CORE 3: FIRST AID

FOCUS 1: WHAT ARE THE MAIN PRIORITIES FOR ASSESSMENT AND MANAGEMENT OF FIRST AID PATIENTS?
SETTING PRIORITIES FOR MANAGING A FIRST AID SITUATION AND ASSESSING THE CASUALTY:
Plan and conduct appropriate assessment and management procedures in response to a range of first aid scenarios: First aid: the initial help given to someone who has become ill or injured Can be administered by anyone based on their experience, training and knowledge First aider can help in an emergency situation or a non-life threatening situation/accident An immediate evaluation of the priority of treatment for injured is required to ensure further danger can be prevented

Aims of First aid: Promote a safe environment Preserve life Prevent injured or illness from becoming worse Help promote recovery Provide comfort to the ill or injured

First Aider Should: Assess the situation quickly Identify the nature of injury or illness as far as possible Arrange for emergency services to attend Manage casualty promptly and appropriately Stay with casualty until handed over to healthcare professional Give further help if necessary

Situational Analysis: Making the emergency scene safe for the first aider, bystanders and the injured person can be done by assessing the situation and removing immediate danger or preventing further dangers from occurring Should be performed in a calm and controlled manner to ensure emergency is handled speedily, effectively and efficiently First aider = no use if panic stricken .: increasing injured persons anxiety and contribute to an unstable situation Making an analysis of the situation includes: - Identify cause of injury + obvious surrounding dangers (vehicle accident, live power source, heart attack, drowning, chemicals etc) - Asses possible dangers of situation in relation to

Priority Assessment Procedures Basic Analysis Plan: can be administered in any situation to assess the area of incident and cause of emergency situation Look around for any obvious dangers and check to see if area is safe Analyse what the incident or emergency may involve

Work out how many people are involved in the incident Find out if there is anyone else who is able to assist, firstly ring 000 [emergency services] The most experienced person should make the assessment of the level of injury incurred by casualty, take management of the situation and provide direction for others First priority Life threatening cases: level of consciousness, casualty is breathing Control vital signs: bleeding, burns and fractures become the next level of management Most unresponsive casualty should be the first to receive treatment in the case of multiple casualties

DRABCD (Danger, Response, Airways, Breathing, Compressions, Defibrillations) Danger: Risks, safety, hazards When emergency situation has occurred first aider must first ensure that their safety and those of the casualty and bystanders at the scene are secured and not at risk Take time to conduct primary survey of scene, look for anything that may threaten safety of those or around the scene Event is dangerous: should be left with emergency personnel with the training and equipment to manage it Situation is safe: casualty is not at further risk, first aider should take extreme care and check the injured in position found. If cant be done, first aider should gently roll them onto their back, supporting head and neck during movement

Response: To check for a response: first aider should ask casualty to squeeze their hand or gently squeeze casualtys shoulders and loudly ask: Are you all right? Can you hear me? If injured person doesnt response = considered unconscious If conscious: leave casualty in an area in which they were found [provided they are not in further risk] reassure them, check for further injuries and place them in the recovery position. Ensure casualty is reassessed regularly If casualty is not responding, first aider needs to continue with DRABCD

Airways: Before administering CPR; essential to ensure that casualtys airway is open. This is done by; Placing hand on forehead of casualty Placing fingertips on the point of the casualtys chin Gently tilting the casualtys head backwards and slowly pushing on chin to open the mouth and look in airway If any obstruction, gently roll casualty onto their side to clear it. Gently use fingers to carefully remove any obstructions. Do not remove false teeth if they have not become dislodged. Do not use excessive force in case there is an injury to the back If no obstruction, roll casualty onto their back and continue with breathing

Breathing: Keep casualtys airway open and check to see if they are now breathing Look to see if the casualtys chest is rising or falling Listen for any sounds of breathing in or out by the casualty Feel for any expired air by the casualty is breathing normally If any doubt person is not breathing, treat person as if they are not breathing If person is breathing, roll casualty into recovery position, check their condition and send for help if required. Continue to observe and reassess the casualty for regular breathing

