• To save life
• To protect the casualty from getting more harm
• To reduce pain and Priorities of Casualty Treatment
  

• Asphyxia
• Cardiac Arrest
• Severe Haemorrhage (Bleeding)
• Other Injuries/Illnesses
• Shock

IMMEDIATE REQUIREMENT

Critical four minutes

One of the most common causes of a road accident death is due to loss of oxygen supply. This is mostly caused by a blocked airway. Normally it takes less than four minutes for a blocked airway to cause death.

The ‘golden hour’

The first hour after the trauma is called the ‘golden hour’. If proper first aid is given, road accident victims has a greater chance of survival and a reduction in the severity of their injuries.

D: DANGER

• To self
• Bystander
• Casualty

Make sure it is safe to approach the injured person. Park your vehicle at a distance from the site.

Keep safe and don’t rush. Do not approach if it is too dangerous.

Call at 100 and make the scene as safe as you can. Give them the maximum details. Location of accident? Number of vehicles? Number of people injured?

Signal other road users to stop by waving or using hazard warning triangle.

Turn off the ignition of the vehicles involved in the accident.

Response

Check the status of the casualties. Assess if the person is conscious or unconscious. Shake them lightly and shout to them. If you do not get a reply the victim is unconscious.

Treat the quietest person first, those screaming can at least breathe. Always suspect spinal injuries.

Our priorities are to keep airways open, provide resuscitation if needed and to treat serious bleeding. Other casualties should be kept still and warm.

Encourage people to stay where they are – people should stay in their vehicles unless it is too dangerous for them to be there.

After checking for danger, you must check for a response from the casualty. The casualty
will be either conscious or unconscious.

CONSCIOUS

1. Shout out - if casualty replies it proves the casualty is breathing.
2. Approach carefully
3. Confirm if casualty can hear by asking his name and what happened.
4. Examine softly
5. Check for bleeding, shock and poisoning. Stop any bleeding by applying direct pressure with bandages or clothing.
6. Keep the casualty lying down
7. Keep casualty warm and relaxed.

Note: Do not give anything by mouth. If the scene is safe, do not move an injured casualty.
make possible life saving First Aid.

UNCONSCIOUS

1. Shout out - If casualty does not reply, approach carefully
2. Shout loudly and shake the casualty, check if he responds
3. If unconscious, turn the causality on side to clear and open airway
4. Place casualty's far arm at right angle to the body
5. Place the arm on your side across the chest
6. Bend the knee on your side up
7. Support the head and neck and roll the casualty away from you.
8. Keep the casualty in this position and check their airway and breathing.
   

A: AIRWAY (Open and clear)

Check to see if the casualty's airway is clear. If not, examine and clear airway.

1. Support the casualty in the side position and tilt the head back and a little downward.
2. Open the mouth and clear foreign objects (e.g. broken teeth, food or vomit)
3. Place one hand high on the casualty's forehead to provide support
4. Support the chin with the other hand
5. Tilt the head backwards slightly
6. Lift the jaw and open the casualty's mouth slightly

Remember, there may be spinal injuries. Never roll an unconscious patient onto their back as their tongue may fall to the back of their throat and obstruct their airway.

B - BREATHING

Once the airway has been cleared, check if the casualty is breathing.

1. Check for breathing. Look, feel and listen.
2. If the casualty is breathing, leave them in the Lateral (sideward) position.
3. Monitor and manage shock, bleeding and any other injuries
4. If the casualty is not breathing, support the head and neck, then roll onto their back and give 5 full breaths in 10 seconds.

EXPIRED AIR RESUSCITATION (EAR)

Start EAR if the causality is not breathing. EAR is also called mouth-to-mouth.

There are three methods of EAR:

• Mouth-to-mouth
• Mouth-to-nose
• Mouth-to-mask

Turn the casualty to his side to clear the airway before starting EAR

Mouth to Mouth

1. Turn the casualty onto his back
2. Tilt the head back slightly and lift the jaw forward.
3. Pinch the casualty’s nostrils with thumb and finger to seal the nose.
4. Take a deep breath and breathe into the casualty's mouth.
5. Remove lips. Allow chest to fall. Turn your head to the side to check if the chest is rising and falling after each inflation
6. If chest does not rise, check the angle of the head then check the airway. If the stomach rises, decrease the amount of breath.
7. Give 5 full breaths in 10 seconds, then check the carotid (neck) pulse
8. If pulse is present, commence EAR at the rate of 15 breaths per minute.

Mouth to Nose

This is done if there is an injury in the mouth

1. Tilt the casualty's head back
2. Close the casualty's mouth.
3. Take a deep breath and breathe into the casualty's nose.
4. Take your mouth away and open the casualty's mouth
5. Give 5 full breaths in 10 seconds
6. Check the carotid (neck) pulse. If pulse is present, commence EAR at the rate of 15 breaths per minute.

C - CIRCULATION

Check if the casualty has a pulse.

If casualty has a pulse but is not breathing, start EAR at 15 breaths per minute.

If no pulse is present immediately start CPR.

How to check pulse?

Feel for a carotid (neck) pulse by placing the pads of your fingers in the groove beside the Adam's apple or the middle of the neck on a woman. You can check on either side of the neck. You must check the pulse for 10 seconds.

Note: When the body is in shock, it often shuts down the peripheral circulation, including the radial (wrist) pulse. Therefore it is not advised to check radial pulse.

CARDIO-PULMONARY RESUSCITATION (CPR)

Cardio-pulmonary resuscitation (CPR) is a combination of the Chest Compression procedure and Expired Air Resuscitation (EAR).

Whichever method is used, the pulse must be checked after one minute and then at two
minute intervals. Failure to do so may result in brain damage and lead to death.

Note: CPR must only be practised on a revival dummy.

1. After 5 full breaths, check pulse. If no pulse is present commence CPR immediately.
2. Position the hands on the Compression point
3. Exert pressure using the heel of the lower hand
4. Depress the Sternum about 4-5 centimetres
5. Give equal time from compression and relaxation
6. Give 15 compressions in 10-12 seconds. 2 breaths in 3-4 seconds. 4 cycles per minute.

CPR for Infants

A child’s bones are not properly formed and more delicate. There is a critical differences between giving CPR to adults and children which are as follows:

For children under the age of 1 year:

• Only use two fingers over the lower half of the breastbone
• Do not tilt head backwards
• Jut give small puffs, not full breaths as for adults
• EAR rate 20 breaths per minute
• 1 breath in 5 seconds
• Compression depth is one third depth of the chest

For children aged between 1 and 8 years:

• Use the heel of one hand only
• Give only half a breath
• Ratios & Rates are the same as for a 1 year old child
• Compression depth is one third depth of the chest