First aid
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225950176
2008-07-16T04:21:08Z
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Reverted edits by [[Special:Contributions/202.134.39.50|202.134.39.50]] to last version by Owain.davies (using [[WP:HG|Huggle]])
{{otheruses4|the provision of immediate care|the 'Transformers' character|First Aid (Transformers)}}
{{wikibooks|First Aid}}
[[Image:Sign first aid.svg|right|thumb|First Aid symbol]]
'''First aid''' is the provision of initial limited care for an [[illness]] or [[injury]]. It is usually performed by a [[layman|lay person]] to a sick or injured [[patient]] until definitive [[medical treatment]] can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care. It generally consists of a series of simple and potentially life-saving techniques that an individual can be trained to perform with minimal equipment.
While first aid can also be performed on animals, the term generally refers to care of human patients.
==History==
The earliest instances of recorded first aid were provided by religious knights, such as the [[Knights Hospitaller]], formed in the 11th century, providing care to pilgrims and knights, and training other knights in how to treat common battlefield injuries.<ref name=medicinenet>[http://www.medicinenet.com/script/main/art.asp?articlekey=52749 First Aid: From Witchdoctors & Religious Knights to Modern Doctors], retrieved [[December 10]], 2006.</ref> The practice of first aid fell largely in to disuse during the Dark Ages, and organised societies were not seen again until in 1859 Henry Dunant organized local villagers to help victims of the [[Battle of Solferino]], including the provision of first aid. Four years later, four nations met in [[Geneva]] and formed the organization which has grown into the [[International Red Cross and Red Crescent Movement|Red Cross]], with a key stated aim of "aid to sick and wounded soldiers in the field".<ref name=medicinenet/> This was followed by the formation of [[St. John Ambulance]] in 1877, based on the principles of the Knights Hospitaller, to teach first aid, and numerous other organisation joined them, with the term first aid first coined in 1878 as civilian ambulance services spread as a combination of 'first treatment' and 'national aid'<ref name=medicinenet/>) in large railway centres and mining districts as well as with police forces. First aid training began to spread through the [[British Empire|empire]] through organisations such as St John, often starting, as in the UK, with high risk activities such as ports and railways.<ref>[http://www.sja.org.uk/history/victorian_britain.asp Industrial Revolution: St. John Ambulance], retrieved [[December 10]], 2006.</ref>
Many developments in first aid and many other medical techniques have been driven by wars, such as in the case of the [[American Civil War]], which prompted [[Clara Barton]] to organize the [[American Red Cross]].<ref>[http://www.redcross.org/museum/registry/profile.asp?id=33 American Red Cross -- Museum], retrieved [[December 10]], [[2006]].</ref> Today, there are several groups that promote first aid, such as the [[military]] and the [[Scouting]] movement. New techniques and equipment have helped make today’s first aid simple and effective.
==Aims==
Two international organizations, the [[Red Cross]] and [[St. John Ambulance]], as well as numerous smaller organizations, determine what constitutes "first aid". However, the concepts of preserving life, preventing further injury, and promoting recovery are generally accepted. First aid training often incorporates the prevention of initial injury and responder safety, as well.
==Training==
[[Image:Suicide-prague.jpg|thumb|First aid scenario training in progress]]
Much of first aid is [[common sense]]. Basic principles, such as knowing to use an 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 [[cardiopulmonary resuscitation]] (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.
==Key First Aid Skills==
[[Image:Tongue-blocking-airways.png|right|thumb|300px|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 (medicine)|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''. The same [[mnemonic]] is used by all [[emergency medicine|emergency health professionals]]. Attention must first by 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 [[breath]]ing and provide [[rescue breathing]] if necessary. Assessment of [[circulation]], typically by checking a [[carotid artery|carotid]] or [[radial artery|radial]] [[pulse]] determines the need for [[cardiopulmonary resuscitation]] and completes the initial evaluation.
Some organizations add a fourth step of "D" for ''[[Bleeding|Deadly bleeding]]'' or ''[[Defibrillation]]'', while others consider this as part of the ''Circulation'' step. 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, as required. Some organizations teach the same order of priority using the "3 Bs": ''Breathing'', ''Bleeding'', 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 [[cardiopulmonary resuscitation|chest compressions]] to someone who is not breathing and has no pulse, and the consideration of [[cervical spine]] injuries when ensuring an open airway.