If persons breathing is absent, send for help, calling 000 for an ambulance. IMPORTANT TO ASK FOR THE AUTOMATED EXTERNAL DEFIBRILLATOR (AED). Until help arrives, continue with expired air resuscitation (EAR).THIS IS DONE BY GIVING 2 BREATHS TO CASUALTY in the following ways: Open casualtys airway with head tilt and open the mouth [ensure fingers are not resting on casualtys throat] Pinch casualtys nose closed with the index finger and thumb Blow into casualtys mouth for about ONE second and watch for chest to rise Give a second breath and start compressions When resuscitating children, ensure smaller amount of air is in each breathe, but enough to inflate childs lung. DO NOT TILT THE HEAD BACK AS THIS MAY OBSTRUCT THE AIRWAYS Use mouth to nose method, by breathing into infants mouth and nose at the same time. Only use puffs when resuscitating an infant If casualty has mouth clenched and you are unable to open it, use mouth to nose method to resuscitate them.

Compressions: Shows no signs of life = unconscious, unresponsive, not moving and not breathing normally. Begin compressions or external cardiac compressions (ECC) When performing compressions, the casualty should be on a firm surface to ensure first aider is giving compressions effectively; pressure on heart is maintained and acts as an artificial pump for blood supply in body If casualty does not respond to CPR: automated external defibrillator device should be applied if available.

Defibrillations: Defibrillation is the emergency procedure where an electronic device called an Automated External Defibrillator (AED) is applied to the chest of a person in cardiac arrest, and delivers a controlled electric shock to the casualtys heart Device can be used by anyone as device provides voice instructions: Ensure safety to the injured person and those around Turn on AED Attach the electrode pads to the assigned areas of the casualtys body If there is more than one rescuer present: continue CPR while pads are attached Follow voice/visual prompts of the AED Ensure no one touches casualty while AED is analysing heart rhythm Fully automatic AEDs will deliver the shock automatically; if the casualty starts breathing, place them in recovery position Continue compression if the casualty does not start breathing

STOP (Stop, Talk, Observe, Prevent Further Injury) Where a person is conscious, the injury can still be severe. STOP method is used in the management of other injuries most in the case of sporting injuries. Stop Talk Ask injured: what happened, how it happened, what did they feel when it happened. E.g.: Did you hear a snap or crack when you fell? Where does it hurt? Does it hurt anywhere else? Have you had a previous injury to this area? Stop the injured person from participating or moving, and if necessary, stop the game

Observe Whilst talking to injured, observe if athlete appears to be distressed or lying in any unusual position Check injured area for any signs of deformity, swelling or dislocation Compare injured site with opposite side and ask if they can move the injury Assess if the athletes range of movement is restricted compared to normal or to other side of limb. If no range: arrange appropriate transport e.g. ambulance for broken bones. Prevent Further Injury TOTAPS METHOD: - TALK: o Talk to injured person to determine what has happened and what they might have heard - OBSERVE: o Look at injury and compare to other side: see if any swelling of deformity - TOUCH: o Gently feel area for anything that may be out of place or unusual - ACTIVE MOVEMENT: o Ask injured if they can move injured area. If unable to continue ensure that further medical attention is referred to if necessary - PASSIVE MOVEMENT: o Gently try to move injured area to see where pain is occurring - SKILLS TEST: o Ask injured person to do skills test using movements they were doing before injury; e.g. passing ball or running

