First Aid Stage 2

The Boys’ Brigade 99th Singapore Company

A CCA from Canberra Secondary School

First Aid Stage 2

Content:
The 6 Modules under First Aid Stage 2 badgework are as follows:
- Actions at Emergencies
- Treatment of Strains and Sprains
- Fractures & Immobilisations I (Theory and Upper Limbs)
- Fractures & Immobilisations II (Lower Limbs and Spinal Injuries)
- Handling Shock
- Animal Bites, Insects Stings, Bites

Rank Date

Name

Material adopted from First Aid Manual 8th Edition Page 1



Module 7: Actions at Emergencies

In any emergency, you must follow a clear plan that will enable you to prioritise what set of
steps is required to be employ to a casualty. Remember clearly the purpose of first aid:
Preserve Life
Prevent Condition from worsening
Promote Recovery

To help us do that, first aiders follows a standard 4 sequential profile.




To perform all these actions in a short time is difficult and often, first aider on site might only
be able to perform very limited materials. Hence, the aim for a first aider in an emergency is to:
- Assess the casualty
- Maintain the Vital signs of the casualty

Fortunately, a step-by-step guide is employed and we know it as Primary Survey.




Besides Primary Survey, there is also Secondary Survey and further skills set which will be
discuss in greater details as you pursue a first aider certification. The measure of the well
being of your casualty is based on their vital signs. Vitals signs are as follows:

Level of Response, Pulse, Breathing and Temperature.

Hence, do note how to measure the above.




Recovery Position

Should a casualty remain unconscious, the breathing and circulation are not compromised, no
further treatment necessary, as first aid, we need to position the casualty in Recovery Position.




Module 8: Treatment of Strains and Sprains

Ligaments, muscles and tendons are the softer structures and tissues surrounding our bones
and joints. Often, they are also the easiest to be injured by overstretched, partial or complete
torn due to violent or sudden movement. During sporting activities, strains and sprains are
occurs frequently. As such the responsibility of a First Aider in situation as such revolves
Reducing Swelling/Pain and obtaining medical aid if necessary. Under normal circumstances,
strains and sprains are not life-threatening unless complication occurs.

Recognition of Strains/Sprains

Pain and tenderness
Difficulty in moving the injured part, especially if it is a joint.
Swelling and bruising in the area.

On the onset of strains/sprains, a suitable treatment is characterised as R I C E.

R Rest Rest the injured part

I Ice Apply Ice or cold compress

C Compress Compress the injury

E Elevate Elevate the injured part

Even though many people have strains and sprains, how you asked yourself, why does it swell?

Well, in terms of swelling occurs in injuries that has relationship with bleeding. Often, strain
and sprains swellings as the soft tissues are damaged breaking certain blood vessels. As such,
when blood comes out of the vessels, it cause a red colouration commonly noticed as bruises.
Tenderness and swelling may set in depended on the position of injury.

What if we do not treat strains and sprains properly?

Should the soft tissue be overstretched, give it a few weeks, pain will go away which much
medical attention. However, if the tissue is torn partially or totally, it can result in extreme
pain and lack of mobility/functionality of the injury site.




How do we handle a case strain/sprain using RICE?

Below describe the steps relating to a sprain ankle. However, it can be modify to be applicable
to most strain and sprain.




Attached below are steps to use a roller bandage on ankle or wrist.




Module 9: Fractures & Immobilisations I (Theory and Upper Limbs)
Fracture is a break or crack in a bone as a reason of considerable force. It is as a result of direct
or indirect force acting on the bone. A fracture can occur at any body part whereby bone is
present. As such, there are numerous types of fracture. To simplify matters, there are broadly
classified as Open or Closed Fracture, Stable or Unstable Fracture.




Recognition of Fractures

Deformity, swelling and bruising at the fracture site
Pain and difficulty in moving the area
Shortening, bening or twisting of a limb
Signs of shock, especially if the fracture is to the thigh bone or pelvis (as there are major blood
vessel flowing near this region as fracture will mean breaking of such vessels)
Difficulty in moving a limb normally or cannot move at all
Wound protruding with a bone end

Despite many types of fractures, the aim and purpose for first aid remain relatively the same.
- Prevent Movement at injury site.
- Minimise blood loss and infection at injury site.
- Arrange evacuation to hospital with comfortable support during transport.

In this module, we are looking at handling injuries to the upper limbs, dislocated shoulder,
upper arm, forearm, elbow, hand/fingers and ribcages.

Almost all this required a sling which will be elaborate in the next few pages. But a familiar
knot is required: Reef Knot

Material adopted from First Aid Manual 8th Edition Page
10



Arm Sling
An arm sling holds the forearm in a horizontal or slightly raised position, It
provides support for an injured upper arm, wrist, or forearm, or a simple rib
fracture and is ued for a casualty whose elbow can be bent.

