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First Aid

	First Aid is what you can do to assist an injured person at the scene using only what is available under the prevailing circumstances. In this article we look at basic first aid techniques and a summary of the main circumstances that you may come across when travelling and the treatments you can give.
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Go to top First Aid Principles

First Aid is what you can do to assist an injured person at the scene using only what is available under the prevailing circumstances. You may only have your two hands, remember that first aid does not rely on equipment. In some circumstances if there is nothing, or nothing more can be done, then first aid may mean going for assistance. The patient relies on you. In practical first aid, especially in the bush, clear logical thinking and the ability to improvise are critical aspects.

First Aid is based on commonsense, knowledge, and technique. The order of urgency is protection of the patient from further injury; ensuring those giving aide are also safe from injury; and the restoration of breathing and heart beat. After this, you can attend to stop bleeding, minimise pain, reassure the patient, seek further aid and if necessary transport the person to hospital. Before you can commence rational treatment a diagnosis must be made consisting of History - the story of how the injury occurred, Symptoms - what the patient feels; Signs - what you can observe.

Go to top DRABC Action Plan

This Action Plan is a vital reminder to the first aider in assessing whether the casualty has any life-threatening conditions and if any immediate first aid is necessary.

D - check for DANGER
R - check RESPONSE
A - check AIRWAY
B - check for BREATHING
C - perform CPR

Step 1 - check for DANGER

Is there DANGER to yourself, others or the casualty?

It’s important in every emergency situation to assess the scene and look around to determine if there are any conditions that may be an immediate threat to life. You must consider the situation carefully and make sure the area is safe for the casualty, yourself and any others nearby. Once the environment is safe and the danger has been removed, go to step 2 – check REPONSE.

Step 2 - check RESPONSE

Is the casualty conscious or unconscious?

Ask the casualty for their name, gently squeeze casualty’s shoulder. If the casualty responds, then it is important to calm the casualty, monitor signs of life and manage any life-threatening injuries. If the area is safe for the casualty, quickly get assistance if the injuries require it.

Casualty is Unconscious

If there is no response, then this indicates that the casualty is unconscious and it is important to get help as quickly as possible. Ask someone nearby to call 000 for an ambulance and then go to step 3 – check AIRWAY.

Step 3 - check AIRWAY

It is important for the casualty’s chance of survival to make sure the airway is clear so that breathing is possible. Firstly, open the mouth and carefully check to see if the airway is clear of any foreign material. Obstruction of the airway can be caused by the tongue or solid or semi solid material such as food, vomit, blood, etc.

No foreign material

If there is no foreign material present and the airway looks clear, leave casualty on their back and open the airway. Go to step 4 – check BREATHING.

Foreign material found

If there is foreign material present in the airway, turn the casualty gently into the RECOVERY POSITION and clear the airway with your fingers. With an unconscious casualty, ensuring the airway is clear is a high priority and it’s important to handle the casualty gently with minimum of movement. Once the airway is clear of foreign material, go to step 4 – check BREATHING.

Step 4 - check for BREATHING

Tilt the head slightly back.
Look and feel for chest movement – is the chest rising and falling?
Can you hear breathing from the mouth and the nose – can you feel breath on your cheek?

Is Breathing

If the casualty is breathing, place gently into the RECOVERY POSITION and call 000 for an ambulance. Regularly check and monitor signs of life and manage injuries and shock while waiting for the ambulance to arrive.

Is NOT Breathing

It is very important that an ambulance has been called by someone. If you are alone with the casualty, place the casualty gently in the RECOVERY POSITION before calling an ambulance. Turn casualty gently onto back if not done so already.

Prepare to give two initial breaths by:

tilting the head back to open the airway

pinch the nose closed

lift chin and open mouth

take a breath and blow into casualty’s mouth – watch for chest to rise with each breath

repeat to give the two initial breaths

If breathing has returned, place casualty in the RECOVERY POSITION while regularly checking for continued signs of life. Manage any injuries and shock until medical aid arrives.

