a cholesterol plaque build-up in a coronary
• In truth, 90% of drowning fatalities are caused by a relatively artery cracks and develops a ‘rough surface’. This may lead to
small amount of water in the lungs which interferes with the
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a blood clot forming on the plaque which in turn completely Understanding what shock is can help understand why
blocks the artery resulting in the death of an area of the heart casualties who are in shock need immediate treatment, or the
muscle. condition can result in death.
However, unlike angina, the death of the heart muscle from a The most common causes of life
heart attack is permanent and will not be eased with rest. threatening shock are: 
Signs and symptoms Hypovolaemic Shock.
Please bear in mind that each heart attack is different. They Hypovolaemic shock is caused by loss of bodily fluids, the
may not show all the signs below, in fact up to a quarter of result of which is low blood volume. Hypovolaemic shock is
heart attacks are ‘silent’ and happen without any chest usually caused by:
pain. • External bleeding.
Treatment of angina / heart attack • Internal bleeding.
• Sit the casualty down and make them comfortable. Try to • Burns.
stop them from walking around or doing anything • Vomiting and diarrhoea.  Excessive sweating.
strenuous. Sit them in the Fowler position (or the Signs and symptoms
‘W’position). Have them lean against a wall, or your knees Usually the first response is a release of adrenaline
if no other option, and raise their knees. which will cause:  Pulse rate to rise.
• Ask the casualty if they have any medication with them. If • Pale, clammy skin. For dark skinned casualties check the
they do, allow them to take their own glyceryl tri-nitrate colour of the skin inside the lips.
(G.T.N.) medication if they have it. As the condition deteriorates:
DO NOT GIVE IT TO THEM DIRECTLY BUT HELP • Shallow, fast breathing.
THEM SELF MEDICATE. • Nausea or vomiting.
• Reassure the casualty. Remove any causes of stress or • Weak, rapid pulse.
anxiety if possibl Shock • Dizziness or weakness.
The usual association with the word shock is a nasty surprise, an • Cyanosis (grey/blue tinge to lips and skin).  Sweating.
earthquake or electrical shock. As the brain receives less oxygen:
The medical definition of shock is ‘inadequate tissue • Deep, sighing breathing (air hunger).
perfusion, caused by a fall in blood pressure and blood • Unconsciousness.
volume’. This means there is an inadequate supply of • Anxiety, confusion, possible aggression.
oxygenated blood to the tissues of the body. Treatmentof Hypovolaemic Shock

