A handy, splash-proof, on-the-water reference guide for most of the first aid emergencies you could come across afloat, including drowning, unconsciousness, external bleeding, immersion, hypothermia and more. Highly illustrated to make the concepts easy to understand and follow.

First Aid Companion

By Sandra Roberts

John Wiley & Sons

Copyright © 2010 John Wiley & Sons, Ltd
All right reserved.
ISBN: 978-0-470-68206-7

Contents

RESUSCITATION.............................4DROWNING..................................5UNCONSCIOUS CASUALTY......................7CHOKING...................................8SHOCK.....................................9BLEEDING..................................11BURNS.....................................13FRACTURES/DISLOCATION.....................14IMMOBILISATION............................17SPINAL INJURY.............................19CHEST PAIN/ASTHMA.........................20SEIZURES..................................21DIABETES..................................22CASUALTY ASSESSMENT.......................24

Chapter One

RESUSCITATION

1. Shout at the casualty. Do they respond? - tell them to stay still. No response? - kneel by the casualty and shout again. Gently tap and shake their shoulders. Still no response? - turn the casualty onto their back. Shout for help.

2. Open the airway. Place a hand on the forehead and gently tilt the head back. Place fingertips under the chin and lift the chin up.

3. Check for breathing. Place head next to casualty's face. Keep chin supported. Look, listen and feel for evidence of normal breathing for no longer than 10 seconds. Can you feel breath on your cheek? Can you see the chest rise and fall? Can you hear any sounds? If you don't think breathing is normal continue with resuscitation. Raise the alarm. Leave casualty to do this if necessary.

4. Start chest compressions. Kneel by the side of the casualty. Place the heel of one hand in the centre of their chest. Place the heel of the other hand on top of the heel of the first. Interlock fingers and raise them off the chest.

Maintain vertical position over casualty. Keep arms locked straight, with hand, elbow and shoulder in line. Press down on the breastbone to a depth of 4–5 cm. Release pressure on the chest, letting it return to its original position. Do not remove hands from the chest. Repeat this at a rate of 100 per minute. Complete 30 compressions.

5. Open airway using the head tilt chin lift method. Pinch soft part of the nose using thumb and index finger. Maintain chin lift keeping the mouth open. Take a normal breath and place lips around the casualty's mouth making sure there is a good seal. Blow steadily in the mouth and watch for the chest to rise as in normal breathing. Take mouth away and watch for the chest to fall as the air comes out. Repeat this once more. This completes two effective rescue breaths.

Rescue breaths didn't make the chest rise and fall? - before next attempt at breaths, check the mouth for visible obstructions and ensure head tilt and chin lift are adequate. Do not attempt more than two breaths before returning to compressions.

Do not interrupt resuscitation. Only stop CPR if in danger, exhausted, or help arrives to take over.

Two rescuers present? - take turns, swapping over every two minutes, attempting to do so without any break in the CPR.

Unable to do ventilations because of infection risk, presence of blood or vomit, suspicion of poisoning, or just choose not to? - it is important to still do compressions. Continue compressions without any break until help arrives.

The casualty needs to be on a hard surface so may need to be moved from a bunk onto the deck.

DROWNING

Casualty not breathing? - if alone with casualty give 5 rescue breaths then continue with compressions and ventilations at a ratio of 30:2 for 1 minute before leaving the casualty to raise the alarm. Where there is another rescuer available to raise the alarm, give 5 rescue breaths and continue with compressions and breaths at 30:2 until help arrives.

UNCONCIOUS CASUALTY

No response? - open the airway and check that breathing is present.

Breathing but unconscious? - place in recovery position.

1. Kneel next to casualty. Straighten their legs. Quickly remove their spectacles and empty pockets. Place the arm closest to you out at right angles to the body with the elbow bent and the palm uppermost.

2. Bring the casualty's opposite arm across their chest. Hold the back of the casualty's hand against their cheek with your own palm. Do not let go. This hand supports the head as the casualty is turned.

3. With your other hand grasp the leg furthest away from you just above the knee and pull it up keeping the foot on the ground. With your hand on the knee pull this leg towards you to roll the casualty on their side.

4. Tilt the head back to make sure the airway remains open. The casualty's hand may be adjusted under the cheek to support the head or a pillow may be used. Adjust the upper leg so the hip and knee are at right angles.

5. Check breathing every 1 to 2 minutes. If the casualty is not breathing, roll them onto their back and commence resuscitation. (see Resuscitation p.2)

6. If the casualty has to be kept in the recovery position for more than 30 minutes, turn them to the opposite side to relieve pressure on the lower arm.

