Providing First Aid for Different Emergency Situations

Emergency Childbirth

Childbirth generally begins naturally around 280 days (9 months) after conception. For a first-time pregnancy, the average length of labour is about 14 hours but can reduce to eight hours in following pregnancies. Nevertheless, many women experience much shorter or longer labour.

In modern society, it has become quite common for women to continue working at their place of employment late into the final stage of their pregnancy. Emergency childbirth is where the birth occurs in or out of the hospital without standard obstetric procedures and preparations.

It is important for a first aider to understand the fundamental principles of assisting with emergency childbirth in case they are faced with this emergency situation.

Preparation Steps

In the event of emergency childbirth occurring, the following can be done. This is based on time permitting as support for the delivery should not be delayed.

• Thoroughly wash and dry hands. Wear disposable gloves if available
• If available, have a clean surface area. Place a sheet of plastic with a clean sheet on top
• Get and arrange for the following supplies:
  o A sheet or blanket to cover the mother
  o Tissues, baby wipes or toilet paper – in case soiling occurs
  o Clean towels – To place an infant on and another to wrap the infant in
  o Scissors that have been sterilized – to cut the umbilical cord
  o Clamping devices that have been sterilized – Can be shoe laces, cord, string, or cable ties – to clamp the umbilical cord
  o Cotton wool or clean soft cotton cloth – To gently clean the baby’s face
  o Container for disposal of contaminated materials
  

The process of childbirth can be divided into three stages of labour.

1) First stage of labour: Labour and dilation of the cervix

2) Second stage of labour: Birth

3) Third stage of labour: Expulsion of the Placenta – Afterbirth

The first stage of labour: Labour and dilation of the cervix

Dilation of the cervix commences. It will dilate from 0 to 10 cm (fully dilated) over a period of time in which the expectant mother will have many contractions. Contractions increase in frequency, strength and intensity as labour progresses. The mother can be lying down or sitting in a leaning position.

Active pushing by the mother should not commence until the second stage. In the final phase of the first stage, the contractions may feel as though they are no longer separate, but running into each other. The birth of the baby will be imminent from this point.

Support for the first stage of labour

Reassure the mother that the birth process is going smoothly.

Help the mother to be calm, patient and relaxed as possible. Standing up or walking can tend to shorten labour, so if the mother feels comfortable doing so, let her. Let her eat or drink small amounts of food, fruit juice, or suck on ice if she becomes hungry or thirsty. To relieve discomfort, the mother may need to empty her bowels or urinate frequently but don’t allow her to sit on a toilet.

It is important to know how to time the contractions. This will aid in knowing how far into labour the mother is and what time is left until the baby arrives.

Time the intervals of the contractions. Start timing from the beginning of one contraction to the start of the next contraction. As labour progresses, the time between contractions decreases.

The second stage of labour: Birth

The mother enters the second stage of labour when the cervix is fully dilated and ends with the birth of the baby. Can last from 30 minutes to two hours.

The contractions of the second stage are often of a different kind. They may come further apart and the mother usually feels inclined to bear down (push) with them helping the baby to come down the birth canal. The birth of the baby is nearing completion when the top of the baby’s head appears known as the “crowning”.

Once the head is out, the shoulders follow.