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• Try to treat the cause of the shock (e.g. external bleeding). • Slow pulse.
• Lay the casualty on a flat surface (preferably the floor) and • Clammy, pale skin.  Quick to recover.
raise their legs so they are above the chest (heart). This will Treatment of fainting
cause the blood to return to the vital organs • Lay the casualty on a flat surface, preferably the floor and
• Keep the casualty warm – place a blanket or coat under the raise their legs which will return the blood to the vital organs
casualty if they are on the floor or other cold surface. However, and raise blood pressure.
be careful not to overheat them as this dilates the blood vessels • Check the casualty’s airway and breathing.
which will cause their blood pressure to drop further. • Try to remove the cause of stress such as people crowding the
• Do not allow the casualty to drink, eat or smoke. Nil by mouth casualty and allow plenty of fresh air.
is best! • Reassure the casualty as they come to. Try to stop them from
• Loosen any tight clothing such as ties and belts. sitting up suddenly.
• Monitor the casualty’s breathing, pulse and response levels. • If the casualty feels faint again, repeat the treatment and
• Be prepared to perform CPR. check for an underlying cause.
Fainting • If the casualty does not recover in a short amount of time and
This reaction is caused by poor nervous control of the blood remain unconscious, or you are unsure: check the airway and
vessels and the heart. breathing again, place them in the recovery position.
When a casualty faints the blood vessels in the lower body Wounds and bleeding
usually dilate which slows the heart. This results in falling A wound is an abnormal break in the continuity of the tissues of
blood pressure and the casualty has a temporary reduction in the body. Any wound will, to a greater or lesser extent, result in
blood supply to the brain. either internal or external bleeding. Severe blood loss could
Typical causes of fainting are: result in shock, so it is important to treat wounds promptly.
• Fright or pain. There are several types of wound.
• Extended periods of inactivity (such as standing or sitting). .Always dispose of soiled dressings or disposable towels used to
• Lack of food. clean up bodily fluid in a yellow ‘clinical waste’ container.
• Emotional stress.  Heat exhaustion. These need to be taken away and incinerated (send the container
Signs and symptoms to the hospital with the casualty if you have no clinical waste
• Temporary loss of consciousness resulting in falling to the facilities where you are).
floor. • Always wash your hands thoroughly before and after dealing
• Before fainting the casualty may have had nausea, blurred with a casualty. This helps reduce the risk of infection.
vision, stomach ache or dizziness.
Page | 12
• If you are dealing with body fluids on a regular basis, ask your dressing should not restrict the flow of blood to the rest of
doctor about vaccination against hepatitis ‘B’. the limb
Treatment of external bleeding If the bleeding is severe, it may be necessary to apply direct
The aim of treating external bleeding is firstly to stop the pressure by hand and elevate the wound. If the dressing
bleed, then prevent the casualty from going into shock and becomes soaked with blood, put a larger dressing on the top. If
finally to prevent infection. the bleeding continues and soaks the second dressing, remove
both dressings and start again. This is to ensure any bacteria is
1. Examine the wound for foreign objects and make a note of removed from the wound with the first bandage.
how the Embedded objects
2. wound is bleeding. Make sure to tell the medical staff how Objects embedded in a wound:
the wound was bleeding once it is covered with a bandage. If there is an object embedded in the wound (other than a
3. Elevate the wound so that it is above the heart, which will small splinter) you should not attempt to remove it as it may
use be stemming a severe bleed, or further damage may result.
4. gravity to restrict the flow of blood to the injury. Use sterile dressings and bandages to build up around the
5. Apply direct or indirect pressure to help slow the bleeding. object, which will supply the pressure needed to stem the
6. Direct pressure to the wound is the best way of bleed and help support the object. Take the casualty to
stemming a bleed. You can use your hands to do this, hospital to have the object removed safe
but you should take precautions to minimise the risk Objects embedded in the ears, nose or other orifice:
of coming in contact with the casualty’s blood, If there is a foreign body stuck in a casualty’s ear, nose or other
preferably by wearing disposable gloves. Keep orifice, do not
pressure on the wound continuously for at least ten attempt to remove it. Take them directly to hospital where it will
minute. be safely removed.
Dressings: Nose bleeds
Dressings should be sterile and just large enough to cover Nose bleeds are usually the result of weakened or dried out
the wound. They should be made out of a material that will blood tissues in the nose. A nose bleed can be triggered by a
not stick to the clotting blood and be absorbent (a ‘non- bang to the nose, picking or blowing it. However, it can be
adherent’dressing). the symptom of a more serious problem such as high blood
Usually, a firmly applied dressing is enough to stem pressure or a fractured skull.
bleeding from the majority of minor wounds, but any