7. Never leave an unconscious casualty alone unless it is necessary in order to raise the alarm. Cover them to prevent heat loss and protect from the environment as needed.

8. Do not move the casualty unless they are in danger as this may cause further harm.

9. Assess the casualty for signs of injury or possible cause of the unconsciousness, and monitor their pulse. (see Casualty Assessment p.22)

CHOKING

It is important not to confuse this with other emergencies when the casualty may appear to have difficulty breathing. If the obstruction is mild the casualty will be able to answer or cough and will recover without assistance. If the casualty is unable to answer they may clutch or point to their throat to indicate the problem. Choking frequently occurs during eating.

1. Casualty still conscious? - attempt to dislodge the object. Stand beside the casualty and lean them forward supporting them with an arm. Give up to five sharp blows between the shoulder blades with the heel of your other hand. Check after each slap to see if the object has dislodged.

2. This does not relieve the situation? - do abdominal thrusts. Stand behind the casualty and lean them forward, putting both arms around the upper part of their abdomen. Clench a fist and place it midway between the belly button and the bottom end of the breast bone. Grasp this hand with the other and pull sharply upwards and inwards. Repeat up to five times checking after each thrust to see if the object has dislodged.

3. If the obstruction is not relieved continue alternating five abdominal thrusts with five back slaps.

4. If the casualty becomes unconscious commence CPR. (see Resuscitation p.2)

5. Abdominal thrusts may cause serious internal injury. Medical advice should be sought if they have been carried out and the casualty observed for evidence of internal injury. Following successful treatment for choking, foreign material may remain in the upper or lower respiratory tract and cause complications later. A casualty with a persistent cough, difficulty swallowing, or with the sensation of an object being still stuck in the throat, should always be referred for a medical opinion.

SHOCK

Shock may be the result of severe pain, injury, allergy, infection, fluid loss or medical conditions, such as heart attack. It may happen at any time during an emergency resulting in unconsciousness and death if not managed immediately.

1. How to recognise shock: Is the casualty pale, cold and clammy? Drowsy, confused, agitated, or dizzy? Thirsty, nauseated or vomiting? Breathing fast and shallow? Pulse fast and weak? Any of these may indicate shock.

2. Lay the casualty down flat on their back and raise their legs if the injury allows this. This helps blood flow to the core body organs.

3. Do not move the casualty unless they are in danger as this may worsen the shock. Protect them from the elements. Cover the casualty to prevent them losing heat but do not over warm them. If possible lie them on something, rather than directly onto a cold deck. Constantly reassure the casualty and try to keep them comfortable.

4. Loosen tight clothing at the neck and waist to aid breathing. Moisten their lips but do not allow them to eat or drink. This is likely to cause vomiting and they may choke.

5. Deal with the cause of the shock and monitor the casualty. (see Casualty Assessment p.22)

BLEEDING

1. Sit or lie casualty down. Place in the shock position if the bleed is major.

2. Identify the type of bleeding to determine the urgency and seriousness of the situation. Bright red and spurts? = Arterial Dark red and gushes? = Venous

3. Identify the wound. If no penetrating objects seen, apply direct pressure to the wound. Penetrating objects? - apply pressure at the base of the object and not on top of it. Apply dressing pad.

4. Elevate the wound as high as possible above heart level.

5. Can't control bleeding with direct pressure and elevation? - apply indirect pressure. Artery is compressed at pressure point to restrict flow of blood. Maximum time to hold is 10 minutes. Release slowly. May be reapplied.

6. Uncontrollable life threatening bleeding? last resort? - apply a tourniquet. Goes on and stays on. Place as close to the wound as possible. Record time it goes on.

7. Check for shock and manage immediately if recognised. (see Shock p.8)

8. Casualty unconscious? - put in recovery position and maintain pressure and elevation.

9. Bleeding under control? - check dressing for evidence of renewed bleeding.

10. Keep the casualty still to slow blood flow. Do not move unless in danger. If the bleed has been from an arm wound immobilised in a sling to keep it still or to maintain elevation.

11. Monitor casualty. Limb beyond dressing cold and pale? - it may have been damaged by the injury or is restricted by a dressing which is too tight. Slacken dressing slightly. Check pulse and breathing. (see Casualty Assessment p.22)

NOSE BLEED

1. Sit the casualty down with head leaning forwards. Firmly pinch the soft part of the nose. Maintain pressure for 10 minutes then release. Spit blood out don't swallow.