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Elevation Sling
An elevation sling is used to keep the forearm and hand raised in a higher position. This form
of sling supports the forearm and hand with the fingertips touching the casualty’s shoulder. In
this way, an elevation slins helps to control bleeding from wounds in the forearm or hand, to
minimise swelling and to support the chest in complicated rib fractures.

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Below summarises the usage of arm slings and elevations slings for different fractures and
injury that is common.

Slings are used when the elbow is able to bend. The next page depicts the case whereby
elbow could not be bend.

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Note that even when transportation, the bandage 1,2, 3 does not fall on the injured elbow.
Hence, remember to tie the broad bandage in a secure fashion.

How will an elbow be injured?
Well, besides direct impact that occurs in road-traffic-accidents, it is more than likely that
elbow injuries occur when a casualty attempts to break a fall. During a fall, upon a high impact,
the force of the fall travels from the palm upwards to the elbow. Since elbow is the first
structure upwards, it is prone to damage. As such, an unstable fracture will occur which is
characterised as stiff and difficult to straighten.

Why should be check for circulation after immobilisation?
After injury has occur, the blood vessels may not be in the normal position. Hence, even
though the immobilisation might be possible in a comfortable position, the blood vessels
might be hindered. Hence, check for pulse on the downstream of the limb or looking out for
signs of poor circulation is important to save the injured limb. Signs of poor circulation could
apply as slow refill of redness in fingernail beds and turning of purplish.

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This part of the notes touch on cases whereby ribcage are fracture. Note that during a rib
injury, there will be lots of blood loss. At the same time, lung are jeopardise as a result. Hence,
the type of dressing employed is special.

Recognition of Chest Injuries

Sharp Pain over site of fracture
Pain on taking deep breath
Shallow breathing
Open wound at chest. Sucking noise might be hear as air are suck into the chest cavity via
wound
Paradoxical Breathing

Notice that the wound is cover on 3 sides and not 4 sides. This will allow air to escape on the
loss side.

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Module 10: Fractures & Immobilisations II (Lower Limbs and Spinal Injuries)

In this module, we are going to briefing touch on improvised slings and injuries to the lower
limbs.

In the event whereby there are no triangular bandages, we can still make use of materials that
are ready for usage. Here we present 4 types of materials are could be used.

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Lower limb injuries can be broadly classified as injuries to pelvis (hip-bone), injury before knee
and injury after knee.

Injury to pelvis can be as a result of indirect force. It is common for casualty of a car crash to
suffer pelvis fractures. As there are major organs, blood vessels in the pelvis region, injuries to
pelvis should be consider as severe and handled properly.

Recognition of Pelvis Fracture/Injuries

Inability to walk or even stand although legs appear uninjured
Pain and tenderness in the region of hip, groin, or back that increases with movement
blood at the urinary outlet, especially in a male casualty
Signs of shock and internal bleeding

In such a case, help the casualty to lie on the back. Then place padding in between the
straighten legs near the ankle and knee. Tie using 2 bandages, 1 to immobilise the ankles, the
other to lock the knee. Then at regular intervals, monitor the vital signs and record accordingly.

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For injuries before the knee, we can visualised that the injuries occurs at the thigh region.
Similarly, we should get the casualty to lie down on the flat surface. Then straighten the legs
of the casualty gently. Then applying 4 bandages first at the ankles, second on the knees,
thirdly above the site of injuries and lastly after the injury. A soft padding can be placed in
between the legs for provide comfort for the casualty.

Remember, to check to check for signs of shocks and reassure the casualty accordingly. Notice
that the knots are tied on the non-injured side. This rule of thumb is also applicable in other
cases of fractures.

In the event whereby both legs are injured, or whereby a splint is available, the similar step
should be employed but instead the knots to be tied on the splint.

A splint is a medical equipment structure that provides solid support for injured site. An
improvised splint could be any straight wooden pole, long branch, or even a broomstick.

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For injuries after the knee, it is often associated with the injures/fractures over at the shin
area. While controlling bleeding, it is important to immobilise especially when the casualty no
longer have the ability to walk.

Similar to injury before the knee, 4 bandages are required. There are place on first at the
ankles, second on the knees, thirdly above the site of injuries and lastly after the injury. A soft
padding can be placed in between the legs for provide comfort for the casualty.

It is noted that the first bandage uses a narrow bandage. It is a Figure-of-8 tie across the 2
ankles to pull the ankle in place. As such, when there are injuries to the ankles, the knots to
this narrow bandage should be employ on the non-injured side.

Up to now, you have learn from Module 9 to Module 10 the different immobilisation on
different portion of the body. There are lots of different knots and bandages coupled with
different technique which may sometimes apply to be difficult and confusing. However, the
key principle of immobilisation and first aid should be employed.