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• Have the casualty sit with their head tipped forward to allow good eye to prevent it moving. Please be sure to give the
the blood to drain. casualty lots of reassurance at this po
• Gently pinch the soft part of the nose, and maintain constant For chemical eye injuries:
pressure for 10 minutes. Make sure you are wearing protective gloves if possible.
• Tell the casualty to breathe through their mouth. Wash the injured eye with lots of clean tap water, making
• Give the casualty some tissues or a cloth to clean up the sure the water runs away from the good eye. Gently, but
blood while you maintain pressure on the soft part of the firmly try to open the casualty’s eye fully to wash it as much
nose. as possible.
• Once the bleeding has stopped, recommend to the casualty Internal bleeding
that they try to continue breathing through their mouth and This is a very serious condition, but it can be very hard to
not blow their nose for the next couple of hours as this may recognise in the early stages. Internal bleeding can be
trigger another nose bleed. attributed to lung or abdominal injuries, but can also happen
• However, if the bleeding continues for more than 30 spontaneously to someone who appears well, such as a
minutes, or they take an ‘anti-coagulant’ drug (e.g. bleeding stomach ulcer or a weak artery.
warfarin), get them to hospital ensuring they stay in an Even though the blood is not lost from the body, it is lost
upright position. internally out of veins or arteries and can quickly cause the
• If the casualty has a history of frequent nose bleeds, casualty to go into shock.
recommend they visit their doctor to determine why. Internal bleeding can result in serious, life threatening
Eye injury complications such as a brain haemorrhage or bleeding into the
If there are small particles of dust or dirt in the eye, this can lungs.
be easily washed out using cold tap water. Make sure the Signs and symptoms:
water runs away from the good eye. You should be aware and looking for internal bleeding if there
For more serious eye injuries: are signs of the casualty going into shock, but there is no
• Try to keep the casualty still and calm. Gently place a obvious cause such as external bleeding.
soft, sterile dressing over the injured eye. You can tape it There may be:
in place if necessary. • Shock
• Ask the casualty to close both their eyes, as any • Pain or a recent history of pain at the site of the bleed.
movement of the good eye will cause the injured eye to • Bruising and/or swelling.
move too. If necessary, you can place a bandage over the • Other symptoms at the site of the bleed (such as difficulty with
breathing if there is bleeding in the lungs).
Page | 14
Treatment of internal bleeding: • Nausea, retching or vomiting.
• call an ambulance immediately. • Abdominal pain.
• Treat the casualty for shock • Burns (or a burning sensation) around the area of entry.
Poisons • Problems breathing.

Poisons can be defined as a liquid, solid or gaseous substance • Hallucinations or confusion.

that causes damage to the body when it enters in sufficient • Headache.

quantity. • Unconscious. Sometimes the casualty may start fitting.

There are 4 ways a poison can enter the body: Treatmentfor poisoning:
1. The substance is swallowed, either by For a corrosive substance firstly make sure that your safety is
accident or on purpose. secure – is it safe to help the casualty?
2. The substance is breathed in, entering the Dilute or wash away the substance if possible:
blood stream very quickly through the • Substance on the skin – see chemical burns

alveoli. Ingested substances – try to get the casualty to rinse their

3. The substance comes in contact with skin mouth, then give frequent sips of milk or cold water.
4. The substance is introduced through the Give clear and concise informationabout the poison if
skin directly into tissue or a blood vessel. possible. Follow any advice given by the ambulance operator.
A poison can be one of two things: If the casualty becomes unconscious, immediately open the

These include acids, bleach, petrol, ammonia, dishwasher airway and check for breathing. If they are not breathing
powder, commence CPR using a protective face shield. If the casualty
Turpentine, etc. is breathing but unconscious, place them in the recovery
These include tablets, plants, drugs, perfume, alcohol, etc. position
Signs and symptoms: Never try to get the casualty to vomit as this may damage the
There are a wide variety of signs and symptoms for poisoning, airway.
depending on the substance. Some clues you can look for are: For non-corrosive substances:
• Bottles or containers. • Give clear and concise informationabout the poison if possible.

