First aid providers are often called to assist with traumatic injuries. Knowing how to respond to a variety of situations is important for first aid providers. First aid responders are valuable in providing initial care and assisting more skilled providers in delivering care to the seriously injured persons.

CONTROLLING BLEEDING

Blood loss often gets the most attention. Many times the amount of bleeding is overestimated and draws attention to wounds when more serious injuries should be dealt with first. Whenever confronted with bleeding, perform a quick overview of the person to make sure something more serious is not being overlooked.

Always use personal protective equipment prior to caring for an injured and bleeding person. The person can be instructed to perform some self-care while you put on your protective gear.

The most effective way to stop bleeding from a wound is to apply direct pressure. Use a dressing and your gloved hand to apply firm and direct pressure to the injured area. Continue to hold the pressure until the bleeding stops. If there are multiple wounds, apply pressure dressings to the worst injuries first, and then to the lesser bleeding injuries. The person may temporarily be able to assist by holding pressure on some areas.

Very small wounds such as scrapes can heal more rapidly by using an antibiotic salve. Ask the person if they have any allergies before applying the antibiotic salve. If they do have allergies, do not apply the salve. Thoroughly wash minor scrapes and abrasions with soap and water before bandaging.

Massive bleeding can occur due to extreme injuries such as open fractures or deep lacerations. When direct pressure does not control bleeding, a tourniquet may be required. Tourniquets can consist of a blood pressure cuff, belt, or premade versions. Although commercially prepared tourniquets are more effective than improvised ones, if none is available, one can be made quickly using a piece of cloth and stick-like object. Understand that the application of a tourniquet is painful but may be necessary to prevent life-threatening blood loss. Tourniquet use is difficult and can be dangerous if done incorrectly. Direct pressure should be applied first.

Tourniquet

Figure 6

To apply a tourniquet, do the following:

  1. Put on personal protective gear.
  2. Apply tourniquet approximately two inches above wound.
  3. Tighten until the bleeding stops.
  4. Record the time the tourniquet was applied.
  5. Call 911/EMS.
  6. Stay with the person and do not release tourniquet until advanced help assumes care. Only a medical professional should remove a tourniquet.

Certain situations may produce massive internal bleeding that is not visible when examining the person. This may occur from trauma, falls from a height, car accidents, or crush injuries.

Penetrating injuries caused by a knife or gunshot may produce devastating internal bleeding with very little external blood loss. Immediately call 911/EMS whenever these injuries are suspected. Help the person lie down and remain still. Check for signs and symptoms of shock. You may need to cover the person to keep them from getting cold. Stay with them until advanced help arrives.

TEETH INJURIES

Teeth may be broken, chipped, or completely knocked out of the mouth. Always use gloves when handling another person’s teeth.

Sometimes teeth can be re-implanted and should be transported with the person to the dentist or to the medical facility. Always handle teeth gently and avoid touching the roots. Gently wash the tooth with clean water but never scrub it or its roots. A tooth can be transported in milk, saline solution, or under a cooperative person’s tongue. The person must see a dentist or a medical provider immediately.

If a tooth is simply loose, have the person bite down on a piece of gauze and call their dentist. Chipped or cracked teeth can be quite painful. If blood is visible at the crack, prompt dental care is required to prevent loss of the tooth. Injured teeth may later begin to turn color. This suggests an injury to the nerve, and a visit to the dentist is warranted.

NOSEBLEEDS

Nosebleeds can be quite dramatic and are often messy. Be sure to wear personal protective equipment and eye protection when attending to nosebleeds. People with nosebleeds often swallow a fair amount of blood, which may result in vomiting. Therefore, you should prepare for the worst.

After ensuring that the scene is safe and protective equipment is on, press both sides of the nostrils just below the bony portion of the nose for a minimum of 5 to 10 minutes. If bleeding continues, try holding pressure for an additional 10 minutes. Sit upright and lean your body and your head slightly forward. This will keep the blood from running down your throat, which can cause vomiting. (Do NOT lay flat or put your head between your legs.) If bleeding continues after this, seek further medical care. If the victim has trouble breathing or shows signs of severe distress, call 911/EMS.

