CHAPTER 9�Procedures and�Techniques in�First Aid

LEARNING OBJECTIVES

CHAPTER OUTLINE

• Section A: Preparation of First

Aid Kit First Aid Kit

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• Section B: Dressing, Bandaging

and Splinting

• Bandages and Binders

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• Section C: Transportation of

Injured

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• Section D: Cardio Pulmonary

Resuscitation

SECTION A: PREPARATION OF

FIRST AID KIT

FIRST AID KIT

FIRST AIDER

• A first aider is a person who can provide emergency care to the victim at the time of accidents or any kind of mishap.
• A first aider should know what is best and what is needed.

QUALITIES OF A FIRST AIDER

Qualities of first aider

Good observer

Tactful

Resourceful

Discriminate

Cool and calm

Qualities of first aider

Good thinker

Good decision maker

Confident

Good judgement

Good leader

SECTIONB: DRESSING,BANDAGING

AND SPLINTING

• Dressing is a covering material made of sterile gauze to protect

the wound form being contaminated and protect from any

complications.

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• Surgical dressing is a sterile protective surgical covering, applied

to a wound/incision with aseptic technique, with or without

medication.

The dressings are applied to aid certain purposes. They

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• Protect the wound from injury
• Protect the wound from microbial contamination
• Maintain moist wound healing
• Provide thermal insulation
• Absorb drainage or debride a wound or both
• Prevent haemorrhage (when applied as a pressure dressing

or with elastic bandages)

• Helps in immobilization of the wound site and facilitate healing.

PURPOSES

A number of dressing materials are available to cover wounds.

The form of dressing used depends on

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• The location, size, and type of the wound;
• The amount of exudate;
• Whether the wound requires debridement or is infected; and
• Frequency of dressing change, ease or difficulty of dressing

application, and cost.

TYPES OF DRESSING

STEPS OF PROCEDURE

FOR WOUND DRESSING

REFER PAGE NO.- 411

SECURING DRESSING

The nurse secures the dressing over the wound, ensures that the dressing covers the

entire wound and does not get dislodged. The correct type of tape must be selected

for the purpose.

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The nurse follows these steps:

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• Place the tape so that the dressing cannot be folded back and expose the wound. The

tape should adequately cover the wound.

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• Ensure that the tape is long enough and wide. enough to adhere to several inches of

skin on each side of the dressing.

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• Montgomery straps (tie tapes) are used for wounds requiring frequent dressing changes.

These straps prevent skin irritation and discomfort caused by adhesive tapes each time

the dressing is changed. Medical tapes can cause injuries if used incorrectly.

Bandages and binders are used to serve various purposes:

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• Secure the dressing
• Protect the wound from further deterioration
• Restrain in fracture (plaster of Paris cast),
• Provide support in sprain
• Compress the affected area
• Prevent edema
• Control bleeding from the wound area

A binder on the other hand, plays a significant role in

prevention of wound dehiscence, provision of a pressure

support and holds the dressing in place.

BANDAGES AND BINDERS

According to the size and shape of the bandages they are categorised as

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• Triangular bandages

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• Roller bandage

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• Plaster

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• Adhesive

TYPES OF BANDAGES

Bandage application to various body parts includes one or more of five

basic bandaging technique/turns: circular, spiral, spiral reverse, recurrent,

and figure-eight.

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Roller bandages are of toe types crepe bandage and gauze bandage. Crepe

bandage has ability to stretch and snuggly fits, gauze bandage is made of

gauze cloth and has absorbent ability, but easily slips off .

Basic Application for Roller Bandages

These are used to adhere the bandage to the wound and to

terminate them. Circular turns commonly are not applied

directly over a wound because it causes discomfort to the

wound.

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CIRCULAR TURNS

Fig.1: Roller bandaging

These are used to bandage parts of the body that are fairly

even in circumference (i.e., the upper arm or upper leg).

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SPIRAL TURNS

These are used to bandage cylindrical parts of the body that

are usually non- uniform in circumference, for example, the

lower leg or forearm.

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SPIRAL REVERSE TURNS

RECURRENT TURNS

These are used to cover distal parts of the body, for example,

the end of a finger, the skull, or the stump of an amputation.

These are used to bandage an elbow, knee, or ankle, because

they permit some movement after application.

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FIGURE-EIGHT TURNS

BINDER APPLICATION

Binders are special bandages used to support a specific

part of the body. Binders are usually well-fitted and

made in such shapes that it solves the purpose of its use.

The most common binder being used is abdominal and

chest binder. They are applied to exert uniform pressure

and to prevent complications.