• Tablets or drugs. Follow any advice given by the ambulance operator.

breath. airway and check for breathing. If they are not breathing
Some other signs that can accompany poisoning may be: commence CPR using a protective face shield. If the casualty

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 is breathing but unconscious, place them in the recovery from a burn and they may be more susceptible to
position infection.
Pass on the container the substance was in, or pass on any Location The location of the burn may affect the severity, in
information you may have regarding what the casualty has particular the inhaling of hot gasses will burn the
taken. airway resulting in instant death. Burns to the eye
Let them know how much was taken, if you are able to may well result in permanent blindness.
ascertain this information. DepthThe deeper the burn, the more severe it is going to be.
Let them know when the substance was taken, if you can Depth of burns:
ascertain this information. Skin consists of three layers, these are the epidermis on the
• Keep any sample of vomit from the casualty for hospital outside, the dermis underneath which lies on a layer of
analysis. subcutaneous fat.
Burns and scalds The depth of a burn can be defined as:
Estimating the severity of a burn: This is a burn only to the outer epidermis layer. This is most
There are five factors that affect the seriousness of a burn: commonly caused by scalds. The burn looks sore, red and
Size swollen.
The larger the area of the burn the more severe it is likely to be. The
These burns affect both the epidermis and the
size is usually given as a percentage of the body’s surface area. An
dermis. These burns look raw and blisters will
easy way to work out the percentage is to compare the size of the form.
burn to the casualty’s hand. The casualty’s open hand (including the With this type of burn, both the epidermis and
fingers) is the equivalent to 1% of their body area. dermis are
Cause The cause of the burn will influence the severity of the burn, burned
for away completely, leaving the exposed subcutaneous fat
example electrical burns could leave the casualty with internalorburns
beyond.
These burns may appear pale, charred or waxy.The casualty’s
and some chemicals (such as hydrofluoric acid) may cause
nerve endings will have been burned away so pain may well
poisoning to the burns as an added complication. be absent which can mislead both you and the casualty.
Age The casualty’s age will affect the severity of the burn and how long Causes of burns and treatment
their recovery rate will be. Babies and young Burns can be separated into five different areas, the treatment for
children will burn at a lower temperature than each burn will differ slightly depending on the cause.
adults will. The elderly will take longer to heal Electrical burns:
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These burns are caused by heat from an electrical charge flowing running water available if possible. Be careful not to cool large
through the bodily tissue. You may be able to determine where areas too much as this may cause hypothermia.
the current entered the body, and the point of exit, but there will • If possible, remove any rings, watches, bangles, etc., during
certainly be deep internal burns which are cooling as the burned area will swell. If there is any clot
not visible to the eye between the entry and exit burns. The • If the chemical is a dry powder, it can be brushed off the
extent of the casualty’s skin before treatment. Make sure that you protect
internal damage can usually be guessed at by the severity of the yourself.
entry and exit burns. • Use lots of cold running water to wash the chemicals off the
An electric shock may well cause cardiac arrest, so be prepared skin. This should be done for a longer period of time than for a
to perform thermal burn, at least 20
CPR. Remember in this case that the casualty’s airway and minutes. Be careful not to wash the chemical onto
breathing are the priority. unaffected areas of the body. Try not to let any
Ensure that it is safe to approach and help the casualty – contaminated pools of water collect under the casualty.
