First Aid & Basic Life Support (BLS) Management

Prelude

Practical knowledge of first aid is a crucial skill that allows individuals to respond quickly and efficiently during medical emergencies. Whether it’s a small injury or a life-threatening situation, being able to provide immediate care makes a significant difference between life and death.

First aid and Basic Life Support (BLS) is a comprehensive and necessary technique that concentrates on maintaining the vital medical functions when a person’s life is at risk. Accidents can happen anytime and anywhere, from cardiac arrests to choking incidents etc., having a solid understanding of BLS can turn a bystander into a potential lifesaver.

In this article, we will try to explore the significance of First aid and BLS, its role in sustaining life until advanced assistance is available, and how it empowers individuals to become proactive and effective responders in times of medical crisis.

Important Terms

Triage – is an activity of dealing with multiple casualties. Whilst handling these incidents, it is easy to be tempted to approach the person nearest to you or the one who is making lot of hue & cry, causing a delay in helping someone who really needs it more. To effectively manage such a situation, you need to have triage. Triage is where you will quickly access everyone’s injuries and put them into categories.

Star of Life – is a well-known emblem that represents emergency medical services (EMS) and ambulances. The Star of Life consists of a six-pointed star and each point of the star represents one of the six tasks that EMS personnel has to perform i.e., detection, reporting, response, on-site care, care in transit, and finally transfer to appropriate care. When displayed on an ambulance, it signifies the presence of skilled emergency medical staff and equipment.

Golden Hour – refers to the crucial period of time following a severe injury or medical emergency, during which immediate medical attention can significantly impact the patient’s chances of survival and recovery. This critical window typically spans the first 60 minutes after the injury occurs.

Vital Signs – BLS professionals during an emergency evaluate a person’s medical vital signs to gauge his/her post trauma condition. These signs indicate whether a person is stable or experiencing otherwise, and needs medical care up to what extent. The four primary emergency vital signs to be checked post trauma are Consciousness, Breathing, Bleeding and Pulse. 

Safety Signs – First aid related safety signs, duly marked on the walls of the premises, are essential for indicating the location of related equipment like first aid box, automated external defibrillators (AED), safety actions etc.

Policy, Plans and Procedures for Medical Emergencies

An organization’s policy and plan to tackle medical emergencies must prioritize the well-being of its employees, customers, and visitors. It should be thorough, effectively communicated, frequently rehearsed, and regularly revised to guarantee that everyone is aware of the procedures to follow in case of a medical emergency. Below are some crucial components that such a policy should contain.

• Develop a comprehensive emergency action plan that outlines the steps to be taken in case of various medical emergencies, such as heart attacks, strokes, allergic reactions, seizures, and other serious incidents.

• Establish a reliable communication system to quickly alert employees and relevant personnel about the emergency. This may involve alarms, intercoms, or other communication tools.

• Train and appoint a team of employees to act as first responders in emergency situations. This team should include individuals who have regular first aid-CPR trainings and quality certifications.

• To ensure the safety of all employees, it is important to have access to emergency equipment such as first aid kits, automated external defibrillators (AEDs), and emergency medications like EpiPens. These should be easily accessible in case of an emergency.

• Additionally, make sure your organization is complying with all health and safety regulations related to medical emergencies, and take steps to protect the privacy of sensitive medical information to ensure compliance with data protection laws.

• When developing an emergency plan, it is crucial to consider the needs of employees with disabilities or specific medical conditions. It is also important to maintain a list of emergency contact information for all employees, including their next of kin or designated emergency contacts.

Important Items of a First Aid Kit

It is essential to have a well-supplied first aid kits (the number of kits depends upon the spread of the organization) at hand to provide prompt medical attention in case of medical emergencies. The contents of a first aid kit may vary depending upon its purpose, location, and the specific requirements of its users. It’s equally important to regularly check and replenish your first aid kit, as some items may be used up or got expired. If you have any specific medical conditions or unique needs, it’s wise to consult with a healthcare professional and add any additional recommended items to the kits. Nonetheless, certain essential items, which are mentioned below, should be included in a basic first aid kit:

Adhesive bandages, sterile gauge pads & rolls, adhesive tape, antiseptic wipes, scissors, tweezers, instant cold pack, disposable gloves, CPR face shield and instruction card, resuscitation device, triangular bandages, safety pins, eye wash solutions, thermometer, emergency medications like EpiPens, pain relievers (e.g. brufen), medical gloves, Insect sting relief pads or cream, burn gel, dressing, antibiotic ointment, space or emergency blanket, tourniquet, splint, AED (Automated External Defibrillator) and emergency contact numbers.

Keep your first aid kit in a cool and dry place, away from the direct sunlight. At home, a kitchen shelf is the best place to keep your first aid kit as most of the injuries like cuts and burns happen there.

First Aid Training and Certifications International Standards

Various organizations have developed training, certifications, guidelines, and recommendations for providing first aid in different countries and regions. These international standards aim to ensure consistency, safety, and effectiveness in emergency situations. They promote best practices and are adaptable to various situations.