===Preserving Life===
As the key skill to first aid is preserving life, the single most important training a first aider can receive is in the primary diagnosis and care of an unconscious or unresponsive patient. The most common [[mnemonic]] used to remember the procedure for this is [[ABC (medical)|ABC]], which stands for '''[[Airway]]''', '''[[Breath]]ing''' and '''[[Circulation]]'''.
In order to preserve life, all persons require to have an open airway - a clear passage where air can move in through the [[mouth]] or [[nose]] through the [[pharynx]] and down in to the lungs, without obstruction. [[Conscious]] people will maintain their own airway automatically, but those who are unconscious (with a [[Glasgow coma scale|GCS]] of less than 8) may be unable to maintain a patent airway, as the part of the brain which autonomously controls in normal situations may not be functioning.
If an unconscious patient is lying on his or her back, the tongue may fall backward, obstructing the oropharynx (sometimes incorrectly called “swallowing” the tongue). This can be easily rectified by a first aider tipping the head backwards, which mechanically lifts the tongue clear.<ref>St. John Ambulance (2006). First Aid Training:First on the Scene. Student Reference Guide Activity book. [[St. John Ambulance]]. page 23-7. ISBN 1-894070-56-9</ref>
If the patient was breathing, a first aider would normally then place them in the [[recovery position]], with the patient leant over on their side, which also has 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 through a foreign object becoming lodged in the pharynx or larynx, commonly called [[choking]]. The first aider will be taught to deal with this through a combination of ‘back slaps’ and ‘abdominal thrusts’.
Once the airway has been opened, the first aider would assess to see if the patient is breathing. If there is no breathing, or the patient is not breathing normally, such as [[agonal breathing]], the first aider would undertake what is probably the most recognized first aid procedure - Cardiopulmonary resuscitation or CPR, which involves breathing for the patient, and manually massaging the heart to promote blood flow around the body.
===Promoting Recovery===
The first aider is also likely to be trained in dealing with injuries such as [[wounds|cuts]], [[Abrasion|grazes]] or [[broken bones]]. They may be able to deal with the situation in its entirety (a small adhesive bandage on a paper cut), or may be required to maintain the condition of something like a broken bone, until the next stage of definitive care (usually an [[ambulance]]) arrives.
==First Aid symbols==
{{details|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 law, the use of this and [[International Red Cross and Red Crescent Movement#Protection symbols vs. organizational emblems|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 at the start of the page.
Some organizations may make use the [[Star of Life]], although this is usually reserved for use by Ambulance services, or symbols such as the [[Maltese Cross]] such as the [[Order of Malta Ambulance Corps]] and [[St John Ambulance]], or other symbols.
<gallery>
Image:Sign_first_aid.svg | ISO First Aid Symbol
Image:Flag_of_the_Red_Cross.svg | Symbol of the Red Cross
Image:Maltese-Cross-Heraldry.svg | Maltese Cross
Image:Star_of_life2.svg | Star of life
</gallery>
==First Aid training around the world==
===Australia===
In '''Australia''', Nationally recognized First Aid certificates may only be issued by [[Registered training organisation]]s who are accredited on the National Training Information System (NTIS). Most First Aid certificates are issued at one of 3 levels:
*Level 1 (or “Basic First Aid”, or “Basic Life Support”): is a 1-day course covering primarily life-threatening emergencies: [[CPR]], bleeding, choking and other life-threatening medical emergencies.
*Level 2 (“Senior First Aid”) is a 2 day course that covers all the aspects of training in Level 1, as well as specialized training for treatment of burns, bites, stings, electric shock and poisons. Level 2 reaccreditation is a 1 day course which must be taken every 3 years, but CPR reaccrediation may be required more frequently (typically yearly).
*Level 3 (“Occupational First Aid”) is a 4-day course covering advanced first aid, use of oxygen and [[Automated external defibrillator]]s and documentation. It is suitable for workplace First Aiders and those who manage First Aid facilities.
Other courses outside these levels are commonly taught, including CPR-only courses, Advanced Resuscitation, Remote Area or Wilderness First Aid, Administering Medications (such as [[salbutamol]] or the [[Epi-Pen]]) and specialized courses for parents, school teachers, community first responders or hazardous workplace first aiders. CPR Re-accredidation courses are sometimes required yearly, regardless of the length of the overall certification.