never put yourself in harm’s way. Make sure the contact Take note of what the chemical isand give this information to
between the casualty and the electrical current is broken. the ambulance operator if you can.
• Make sure to maintain the casualty’s airway and breathing. • Carefully remove any contaminated clothing from the casualty
Try to irrigate the area of the burn, including the area while you are washing the burn.
between the entry and exit burns for at least ten minutes. • If the chemical is in the casualty’s eye, wash it as
• Continue treating the casualty as you would for a ‘dry recommended on page 43, making sure the water runs away
heat’burn. from the casualty’s uninjured eye.
Dry heat burns: • Some chemicals cannot be safely diluted with water, in this
These burns are caused by any dry heat source or friction. case health & safety regulations insist that an ‘antidote’ be
• Ensure it is safe to approach and help the casualty – never put available in case of an emergency. You and any other first aider
yourself in harm’s way. should be trained in the use of the antidote.
• Make sure to maintain the casualty’s airway and breathing. Never do any of the following when burns are concerned:
• Try to take the heat out of the burn by using cold (preferably • Burst a blister or blisters (the blisters are there to protect
running) water for about 10 to 15 minutes. If water is not against infection).
readily available, any other cold, non-harmful liquid such as • Touch the burn.
milk may be used, as some cooling to the burn is better than
none. Do this initially, and move to an area where there is
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 Types of fracture Never try to manipulate a dislocated joint back into place as this
Afracture is a ‘break in the continuity of the bone’. These are is best left to medical experts, and the process can be extremely
the basic categories for a fracture: painful and traumatic to the casualty. Also, you may
Closed Aclean break or crack to the bone with no complications inadvertently cause further damage.
arising. Sprains and strains
Open A broken bone will break the skin, and may or may A sprain is an injury to the ligament at a joint. A strain is an
not still be protruding from the wound. Please injury to a muscle. These types of injury are usually caused
bear in mind that these types of injury carry a by sudden wrenching which causes the joint to over stretch
high risk of infection. tearing the surrounding muscles and ligaments.
Complicated There are usually complications with this type Minor fractures can be easily mistaken for a sprain or a strain.
of fracture, such as trapped blood vessels or If you have any doubts, treat the injury as if it were a fracture
nerves. to be on the safe side. The only way you can be sure if it is or
Green stick These are more likely to occur in children who is not a fracture is by x-ray.
have young, more flexible bones. The bone Signs and symptoms of fracture:
splits, but is not completely severed. Green Pain Pain will occur at the site of the fracture. The
stick fractures can easily be mistaken for may have taken strong pain killers, have nerve
sprains and strains as only a few of the signs of or dementia, so be aware.
fracture are present.
Loss of power For example, the casualty will not be able
Dislocations
A dislocation occurs when a bone becomes partially or anything with a fractured arm.
completely dislodged at the joint, usually resulting from a Unnatural movement If a limb is moving in an unnatural way, it is
wrenching movement or sudden muscular
contraction. The most common areas of dislocation are the to be an ‘unstable’fracture and care should be
jaw, thumb, knee cap, shoulder or finger. to prevent the fracture from moving and c
Fractures can occur at or near the site of a dislocation, further damage.
along with damage to ligaments, tendons and cartilage. It
is sometimes difficult to distinguish between a fracture Swelling and bruising This usually occurs around the site of the fractu
and a dislocation.
Deformity If the limb is bent in the wrong place, it is brok