TYPES OF BINDER APPLICATION

1. BREAST BINDER

2. ABDOMINAL BINDER

3.T-binders:

They are used to hold the dressing on the rectum and

perineum or in the groin. The single T-binder is used

in female patients and the double T-binder is used for

male patient

4. SLING

General instruction for applying bandages and binders:

SECTION C:TRANSPORTATION

OF INJURED

TRANSPORTATION OF AN INJURED PATIENT

• Vital step of action.
• Healthcare provider who is first aider should check the casualty before transportation for:
• Victim’s respiration to be normal.
• Normal pulse rate.
• Bleeding should be arrested.
• Injured part should be well-supported or immobilized.
• Transportation must be done in that way so that no further injury occurs.
• Always keep the victim warm.

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GENERAL PRINCIPLES OF HANDLING INJURED CASUALTY BEFORE TRANSPORTATION

METHODS OF TRANSPORTATION

Methods of transportation

Manual

lifting

By one

first aider

By two

first aiders

Carry chair

Stretchers

Rescue by

Air – helicopter

Land – ambulance, motorbikes

Water – boat

MANUAL LIFTING

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• Safe method for first aider as well as the victim.
• General rules to be kept in mind while using manual lift are following:
• Always use the strongest muscles of body parts, i.e., shoulder, thigh and hip muscles.
• Keep feet wide apart to keep the body well-balanced and stable. A wide base helps to have better stability.
• Keep back straight, to prevent strain on the back.
• Hold with your entire hand.
• Hold the victim as close as feasible.
• Bring down the victim if imbalance is felt.
• Change position of the first aider if there are two first aiders and begin lifting again.

MANUAL LIFT BY ONE FIRST AIDER

Human crutch

Drag method Cradle method Pick a back

Fireman’s lift and carry method

HUMAN CRUTCH

• Reassure the victim. For this method, the victim must be conscious and capable of giving assistance.
• Stand on the weaker side of the victim and wrap the weaker arm around the neck (of the first aider).
• Hold the wrist (of the arm around the neck of the first aider) and support the victim taking a firm grip of the clothes at the waist on the far side of the body. The injured side of the casualty should be closest to the rescuer.
• Walk with the victim and take small steps.
• Provide a stick for walking to the victim, if he/she needs extra help.

HUMAN CRUTCH

DRAG METHOD

• This type of method is used when the injured victim requires to move immediately from the source of danger, and when the victim is not able to move.
• Steps of using drag method:
• Reassure the victim.
• Keep the victim’s arms across his/her chest.
• Crouch at the head end of the victim.
• Hold the armpit and support the victim’s head on the first aider's forearms.
• Drag the victim along with ground without lifting.

CRADLE METHOD

• This method is used for an injured child because children are lighter and can be easily lifted.
• Steps for using cradle method:
• Place one arm under the victim’s knees or thighs.
• Place another hand around the trunk or above the waist.
• Lift the victim and transfer him.

PICK A BACK

• Victim is carried out in a normal fashion.
• Used when the victim is small, light, oriented and able to hold the arm.
• Steps to be followed include:
• First aider stands in front of the victim. First aider lowers down oneself and brings the arms of the victim on shoulders and lifts the victim.
• Victim’s hips and body literally drapes across the rescuer’s back.
• After that, raise the victim’s trunk by passing your hand under the victim’s armpits.
• Hold his wrist on the injured chest.
• Lift the injured person and walk in step.

PICK A BACK

FIREMAN’S LIFT

• Used when the injured person is light weight.
• Steps to be followed are:
• Reassure victim.
• Assist victim to raise in an upright position. The victim and first aider should be face to face.
• Hold the victim’s right wrist with left hand.
• Bend downward with the First aider’s head below the victim’s extended right arm.
• With the dominant hand, support the body of the victim.
• Allow the victim’s body to lean on the right shoulder of the first aider. Adjust the victim’s body appropriately.
• While lifting up the victim, the first aider should stand straight. Wrap around the arm of the victim

across the first aider’s chest.

• Keep your left side hand free.

FIREMAN’S LIFT

• Methods:
• Two handed seat
• Four handed seat
• Fore and aft method

TWO HANDED SEAT

• Used for those injured persons who are not able to help first aider.
• Steps to be followed are:
• Both first aiders squat facing each other on either side of the victim.
• Reach under the victim’s shoulders and under their knees.
• First aiders grasp each other’s wrists.
• From the squat, with good lifting technique, first aiders stand.
• Hold each other’s wrists if possible, otherwise you can hold the victim from clothes.
• Lift together by keeping back straight, walk together, in the direction that the victim is facing.

TWO HANDED SEAT

FOUR HANDED SEAT

• Used when the victim is able to support the first aider by using one or both arms, in which the victim is conscious.
• Steps to be followed include:
• First aiders stand facing each other.
• Both first aiders make seat by holding their own left wrist by their own right hand.
• With free hand, first aiders hold each other’s wrists.
• Guide victim to put an arm around the neck of first aiders and sit on the hands of first aiders.
• Lift together by keeping back straight, walk together at the same pace.