===Canada===
In [[Canada]], first aid certificates are awarded by one of several organizations including the [[Canadian Red Cross|Red Cross]], the [[Royal Life Saving Society of Canada|Lifesaving Society]], [[St. John Ambulance]], the [[Heart and Stroke Foundation]], and [[Canadian Ski Patrol System|Ski Patrol]]. Workplace safety regulations vary depending on occupation. Many workplaces opt to have their employees trained in Standard First Aid (see below).
*Emergency First Aid: is an 8-hour course covering primarily life-threatening emergencies: [[CPR]], bleeding, choking and other life-threatening medical emergencies.
*Standard First Aid: is a 16-hour course that covers the same material as Emergency First Aid and will include training for some, but not all, of the following: breaks; burns; poisons, bites and stings; eye injuries; head and neck injuries; chest injuries; wound care; emergency child birth; and multiple casualty management.
*Medical First Responder (BTLS - known by different names among different Canadian organizations): is a 40 hour course. It requires Standard First Aid certification as a prerequisite. Candidates are trained in the use of oxygen, [[Automated external defibrillator]]s, airway management, and the use of additional emergency equipment.
CPR certification in Canada is broken into several levels. Depending on the level, the lay person will learn CPR and choking procedures for adults, children, and infants.
CPR H.C.P. (Health Care Professional) also provides training on artificial respiration, the use of bag valve masks, and suction. This level of qualification is usually not offered to the general public.
===Ireland===
In Ireland, the workplace qualification is the Occupational First Aid Certificate. The [[Health and Safety Authority]] issue the standards for first aid at work and hold a register of qualified instructors, examiners and organisations that can provide the course. The certificate is awarded after a three day course and is valid for three years from date of issue. Organisations offering the certificate include, Irelands largest first aid organization, the [[Order of Malta Ambulance Corps]], the [[St. John Ambulance Brigade of Ireland|St John Ambulance Brigade]], and the [[Irish Red Cross]].
The Irish Red Cross also provides a Practical First Aid Course aimed at the general public dealing primarily with family members getting injured. Many other (purely commercially run) organisations offer training.
===United Kingdom===
In the '''United Kingdom''', there are two main types of first aid courses offered. An “Emergency Aid for Appointed Persons” course typically lasts one day, and covers the basics, focusing on critical interventions for conditions such as [[cardiac arrest]] and severe bleeding, and is usually not formally assessed. A “First Aid at Work” course is usually a four-day course (two days for a re-qualification) that covers the full spectrum of first aid, and is formally assessed by recognized [[Health and Safety Executive]] assessors. Certificates for the “[[First Aid at Work]]” course are issued by the training organization and are valid for a period of three years from the date the delegate passes the course. Other courses offered by training organizations such as [[St. John Ambulance]], [[St. Andrew’s Ambulance Association]] or the [[British Red Cross]] include Baby & Child Courses, manual handling, people moving, and courses geared towards more advanced life support, such as [[defibrillation]] and administration of medical gases such as oxygen & [[entonox]]).
==Specific first aid disciplines==
There are several types of first aid (and first aider) which require specific additional training. These are usually undertaken to fulfill the demands of the work or activity undertaken.
*'''Aquatic/Marine first aid''' - Usually practiced by professionals such as [[lifeguards]] or in [[diver rescue]], and covers the specific problems which may be faced after water-based rescue.
*'''[[Battlefield medicine|Battlefield first aid]]''' - This takes in to account the specific needs of treating wounded combatants and non-combatants during armed conflict.
*'''[[Hyperbaric medicine|Hyperbaric]] first aid''' - Which may be practiced by [[Scuba diving|SCUBA diving]] professionals, who need to treat conditions such as [[decompression sickness|the bends]].
*'''[[Oxygen therapy|Oxygen]] first aid''' - Providing oxygen to casualties who suffer from conditions resulting in [[hypoxia (medical)|hypoxia]].
*'''[[Wilderness first aid]]''' is the provision of first aid under conditions where the arrival of emergency responders or the evacuation of an injured person may be delayed due to constraints of terrain, weather, and available persons or equipment. It may be necessary to care for an injured person for several hours or days.
==Conditions that often require first aid==
''Also see [[medical emergency]].''
*[[Altitude sickness]], which can begin in susceptible people at altitudes as low as 5,000 feet, can cause potentially fatal [[cerebral oedema|swelling of the brain]] or [[pulmonary oedema|lungs]].
*[[Anaphylaxis]], a life-threatening condition in which the airway can become constricted and the patient may go into [[Shock (medical)|shock]]. The reaction can be caused by a systemic allergic reaction to [[allergen]]s such as insect bites or peanuts. Anaphylaxis is initially treated with injection of [[epinephrine]].