CRISIS MANAGEMENT :
It is imp. For first aider to be aware of how to promote safe environment, preserve life, prevent any further injury or illness, promote recovery and provide comfort to ill/injured. Act calmly and confidently in a crisis to manage situation Cardiopulmonary Resuscitation (CPR) CPR combination of expired air resuscitation (EAR) first aider breathe for injured person by artificially ventilating lungs; External Cardiac Compressions (ECC) or chest compressions Used when there is no signs of life = no breathing, response, movement from injured person When administering compressions: 1. Kneel by side of casualty 2. Place heels of hands, one on top of the other (two fingers for an infant of the heel of one hand for a small child) and interlock fingers 3. Lean over casualty and, with arms straight, press down about 1/3 of casualtys chesty 4. Administer 30 compressions at rate of approximately 90 compressions/min. Compressions and release should take equal amount of times 5. Give 2 more breathes 6. Return hands/fingers quickly to casualtys chest and give next set of compressions and breaths 7. Continue 30 compressions and 2 breaths cycles until AED or emergency services arrive 8. If more than one rescuer present, change roles every 2 minutes to prevent fatigue 9. Only stop to re-check casualty if they start breathing normally, otherwise do not interrupt resuscitation Continue CPR until: - Scene becomes unsafe - Qualified help arrived and takes over - Signs of life returns - You become physically unable to continue - Authorized person pronounces life extinct.

Bleeding: Can be either external from the bodys arteries, veins or capillaries; internal [may not be recognised] External bleeding can come from the: - Arteries: blood is oxygen rich, bright red in colour and tend to spurt out from wound. Hardest to control - Veins: blood tends to be dark red in colour, flow more evenly from body due to less pressure - Capillaries: Small blood vessels are ruptured and blood will ooze from wound and tends to clot quickly. If ruptured under the skins surface: blood escapes into surrounding tissue and causes bruising. Symptoms and signs of major bleeding in casualty include: - Feeling faint or dizzy - Restless - Nauseous - Thirsty - Weak and rapid pulse - Skin cold and clammy - Sweaty - Progressively losing consciousness Management of severe bleeding in a casualty include: 1. Follow DRABCD in first instance 2. Lay casualty down and remove or cut clothing to expose wound 3. Apply direct pressure to wound by using a sterile dressing or pad if available (use gloves if available to avoid infection) 4. If bleeding continues through dressing , do not remove it, add another dressing 5. When bleeding stops, firmly bandage the dressing pad to hold it firmly 6. Raise and rest injured part where possible 7. Call or refer to medical advice 8. Stay with casualty and watch for any signs of shock or unconsciousness Whee only minor bleeding: wash in water or saline solution and cover with sterile or non-stick dressing before bandaging.

Shock: Result of circulatory system no functioning properly and can become fatal Blood is depressed from circulating through body .: oxygen is not being carried to tissues and vital organs of the body; such as brain, heart and lungs Causes of shock: witnessing distressing events, heart attack; poisoning, burn , severe bleeding, heat exhaustion; bites and stings Symptoms: - Weak + rapid pulse - Cold + clammy skin - Rapid and shallow breathing - Nausea - Faintness and dizziness - Pale face, fingernails + lips Management: 1. Calm casualty and lay them down (try and protect them from cold grounds) 2. Follow DRABCD 3. Control and bleeding 4. Raise casualtys legs (unless broken) above heart 5. Dress any wounds or burns 6. Immobilise any fractures or dislocations 7. Keep casualty warm, but make sure they dont overheat 8. Do not administer anything to eat or drink, moisten lips if thirsty

9. Loosen any tight clothing around neck, chest or waist 10. Monitor casualtys breathing and pulse Neck and Spinal Injury: Suspected neck and spinal injury = classified as serious may lead to paralysis if not managed correctly If spinal cord is damaged, no messages are able to be sent from and received to brain from the body below the injured part Common causes = falls from heights, diving accidents, high speed accidents whiplash, direct blow to the spine, penetrating injury such as a gunshot wound Symptoms: - Pain at, near or below site of injury - Numbness or tingling in hands and feet - Tenderness over site of injury - Loss of power, movement or impaired movement below sight of injury Management: 1. Calm casualty is conscious 2. Follow DRABCD plan if casualty is unconscious. When moving casualty always ensure neck and spine are supported at all times to prevent any twisting or bending movement 3. Carefully loosen any tight clothing 4. DO NOT move casualty unless they are in danger 5. Hold the casualtys head and spine steady with supports or apply cervical collar, if available. 6. Call for an ambulance.