FOUR HANDED SEAT

FORE AND AFT METHOD

• Used to put an unconscious victim on a stretcher or a carry chair.
• Steps to be followed are:
• Firstly, put the victim’s arms over his abdomen.
• Squat at the backside of the victim and slide arms below his/her armpits, then hold his/her wrist.
• Command another person (first aider) to squat between the legs of the victim, and hold the victim below his/her knees.
• Lift together by keeping your back straight, walk together at the same pace.

FORE AND AFT METHOD

CARRY CHAIR

• Commonly known as the chair method.
• Used for those people who are not with serious injury and are conscious.
• Used to take the victim upstairs or downstairs and the victim can be seated on a simple chair, and is carried by two first aiders.

Chair method

Methods

Wheel chair method

CHAIR METHOD

• First aider can use an ordinary chair.
• Steps to be followed:
• Check that the chair is strong enough to carry the victim.
• Help the victim to sit on the chair and secure the victim with the help of bandages.
• Stand, one in front and another one behind the victim.
• Support backside of chair and victim.
• Second person holds chair from front legs.
• To secure the victim, tilt the chair backward slowly.
• Raise victim in the chair and move together at the same pace.

CHAIR METHOD

WHEEL CHAIR METHOD

All the steps are the same as the chair method but points to remember in wheel chair method are (those which are different from the chair method):

• Firstly, find out breaks of wheel chair.
• Secondly, lock the brakes.
• Hold chair from their handles or fixed parts (these are secured parts of the chair) and never by wheels.

STRETCHERS

Used to take away seriously injured person so, that further risk of injury can be minimized and used to carry an injured person to ambulance or the shelter.

The principles of using stretcher:

• Check the stretcher to make sure that it is in working condition.
• Assess that the stretcher is solid/strong enough to bear the weight of an injured person.
• Always explain and reassure the injured person before putting the victim over the stretcher.
• Secure the victim with straps.

STRETCHER

TYPES OF STRETCHERS

Standard stretcher

Pole and canvas stretcher

Improvised stretcher

Trolley cot

• Also known as Furley stretcher.
• This type of stretcher contains one plastic sheet or a canvas, which is connected with two carrying poles with one stand on the lower side.
• The transverses are attached to open and close the stretcher easily.
• When we close the stretcher, plastic sheet/canvas folds on top and poles lie closely together.

STEPS OF USING STANDARD STRETCHER

• Unwrap canvas and pull the poles to be separated.
• Push outward and face toward transverse open.
• The stretcher should be held upward on its end and open another transverse by pressing over it.

STEPS OF FOLDING A STANDARD STRETCHER

• Put the stretcher on the side.
• Now, release the hinged transverse.
• Together join both poles, then wrap canvas cleanly upon poles.
• At last first aider should secure/protect the stretcher with the help of a strap.

POLE AND CANVAS STRETCHER

• Most commonly used stretcher, which is used to carry the victim from one to another stretcher/from stretcher to trolley.
• It contains one plastic/canvas sheet with handle, side sleeves and pair of poles.
• To make the stretcher stable and hard/rigid, open the rods by fixing them over the ends of poles to keep them apart.

TROLLEY COT

• It is fully fit stretcher beds on wheels commonly available in hospitals.
• In trolley cot, adjust the height at just above knees level, backrest can be used if needed, according to the condition of the victim.
• It has side rails to protect patient from falling and straps for protection and brakes for the wheels.

• Put blanket or sheet above stretcher diagonally.
• Hang blanket corners at the sides of the stretcher, both top and bottom.
• Reassure the victim.
• Explain the procedure to the victim.
• Place the victim at the center of the stretcher.
• With the help of a blanket from the corner side, at the bottom, cover the victim’s feet and tuck it around the ankle.
• Take one side of blanket/sheet above the victim, then tuck it safely under the victim.
• Repeat the same thing along with the other side of the blanket or sheet.
• With the help of the top corner of the blanket, cover the victim’s head and neck.

STEPS OF USING TWO BLANKETS OR SHEETS

• Put the first blanket lengthwise along with stretcher, with one edge covering half handles at the head, after that open the sides of the stretcher.
• Double/fold second blanket (same as first) lengthwise into three parts.
• Put on the blanket on a stretcher along with the upper edge, about one-third of the way down the stretcher, leaving enough at the bottom end so that to fold it above feet.
• Reassure the victim.
• Explain the procedure to the victim.
• Place the victim over the stretcher.
• Cover the feet with the blanket (top fold), then tuck it around the legs and feet.
• Take one side of the blanket over the victim and gently tuck it around.
• Repeat it with another side also.
• Finally take it over the head and tuck it around.