The International Federation of Red Cross and Red Crescent Societies (IFRC) offers comprehensive standards that cover everything from BLS to wound care and handling post trauma medical emergencies. The American Heart Association (AHA), based in the United States, is known around the world for its CPR and emergency cardiovascular care guidelines. In Europe, the European Resuscitation Council (ERC) issues guidelines for resuscitation and first aid protocols. The International Liaison Committee on Resuscitation (ILCOR) is a group formed by resuscitation councils from different countries. The World Health Organization (WHO) offers direction on fundamental emergency care, such as first aid, as a component of its mission to reinforce healthcare systems worldwide. The Occupational Safety and Health Administration (OSHA) is also an organization which offer significant knowledge on first aid and emergency care for workplace safety and are frequently cited globally. In Pakistan, besides the International Committee of the Red Cross (ICRC), many private organizations are imparting training as per international standards and local conditions. 

It is crucial to understand that various nations and institutions may have their own unique protocols and modifications based on regional policies and healthcare frameworks. Nevertheless, these global benchmarks act as a useful source and foundation for devising and executing first aid education initiatives across the globe. First responders must keep themselves abreast of the latest guidelines, and should perform optimal practices to guarantee the most efficient and proven care.

In many advanced countries, AEDs are placed along roads/busy markets, and the location of the nearest first aider (they register themselves) can be visible 24/7 through a mobile application. The emergency control room (like 1122 in Pakistan) tries to locate the nearest AED & first aider and guide them to the emergency location, before sending an ambulance. In some other countries, drones are also used to fly AEDs on the emergency location.  

The Substance of First Aid Training

Although in the succeeding paragraphs, I would be explaining certain important subjects related to first aid, but it is to be ensured that only repeated practical exposure of the staff would enable them to handle the situation satisfactorily, in case of an emergency. In training, the PowerPoint presentations, pictures, and videos have absolutely no significance in comparison to practical application. 

• Cardio Pulmonary Resuscitation (CPR) is a life-saving technique used to revive the heartbeat of someone experiencing cardiac arrest. Initial symptoms of this condition may include crushing pain or pressure behind the breastbone, pain in the arms, neck, or shoulder, anxiety, difficulty breathing, heavy perspiration, weakness, nausea, and loss of consciousness. In CPR, artificial respiration and external heart massage are used to keep blood flowing through a victim’s body. CPR should only be performed by those who have received special training in recognizing cardiac arrest and performing CPR skills properly, and it is only given when heart has stop functioning. 

• AED – A portable medical device called an Automated External Defibrillator (AED) is used to deliver an electric shock to the heart in order to restore its normal rhythm during sudden cardiac arrest. This condition occurs when the heart suddenly stops beating effectively, leading to a lack of blood flow to vital organs. The AED delivers an electrical shock to the heart, called defibrillation, which may allow the heart to resume its normal rhythm. AEDs are designed with safety features like – analyse the victim’s heart rhythm, ensuring that a shock is only delivered when necessary. One of the advantages of AEDs is that these come with clear visual and voice instructions to guide the user through the process. In many European countries, AEDs can be easily found in public places, workplaces, airports, schools, and other areas where people gather in large numbers.

Regular maintenance and testing of AEDs, checking the battery life, pad expiration dates, and overall functionality are also necessary to ensure that they are in working condition. Additionally, in many countries, there are “Good Samaritan” laws that protect individuals from any liability, who use AEDs in good faith during emergencies.

• Severe Bleeding – If someone is experiencing severe bleeding, it’s crucial to take immediate action to control the bleeding while waiting for professional medical help. There are around five litres of blood in an average human adult body, and if someone loses more than 40 percent of it, will die; which is about two litres. During the training, just to make the staff understand the phenomena, spill around two litres of water on the floor and let them guess the quantity. 

First of all, locate the source of bleeding, and apply firm and direct pressure of your hand to the wound using a clean cloth and/or sterile gauze, and maintain constant pressure without lifting it for at least 15 minutes. If the cloth becomes soaked with blood, don’t remove it, instead, place another layer of cloth on top. Stay calm and continue applying pressure until professional medical help arrives. To slow down bleeding, it is also recommended to elevate the bleeding area above the heart level, if possible. If direct pressure does not work, apply pressure to arterial pressure points near the wound. However, this should only be attempted by trained individuals to avoid causing further harm.

• Burns – Burns are injuries to the skin caused by different factors such as fire, hot liquids or metals, radiation, chemicals, electricity, or exposure to the sun’s ultraviolet rays. The classification of burns is based on the extent of tissue damage and the depth of the burn. A first-degree burn affects only the surface of the skin and is characterized by reddening, while a second-degree burn affects the skin beneath the surface, causing blistering and severe pain. A third-degree burn, on the other hand, causes charring and destruction of the skin’s cell-producing layer.

