Appendix D: Quick Reference First Aid

First Aid Steps

(adapted from the American Red Cross)

1

Scene Size Up

Before administering care to an ill or injured person, check the scene and the person. Size up the scene and form an initialimpression. Pause and look at the scene and the person before responding. Answer the following questions:

  • Is the scene safe to enter?
  • What happened?
  • How many people are involved? –What is my initial impression about the nature of the person’s illness or injury? (How bad does it look?)
  • Does  the  person  have  any  life-threatening  conditions,  such  as  severe,  life-threatening bleeding?
  • Is anyone else available to help?
 
2

Awake and Responsive

  • Obtain consent: Tell the person your name, type and level of training, what you think is wrong and what youplan to do, and ask permission to provide care.
  • Use appropriate PPE: Put on gloves
  • REMEDY ANY LIFE THREATS IMMEDIATELY
  • Interview the person: Use SAMPLE questions to gather more information about Signs and Symptoms, Allergies,Medications, Pertinent medical history, Last food or drink and events leading up to the incident.
  • Conduct a head-to-toe check: Check head and neck, shoulders, chest and abdomen, hips, legs and feet, armsand hands for signs of injury.
  • Provide care consistent with knowledge and training according to the conditions you find.
 
3

If the Person Appears Unresponsive

Shout to get the person’s attention, using the person’s name if it is known. If there is no response, tap the person’sshoulder (if the person is an adult or child) or the bottom of the person’s foot (if the person is an infant) andshout again, while checking for normal breathing. Check for Responsiveness and breathing for no more than 5-10seconds.

Implied Consent:

If a patient is unresponsiveand cannot give verbal, informed consent, Implied Consentis recognized a situation where a reasonable person, given their situation, would consent if responsive and capable of consenting. If the patient becomes responsive while treating them under implied consent, stop, explain the situation, and ask for consent.

 
4

If the Person is Breathing

  • Send someone to call 911 or the designated emergency number and obtain an AED and first aid kit.
  • Conduct a head-to-toe examination.
  • Roll the person onto their side intothe recovery position if there are no obvious signs of injury and there is no concern of a spinal injury.
 
5

If the Person is NOT Breathing AND does not have a Pulse

  • Send someone to call 911 or the designated emergency number and obtain an AED and first aid kit.
  • Ensure that the person is face-up on a firm, flat surface such as the floor or ground.
  • Begin CPR (starting with compressions) or use an AED if one is immediately available.
  • Continue administering CPR until the person exhibits signs of life, such as breathing, an AED becomes available, or EMS or trained medical responders arrive on scene.
 

Note: End CPR if the scene becomes unsafe or you cannot continue due to exhaustion.

CPR/AED Instructions

The 2020 American Heart Association Guideline Updates for healthcare providers and those trained: conventional CPR using chest compressions and mouth-to-mouth breathing at a ratio of 30:2 compressions-to-breaths. In adult victims of cardiac arrest, it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min and to a depth of at least 2 inches (5 cm) for an average adult, while avoiding excessive chest compression depths (greater than 2.4 inches [6 cm]).