Support for the second stage of labour

• Give verbal encouragement saying how well she is doing
• Don’t be distressed if she displays anger or becomes emotional
• Support the baby’s head as it emerges but allow it to rotate naturally
• Immediately check to determine whether or not the umbilical cord is wound around the neck. If it is, gently hook it with your finger and slip it over the baby’s head
• If the cord is too tight, it has to be clamped in two spots, 5 to 8cm apart. Cut the cord between the clamps and deliver the baby rapidly
• As the shoulders emerge, be ready for the rest of the body to come out quickly. Use the cleanest material or towel available to receive the baby. Be careful as newborn babies are very slippery
• Hold the baby over the bed while raising the baby’s body slightly higher than the head to drain fluid and mucous from the baby’s nose and mouth. Gently clean baby’s face
• In most cases, the baby will almost immediately breathe and cry
• If the baby doesn’t spontaneously breathe, use your finger to gently clear the mouth of mucous. Softly rub its back to stimulate crying. If still not breathing, give extremely gentle mouth-to-mouth resuscitation with small puffs, at 20 puffs a minute
• After gently drying the baby, place the baby onto the mother’s abdomen or chest if the cord is long enough. Cover baby and mother with a clean dry towel or blanket
• Do not pull the umbilical cord at any time
• 2 to 5 minutes after the birth of the baby, the umbilical cord can be clamped/tied and then cut
  o For emergency childbirth the cord is to be tightly clamped/tied in three places – Going from the baby’s navel, tie the 1st clamp at 10cm, the 2nd at 15cm and the 3rd one at 20cm.
  o To prevent bleeding when cutting the cord, make sure all clamps are firmly tied
  o Cut the cord between the 2nd and 3rd clamp. This will leave two clamps on the baby’s side
  o The cord is extremely tough to cut but will be painless due to the absence of nerves

The third stage of labour is the delivery of the placenta which can range from 5 to 30 minutes to take place.

The process begins with the placenta separating from the uterine wall. Contractions will naturally occur and the mother may help expel it by bearing down. Do not pull the umbilical cord at any time.

Image: Stages of Childbirth by OpenStax College: Anatomy & Physiology, Connexions Web site

Support for the third stage of labour and after

• Massage the uterus to ensure that it is contracted and hard. This helps to reduce excessive bleeding
• Quickly assess the baby (skin colour, cry and movement) and check the mother is not bleeding excessively
• Have the mother nurse the baby
• After delivery of the placenta, rinse the perianal area with warm sterile water. Dry area with a clean towel. Apply sanitary pads or a small towel in such a manner that the mother can hold them in place by drawing her legs together
• Encourage the mother to rest and maintain her privacy

 Breastfeeding in Supine Position: Image by BruceBlaus (Own work) [CC BY-SA 4.0]

•  Be alert for signs of shock due to blood loss. Keep mother covered and warm
• Keep the placenta for medical review purposes
• Place all soiled materials into a bag/container for disposal

Providing First Aid to Casualties who are Aged or Infirmed

Older adults are more likely to be vulnerable to accidents and injuries than younger people, even though they are currently energetic and active though they may be affected by diminished levels of the senses such as touch, hearing and sight. When an incident does occur, a first aider needs to beware of how best to care and aid an elderly or infirmed casualty.

The basic first aid guidelines that apply for adults are generally the same for the elderly though there are aspects that need to be considered.

Situations that may require first aid are:

• Falls
• Cardiovascular issues
• Cuts, knocks and scrapes
• Cold and heat-related illness

Image of an elderly frail person by James Heilman, MD

Falls

Hospitalisations due to falls by Australians aged 65 and over, in 2009-10. The estimated number of hospitalised injury cases due to falls in older people was 83,800 – more than 5,100 extra cases than in 2008-09 – and about 70% of these falls happened in either the home or an aged care facility. One in every 10 days spent in hospital by a person aged 65 and older in 2009-10 was directly attributable to an injurious fall.

As in previous years, a fall on the same level due to slipping, tripping and stumbling was the most common cause of hospitalised injury.

The above information quoted from Hospitalisations due to falls by older people, Australia: 2009-10 by Australian Institute of Health and Welfare (Copyright holder)

Based on the previous page, it can be noted that the elderly are more vulnerable to falls. This could be due to:

• The common effects of aging with a reduced level of:
  o Motor skills, balance and coordination
  o Muscle strength
  o Eyesight
• Some medications can cause rapid drops in blood pressure or dizziness
• Physical immobility or inactivity

An elderly person is much more likely to suffer a serious injury from a fall than a younger person.

Falls – First Aid Guideline

• Follow DRS ABCD
• Don’t try to help them up right away
• Assess them for any injuries – visual and verbal assessment
• Be calm and reassuring
• Be respectful, gentle and considerate
• For serious injuries, immediately call 000
  o Don’t move the casualty unless unconscious
• If the casualty appears to be okay, help and support them to get up
  o Take them to a doctor to assess whether there was a medical cause for the fall and to check for any injuries

Cardiovascular Issues

Age-related changes in the heart and blood vessels place older adults at an increased risk of heart attacks, heart failure, and strokes.