The severity of a burn is also determined by the percentage of the total body surface area affected. Medical professionals use the “Rule of Nines” or “Lund and Browder Chart” to calculate the percentage of a body burn. This approach divides the body into many regions, while each representing a specific percentage of the Total Body Surface Area (TBSA). When assessing the body surface affected by burns, the percentages are assigned for each specific area – head and neck (9%), each arm (9%, with a total of 18% for both arms), front torso (18%), back torso (18%), each leg (18%, with a total of 36% for both legs), and genital area (1%). If a person suffers from third-degree burns over more than 10 percent of their body surface area, they should be hospitalized ASAP.

• Fractures – It is important to know that treating fractures requires more advanced knowledge and skills than basic first aid. If someone is not trained or is unsure of how to handle a bone fracture, the best course of action will be to prioritize providing comfort, minimizing movement of the affected part, and seeking medical help immidiatly. It would also be wise to take a first aid course and gain the required knowledge and confidence to efficiently handle such situations.

After a fracture, it’s important to immobilize the affected area to prevent any movement. If you have first aid training and the necessary supplies, like splints, you can gently immobilize the injured body part. However, refrain from attempting to realign the bone, as this should be left to medical professionals. If it doesn’t cause more pain or discomfort, elevate the injured limb slightly to help reduce swelling. Applying a cold pack or ice wrapped in a cloth to the injured area can also help reduce swelling and pain. If the injured person is an adult and not allergic to pain medications, you can consider offering over-the-counter pain relief, such as brufen.

How to Conduct First Aid Activity 

In any post trauma emergency situation, the 9 principles of first aid serve as a foundation for providing immediate and appropriate care. These principles act as guidelines to follow when helping someone in need.

• Protect yourself – It is important to first assess the scene before administering any aid to ensure your own safety and the safety of the victim. Be aware of any potential hazards that could be harmful to you or others nearby. If the situation is serious or beyond your ability to handle, call for emergency medical assistance immediately.

• Call for help – If someone appears to be in distress, it’s important to seek professional assistance.

• Check the responsiveness – To assess the level of responsiveness, try asking loudly if they are okay or gently shaking the shoulders. It is important to know immediately whether the heart is beating or not. 

• Open the airway – If there is no response, activate the emergency response system and begin CPR, if heart is not beating. If the person is unconscious and not breathing, ensure their airway is open by tilting their head back and lifting their chin to allow for proper airflow.  

• Check the breathing – Check for signs of breathing by observing, listening, and feeling for breaths. If the person is not breathing or only gasping, begin CPR immediately.

• Control bleeding – To manage any visible open wounds, use direct pressure and use sterile dressings or clean cloth, if possible.

• Immobilize injuries – If there are indications of broken bones or spinal injuries, immobilize them to avoid further injuries during transport.

• Treat for shock – If the victim is in shock, lay them down, elevate their legs (unless there are suspected leg injuries), and cover them with a blanket to maintain body temperature.

• Comfort and reassure – Lastly, offer comfort, reassurance, and emotional support to the victim. Stay calm and communicate clearly throughout the process. It is crucial to understand that although these principles are useful general guidelines, obtaining proper first aid training and certification can equip you with more comprehensive knowledge and skills. In any possible situation, it is highly recommended to seek professional medical assistance or consult a healthcare provider after administering first aid.

Another established way of doing above has an acronym of DR-ABCD; where D is to look for any danger around, R is to check Response of the injured, A is to check Airway, B is to check Breathing in case there is no breathing/heartbeat go for C that is start CPR, and D stands for using of Automated External Defibrillator (AED).   

It is important to remember that while using AED, keep on giving CPR in the intervals & gap between AED operation.

First Aid Legal Obligations

As a trained first aider, one does not have an automatic legal obligation/permission to provide first aid, unless you already have a “duty of care” for that person, i.e., workplace first aiders, teachers, and/or family members. In an impromptu situation, one may have concerns about the bad outcomes of the assistance. Before providing first aid to a casualty, one must try to obtain consent from the casualty or their parent/guardian, etc. Ask the casualty “I am a trained first aider, may I help you?” If the casualty is reluctant to accept your help but it appears very obvious he/she is seriously unwell or injured then you should consider calling an ambulance or other emergency assistance. But, if a casualty is unconscious or unable to communicate, the law assumes that the casualty would have given his/her consent.

Conclusion

Knowing first aid and BLS techniques can be a crucial skill in emergency situations, and by virtue of that we can offer immediate help and support to those in need. This article has provided an overview of important first aid principles, highlighting the significance of staying composed, evaluating the circumstances, and prioritizing safety. It is equally essential to understand that first aid is not a substitute for professional medical care but only serves as a vital interim measure until authorized assistance arrives.

Making your staff familiar with quality first aid training can greatly improve abilities and necessary skills to ensure the safety of those around us. Remember that every second counts in an emergency, so stay prepared and stay safe.