Moving the casualty: Injured should never be moved unless in immediate danger from: collapsing building, fire, poisonous fumes or traffic hazard. Unnecessary movement can cause further injury to person Should be done quickly, informing casualty what is happening to make them feel secure First aider: should bend at the knees, keep back straight and head up. Keep balanced in position, holding weight of casualty close to body and move with small steps. If others are available work as a team Emergency lifts and moves include: - Clothes drag: used when someone is suspected of having a head or spinal injury; head is cradled by the first aider by back of the persons collar and first aiders hands - Human crutch: used when casualty has an injured foot or leg, but is able to walk with assistance after injury is immobilised - A four handed seat: Can be used by TWO FIRST AIDERS to carry the casualty. Hold each wrist firmly. Squat down and allow casualty to sit on hands. Lift and move together - A two handed seat: when TWO FIRST AIDERS hold wrists of one arm and lift the casualty while supporting their back with free arm Stretcher = best transportation

Medical referral: Important to get medical assistance as quickly as possible Always call 000 or send someone else for help and continue to follow the DRABCD method Emergency services receive accident location, nature of injury to the casualty, management of injury thus far, name and contact number of person calling Accident not an emergency, still important to seek medical advice for an injury to prevent any further injury and enhance treatment and rehabilitation E.g. BURNS: need medical attention to prevent infections, lacerations stitches, sports injuries xrays etc

Care of the unconscious casualty: After DRABCD method casualty may still not be breathing. Important to ensure the utmost care is continued by the first aider until help arrives or until the casualty can be moved to medical attention. Caring for unconscious includes: 1. Roll casualty onto their side in recovery position, being aware of supported movement in case of neck or spinal injury 2. While waiting for assistance, monitor airways, breathing, pulse level of consciousness 3. Treat other injuries, such as bleeding, burns or bones (breaks, fractures or dislocations) 4. Loosen any tight clothing to make casualty more comfortable 5. Protect casualty from their environment If casualty gains consciousness do not move them, but reassure them until assistance arrives

FOCUS 2: HOW SHOULD THE MAJOR TYPES OF INJURIES AND MEDICAL CONDITIONS BE MANAGED IN FIRST AID SITUATIONS:
MANAGEMENT OF INJURIES:
Identify signs and symptoms, and primary management for each injury and medical condition. Cuts and Lacerations: Wounds: injuries that can cause tissue to rupture in organs or the skin In all cases any bleeding needs to be stopped and the wound then treated. Open wounds may become infected, so it is important that skin of first aider is intact or gloves are worn for their protection SIGNS AND SYMPTOMS: MANAGEMENT OF CONDITION LACERATIONS: Generally result of a piece of wire or Clean wound thoroughly with saline or cool boiled water animal claw tearing skin and underlying tissue Apply a non-adherent dressing + seek medical advice if ABRASIONS: A shallow tearing or grating of the necessary outer layer of skin exposing underlying blood vessels, generally the result of a fall on a hard surface CUT (INCISION): A cutting of skin, tissues or DRABCD if needed and pressure to stop bleeding muscles may be severed, which can be a result of a Clean wound thoroughly with saline or cool boiled water piece of glass or knife blade Apply non-adherent dressing and seek medical advice if PUNCTURE (PENETRATION): Deep penetration of necessary the tissue caused by a blunt or pointed object If object is embedded in wound, it should not be removed as it may start bleeding: seek medical advice immediately Fractures: Usually caused by either direct or indirect force to the bone Classified according to the type and extent of the damage Bone may break when it receives a direct blow from contact with another person, obstacle or ground Blow can also cause an indirect break in another bone; e.g. heaving landing on hard surface can send a blow through the arm and cause collarbone to crack Indirect fracture: generally caused by a muscle pulling violently on a bone .: separating bone fragment First aider do not attempt to force a fracture back into place; movement is restricted as much as possible Splints + slings = used to immobilize injury site to restrict movement Management of condition DRABCD Immobilise injured site to reduce pain