If you suspect at any time that an elderly person is having heart problems or a stroke, immediately call 000. Be calm and reassuring while keeping them warm until emergency help arrives.

For specific first aid, guidelines refer back to pertinent topics previously covered.

Cuts, Knocks and Scrapes

As the skin ages, it becomes thinner and more delicate, making it more prone to cuts, knocks and scratches. These can be quite serious or superficial and take longer to heal. As well, the skin will bruise more easily as the blood vessels under the skin have become more fragile

Cuts, Knocks and Scrapes: Awareness Points

• All superficial cuts and scratches need to be properly cleaned and dressed if required
• After cleaning the wound and surrounding area, follow R.I.D for deep cuts. Take the casualty to a doctor to assess
• Be gentle in how you touch the casualty to avoid causing bruising or skin tears

Image by Andreas Bohnenstengel

Cold and Heat-Related Illness

As a person age, they become more vulnerable to temperature fluctuations, especially those with chronic illnesses or by taking certain prescription medications that can affect their temperature balance.

When outdoors, the elderly should always wear sunscreen and protective clothing, irrespective if it’s hot or cold outside.

• COLD: Protect all of their skin from exposure by wearing enough layers of clothing
• HOT: Stay hydrated and protect their skin from the sun

If you suspect at any time that an elderly person is suffering from heatstroke or hypothermia, immediately call 000. Be calm and reassuring while keeping them cool or warm (as applicable to the issue) until emergency help arrives.

For specific first aid, guidelines refer back to pertinent topics previously covered.

Before providing first aid to an elderly or infirmed casualty, we need to consider the previous points. At all times when providing first aid to the elderly or infirmed remember to:

• Be caring and compassionate
• Be calm and reassuring
• Be respectful and considerate
• Help them to preserve their dignity
• Explain carefully what you are doing. If possible, include the carer in the discussion
• Refer them to professional help for pain management
• Beware of pre-existing conditions or medications that they may be taking

Providing First Aid to Children

Procedures and principles for providing first aid to children are basically the same as for an adult but there are variances between infants, children and adults in physiological, anatomical, cognitive and emotional ways which need to be considered.

Awareness Points Regarding Children

Before providing first aid to children, the following points need to be considered and/or followed:

• If a casualty is a minor (under 18yrs) you should gain consent from a parent/guardian
• A child’s resting heart rate is faster than an adult
• Children have quicker respiratory rates than adults
  o When compared to adults, children may be more vulnerable to toxins absorbed through the pulmonary route
• A high fever in a child may trigger a convulsion/seizure known as a febrile convulsion
• The principles of DRS ABCD are the same between children and adults while processes are slightly different due to physiological and anatomical variances
• An infant’s trachea is shorter and softer than an adult
  o Tilting the head during CPR may result in airway collapse
• A child’s airway is smaller and softer
  o More prone to foreign body obstruction or choking
• Children have thinner skin than adults.
  o Children are at greater risk for the absorption of toxins that can be absorbed through the skin
• The body surface area of children is proportionately larger than adults. Children are at greater risk of:
  o Excessive loss of heat
  o Excessive loss of fluids – Dehydration
• Cognitive and emotional levels of children are not as developed as an adult
  o Need to be mindful of how we communicate to a child based on their cognitive level of development
  o Children are still developing their ability to recognize and manage their emotions or feelings

When providing first aid to an infant or a child we need to consider the previous points. At all times when providing first aid we should be:

• Caring and compassionate
• Calm and reassuring
• Respectful and considerate

Burns: Chemical, Electrical

Chemical Burns

Government regulations on hazardous substances and WHS requires all premises to have a safety data sheet (SDS) per hazardous chemical. These SDS’s provide directions on administering first aid specific to each chemical and include information relevant to eye contact, skin contact, inhalation and ingestion.

Note: The objective of first aid for chemical burns is not to cool the burn but to dilute the chemical.

