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The universal first aid symbol
The universal first aid symbol
A US Navy corpsman gives first aid to an injured Iraqi citizen.
A US Navy corpsman gives first aid to an injured Iraqi citizen.

First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury,[1] with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial intervention in a serious condition prior to professional medical help being available, such as performing cardiopulmonary resuscitation (CPR) while waiting for an ambulance, as well as the complete treatment of minor conditions, such as applying a plaster to a cut. First aid is generally performed by someone with basic medical training. Mental health first aid is an extension of the concept of first aid to cover mental health,[2] while psychological first aid is used as early treatment of people who are at risk for developing PTSD.[3] Conflict First Aid, focused on preservation and recovery of an individual's social or relationship well-being, is being piloted in Canada.

There are many situations that may require first aid, and many countries have legislation, regulation, or guidance, which specifies a minimum level of first aid provision in certain circumstances. This can include specific training or equipment to be available in the workplace (such as an automated external defibrillator), the provision of specialist first aid cover at public gatherings, or mandatory first aid training within schools. First aid, however, does not necessarily require any particular equipment or prior knowledge, and can involve improvisation with materials available at the time, often by untrained people.[4]

Early history and warfare

Skills of what is now known as first aid have been recorded throughout history, especially in relation to warfare, where the care of both traumatic and medical cases is required in particularly large numbers. The bandaging of battle wounds is shown on Classical Greek pottery from c. 500 BC, whilst the parable of the Good Samaritan includes references to binding or dressing wounds.[5] There are numerous references to first aid performed within the Roman army, with a system of first aid supported by surgeons, field ambulances, and hospitals.[6] Roman legions had the specific role of capsarii, who were responsible for first aid such as bandaging, and are the forerunners of the modern combat medic.[7]

Further examples occur through history, still mostly related to battle, with examples such as the Knights Hospitaller in the 11th century AD, providing care to pilgrims and knights in the Holy Land.[8]

Formalization of life saving treatments

During the late 18th century, drowning as a cause of death was a major concern amongst the population. In 1767, a society for the preservation of life from accidents in water was started in Amsterdam, and in 1773, physician William Hawes began publicizing the power of artificial respiration as means of resuscitation of those who appeared drowned. This led to the formation, in 1774, of the Society for the Recovery of Persons Apparently Drowned, later the Royal Humane Society, who did much to promote resuscitation.[9][10]

Napoleon's surgeon, Baron Dominique-Jean Larrey, is credited with creating an ambulance corps, the ambulance volantes, which included medical assistants, tasked to administer first aid in battle.[11]

In 1859, Swiss businessman Jean-Henri Dunant witnessed the aftermath of the Battle of Solferino, and his work led to the formation of the Red Cross, with a key stated aim of "aid to sick and wounded soldiers in the field".[8] The Red Cross and Red Crescent are still the largest provider of first aid worldwide.[12]

Esmarch bandage showing soldiers how to perform first aid
Esmarch bandage showing soldiers how to perform first aid

In 1870, Prussian military surgeon Friedrich von Esmarch introduced formalized first aid to the military, and first coined the term "erste hilfe" (translating to 'first aid'), including training for soldiers in the Franco-Prussian War on care for wounded comrades using pre-learnt bandaging and splinting skills, and making use of the Esmarch bandage which he designed.[5] The bandage was issued as standard to the Prussian combatants, and also included aide-memoire pictures showing common uses.

In 1872, the Order of Saint John of Jerusalem in England changed its focus from hospice care, and set out to start a system of practical medical help, starting with making a grant towards the establishment of the UK's first ambulance service. This was followed by creating its own wheeled transport litter in 1875 (the St John Ambulance), and in 1877 established the St John Ambulance Association (the forerunner of modern-day St John Ambulance) "to train men and women for the benefit of the sick and wounded".[13]

Also in the UK, Surgeon-Major Peter Shepherd had seen the advantages of von Esmarch's new teaching of first aid, and introduced an equivalent programme for the British Army, and so being the first user of "first aid for the injured" in English, disseminating information through a series of lectures. Following this, in 1878, Shepherd and Colonel Francis Duncan took advantage of the newly charitable focus of St John,[5] and established the concept of teaching first aid skills to civilians. The first classes were conducted in the hall of the Presbyterian school in Woolwich (near Woolwich barracks where Shepherd was based) using a comprehensive first aid curriculum.