Remember, you may not always have a first aid kit with all the bandages in place and all the
pictures depicted here represent the ideal cases. Hence, it is up to your own reasoning to
decide what is to be done.

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Spinal / Back injuries

For Spinal or back injuries are not uncommon cases of injuries. It can occurs when the casualty
suffers from the following situations:
- Falling from height
- Falling awkwardly while doing gymnastics, trampolining, skateboarding
- Diving into shallow pool and hitting the bottom
- Thrown off a horse or motorbike
- Sudden braking of a vehicle

As a first aider, we know that spinal injuries have major implication to mobility when the
casualty recovers. Hence, our purpose is to prevent further injury, maintain Casualty ABC and
arrange for urgent evacuation to hospital.

Should the casualty be conscious, the first thing you should suggest to the casualty is to
reassure the casualty and advise the casualty not to move.
Next, kneel behind the casualty’s head and grasp firmly on the casualty head. Keep in mind
not to cover the ears and stay within view of the casualty.
Next, rest your elbow on your thigh to keep your arms steady.
Alight the head, neck and spine to assume a neutral position, a position that is least harmful
head position for a casualty suspected from a spinal injury.

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Module 11: Handling Shock

Shock is a life-threatening condition occurs when the circulatory system fails and as a result,
vital organs like brain, heart are deprived of oxygen. It needs immediate action to prevent
permanent organ damage and even death. To make matter worse, casualty that suffers from
shock also experiences fear and pain which could made the condition worse. Hence,
communicating and reassuring the casualty suffering from shock is important.

Unlike the shock we learn from our English language lesson, medically, it is describe as the
failure of delivering oxygen to vital organs. It could be due to loss of body fluid or blood which
limits the amount of fluids active in the circulatory system. Typical cases of such are external
bleeding or internal bleeding. Hence, any case of shock can be in the form of allergic reactions
due to foreign chemical present in the blood stream or in contact with the body that causes
anaphylactic shock, a case of extreme allergic reaction.

Regardless of the type of shock a casualty experience, their recognition signs are similar.

Recognition of Shock

Initially – Rapid Pulse; Pale, cold clammy skin; sweating
As shock develops
- cyanosis of lips, fingernail
- weakness and dizziness
- nausea, vomiting, thirst
- rapid, shallow breathing
- weak pulse
As brain ‘s oxygen supply weakens
- restlessness and aggressiveness
- Yawning and gasping for air
- Unconsciousness
Finally, Heart may stop.

As such, you aim as a first aider is to 1) Recognise shock 2) Treat Obvious signs of shock 3)
Improve blood supply to brain, heart lung 4) Remove casualty urgently to hospital.

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A simple steps are describe below:

It is noted that monitoring the vital signs are important. And there should be strictly NO
consumption of food, drink or smoke. Wetting of lips is however permitted.

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Module 12: Animal Bites, Insects Stings, Bites
Bites and Stings are by at large common when venturing into the wilderness or at the forested
areas. As far as possible, keeping a cautious state of mind can help to reduce the possibility of
getting a bite or sting. However, in the event that such a case occurs, the principle is wound
care to prevent infection and monitor for signs of shocks.

In cases of animal/insects stings or bites, which includes snake bites, it is important to identify
the animal or insects. This could be done by catching the animal/insect (dead or alive) or
simply taking a photo of the animal/insect.

For a insect sting, the key principle is to relieve swelling/pain followed by evacuated to
hospital if casualty show signs of shock. These are done by using ice pack compression which
could easily relieve the pain. Should the stinger remains, do NOT use a tweezers as the
pressing action will cause more venom to be injected. Instead, brush or scrape it off sideways
using fingernails or the blunt edge of a knife. Shock might occur for cases of multiple stings or
allergic reactions. Hence, evacuation to hospital may be necessary.

For snake bites, it is firstly important to recognise the snake as venomous or not. Typically,
should the bite create 2 holes, snake is venomous. More than that, snake is likely to be non-
venomous. In cases of venomous species, it is important to remember to reassure the casualty
and delay the spread of venom. This is done by asking the casualty to lie down and be calm.
Do not attempt to apply a tourniquet, suck the venom out or slash the wound with a knife. But
rather keep the heart above wound and recognise the snake as far as possible.

In case of a animal bite, the 3 objectives of first aid is to
- Control Bleeding
- Minimise risk of infection to both casualty and first aider, wound care.
- Obtain medical aid if necessary
In countries of known threats of bite-related diseases like rabies, special caution needs to be
employ and medical aid is therefore necessary when such cases arise.

One point to note is that animals/insects do not just bite or sting without any rhythm reasons.
Their signs of aggression are often an intrusion of their spaces. As such, keep the eyes open in
nature will help a lot in minimising such cases.

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