Chemical Burns – First Aid

• Check for danger. Evaluate and manage any hazards. Control any risks
• Use appropriate personal protection equipment/clothing (PPEC) to avoid contact with any chemical or contaminated material
• Remove the casualty to a safe area
• As soon as practical, remove the chemical and any contaminated clothing and jewellery
• Brush powdered chemicals from the casualty’s skin away from you
• Immediately run cool running water directly onto the area for one hour or until the stinging stops.
  o Note: Be careful not to spread the chemical to unaffected areas
• Even if no burn mark is obvious, apply a non-adherent dressing
• If a chemical enters the eye, open and flush the affected eye(s) thoroughly with water for as long as tolerated and refer the victim for urgent medical attention. If only one eye is affected, then flush with the head positioned so as the affected eye is down to avoid spread of the chemical to the unaffected eye.
  o Note: Flushing the eye straightaway is vital, even more, important than the immediate transfer to medical facilities
• Follow specific first aid instructions found on the label of the chemical’s container
• Refer to the chemical’s Safety Data Sheet (SDS) for specific treatment (If available)
• For further advice, call the Poisons Information Centre on 13 11 26

DO NOT:

🗵 Do not apply hydrogel dressings or cling wrap plastic to chemical burns

🗵 Do not try to neutralise either acid or alkali burns, as this will increase heat generation which may cause further damage

Electrical Burns

Electrical burns, as well as lighting strikes, are regularly linked with other injuries including issues with the cardiac and respiratory systems, trauma and loss of consciousness.

First Aid

• Manage the hazard and control the risk. Safely isolate/turn off the power supply without touching the casualty
• Commence CPR if required, following DRS ABCD
  o Note: Lightning may cause cardiac arrest
• If safe to do so, cool burns with cool running water for 20 minutes
• Give oxygen, if available and trained to do so
• Call 000 for an ambulance

Skin Injuries

As the outer covering of the body, the human skin is the largest organ. There are a number of types of skin injuries in which the skin has been broken, cut, torn etc., known as an open wound or a closed wound where the damage is beneath the skin.

Irrespective of the type of skin injury, first aid treatment is required due to the risk of infection, bleeding or further damage.

Some of the types of skin injuries are: Abrasion, Avulsion, Bite, Burn, Chafing, Contusion, Incision, Laceration, Puncture, Scratch

Image: Anatomy of the human skin

Abrasion

Type: An abrasion is a type of wound in which the skin is scraped or rubbed off from contact with a rough surface. Also known as scrapes, grazes and carpet burns.

Skin Level: Abrasions are generally superficial wounds, with only the outer layers of skin being affected. A deep abrasion can leave a scar as it penetrates the inner layers of the skin. The knees and elbows have thin layers of skin and are most prone to abrasions (refer to image – elbow injury will leave a scar).

Image: Abrasion after 18 hours

First Aid: An abrasion should be thoroughly cleaned and any dirt or debris removed. Cover with a sterile dressing to prevent the wound from drying out.

Skin Avulsion

Type: An avulsion is a type of wound similar to abrasion but more severe. A tearing away of the skin. Can range from skin flaps, and degloving to amputations. This can include the loss of a fingernail from the nail bed.

Skin Level: A severe surface trauma where all layers of the skin have been ripped away, exposing what is underneath the skin (muscle, tendons, subcutaneous tissue or bone).

Image: Avulsion of the left index finger by Sadeq Rahimi First Aid: An avulsion should be thoroughly cleaned. Apply RID to stop the bleeding. Seek medical attention.

Incision

Type: An incision is a cut to the skin caused by a sharp-edged item such as a knife, broken glass, razor blade, sheet metal, scissors, etc. The cut edges of the skin are usually neat, straight or smooth.

Skin Level: Incisions can be shallow, only harming the surface skin, or quite deep, causing injury to the ligaments, muscles, tendons, blood vessels or nerves.

First Aid: All incisions should be thoroughly cleaned. Apply RID to stop the bleeding. Seek medical attention for deep incisions.