First aid training began to spread through the British Empire through organisations such as St John, often starting, as in the UK, with high risk activities such as ports and railways.[14]

Aims

The primary goal of first aid is to prevent death or serious injury from worsening. The key aims of first aid can be summarized with the acronym of 'the three Ps':[15]

It is important to note that first aid is not medical treatment and cannot be compared with what a trained medical professional provides. First aid involves making common sense decisions in the best interest of an injured person.

Setting the priorities

Protocols such as ATLS, BATLS, SAFE-POINT are based on the principle of defining the priorities and the procedure where the correct execution of the individual steps achieves the required objective of saving human life. Basic points of these protocols include:

A major benefit of these protocols is that they require minimum resources, time and skills with a great degree of success in saving lives under conditions unfavourable for applying first aid.

ABCDE method

Importantly, high-flow oxygen should be provided to all critically ill persons as soon as possible.

Key skills

In case of tongue fallen backwards, blocking the airway, it is necessary to hyperextend the head and pull up the chin, so that the tongue lifts and clears the airway.
In case of tongue fallen backwards, blocking the airway, it is necessary to hyperextend the head and pull up the chin, so that the tongue lifts and clears the airway.

Certain skills are considered essential to the provision of first aid and are taught ubiquitously. Particularly the "ABC"s of first aid, which focus on critical life-saving intervention, must be rendered before treatment of less serious injuries. ABC stands for Airway, Breathing, and Circulation.[17] The same mnemonic is used by emergency health professionals. Attention must first be brought to the airway to ensure it is clear. Obstruction (choking) is a life-threatening emergency. Following evaluation of the airway, a first aid attendant would determine adequacy of breathing and provide rescue breathing if necessary.

Assessment of circulation is now not usually carried out for patients who are not breathing, with first aiders now trained to go straight to chest compressions (and thus providing artificial circulation) but pulse checks may be done on less serious patients.

Some organizations add a fourth step of "D" for Deadly bleeding or Defibrillation, while others consider this as part of the Circulation step simply referred as Disability. Variations on techniques to evaluate and maintain the ABCs depend on the skill level of the first aider. Once the ABCs are secured, first aiders can begin additional treatments or examination, as required if they possess the proper training (such as measuring pupil dilation).[18] Some organizations teach the same order of priority using the "3Bs": Breathing, Bleeding, and Bones (or "4Bs": Breathing, Bleeding, Burns, and Bones). While the ABCs and 3Bs are taught to be performed sequentially, certain conditions may require the consideration of two steps simultaneously. This includes the provision of both artificial respiration and chest compressions to someone who is not breathing and has no pulse, and the consideration of cervical spine injuries when ensuring an open airway.

Skills applicable to the wider context are reflected in the mnemonic AMEGA, which refers to the tasks of "assess", "make safe", "emergency aid", "get help" and "aftermath". The aftermath tasks include recording and reporting, continued care of patients and the welfare of responders and the replacement of used first aid kit elements.[19]

Preserving life

The patient must have an open airway—that is, an unobstructed passage that allows air to travel from the open mouth or uncongested nose, down through the pharynx and into the lungs. Conscious people maintain their own airway automatically, but those who are unconscious (with a GCS of less than 8) may be unable to do so, as the part of the brain that manages spontaneous breathing may not be functioning.

Whether conscious or not, the patient may be placed in the recovery position, laying on their side. In addition to relaxing the patient, this can have the effect of clearing the tongue from the pharynx. It also avoids a common cause of death in unconscious patients, which is choking on regurgitated stomach contents.

The airway can also become blocked by a foreign object. To dislodge the object and prevent choking, the first aider may use techniques such as 'back slaps' and 'abdominal thrusts'.

Once the airway has been opened, the first aider would reassess the patient's breathing. If there is no breathing, or the patient is not breathing normally (e.g. agonal breathing), the first aider would initiate CPR, which attempts to restart the patient's breathing by forcing air into the lungs. They may also manually massage the heart to promote blood flow around the body.

If the choking person is an infant, the procedure is to deliver five strong blows on the infant's upper back after placing the infant's face in the aider's forearm. If the infant is able to cough or cry, no breathing assistance should be given. Coughing and crying indicate the airway is open and the foreign object will likely to come out from the force the coughing or crying produces.[20]

A first responder should know how to use an Automatic External Defibrillator (AED) in the case of a person having a sudden cardiac arrest. The survival rate of those who have a cardiac arrest outside of the hospital is low. Permanent brain damage sets in after 5 minutes of no oxygen delivery, so rapid action on the part of the rescuer is necessary. An AED is a device that can examine a heartbeat and produce electric shocks to restart the heart.[21]

A first aider should be prepared to quickly deal with less severe problems such as cuts, grazes or bone fracture. They may be able to completely resolve a situation if they have the proper training and equipment. For situations that are more severe, complex or dangerous, a first aider might need to do the best they can with the equipment they have, and wait for an ambulance to arrive at the scene.