If breathing has NOT returned and there are no signs of life (i.e. breathing, responding, moving), go to step 5 - CPR

Step 5 - CPR (Cardiopulmonary Resuscitation)

To perform CPR on ADULTS/CHILDREN (over 1 year), you kneel down beside the casualty and then:

Place the heel of your hand on casualty’s lower half of sternum (breastbone) in the centre of their chest

Place your other hand on top of the first and interlock and raise fingers

With arms straight, give 30 compressions (at approximately 100 per minute and press down 1/3 depth of their chest)

Tilt the head back and lift chin

Give 2 breaths

Continue compressions and breaths at a ratio of 30:2 until medical aid arrives

CPR For INFANTS

For infants under 1 year old, place two fingers (index and middle) over lower half of sternum (breastbone) and press down about one third of their chest. Compression to breath ratios are the same.

When to stop CPR

If the casualty shows signs of life

If more qualified help arrives

You are physically unable to continue

If the casualty shows signs of life, but is unconscious

Turn casualty onto side into the RECOVERY POSITION

Continually check the casualty’s condition and monitor signs of life until medical aid arrives

Manage any injuries and shock

Be ready to turn casualty onto back and start CPR if necessary

TIP

Remember the acronym DRABC and the CPR ratio which is 30:2 (30 compressions - 2 breaths)

Go to top Recovery Position

This position is a first aid technique frequently taught as part of the CPR curriculum. It is recommended for assisting people who are unconscious or nearly at the point of unconsciousness, but nevertheless, are still breathing. There are major risk factors associated with an unconscious breathing person lying face upwards. For example, the tongue can fall to the back of the throat due to loss of muscular control and fluids such as blood or vomit can collect in the back of the throat. To a limited extent, you can protect against risks to the airway from the tongue, by tilting the head back and lifting the jaw. That said however, an unconscious person will not remain in this position unless held constantly and it doesn’t safeguard against risks due to fluids. If the person is placed in the recovery position, the action of gravity will both keep the tongue from obstructing the airway and also allow any fluids to drain. The chest is also raised above the ground, which helps to make breathing easier.

Moving into the Recovery Position

Kneel beside the casualty

Position casualty’s arms by placing the furthest arm at right angles to their body

Place the nearest arm across their chest

Position casualty’s legs by lifting nearest leg at knee so it is fully bent upwards

Roll casualty into position by rolling casualty away from you on to side while carefully supporting the head and neck

Prevent the casualty from rolling on their face by keeping the leg at right angles with the knee touching the ground

Warning

If the casualty has head or neck injuries – ensure the head and neck is supported at all times and do not allow rotation between the head and spine. Movement of spinal-injured victims should be minimized as much as possible. Such victims should only be moved to a recovery position when it is necessary to drain blood or vomit from the airway.

Go to top Choking

Some of the common causes of choking are: eating or drinking too quickly, not chewing food sufficiently, swallowing small bones and swallowing small objects. The signs and symptoms of choking include: clutching the throat, coughing, gagging, wheezing, difficulty breathing, difficulty speaking or swallowing, making a whistling or ‘crowing’ noise and making no noise at all. Other signs and symptoms include the face, neck, lips, ears and fingernails starting to turn blue and in worse case scenarios, collapsing or going unconscious.

What to do for ADULTS/CHILDREN (over 1 year)

Coughing to remove object:

Encourage the casualty to relax and breathe deeply

Ask casualty to cough to remove the object

If this does not remove the object call 000 for an ambulance and then:

bend casualty well forward

give up to 5 sharp blows with the heel of one hand in the middle of the back between the shoulder blades

check to see if the obstruction has been relieved after each back blow

If blockage has not cleared after 5 back blows then:

place one hand in the middle of the casualty’s back for added support

place the heel of the other hand in the CPR compression position on the casualty’s chest

give 5 chest thrusts (slower but sharper than CPR compressions)

check to see if the obstruction has been relieved after each chest thrust

If the blockage has not cleared after 5 chest thrusts then you continue alternating five back blows with five chest thrusts until medical aid arrives. If the casualty becomes unconscious, then remove any visible obstruction from the casualty’s mouth and commence CPR.
NOTE: Chest thrusts may be given to children from one year and adults in the standing or sitting position. Infants should be placed on a firm surface on their back or held with their head low.

Go to top Common Conditions

Snake/Insect/Marine Stingers

Prevention

For snakes, 90% of bites are below the ankle so above-ankle boots, thick socks and long trousers. Avoid walking in long grass & swampy areas. For insects, a mosquito net will alleviate 99% of all insect bites! For marine stingers, in tropical areas read the signs and stay out of the water (no matter how tempting).