*[[Battle]]field First aid - This protocol refers to treating shrapnel, gunshot wounds, burns, bone fractures, etc. as seen either in the ‘traditional’ battlefield setting or in an area subject to damage by large scale weaponry, such as a [[bomb]] blast or other [[terrorist]] activity.
*[[Bone fracture]], a break in a bone initially treated by stabilizing the fracture with a [[splint (medical)|splint]].
*[[Burn (injury)|Burns]], which can result in damage to tissues and loss of body fluids through the burn site.
*[[Choking]], blockage of the airway which can quickly result in death due to lack of [[oxygen]] if the patient’s trachea is not cleared, for example by the [[Heimlich Maneuver]].
*[[Childbirth]].
*[[Cramp]]s in muscles due to lactic acid build up caused either by inadequate oxygenation of muscle or lack of water or salt.
*[[Joint dislocation]].
*[[Diving disorders]] resulting from too much pressure.
*Near [[drowning]] or [[asphyxiation]].
*[[Gastrointestinal bleeding]].
*Gender-specific conditions, such as [[dysmenorrhea]] and [[testicular torsion]].
*[[Myocardial infarction|Heart attack]], or inadequate blood flow to the blood vessels supplying the heart muscle.
*Heat stroke, also known as sunstroke or [[hyperthermia]], which tends to occur during heavy exercise in high humidity, or with inadequate water, though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the victim has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. [[Coma|Unconsciousness for more than two hours]] usually leads to permanent disability. Emergency treatment involves rapid cooling of the patient.
*[[Heat syncope]], another stage in the same process as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from the latter by some authorities.
*Heavy bleeding, treated by applying pressure (manually and later with a [[pressure bandage]]) to the wound site and elevating the limb if possible.
*[[Hyperglycemia]], or [[diabetic coma]].
*[[Hypoglycemia]], or [[insulin shock]].
*[[Hypothermia]], or Exposure, occurs when a person’s core body temperature falls below 33.7°C (92.6°F). First aid for a mildly hypothermic patient includes rewarming, but rewarming a severely hypothermic person could result in a fatal [[arrhythmia]], an irregular heart rhythm.
*Insect and animal [[bite (medicine)|bites]] and stings.
*[[Strain (injury)|Muscle strain]].
*[[Poison]]ing, which can occur by injection, inhalation, absorption, or ingestion.
*[[Seizures]], or a malfunction in the electrical activity in the brain. Three types of seizures include a grand mal (which usually features convulsions as well as temporary respiratory abnormalities, change in skin complexion, etc) and petit mal (which usually features twitching, rapid blinking, and/or fidgeting as well as altered consciousness and temporary respiratory abnormalities).
*[[Sprain]], a temporary [[dislocation]] of a [[joint (anatomy)|joint]] that immediately reduces automatically but may result in ligament damage.
*[[Stroke]], a temporary loss of blood supply to the brain.
*[[Pneumothorax|Sucking chest wound]], a life threatening hole in the chest which can cause the chest cavity to fill with air and prevent the lung from filling, treated by covering with an [[occlusive dressing]] to let air out but not in.
*[[Toothache]], which can result in severe pain and loss of the tooth but is rarely life threatening, unless over time the infection spreads into the bone of the jaw and starts [[osteomyelitis]].
*[[Wound]]s and [[bleeding]], including [[laceration]], [[incision]] and [[Abrasion (medical)|abrasion]], and [[avulsion]].
==See also==
*[[Choking#Abdominal thrusts|Abdominal thrusts]]
*[[Ambulance]]
*[[Artificial respiration]]
*[[Cardiopulmonary resuscitation]] (CPR)
*[[Mental health first aid]]
*[[Occlusive dressing]]
*[[Oxygen first aid]]
*[[Triage]]
*[[Tourniquet]]
*[[Recovery position]]
==References==
<references />
==External links==
*[http://www.mayoclinic.com/health/FirstAidIndex/FirstAidIndex First Aid Guide at the Mayo Clinic]
*[http://www.cdc.gov/nasd/menu/topic/firstaid.html First Aid References at the U.S.A. Center for Disease Control]
*[http://www.bbc.co.uk/health/first_aid/index.shtml First Aid at BBC Health]
{{First aid|state=expand}}
{{Emergency medicine}}
{{Lifesaving and Lifeguarding}}
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