Basic First Aid Reference Table

Injury Explanation
Control bleeding Put on gloves. Cover the wound with a dressing andpress firmly against the wound (direct pressure). Elevate the injured area above the level of the heart if you do not suspect that the victim has a broken bone. Cover the dressing with a bandage. If the bleeding does not stop, apply additional dressings and bandages, and use a pressure point to squeeze the artery against the bone. Provide care for shock.
Care for Shock Keep the victim from getting chilled or overheated. Elevate the legs about 12 inches (ifbroken bones are not suspected). Do not give food or drink to the victim.
Burns Reduce pain by gently cooling the burn. Pour large amounts of water over the burned area. Cover the burn with dry, clean dressings or cloth.
Muscles, Bones and Joint Injuries Rest the injured part. Apply ice or a cold pack to control swelling and reduce pain. Avoid any movement or activity that causes pain. If you must move the victim because the scene is becoming unsafe, try to immobilize the injured part to keep it from shifting.
Poisoning Call the Poison Control Center (1-800-222-1222) and communicate what was swallowed and how much. Follow the directions given exactly.
Allergic Reaction Allergic reactions range from mild (e.g. hay fever) to severe (e.g. anaphylaxis). Anaphylaxis (an-a-fi-LAK-sis) is a serious, life-threatening allergic reaction. The most common anaphylactic reactions are to foods, insect stings, or medications.  More specific response actions outlined below.  
Heat Illness Heat exhaustion is the most common type of heat illness. Move to a cool, shaded place; hydrate with cool water. If no improvement, call 911 and seek medical help. Do not return to work in the sun.  Heat exhaustion can progress to life-threatening heat stroke. More specific response actions outlined below. 
Hypothermia Move the victim into a warm room or shelter and remove wet clothing. Warm the center of their body first-chest, neck, head, and groin-under loose, dry layers of blankets, clothing, towels, or sheets. Warm beverages may help increase the body temperature, but do not give alcoholic beverages. Do not try to give beverages to an unconscious person. After their body temperature has increased, keep the victim dry and wrapped in a warm blanket, including the head and neck. If victim has no pulse, begin cardiopulmonary resuscitation (CPR).
Frostbite Get into a warm room or shelter as soon as possible. Unless absolutely necessary, do not walk on frostbitten feet or toes-this increases the damage. Immerse the affected area in warm-not hot-water (the temperature should be comfortable to the touch for unaffected parts of the body). Warm the affected area using body heat; for example, the heat of an armpit can be used to warm frostbitten fingers. Do not rub or massage the frostbitten area; doing so may cause more damage. Do not use a heating pad, heat lamp, or the heat of a stove, fireplace, or radiator for warming. Affected areas are numb and can be easily burned.
Other Environmental Injuries Signs/symptoms and treatment are described thoroughly in the reference NOLS Wilderness Medicine 6th edition by Tod Schimelpfenig (2016) for altitude sickness, lightning, stings and bites, and cold-waterimmersion. As these types of injuries occur infrequently, it’s important to carry a wilderness medicine reference with you; a condensed field version is typically provided during wilderness first aid training.  

Links

Anaphylaxis

Allergic reactions range from mild (e.g. hay fever) to severe (e.g. anaphylaxis). Anaphylaxis (an-a-fi-LAK-sis) is a serious, life-threatening allergic reaction. The most common anaphylactic reactions are to foods, insect stings, or medications. Symptoms may develop immediately, rapidly progress over minutes, or develop slowly over hours. Anaphylaxis requires immediate medical treatment, including a prompt injection of epinephrine and a trip to a hospital emergency room. If it isn’t treated properly, anaphylaxis can be fatal.

Note: Epinephrine requires a medical prescription. Individualswith known allergy may carry their own epinephrine auto-injector, typically in a two-pack. Utah law does allow trained “lay rescuers” to carry epinephrine auto-injectors in first aid supplies and administer to a person experiencing anaphylaxis, but the “lay rescuer” must have a current medical training certification that includes the administration of epinephrine. In all situations when an epinephrine auto-injector is administered, the patient must immediately be taken to an emergency room for medical evaluation.

Signs and Symptoms of Anaphylaxis may include:

  • Red rash, with hives / welts, that is usually itchy*
  • Swollen throat or swollen areas of the body
  • Wheezing
  • Passing out
  • Chest tightness
  • Difficulty breathing, cough
  • Hoarse voice▪Difficulty swallowing
  • Vomiting
  • Diarrhea
  • Stomach cramping
  • Pale or red color to the face and body
  • Feeling of impending doom

First Aid Response to Treat Anaphylaxis

1

Contact EMS by calling 911

 
2

If possible, separate the patient from the allergen

 
3

If the patient can speak and swallow, give oral antihistamines and continue until EMS takes responsibility for care.