Snake Bite

Bandage directly over the bite and then up the limb. Limit the movement of the bite victim as much as possible and seek help.

Insect Bites

These can include mosquito/wasp/ant etc and you should avoid scratching them! Infection is a real problem more so than the bite. Treat with Stingose or insect lotion.

Marine Stingers

This can be quite nasty and there are a number of different treatments. Blue-ringed octopus - you may not even know you have been bitten and the signs are difficulty swallowing, numbness and no breathing. You need to commence DRABC as below and continual EAR (mouth-to-mouth resuscitation). Box jellyfish - intense pain & whip-like marks and commence DRABC and flood area with vinegar & apply ice. Sting ray - intense pain and barb-like cut. Treatment is immersion of area in hot water.

Burns

Prevention

Bush fires/car fires can result in nasty burns. How quickly you act can minimise the degree of burn.
If clothing is on fire: STOP, DROP AND ROLL and pull casualty to ground. Wrap in blanket or similar and roll casualty along ground until flames extinguished.
Cool the burnt area in cold running water - at least 10 minutes. If a chemical burn, run cold water over burnt area - at least 20 minutes. If a bitumen burn, run cold water over burnt area for 30 minutes. If burn is to eye, flush eye with water for 20 minutes.
Remove any constrictions - remove clothing and jewellery from burnt area (unless sticking to the burn).

Cover Burn

Place sterile, non-stick dressing over burn. Do not touch area as risk of infection is high.
Calm casualty and seek help.

Dehydration/Heat Stroke

Prevention

Avoid the heat of the midday sun, carry plenty of water, cover up with a hat, sunburn cream and long cool clothing. You can lose an incredible amount of fluid in the hot Australian conditions (can get up to 60 degrees Celsius in the sun in the desert in summer) so drink plenty of water (2L per person/day is recommended).

Symptoms

Hot, weak, headaches, nausea, fatigue, pale/clammy are all signs of dehydration/heat stroke.

Treatment

Lie casualty down and move patient to a cool place with circulating air. Loosen tight clothing and remove unnecessary garments. Sponge with cold water or apply cold packs to neck/groin and armpits. Give fluids to drink.

This is by no means a comprehensive list of the potential dangers and you should always carry with you a First Aid book.

Go to top First Aid Kit

There are many first aid kits available and you may like to purchase one off the shelf or create your own.

EACH INDIVIDUAL should also ensure they take adequate supplies of their personal medication plus any emergency medications for known allergies (eg. if allergic to Penicillin, take a supply of an antibiotic that you can use - a doctor will prescribe this to you if you explain that you are going on a remote trip where emergency assistance could be days away). Some standard additions to any kit should be:

Antihistamine tablets (non-drowsy)

This is especially useful as a preventative treatment for sand-fly bites for people known to have adverse reactions to bites.

Antibiotics

Each person in your party should see their doctor before travel departure and request a course of antibiotics to take just in case of infection. It is very unsafe practise to take another person's medication and since antibiotics are only available on prescription, then each person should have their own medication and dosage clearly labelled and stored in the First Aid Kit. Common infections in the outback that require antibiotic treatment are: ear infections and skin infections.

Diarrhoea and Vomiting

Not only uncomfortable when travelling but increases the chance of dehydration. Take anti-diarrhoeal medication and Fluid and electrolyte replacement medications (eg. Gastrolyte, a water soluble powder). Note - drinking untreated water that comes directly from lakes and rivers may contain Giardia parasites that cause diarrhoea. This parasite is also spread by touching wild, pet or farm animals and especially after toileting if soap and water is not used before handling food. A typical mistake with food handling when camping is leaving hot food out to cool - this increases the chance of bacteria breeding but the likelihood of a fly landing on the food and laying maggots is extremely high. Flies will usually find a way into food wrapped in foil, so we advise the use of plastic containers with airtight lids. Portable fridges must be kept below 4 degrees Celsius to keep dairy and meat produce from spoiling. Small temperature gauges are available with probes that can be placed inside to show the internal temperature. If using an esky and ice, be particularly aware of this risk and be wary.