Training Principles

First aid scenario training in progress
First aid scenario training in progress

Basic principles, such as knowing the use of adhesive bandage or applying direct pressure on a bleed, are often acquired passively through life experiences. However, to provide effective, life-saving first aid interventions requires instruction and practical training. This is especially true where it relates to potentially fatal illnesses and injuries, such as those that require CPR; these procedures may be invasive, and carry a risk of further injury to the patient and the provider. As with any training, it is more useful if it occurs before an actual emergency, and in many countries, emergency ambulance dispatchers may give basic first aid instructions over the phone while the ambulance is on the way.

Training is generally provided by attending a course, typically leading to certification. Due to regular changes in procedures and protocols, based on updated clinical knowledge, and to maintain skill, attendance at regular refresher courses or re-certification is often necessary. First aid training is often available through community organizations such as the Red Cross and St. John Ambulance, or through commercial providers, who will train people for a fee. This commercial training is most common for training of employees to perform first aid in their workplace. Many community organizations also provide a commercial service, which complements their community programmes.

1.Junior level certificate Basic Life Support

2.Senior level certificate

3.Special certificate

Types of first aid which require training

A first aid box
A first aid box

There are several types of first aid (and first aider) that require specific additional training. These are usually undertaken to fulfill the demands of the work or activity undertaken.

Shown here is an example of a way for people to practice CPR in a safe and reliable manner.
Shown here is an example of a way for people to practice CPR in a safe and reliable manner.

First aid services

First aider of the British Red Cross accompanies parade of morris dancers at the Knutsford Royal May Day, Knutsford, Cheshire, England, 2012
First aider of the British Red Cross accompanies parade of morris dancers at the Knutsford Royal May Day, Knutsford, Cheshire, England, 2012

Some people undertake specific training in order to provide first aid at public or private events, during filming, or other places where people gather. They may be designated as a first aider, or use some other title. This role may be undertaken on a voluntary basis, with organisations such as the Red Cross society and St John Ambulance,[22] or as paid employment with a medical contractor.

People performing a first aid role, whether in a professional or voluntary capacity, are often expected to have a high level of first aid training and are often uniformed.

Symbols

Further information: Emblems of the Red Cross § Use of the emblems

Although commonly associated with first aid, the symbol of a red cross is an official protective symbol of the Red Cross. According to the Geneva Conventions and other international laws, the use of this and similar symbols is reserved for official agencies of the International Red Cross and Red Crescent, and as a protective emblem for medical personnel and facilities in combat situations. Use by any other person or organization is illegal, and may lead to prosecution.

The internationally accepted symbol for first aid is the white cross on a green background shown below.

Some organizations may make use of the Star of Life, although this is usually reserved for use by ambulance services, or may use symbols such as the Maltese Cross, like the Order of Malta Ambulance Corps and St John Ambulance. Other symbols may also be used.

Physical conditions that often require first aid

See also: Medical emergency

Many accidents can happen in homes, offices, schools and laboratories which require immediate attention before the patient is attended by the doctor.

First aid kits

A first aid kit consists of a strong, durable bag or transparent plastic box. They are commonly identified with a white cross on a green background. A first aid kit does not have to be bought ready-made. The advantage of ready-made first aid kits are that they have well organized compartments and familiar layouts.

Contents

There is no universal agreement upon the list for the contents of a first aid kit. The UK Health and Safety Executive stress that the contents of workplace first aid kits will vary according to the nature of the work activities.[27] As an example of possible contents of a kit, British Standard BS 8599 First Aid Kits for the Workplace[28] lists the following items:

