I         INTRODUCTION   First Aid, emergency care for a victim of sudden illness or injury until more skillful medical treatment is available. First aid may save a life or improve certain vital signs including pulse, temperature, a patent (unobstructed) airway, and breathing. In minor emergencies, first aid may prevent a victim’s condition from worsening and provide relief from pain. First aid must be administered as quickly as possible. In the case of the critically injured, a few minutes can make the difference between complete recovery and loss of life.
First-aid measures depend upon a victim’s needs and the provider’s level of knowledge and skill. Knowing what not to do in an emergency is as important as knowing what to do. Improperly moving a person with a neck injury, for example, can lead to permanent spinal injury and paralysis.
Despite the variety of injuries possible, several principles of first aid apply to all emergencies. The first step is to call for professional medical help. Determine that the scene of the accident is safe before attempting to provide first aid. The victim, if conscious, should be reassured that medical aid has been requested, and asked for permission to provide any first aid. Next, assess the scene, asking bystanders or the injured person’s family or friends about details of the injury or illness, any care that may have already been given, and preexisting conditions such as diabetes or heart trouble. The victim should be checked for a medical bracelet or card that describes special medical conditions. Unless the accident scene becomes unsafe or the victim may suffer further injury, do not move the victim.
First aid requires rapid assessment of victims to determine whether life-threatening conditions exist. One method for evaluating a victim’s condition is known by the acronym ABCs, which stands for:
A — Airway—is it open and unobstructed?
B — Breathing—is the person breathing? Look, listen, and feel for breathing.
C — Circulation—is there a pulse? Is the person bleeding externally? Check skin color and temperature for additional indications of circulation problems.
Once obvious injuries have been evaluated, the injured person’s head should be kept in a neutral position in line with the body. If no evidence exists to suggest potential skull or spinal injury, place the injured person in a comfortable position. Positioned on one side, a victim can vomit without choking or obstructing the airway.
Before treating specific injuries, protect the victim from shock—a depression of the body’s vital functions that, left untreated, can result in death. Shock occurs when blood pressure (pressure exerted against blood vessel walls) drops and the organs do not receive enough blood, depriving them of oxygen and nutrients. The symptoms of shock are anxiety or restlessness; pale, cool, clammy skin; a weak but rapid pulse; shallow breathing; bluish lips; and nausea. These symptoms may not be apparent immediately, as shock can develop several hours after an accident. To prevent shock, the victim should be covered with blankets or warm clothes to maintain a normal body temperature. The victim’s feet should be elevated. Because of the danger of abdominal injuries, nothing should be administered by mouth.
            II      ASPHYXIATION  
Asphyxiation occurs when air cannot reach the lungs, cutting off the supply of oxygen to circulating blood. This can cause irreparable damage to the brain. Among the causes of asphyxiation are drowning, gas poisoning, overdose of narcotics, electrocution, choking, and strangulation. Victims may collapse, be unable to speak or breathe, and have bluish skin. Most people will suffer brain death within four to six minutes after breathing ceases unless first aid is administered.

In the case of choking, a procedure known as the Heimlich maneuver can be used to clear the windpipe of food or other objects. In this procedure quick upward thrusts are applied to the victim’s abdomen to eject the object blocking the windpipe. The first-aid provider stands behind the victim with both arms around the victim’s waist. One fist is placed slightly above the navel and below the rib cage with the thumb against the victim’s body. The other hand is used to hold the fist and apply pressure. The abdomen is then pressed quickly inward and upward, forcing air from the lungs to eject the object from the windpipe. If the victim is too large to hold while standing, or becomes unconscious, the maneuver can be accomplished by laying the person down face up and using the heel of one hand in the same manner as above. The person performing the maneuver must be careful not to apply pressure on the rib cage to avoid breaking ribs, especially in children and the elderly. For obese or pregnant choking victims, the providers hands should be placed over the lower half of the sternum (breastbone) and pressure applied as described above.
For victims of other types of asphyxiation, the most practical method of artificial respiration is the mouth-to-mouth technique in which the first-aid provider forcefully exhales air into the victim’s lungs after first clearing the airway of any obstruction. The provider tilts the victim’s head backward by placing one hand under the victim’s chin and lifting while the other hand presses down on the victim’s forehead. At this point, the mouth and airway can be checked for foreign objects, which can be removed with the fingers. To begin mouth-to-mouth resuscitation, gently pinch the victim’s nostrils together to prevent air from escaping out the nose. Take normal breaths, seal the victim’s mouth with a pocket mask or mouth, and exhale into the mouth. When performed properly the victim’s chest should rise visibly. The provider then listens for the victim to exhale; if using a pocket mask, it need not be removed. This process is repeated at a rate of about 12 times per minute (one breath every five seconds) for adults and about 20 times per minute for children, using less pressure and volume for children. Once beginning artificial respiration, the first-aid provider should continue until the victim begins to breathe or medical help arrives.
In cases of drowning, artificial respiration should be attempted even if the victim appears dead. People submerged in cold water for more than 30 minutes who appeared blue have responded to first-aid efforts and recovered with no brain damage.
            III  CARDIOPULMONARY ARREST  
Cardiopulmonary resuscitation (CPR) is used to restore the heartbeat in a victim whose heart has stopped—a condition known as cardiac arrest. Symptoms of this life-threatening condition may include crushing pain or pressure behind the breastbone; pain in the arms, neck, or shoulder; anxiety and a feeling of impending doom; difficulty breathing; heavy perspiration; weakness; nausea; and loss of consciousness. The American Red Cross recommends that CPR be performed only by individuals who have received special training in the recognition of cardiac arrest and proper performance of CPR skills.
CPR combines the techniques of artificial respiration with the application of external heart massage to keep blood flowing through the victim’s body. The first-aid provider positions the victim face up on a firm surface and clears the airway of any obstructions. To maintain an open airway, the head is tilted back and the chin lifted forward. The provider then gives the victim two breaths by mouth or mask. If no pulse is detected at the carotid artery (located in groove beside windpipe in the neck), the first-aid provider kneels next to victim, placing the heel of one hand on top of the other over the lower half of the sternum. The provider depresses the chest about 5 cm (2 in), forcing blood from the heart through the victim’s arteries. When the pressure is released, blood flows into the heart. The first-aid provider applies the pressure in short, rhythmic thrusts about 15 times every ten seconds. This cycle of two breaths followed by 15 chest compressions is repeated until the victim revives or professional medical help arrives.
            IV    SEVERE BLEEDING   
The presence of blood over a considerable area of a person’s body does not always indicate severe bleeding. The blood may ooze from multiple small wounds or be smeared, giving the appearance of more blood than is actually present. The rate at which blood is lost from a wound depends on the size and kind of blood vessel ruptured. Bright red, spurting blood indicates injury to an artery while welling or steadily flowing, dark red blood indicates injury to a vein.

Welling or spurting blood is an unmistakable sign of severe bleeding. If a major artery ruptures, a person may bleed to death within a minute. Injuries to veins and minor arteries bleed more slowly but may also be fatal if left