(adult dose = 25mg -50mg of Diphenhydraminehydrochloride(Benadryl)every 4-6 hours)

 
4

Inject epinephrine via auto-injector for:

(adult dose = 0.3mg intramuscular into the upper thigh)

  • any airway swelling (lips, tongue, uvula, voice changes)
  • large areas of swelling
  • respiratory compromise or shock
 
5

If severe allergic reaction continues, administer a second dose of epinephrine via auto-injector.

 
6

Evacuate to seek emergency medical care for the patient immediately.

Directions for Use of Auto-injectors
  1. Never put thumbs, fingers, or hands over the tip of the auto-injector.
  2. Wear gloves.
  3. Inform the patient of your actions and obtain consent from the patient before administering epinephrine. If unresponsive, implied consent is acceptable in a life-threatening situation.
  4. Form a fist around the auto-injector.
  5. With your other hand, remove the safety-caps.Jab the auto-injector firmlyinto patient’s outer thigh so that the auto-injector is perpendicular to the thigh.
  6. Hold the auto-injector firmly in the thigh for 10 seconds to allow time for the medication to disperse.
  7. Remove the auto-injector, and then massage the injection areafor several seconds.
  8. Store used auto-injectors in their carrying case, inserting them carefully and needle-first into the labeled side.
  9. Continuously monitor the patient and immediately seek emergency medical care.
  10. As needed, a second dose of epinephrine may be administered 15 minutes after the initial dose.

Additional Guidelines for Auto-injectors
  • Become familiar with the auto-injector before the need to use it arises; know where it is physically located.
  • Epinephrine should be administered at the first sign of anaphylaxis.
  • If a participant or coworker is experiencing signs/symptoms of anaphylaxis, and does not have a prescription for epinephrine, only trained staff may administer auto-injector(s) asdescribed in their emergency action plan.
  • ANY administration of epinephrine, intentional or accidental, initiates an evacuation to emergency medicalcare.
  • Protect auto-injectors from heat/light and do not refrigerate.
  • Replace and do not use auto-injectors if solution is discolored, cloudy, or contains particles.

 

First Aid–Signs & Symptoms of Heat Exhaustion

Signs & Symptoms

  • Dizziness, headache
  • Rapid heart rate
  • Pale, cool, clammy or flushed skin
  • Nausea and/or vomiting
  • Fatigue, thirst, muscle cramps

Treatment

  1. Stop all exertion.
  2. Move to a cool shaded place
  3. Hydrate with cool water.

Response Action

Heat exhaustion is the most common type of heat illness. Initiate treatment. If no improvement, call 911 and seek medical help. Do not return to work in the sun. Heat exhaustion can progress to heat stroke. 

First Aid–Signs & Symptoms of Heat Stroke

Signs & Symptoms

  • Disoriented, irritable, combative,unconscious
  • Hallucinations, seizures, poor balance
  • Rapid heart rate
  • Hot, dry and red skin
  • Fever, body temperature above 104ºF

Treatment

  1. Move (gently) to a cooler spot in shade.
  2. Loosen clothing and spray clothes and exposed skin with water and fan.
  3. Cool by placing ice or cold packs along neck, chest, armpits and groin (Do not place ice directly on skin)

Response Action

Call 911 or seek medical help immediately. 

Heat stroke is a life threatening medical emergency. A victim can die within minutes if not properly treated. Efforts to reduce body temperature must begin immediately!

Psychological First Aid

Psychological First Aid is basic, pragmatic support for victims, survivors, and responders who exhibit acute stress response following trauma, violence, or disasters. The intent is to recreate a sense of safety, ensure basic physical needs are met, and protect the patient from additional harm:

  • Help people meet basic needs for food, shelter, and first aid
  • Offer accurate information about the situation and rescue efforts
  • Give practical suggestions that steer people toward helping themselves
  • Help people contact friends and loved ones
  • Direct people to support services.