Figure 7

PUNCTURES AND IMPALED OBJECTS

Puncture wounds and impaled objects pose special risk to the injured person. Puncture wounds may penetrate deeper than is apparent and injure sensitive structures such as nerves, muscles, tendons, or blood vessels. Control the bleeding from puncture wounds with direct pressure, and then seek further medical attention. Puncture wounds may carry germs deep within a wound and may result in serious infections. Therefore, any serious puncture wound should be evaluated by a professional as soon as possible.

Impaled objects must be left in place. It is important to understand that the object may pinch off a blood vessel, and removal of the object may result in massive blood loss from an injured blood vessel. Stabilize impaled objects with gauze and dressings and transport the person to the emergency department.

EYE PROBLEMS

Eye Problems

Figure 8

Common eye injuries can result from direct blows, foreign bodies, or inadvertent scratching of the eye. Symptoms include immediate pain, tearing, changing vision, and redness. Bruising and bleeding can also occur. More serious injuries include punctures and lacerations.

Simple irritants such as dust or debris can be flushed using water. Any chemical exposure to the eye should be flushed with copious amounts of water, and you should call 911/EMS. Special equipment can be required to adequately irrigate the eye, so you should seek professional care.

If a more serious injury to the eye is suspected, call 911/EMS. Protect both eyes with a bandage or eye shield. Because the eyes work in pairs, leaving one eye uncovered causes both eyes to move when the good eye tracks objects. Covering both eyes minimizes the movement of the injured eye. However, doing so leaves the person effectively blind, which can be dangerous and frightening to the person. Never leave a person with both eyes bandaged alone. They will require verbal cues about their environment around them as well as reassurance. A physician skilled in eye care must evaluate these injuries.

Head Injury

Figure 9

HEAD INJURIES

Head injuries can accompany any traumatic event.

Signs and symptoms of a head injury or traumatic brain injury include the following:

  • Confusion
  • Headache
  • Nausea and vomiting
  • Memory loss
  • Loss of balance and coordination
  • Seizure
  • Loss of consciousness

A person demonstrating any of the above should be further evaluated by a physician. Head injuries can be devastating and have lifelong consequences resulting in loss of function and decreased productivity. Permanent disability can occur in more severe cases. Protect the person from further injury by stabilizing the head and neck manually and prepare them for transport to advanced medical care. Observe closely for changes in condition. Be prepared to start CPR if the person becomes unconscious.

spine injury

Figure 10

SPINE INJURIES

Spine injuries can occur from a fall, diving, car accident, sporting event, or almost any other physical activity. Head injuries may accompany spine injuries. A high index of suspicion must be maintained and efforts must be made to protect against further injury to the spine and the spinal cord.

The following increases the risk of a spine injury:

  • Age greater than 65 years

  • Bicycle or motorcycle crash

  • Car accident

  • Fall from heights

  • Pain in the midline of the neck or back overlying the bony prominences

  • Numbness, tingling, or weakness

  • Intoxication or substance use

  • Other distracting painful injuries

Injuries to the spine can be unstable. Unnecessary movement of the person can result in spinal cord injury and permanent paralysis. When performing first aid on a person with a suspected spine injury, avoid bending, flexing, or twisting the person’s head or neck. If they begin to vomit, stabilize their head and neck by placing both hands on the side of the head and neck and assist them to their side. Maintain stabilization until advanced help arrives. Also, call 911/EMS as soon as possible.

BONE AND JOINT INJURIES

Bone and joint injuries are common occurrences in daily life. Physically active people such as those participating in sports are more likely to suffer these types of injuries. The elderly and the disabled are also at high risk for fall-related sprains, strains, and breaks. Sprains occur when excessive force or abnormal motion stretches a joint beyond a normal degree. The result of a sprain is pain, swelling, and even bruising. It is impossible to rule out a fracture without an x-ray.