References

  1. ^ First aid manual: 9th edition. Dorling Kindersley. 2009. ISBN 978-1-4053-3537-9.
  2. ^ "Mental Health First Aid USA". Mental Health First Aid. October 10, 2013. Retrieved November 20, 2019.
  3. ^ Peterson, Sarah (January 30, 2018). "About PFA". The National Child Traumatic Stress Network. Retrieved November 20, 2019.
  4. ^ "Duct tape for the win! Using household items for first aid needs". CPR Seattle. Archived from the original on November 4, 2014.
  5. ^ a b c Pearn, John (1994). "The earliest days of first aid". The British Medical Journal. 309 (6970): 1718–1720. doi:10.1136/bmj.309.6970.1718. PMC 2542683. PMID 7820000.
  6. ^ Eastman, A Brent (1992). "Blood in Our Streets: The Status and Evolution of Trauma Care Systems". JAMA Surgery. 127 (6): 677–681. doi:10.1001/archsurg.1992.01420060043008. PMID 1596168.
  7. ^ Efstathis, Vlas (November 1999). "A history of first aid and its role in armed forces" (PDF). ADF Health. Archived (PDF) from the original on November 30, 2014.
  8. ^ a b "First Aid: From Witchdoctors & Religious Knights to Modern Doctors". Archived from the original on January 18, 2012. Retrieved March 23, 2011.
  9. ^ New Scientist, Vol. 193 No. 2586 (13–19 Jan 2007), p. 50
  10. ^ Price, John (2014). Everyday Heroism: Victorian Constructions of the Heroic Civilian. Bloomsbury: London. p. 203. ISBN 978-1-4411066-5-0.
  11. ^ Baker, David; Cazalaà, Jean-Bernard; Carli, Pierre (September 2005). "Resuscitation great. Larrey and Percy--a tale of two barons". Resuscitation. 66 (3): 259–262. doi:10.1016/j.resuscitation.2005.03.009. ISSN 0300-9572. PMID 15990216.
  12. ^ "Event first aid and ambulance support". British Red Cross. Archived from the original on September 8, 2014.
  13. ^ Fletcher NC, The St John Ambulance Association: its history and its past in the ambulance movement. London: St John Ambulance Association, 1929:12–3.
  14. ^ Industrial Revolution: St. John Ambulance Archived 2007-02-20 at the Wayback Machine, retrieved December 10, 2006.
  15. ^ "Accidents and first aid". Archived from the original on May 3, 2008. Retrieved October 4, 2008.
  16. ^ Thim, Troels; Krarup, Niels Henrik Vinther; Grove, Erik Lerkevang; Rohde, Claus Valter; Løfgren, Bo (January 31, 2012). "Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach". International Journal of General Medicine. 5: 117–121. doi:10.2147/IJGM.S28478. ISSN 1178-7074. PMC 3273374. PMID 22319249.
  17. ^ Eisenburger, Philip; Safar, Peter (1999). "Life supporting first aid training of the public—review and recommendations". Resuscitation. 41 (1): 3–18. doi:10.1016/S0300-9572(99)00034-9. PMID 10459587.
  18. ^ "Guidelines and Guidance: The ABCDE approach". Resuscitation Council (UK). Archived from the original on August 12, 2005. Retrieved May 2, 2019.
  19. ^ Furst, J., What does AMEGA stand for in first aid?, updated 12 July 2019, accessed 24 January 2022
  20. ^ "Choking - infant under 1 year: MedlinePlus Medical Encyclopedia". medlineplus.gov.
  21. ^ Nessel, Edward H. (2012). "Treating Sudden Cardiac Arrest and the Use of Automated External Defibrillators in the Community Setting". AAMA Journal. 25: 9.
  22. ^ "Role of a First Aider - First Aid - St John Ambulance". www.sja.org.uk. Retrieved November 20, 2019.
  23. ^ Cymerman, A; Rock, PB. "Medical Problems in High Mountain Environments. A Handbook for Medical Officers". USARIEM-TN94-2. US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report. Archived from the original on April 23, 2009. Retrieved March 5, 2009. ((cite journal)): Cite journal requires |journal= (help)
  24. ^ Longphre, John M.; Petar J. DeNoble; Richard E. Moon; Richard D. Vann; John J. Freiberger (2007). "First aid normobaric oxygen for the treatment of recreational diving injuries". Undersea and Hyperbaric Medicine. 34 (1): 43–49. ISSN 1066-2936. OCLC 26915585. PMID 17393938. Archived from the original on June 13, 2008. Retrieved March 5, 2009.
  25. ^ "Everyday First Aid – Hypothermia". British Red Cross. Archived from the original on November 29, 2014.
  26. ^ Sterba, JA (1990). "Field Management of Accidental Hypothermia during Diving". US Navy Experimental Diving Unit Technical Report. NEDU-1-90. Archived from the original on July 27, 2011. Retrieved March 15, 2013.
  27. ^ First aid at work: The Health and Safety (First-Aid) Regulations 1981. Guidance on Regulations L74
  28. ^ BS 8599-1:2011 BSI 2011