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Treatment of sprains and strains: Inadequate clothing in windy weather will result in cold air in
The best way to treat sprains and strains is to follow the RICE continuous contact with skin, resulting in the body cooling
mnemonic: faster.
R Ensure the casualty rests the injury. For example, do not Signs and symptoms:
allow a sportsman to continue (remind them it • Skin appears pale and cold to the touch.
is better to miss one game than the next ten!). • Initial shivering, with the body stiffening as the body cools
I As soon as you can, apply an ice pack (frozen further.
vegetables such as peas or, if you have it, a • Bodily functions slow, including pulse, speech, breathing and
refrigerant gel pack). This helps to thought.
reduce swelling and speeds recovery. Be sure • Appears to be drunk – lethargic, confused, disorientated.
not to place the ice pack directly onto the skin, • Lowered levels of response leading to unconsciousness and
as this can cause frostbite. A tea towel or any finally death.
sort of thin barrier will suffice. Do this for 10 Treatment of hypothermia:
minutes every 2 hours for 24 hours for If the casualty is unconscious:
maximum effect. • Clear the airway and check the casualty is breathing. If not,
C Apply a firm (not constricting) bandage to the commence CPR.
injured area. This also will help reduce the • call for an ambulance immediately.
swelling, and provide support. The bandage can If the casualty is breathing, carefully place them in the
be applied over an ice pack for the first ten recovery position. Do not move the casualty unnecessarily as
minutes, but be sure to remove the ice pack after the slightest jolt may cause the heart to stop.
this time. Place insulating materials, such as blankets, under and around
E Elevate the injury, as this helps reduc the casualty making sure to cover the head.
The usual cause of hypothermia is over exposure to cold Remember to monitor the casualty’s breathing. Their
temperatures, but the different types of casualty and condition pulse may be hard to locate, but it is safe to assume the
may have an effect on the risk: casualty’s heart is beating if they are breathing.
Wet clothes or submersion in cold water results in the body If the casualty is conscious:
cooling much faster than when dry, as water conducts heat Try to get the casualty to shelter if possible, remove any wet
away from the body. clothing and replace with dry, warm clothing. Cover the head,
as a lot of heat is lost here.
• Give the casualty something warm to drink and eat.
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Seek medical advice if the casualty is a child, elderly or you Low blood sugar (hypoglycemia)
are unsure about their condition. This condition occurs mainly with diabetic people who are
It is vital to NEVER: insulin dependent, as the level of insulin in the body is ‘fixed’
Give the casualty alcohol, as it dilates blood vessels which due to the dose administered by injection.
will cool the casualty further. Blood sugar levels fall if:
Place a heat source directly on or near the casualty, this will • The person has not eaten enough food.
draw the blood to the skin causing the blood pressure to fall • The person over exerts (burns off the sugar in their blood). 
and place stress on the heart. The person has injected a too high dose of insulin.
• Try to warm a baby or elderly person quickly by placing them Why low blood sugar is dangerous:
in a warm bath. Unlike the other cells in the body, glucose (sugar) is the only
A hypothermia casualty’s heart is in energy source the brain can use. If the sugar in the blood drops,
grav this literally starves the brain.
e Signs and symptoms:
dan Treatment of high blood sugar ( hyperglycaemia ):
ger • Arrange for the casualty to see a doctor as a matter of urgency.
Dia • Should the casualty become unconscious, maintain their airway
bete and breathing, place in the recovery position
s Treatment of low blood sugar ( hypoglycaemia ):
This condition occurs when the casualty does not produce If the casualty is conscious:
enough insulin naturally • Sit the casualty in a comfortable position.
The body uses insulin naturally to break down the sugar that Give the casualty a sugary drink (isotonic sports drinks are
we digest so that it can be used by the cells or stored for the best option as they are high in sugar), sugar lumps,
later use If untreated the sugar level cause problems glucose tablets, chocolate or other sweet foods.
High blood sugar (hyperglycemia) If the casualty responds quickly to this treatment, wait five
This occurs when the diabetes is not treated effectively with any minutes then give them some carbohydrates (a sandwich,
of the methods mentioned above. pasta, etc.).
The sugar levels in the blood climb and acids build up. The Stay with the casualty, do not leave them alone. Let them rest
signs and symptoms displayed by a hyperglycemic person until they are fully alert and their response levels are back to
are a result of the body trying to excrete the acid build up. normal.
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Suggest to the casualty they see their doctor, even if they appear twitching in the face, jerking of a limb or lip smacking. The