Signs & Symptoms Closed: bone is fractured but skin is not broken at the injured site. Pain will be obvious: swelling + deformity

around tender area. Any appearance of bruising will be result of tissue damage under skin Open (compound): skin = broken or bone is protruding

Dislocations: Head injuries and concussions: Eye injuries: Nasal injuries

At the heart of representation are acts of deliberate selection and emphasis Power is the ability to act in a FORCEFUL, PERSUASIVE OR MANIPULATIVEparticular way when doing or accomplishing something. It is the possession of control or command over others. Powerplay refers to ways individuals compete for or exercise power in a social context at the expense of others. Shakespeares Antony and Cleopatra, represents powerful characters that use different methods to gain control and power over each other and society. Shakespeare is able to show conflict over two great worlds that struggle for power and happiness through the tension between duty and love. The Poem,' Our Village', by Wopko Jensma, explores an exploitative and destructive use of power, through the motif of two gents and their involvement in a vulnerable village. This deliberate emphasis is able to generate awareness on the issue of racial oppression and suffering during apartheid in South Africa during World War I. Cleopatra is able to exercise her sexual and emotional power through the ability of seduction and manipulation thus demonstrating the power she holds over Antony and Rome. The irony in Canidius speech, So our leaders led,/ And we are womens men, is able to convey the idea that men who have a hold of power, have the aptitude to lose control of it or entirely, when their decisions are swayed by the seductive nature of women. Allusions and epithets are used to depict Shakespeares emphasis on women and how they have the ability to use their sexuality in order to manipulate a mans judgement to suit their agenda, Strumpets fool...enchanting queen...Venus. Cleopatras petulant tone in, If you find him sad, say I am dancing; if in mirth, report. That I am sudden sick, reinforces Shakespeares idea of women using their tumultuous emotions to gain the attention of men, hence Cleopatra is able to further show her ultimate power and emotional control over Antony. Through this context, Shakespeare shapes the text to reaffirm women, like Cleopatra, and their power to demonstrate how a female monarch has the ability to EXERCISEpower and rule during this period.( REFER TO QUEEN ELIZABETH 1?) The political and diplomatic powerplays are able to convey the Romans sense of duty and honour, yet Shakespeare emphasises the conflict between loyalty and personal ambition. Through the condescending tone of Cleopatra, Shakespeare establishes the hierarchy of power in the Roman Empire, questioning Antonys loyalty to Caesar AS is futile BECAUSE as it undermines his own Roman image AND MANHOOD, Scarce bearded Caesar, have not sent/ His powerful mandate to you; do this, or this... Through the downfall to IN Antonys power loss while with Cleopatra, These strong Egyptian fetters I must break, / Or lose myself in dotage, Shakespeare conveys how** Having popular opinion is important when obtaining power, hence when the socially disapproved personal life of powerplayers intrudes upon their public domain, the public opinion lowers. The disapproval of the powerplayers choices therefore leads to a fall in power. RE-PHRASE!!! TRY :SHAKESPEARE CONVEYS HOW**ANTONY REALISES HIS PERSONAL LOVE LIFE WITH CLEOPATRA IS UNDERMINING HIS STATUS AND POWER AS A LEADER IN THE ROMAN EMPIRE. ( YOU MIGHT NOTE ALSO WHAT OTHERS ARE SAYING ABOUT HIM AND HOW THE RUMOURS AND/OR FACTS REACHING ROME ARE HURTING HIS REPUTATION. QUOTES TO THIS EFFECT??) Shakespeare presents divergent types of masculinity, suggesting the particular traits for political success. Octavius Caesar has great politiciAL virtues: patience, hard headedNESS and ambitioN.. He is the epitome of Roman men, putting responsibilities first as opposed to indulgences. However, Antony still holds greater power in Rome than he, Caesar gets money where/ He loses heart. Similar to Cleopatra, Caesar changes personal powerplay into political powerplay by marrying his sister, Octavia, to Antony for an alliance against PompEY. While the only genuine relationship Caesar demonstrates deep concern for is Octavia, he uses her as a political tool to seek ( CONSOLIDATE?) his power in