2. Bleeding continues? - do another 10 minutes of pressure. Get help if three 10 minutes attempts don't stop bleed.

3. Once the bleed has stopped the casualty should not be allowed to blow their nose, pick at blood clots in the nostril, or sniff hard, as this may restart the bleed.

INTERNAL BLEEDING

Has the casualty been ill or injured? - suspect internal bleeding.

If blood cannot escape from the body, internal bleeding can only be recognised by the symptoms of shock. (see Shock p.8) The casualty may also be in pain.

In some situations evidence of internal bleeding may be seen, for example coughing up blood after a chest injury or passing blood in urine after a back injury.

Monitor casualty and get urgent help.

HEAT BURNS

Dry heat, wet heat, electricity, chemicals, friction, and radiation may all result in hot burns.

The area of the body affected by a burn may be estimated by using the size of the casualty's palm as a template. It represents approximately 1% of the body surface area.

1. Remove casualty from the source of heat and place in a safe position.

2. Cool the burn for at least 10 minutes preferably under running water to carry the heat away. If a burn is soaked in a bowl of water, the water should be replaced periodically, as the burn will heat up the water. Never put ice in cooling water or use an ice pack on a burn as this causes further tissue damage. If the burn has been caused by a chemical, it should always be washed off the skin and never soaked in water as this will still contain the chemical. Burns to the mouth may be cooled by rinsing with cold water, ensuring it is spat out and not swallowed.

3. Remove restrictions like rings, watches and other jewellery as swelling will occur very quickly.

4. Clothing that may be burnt into skin should not be pulled off. If hot water has been spilt onto clothing, and it is not stuck to the skin, it should be removed, as contact with the hot wet material will continue to burn.

5. Once cooled, the burn should be covered lightly with a non fluffy dressing. A triangular bandage from a first aid kit is useful for this. Clingfilm from the galley may also be used or any clean non-fluffy fabric such as a clean tea towel. Burnt hands and feet may be placed inside an unused plastic food bag.

6. Elevate the burn when possible to help reduce swelling.

7. A minor burn can then be treated using a burn cream from the first aid kit. However if the burn is severe enough to warrant getting further advice, no burn cream should ever be used. If used it will disguise the burn and need to be cleaned off before the burn can be fully assessed. This will cause unnecessary pain for the casualty.

8. Treat for shock and monitor the casualty. (see Shock p.8 and Casualty Assessment p.22)

COLD BURNS

Contact with ice, chemicals or cold environmental conditions may result in cold burns.

Initially the skin is pale but colour may progress to blackened. The casualty may complain of numbness or pins and needles but not have pain. The skin feels cold and hard to the touch.

1. All restricting jewellery, watches etc. should be removed.

2. Slowly rewarm the cold tissue by immersion in warm water kept at 40 C. Never rub the skin as this can cause further damage.

3. Pain occurs when the tissue warms up and the casualty may need a strong pain killer.

4. As with a hot burn the tissue may swell so when possible it should be elevated. It should also be covered by a light non stick dressing.

FRACTURES

Is it a fracture? - is there a history of injury, swelling or bruising at the fracture site, pain, deformity, shortening of a limb, loss of movement or power, visible bone, or a crunching sensation (crepitus)?

1. Treat any wound. (see Bleeding p.9) If bone is protruding padding and pressure should be placed around the base of the bone only. No pressure should be put on exposed bone.

2. Immobilise the fracture to reduce pain and prevent further damage. (see Limb Immobilisation p.14)

3. Do not straighten any distorted limb to splint it until radio medical help has been sought.

4. Is blood and nerve supply to the limb present below the injury level? - is a pulse present? Skin warm and pink? Numbness or pins and needles?

5. Don't move a casualty unless they are in danger, until radio medical help has been sought.

DISLOCATION

1. Dislocation may be associated with torn ligaments. Consequences may be severe resulting in paralysis if major nerves are damaged. NEVER attempt to replace the dislocation.

2. Treat as for a fracture.

IMMOBILISATION — UPPER LIMBS

Slings are used to support, immobilise or elevate injuries. They are used on upper and lower arm injuries, but may also be used to manage those affecting the collar bone, chest and shoulder.

The low sling is used to support and immobilise shoulder, elbow, upper arm and lower arm injuries. It may also be useful where ribs are broken to remove the weight and movement of the arm.

1. Place the triangular bandage underneath the arm with the long edge of the triangle placed down the body and the point towards the elbow. Lift the lower edge of the fabric up over the arm and tie in a knot at the back of the neck.

2. The lower arm and hand should be well supported within the sling with the elbow held at 90. The fingers should be accessible so circulation may be checked. Padding may be required under the knot at the neck to make it more comfortable.

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