Image: Incision of the leg by ClockFace

Laceration

Caused by a blunt-like object, tearing open the skin. Lacerations can be shallow, only harming the surface skin, or quite deep, causing injury to the ligaments, muscles, tendons, blood vessels or nerves.

Puncture: When a sharp object pierces the skin. Common types of puncture wounds include stepping on a nail, getting a splinter, needle/pin prick or bites from animals

First Aid: Both types of wounds are prone to infection. Wounds should be thoroughly cleaned. Apply RID to stop the bleeding. Seek medical attention.

Image: Punctured foot by James Heilman, MD

Spinal Injuries Using Immobilization Principles

The priorities of management of a suspected neck/spinal injury are:

1. Calling for an ambulance
2. Management of airway, breathing and circulation
3. If unconscious, follow DRS ABCD. Management of the casualty’s airways takes precedence over any suspected spinal injury
4. Remember, DRS ABCD and CPR should not be avoided when a spinal injury is suspected

Spinal care

• If conscious but complaining of pain, weakness or altered sensation in the neck and/or limbs, instruct the casualty to remain as still as possible
• Avoid moving the casualty unless necessary (if they are in immediate danger or become unconscious)
• If movement is necessary, take additional steps to immobilise the neck and spine to avoid movement in any direction such as manually holding the head or neck

The Log Roll

The unconscious casualty with a suspected spinal injury should be moved into the recovery position. This is possible by using the Log Roll technique.

Image: Log roll by Rama

Requires three to four people.

Position people as shown in the image. The lead person securely supports the head while directing the team to gently pull the casualty’s torso and legs towards them. Done in a manner without any twisting while maintaining spinal alignment of the head and neck with the torso.

Note: If the casualty is bleeding from the head, move the casualty so that the bleeding side is down

Use of Cervical Collars by First Aiders

In Guideline 9.1.6, the ARC states that the use of semi-rigid cervical collars by first aiders is not recommended. Consistent with the first aid principle of preventing further harm, the potential benefits of applying a cervical collar do not outweigh harms such as increased intracranial pressure, pressure injuries or pain and unnecessary movement that can occur with the fitting and application of a collar.

Image: Cervical Collar by James Heilman, MD

Note: Do not fit a cervical collar onto a casualty unless trained and approved to do so

Manual In-Line Stabilisation

In Guideline 9.1.6, the ARC states that in suspected cervical spine injury, ANZCOR recommends that the initial management should be manual support of the head in a natural, neutral position, limiting angular movement (expert consensus opinion). In healthy adults, padding under the head (approximately 2cm) may optimise the neutral position.

This is best accomplished by kneeling above the head of the casualty. Using both hands, hold the casualty’s head while stabilizing your arms and elbow on your thighs. This will aid in avoiding your arms from swaying as they become tired and fatigued. Hold head in place until paramedics take over.

 

Responding to Major and Minor Accidents in the Workplace

Dangers

When responding to a workplace accident irrespective of the urgency or degree of the incident, you must take into consideration the situation that you face. Determine any dangers, and check for risks and hazards. YOU are the most important person NOT the casualty. Ensure the safety for yourself (the first aider), bystanders and the casualty.

Checking for danger before approaching any situation is critical. Rushing into a situation without adequately assessing the situation can put yourself and others at needless risk

• The amount of dangers greatly depends on the situation; hence it is important to assess each scene for possible dangers
• Sometimes, danger can be avoided, or the casualty can be moved away from it

Responding to Major and Minor Accidents in the Workplace

Steps to consider:

• Assess what is required, have the right equipment and follow workplace emergency procedures
• Response to an incident involving chemicals or hazardous goods must be guided by the directions found in the Safety Data Sheet (SDS) for that substance
• Wear the appropriate PPE/C to safely handle the incident
• Ensure that someone has contacted emergency services and is waiting at the main entry point to direct them to the correct location of the accident
• Manage the team of first aiders in an effective manner to optimize the team size and skill level
• Automatically take along the first kit and AED to any incident
• Prevent onlookers from intruding into the area of the incident
• Serious accidents must be reported to the employer and to the authorities