to have fully recovered. person can at times make a noise such as a sudden cry.
If the casualty does not respond to the treatment within 10 Treatmentof minor seizures:
minutes, or they become unmanageable, callan ambulance. Remove any danger near the casualty, such as cutlery or hot
Consider the possibility that there may be another cause for the drinks they may be holding.
casualty’s symptoms. • Help the casualty to sit in a quiet place, and reassure them.
If the casualty is unconscious: • Stay with them until they are fully alert.
• Open the airway and check for breath. Resuscitate if necessary. • If the casualty is unaware of any condition, suggest they see
• Place the casualty in the recovery position if they are breathing their doctor.
normally. Major seizures
Epilepsy This is the more serious type of seizure, resulting from a
People with this condition have a tendency to have seizures major disturbance in the brain which causes aggressive fitting
(fits) that come from a disturbance in the brain. However, throughout the body.
bear in mind that one in twenty people will experience a These types of fit can be very frightening to see, but try to
seizure at some point in their lives, so the casualty may not be remain calm as prompt action is essential for the casualty.
epileptic. Signs and symptoms:
The causes of a seizure are many, such as hypoxia, stroke, a Recovery phase This is when the body relaxes even though
head injury or even a high body temperature. the casualty may still be unresponsive. Their
Seizures are common in babies and children whose response levels will improve within a few
temperature is too high due to illness and fever. This is minutes, but they may not be fully alert for
covered under the heading ‘febrile convulsions’, which about 20 minutes or so. They may want to
follows. sleep to recuperate, and be unaware of their
Minor seizures actions.
This condition is also known as ‘absence seizures’ or ‘petit Treatmentof major seizures ( fits ):
mal’ seizures. The person may suddenly appear to be During the seizure:
daydreaming (even in mid-sentence). This may only last a • If you can, help the casualty to the floor to avoid injury.
couple of seconds before recovery, and the person may not Try to cushion the casualty’s head, to avoid head trauma. This
even realise what just happened. On some occasions a minor can be accomplished with a folded coat, jumper or even your
seizure may be accompanied by unusual movements such as hands.
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• Loosen any tight clothing around their neck to help them • Continue to administer 30 chest compressions followed by 2 rescue
breathe. breaths
If your rescue breaths do not make the baby’s chest rise effectively:
• Try to move any objects from the area around the casualty to
Give a further 30 chest compressions before attempting the following:
lessen them hurting themselves • Check inside the mouth and remove any clearly visible obstruction (do
• If you have any concerns about their airway , roll them unto not reach blindly into the baby’s throat)
their sides • Recheck that the head is adequately tilted back and the chin is lifted
• Take time when the seizer started • Do not administer more than 2 rescue breaths before resuming chest
• Check identification compressions
• If lasts more than 3 minutes call the ambulance
Resuscitation with an Automated External Defibrillator (AED ):
The most common cause of a heart stopping (cardiac arrest) is a ‘heart
Baby resuscitation:
attack’ (see page 30). It is worth noting that a heart attack does not
Danger
always result in cardiac arrest. The majority of heart attack victims
Make sure you are safe to help, do not put yourself in danger
remain conscious and survive
Response
An Automated External Defibrillator (AED) is a safe and reliable
• Gently tap the baby’s shoulders and shout to try to wake the baby
computerized device that analyses the heart rhythms and enables a non-
• If the baby does not respond shout for help, but don’t leave the baby yet
medically qualified person to safely administer the life-saving shock,
Airway
with some small amount of training.
Carefully ensure the airway is open by gently tipping the baby’s head
Using an AED can drastically increase the chances of a casualty’s survival
back with the ‘chin lift’:
if their heart stops beating, but prompt use is paramount. For every minute’s
• Place your hand on the baby’s forehead and gently tilt their head back.
delay in delivering the shock, the casualty’s chance of survival is reduced
DO NOT OVER-
by 10 %.
EXTEND THE BABY’S NECK  Using your fingertips
Danger
under the point of the chin, lift the chin to open the airway
• Make sure you are safe to help, do not put yourself in danger
Breathing
• Consider the safety implications of using an AED in this situation
Ensuring the airway is kept open; look, listen and feel to ascertain whether
Response
the baby is breathing normally. Do not take more than ten seconds to do
• Gently shake the shoulders and ask in a loud voice ‘Are you alright?’ If
this.
there is no response from the casualty:
• If the baby is able to breath normally, consider the baby’s injuries and