The first aid care for both sprains and broken bones includes the following:

  1. Ensure the scene is safe and wear personal protective equipment.
  2. Apply gauze to any open wounds.
  3. Apply an ice pack to the injured area for up to 20 minutes.
  4. Encourage further evaluation by a health care provider and avoid use of the injured part.

Call 911/EMS if any of the following are present:

  • Open wound over a joint
  • Abnormal position or bent extremity
  • Obvious joint dislocation

Consider the following as special circumstances that should be discussed:

An open or compound fracture occurs when the bone breaks through the skin. Do not attempt to push the bone back in and/or straighten the extremity. Bones that are in an abnormal position or bent should be splinted in place. Do not attempt to manipulate or correct an abnormally positioned bone or joint.

A splint can protect an injured extremity. A splint can be made by using magazines, wood, or rolled-up towels. Pad the injured extremity, if possible, by using a towel or cloth. Place splint material on either side of the injured extremity and secure in place using tape or gauze. Make sure that the splint is not too tight. The fingertips or toes in a splinted extremity should remain warm and pink. Seek immediate care in a medical facility.

Amputations occur when part of the body is accidentally cut off. Because surgeons may be able to reattach an amputated part, it should always be transported to the hospital with the person.

When dealing with an amputation, do the following:

  1. Ensure scene safety, get the first aid kit, and put on personal protective equipment.
  2. Activate the emergency response system by calling 911/EMS.
  3. Apply direct pressure to the bleeding area using gauze.
  4. Locate the amputated body part and care for it as instructed below.
  5. Stay with the person until more advanced care arrives.

When dealing with an amputation, do the following:

  1. Wear personal protective equipment.
  2. Locate the amputated part.
  3. Gently rinse the amputated part with clean water.
  4. Wrap the amputated part in gauze and place it in a plastic bag. Seal the plastic bag.
  5. Fill up another bag with ice, and place the first bag with the amputated part in the ice bag. Seal the ice bag.
  6. Write the person’s name on the bag.
  7. The amputated part and the person should be transported together to the hospital.

BURNS AND ELECTRICAL INJURIES

Burns can occur from direct contact with any heat source, electricity, or certain chemicals. Burns can vary from minor superficial burns to very deep burns that damage muscles, tendons, nerves, and even bones. High-voltage electrical injuries can produce devastating injuries and can be fatal. Any person sustaining an electrical injury requires an evaluation in the emergency department.

Burns

Figure 11

Small burns can be treated with first aid by doing the following:

  1. Ensure that the source of the burn has been dealt with, and the scene is safe.
  2. Wear personal protective equipment, and get the first aid kit.
  3. Rinse the burn in cool or cold water.
  4. Apply antibiotic or burn cream if no allergies exist.
  5. Cover with a clean, dry non-stick dressing.
  6. Have the person follow up with a health care provider.

Do not apply ice to a burn. This technique will result in a cold injury on top of a burn and cause further tissue damage.

Call 911/EMS when the following occur:

  • A large burn
  • Burns on face, hands, or genitals (Burns to skin over joints, such as the backs of the knees, also require special treatment as constant motion will make healing more complicated.)
  • Difficulty breathing
  • A fire
  • Possibility of carbon monoxide exposure

Stop, drop, and roll is the best way to put a fire out from the person. You can also smother the person with a wet blanket to extinguish the flames. Remove the blanket after the fire is out.

When caring for a person with a large burn, do the following:

  1. Ensure that the scene is safe.
  2. Call 911/EMS.
  3. Put on personal protective equipment and get the first aid kit.
  4. Remove any part of the clothing which is not stuck, and if you have suitable alternative coverings, i.e., a clean plastic film, sheet, blanket, etc., cover them with these. Do not remove clothing that is attached to their skin as it may tear the injury further
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