LOADING A STRETCHER

Loading a stretcher means to carry the victim from the mishap area to the stretcher.

Methods

Blanket lift

Manual lift

BLANKET LIFT

In a blanket lift, we require four persons, two for the foot- end side and the other two for the head-end side.

STEPS OF BLANKET LIFT

• Put the folded blanket lengthwise against the back of the victim.
• Now turn the victim over the blanket by supporting on the other side.
• Blanket should be unfolded according to victim’s body.
• Put the victim in a supine position, then fold the blanket from both sides.
• Command two bearers to hold on the head end side.
• Command other two bearers on the foot-end side of the victim.
• Bearers should keep their back straight to raise/lift the victim together.
• Hold up the victim at the head and waist, another bearer from hip and ankle by grasping the fold of the blanket.
• Instruct all to hold and lift the victim together.

CARDIOPULMONARY RESUSCITATION (CPR)

• Cardiopulmonary resuscitation (CPR) is a lifesaving procedure, which is given to those persons who are in cardiac arrest.
• CPR helps to pump blood in the person’s body, while performing CPR first aider give chest compressions to the victim, along with sequence of rescue breaths, which help to save their life when victims are in cardiac arrest.
• CPR consists the following steps, that has to be performed in sequence:
• Chest compressions
• Airway
• Breathing

Indications

• Any person/victim who is found unconscious, pulse and breathing is found to be absent or gasping.

Contraindications

• DNR order (do not resuscitate)

Steps

• There are 6 major steps.

STEPS OF CPR

STEP 1: SCENE SAFETY

• Before starting CPR
• Firstly check the environment for victim, it should be free from any harm

STEP 2: SHAKE AND SHOUT

• If the victim is unconscious, tap or shake the shoulders of the victim.
• Ask loudly to the victim, are you ok?
• If the victim does not respond, call for help.

STEPS OF CPR

STEP 3: CHECK VICTIM FOR CIRCULATION

🞅 Call the victim and check for a response.

🞅 If unresponsive, tap shoulder and call the victim.

🞅 Simultaneously, observe for pulse (carotid pulse) and rise and fall of the chest with respiration.

🞅 If the pulse is absent and no respiration is observed, position the patient on a flat

surface.

🞅 Start Chest compression.

STEPS OF CPR

STEP 4: GIVE 30 CHEST COMPRESSIONS

• Locate the center of the chest slightly below the nipples (on breast bone/Sternum).
• Place one of your hands on top of the other and interlock your fingers.
• With the heel of the hands and straight elbows, push hard and fast in the center of the chest at a rate of 100–120/minute.
• Push at least 2 inches (5-6 cm) deep.
• Allow the chest to rise fully between compressions.
• Deliver 30 chest compressions.

STEPS OF CPR

STEP 5: PROVIDE TWO RESCUE BREATHS

• Open the airway of the victim using head tilt chin lift method or Jaw thrust.
• Assess for tongue fall or foreign body in the airway.
• If no respiration is observed/heard even after opening the airway, clear the airway.
• Hyper extend the neck to bring the windpipe (trachea) in a straight line.
• The first aider takes a deep breath and pinches the nose while making a seal on the mouth of the victim (respirator mask can also be used for prevention of infection).
• Deliver the breath into the mouth of the victim and look for the rise of the chest with a blow of breath.
• Repeat the breath.
• After delivering two breaths continue chest compression.

STEPS OF CPR

STEP 5: PROVIDE TWO RESCUE BREATHS

STEPS OF CPR

STEP 6: REPEAT THIS WHOLE PROCESS TILL

THE AMBULANCE ARRIVES

• Repeat 30 compressions and two rescue breaths.

CARDIOPULMONARY RESUSCITATION (CRP)

COMPLICATIONS OF CPR

• Fractures of ribs or the sternum due to chest compression.
• Gastric insufflations from excessive artificial respiration.

SCHAFER METHOD & SYLVESTER METHOD

CHAPTER FOCUS POINTS

• First aid is given in all emergencies condition such as wound, hemorrhage, fracture, respiratory emergencies, unconsciousness, and poisoning and community emergencies.
• An injury in which the skin is damaged or penetrated is known as wound.
• Different sizes of bandages are used to prevent cross contamination of wound by placing bandage in proper position.
• Dressings provide support to the injured part, sprained or dislocated joint, to control bleeding.
• First aider should have improvisatory abilities so that the safe transportation is possible using stretchers or appropriate carrying method.
• Respiratory emergencies are serious medical emergencies which is characterized by difficulty in breathing or person is unable to take breathe.
• CPR a lifesaving procedure which is given to person who is in cardiac arrest. CPR helps to pump blood around the whole body of person when person heart fails to do so.

“Textbook of Foundation of

Nursing" by Jyoti Kathwal