Rome. Through this, Shakespeare demonstrates how those who seek power, will often use MANIPULATIVE politics in order to strengthen their own powerplay.GOOD. The world of Rome is opposed to the world of Egypt, with both worlds setting two different characteristic ways of life and values. Shakespeare consciously creates this notion through the contrasting of the businesslike atmosphere of Rome, filled with political divisions and schemes and world conquerors, to the apathetic leisures of Egypt, where the women are seductive and appetitive, always making time for sensual pleasures and gossip. The binary opposition between Rome and Egypt is able to depict orientalist ideologies used by the Romans to reinforce their own power circumstances by thinking of Egypt as aN INFERIOR CIVILIZATION. lower class. Shakespeare presents these orientalist ideologies through the males of Roman Characters, to allow the West to dehumanise and demonise the East and therefore gain control over Egypt. Shakespeare deliberately emphasises the gender and sexual difference through the imagery of gender fluidity. This shows gender as unstable, and as Antony is represented as not more manlike /Than Cleopatra, nor the queen of Ptolemy /More womanly than he expressing the idea of role reversal between Antony and Cleopatra. QUITE GOOD. Through representation, composers are able to emphasise the context THEY want to convey. The destructive and exploitive nature of powerplay is demonstrated through the poem Our Village. The use of the possessive pronoun our in the poems title, emphasises the village as a place of security and comfort. However, the contradiction to this notion is shown in the opening couplet: the two gents with white suits... This further highlights the representation of powerplay where the connotations of the small community alludedTO in the poems title, are juxtaposed WITH the destruction inflicted by the dominant white suits. Wopko immediately establishes the presence of a civilised, wealthy and imperialist force in his village to deliberately emphasise those who are able to ostracise and create power imbalance. Oppression is one theme Wopko clearly demonstrates through the overall power of the force through their use of violence and brutality to rescind the hierarchal order that has been TRADITIONAL IN established by the village. The repetition of they denotes this division and the collective image implies the magnitude of the force. Division is further highlighted through Anaphora HOW?which is able to portray the extent of the oppressors' control. This enables Wopko to emphasise how the force of the two gents indoctrinates the natives to accept their twisted ideals in order to remain under their oppression. The binary opposition between the Two Men in White Suits and the people in the village reinforces the idea of racial power. Hyperbole is able to express this notion, conveying how the force has the dominant control over the vulnerable village, showing the lack of awareness of this village. Through this, Wopko effectively conveys the environment he lives in, and the idea of the apartheid in South Africa. SHOULD 'THE FORCE' BE IN CAPITALS? Wopko connotates the significance of the change and magnitude of the destruction and exploitation resulting from the two gents with white suits that rolled up. By using chiasmus, the rearranging of words of phrases to give a particular effect, Wopko depicts the circular nature of racial oppression and the enormity of the impact that is has had upon the village. This further reinforces the rearrangement of the village in a completely different way, by giving it a negative tone to the situations. The intentional rearrangement of the last two phrases can represent how the village has been flipped upside down and this conveys the obliteration of the change. Through the heart of representation are deliberate acts of selection and emphasis. Composers, through their specific choice of techniques, are able to illustrate the ideology of their context. Shakespeare effectively emphasises the idea of obtaining emotional and political power and control through two different worlds of Rome and Egypt. Whilst demonstrating powerplay, Shakespeare denotes conflict between these two worlds when they both struggle to obtain the power. Wopko Jensma, focuses on the themes of racial DOMINANCE and oppression power, to highlight the context of the apartheid in South Africa during World War I.