• Shout for help immediately
place them in the recovery position
• If you have people with you, ask one helper to call for an ambulance and
Combine rescue breaths with chest compressions:
ask the other to get the AED, but do not leave the casualty yourself just
• Use 2 fingers to depress the baby’s chest to a third of its depth
yet
• Give 30 chest compressions at a rate of 100 compressions per minute
Airway
• Open the airway again by tilting the baby’s head and lifting the chin, and
give 2 more rescue breaths
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• Carefully ensure the airway is open by gently tipping the head back lifting DO NOT REMOVE THE PADS ONCE YOU HAVE PLACED THEM IF
the chin THEY ARE THE WRONG WAY ROUND – THEAED WILL
Breathing STILLWORK.
Ensuring the airway is kept open; look, listen and feel to ascertain whether Wait while the AED analyses the casualty’s heart rhythm – stop CPR while
the casualty is breathing normally. Do not take more than ten seconds to do this happens and ensure no one touches the casualty
this. If the AED advises a shock:
• If the casualty is able to breath normally, consider possible injuries and • Ensure no one is touching the casualty (check from top to toe and clearly
carefully place them in the recovery position (see page 12) shout ‘stand clear!’)
If the casualty is not breathing normally: • Push the shock button when prompted (if the AED is fully automated it
• If you are alone, call an ambulance and get the AED – you may have to will deliver the shock automatically)
leave thecasualty to do this • Continue as directed by the voice or visual prompts from the AED
• If you have people with you, start CPR immediately while one helper If the AED does not advise a shock:
dials 999 for an ambulance and the other helper gets theAED. • Immediately resume CPR using the ratio of 30 chest compressions to 2
Continue CPR yourself until the AED rescue breaths
Arrives • Continue as directed by the voice or visual prompts from the AED
When the AED arrives: Placements of the pads:
If you have someone helping you ask them to take over CPR while Wet chest
you get the AED ready. NOTE: If the person with you is untrained in If the casualty’s chest is wet (from sweating for example) it must be dried
CPR it may be easier for them to administer the chest Compressions before the pads can be applied so they can stick to the skin properly. Also
only (see page 4). be sure to dry the area of the chest between the pads, as electricity can
Switch on theAED immediately and follow the voice prompts: ‘arc’ across the wet skin.
• Attach the leads to the AED if they are not already attached, and attach the Excessive chest hair
pads to the casualty’s bare chest (if possible, do this while the person Hair on the chest will stop the pads from sticking to the skin properly
helping you continues CPR) and will interfere with electrical contact. You only need to shave the
• It may be necessary for you to towel dry or even shave the casualty’s chest chest if the hair is excessive, and even then take as little time as
so the pads adhere to their skin properly. Only shave where the pads are possible as you don’t want to delay defibrillation by any longer than is
going to go, try to delay defibrillation as little as possible absolutely necessary. If there is no razor immediately available, do not
• Peel the backing from the pads one at a time and place them firmly in delay defibrillation.
position, following the instruction on the pads Pad positioning
• Place the first pad below the casualty’s right collar bone Research shows that the position of the pad on the lower left side of the
• Place the second pad on the casualty’s left side, over the lower ribs. Try to chest has an impact on the effectiveness of the shock. When placing the
place the second pad vertically if possible. pad, make sure it is placed around the side of the chest (not on the front)
and place it vertically. This will help ensure the maximum electricity
flows through the heart rather than across the surface of the chest. If the

Page | 23
AED has not been updated, the pads will have a diagram showing
horizontal placement – ignore this advice and place the pad vertically.
AED safety considerations:
Electric shock
Studies have shown that, providing the pads are stuck to a dry chest in
the correct positions, the risk of electrical shock is very low as the
electricity wants to travel from one pad to the other, not to ‘earth’itself
like mains electricity. However, to be on the safe side, always briefly
check that no one is touching the casualty before a shock is delivered.
DO NOT delay defibrillation because the casualty is lying on a wet or
metal surface, providing the chest area is dry it is safe to administer the
shock.
Medication patches
Some casualties will wear a patch to administer their medication (e.g. a
nicotine patch). Some heart patients wear a ‘glyceryl tri-nitrate’ (GTN)
patch. Please be aware that this type of patch can explode if electricity is
passed through it. Remove any visible medication patches before
administering a shock as a precaution.
COMPILED BY: IRENE OPIYO

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