Welcome to our Online CPR Course! 

This online course will cover adult, child and infant CPR. This course will not cover other first aid topics (eg: bleeding or choking). To learn more about these please scroll down to the First Aid section.

Once you’ve completed all the units and the quizzes, you will receive an email with a summary of your responses and a notice of expiration date.

We strongly recommend you attend a hands-on first aid/CPR training session from a local training provider. This online course does not replace a practical first aid training session.

Enjoy the course!

CPR, the kiss of life, resuscitation, heart massage. These are all words used for Cardiopulmonary Resuscitation (CPR) by the media and general public. These terms can lead to confusion around CPR and what it actually is.

In this unit we will introduce the basic science behind CPR.

How does CPR work?

All the cells in your body require oxygen to survive. They also require a good supply of nutrients and the rapid removal of waste products. Oxygen and nutrients are carried around the body in your blood, which is pumped by your heart.

In your lungs, oxygen enters your blood stream and carbon dioxide (a waste product) is removed in a process known as gas exchange.

A cardiac arrest is when your heart stops beating. This is not the same as a “heart attack”, although a heart attack may lead to a cardiac arrest. There are numerous causes of cardiac arrests, including:

• A disturbance in the heart rhythm
• Drugs/poisoning
• Heart disease / a heart attack
• Traumatic injury/blood loss
• Anaphylaxis

If a cardiac arrest occurs, blood will stop circulating around the body. Breathing will also cease as well though it may not stop completely for several minutes.

Without a supply of oxygen, the cells in the body start to die. Brain cells are incredibly sensitive, after about 4 – 5 minutes of no oxygen brain cells will begin dying leading to brain damage and death.

The purpose of CPR is to keep oxygenated blood flowing around the body to keep the vital organs alive. CPR itself will not restart someone’s heart, it just keeps them alive until a defibrillator arrives. A defibrillator is a device which delivers an electrical shock to the heart to restart it.

Will the casualty wake up?

Unfortunately this is very unlikely to happen. By doing chest compressions, you are taking over the job of the casualty’s heart (which has stopped) by forcibly compressing it. In effect, you are acting as a life-support machine for the person.

In order for the heart to be restarted, it may require an electrical shock from a defibrillator or drugs given by a paramedic/doctor. CPR on its own is very unlikely to restart someone’s heart.

However, good quality chest compressions will significantly increases the chance of the defibrillator being able to restart the heart.

You should only stop doing CPR if:

• A defibrillator arrives and is about to be used
• The casualty shows signs of life: coughing, breathing etc.
• You are asked to stop by a healthcare professional (ambulance crew etc.)
• You become too exhausted to continue
• The situation suddenly becomes too dangerous

Ideally, you should only carry out CPR for a couple of minutes before swapping with someone else. This is to ensure that the chest compressions remain of good quality.

If the casualty does start breathing, you should place them on their side. This will prevent the tongue from blocking their airway, and stop any vomit from traveling into their lungs.

Now that we’ve covered the basic science behind CPR, the next units will focus on how to perform CPR on an adult, child & infant.

If you ever find yourself in an emergency situation where someone is ill or injured then you will need to perform a primary survey.

The primary survey is a quick way to assess casualties. It can easily be remembered by the letters D R A B. If you ever find yourself in an emergency situation then all you need to remember is DRAB and you will be able to systematically assess your patient and decide what to do.

D: Danger

Check to see if there are any dangers to yourself or the casualty. 

Try and make the scene as safe as possible, remember YOU are the most important person.

If the area is too dangerous then stay back and call the emergency services.

R: Response

Attempt to wake the person up by shouting loudly in both ears and tapping them on the shoulders

If you do not get a response, then the person is unconscious. So what exactly does this mean?

“complete or near-complete lack of responsiveness”

“unaware of both self and external surroundings”

The difference between being asleep and being unconsciousness is that an unconscious person will not wake up.

A key principle is that being unconsciousness is a medical emergency which requires immediate first aid intervention.

When someone goes unconscious, they loose muscle tone. This means they go all ‘floppy’ – like a rag doll. The tongue (a muscle) can block their airway when it looses muscle tone. This is known colloquially as “swallowing your own tongue”

In addition, loss of control over their stomach muscles can cause stomach contents (vomit) to travel back up to the throat which can block the airway

A variety of medical conditions and traumatic injuries can cause someone to become unconscious. However at this stage do not worry too much about trying to find out why they are unconscious, your immediate aim is to open their airway.

A: Airway

The airway is a series of tubes which caries air from your mouth & nose to your lungs. It can become blocked by the tongue and regurgitation of stomach contents. This will stop the casualty from breathing and can quickly cause death.

You need to open the airway by tilting the head backwards and lifting the chin with two fingers as demonstrated in the picture below.

B: Breathing

Keep your hands on the person’s head & chin. Place your cheek above their mouth and look at their chest.

Look, listen and feel for regular breathing for up to 10 seconds. You are assessing for normal breathing. The occasional gasping or snoring sound is not regular breathing and should be treated as no breathing.

You do not need to check for a pulse, as this often wastes valuable time. If a public defibrillator (AED) is available, then it should be sent for immediately.

Performing CPR on an adult

Once you’ve found someone isn’t breathing, you should start CPR by administering 30 chest compressions. Interlock your hands and place them in the middle of the person’s chest (over the sternum / breastbone) and push down 30 times. You should aim for a depth equal to a third the depth of their chest.

After 30 chest compressions, you should give 2 rescue breaths. Tilt the casualty’s head backwards, make a seal over their mouth and breath in twice. Each breath should only last about one second so as not to over inflate their lungs.

You should aim for a rate of 100 – 120 chest compressions a minute.

If you wish, you can attempt two ‘rescue breaths’ after every 30 chest compressions. Tilt the casualty’s head backwards, make a seal over their mouth and blow in for approximately one second. However these are optional and chest compressions are the most important component of CPR.

Only stop CPR if:

• The casualty shows signs of life: coughing, breathing etc.
• You are asked to stop by a healthcare professional (ambulance crew etc.)
• You become too exhausted to continue
• The situation suddenly becomes too dangerous

Ideally, you should only carry out CPR for a couple of minutes before swapping with someone else. This is to ensure that the chest compressions remain effective.

CPR demonstration video

Watch the following video which demonstrates CPR on an adult patient.

This first module will introduce you to some basic first aid principles. But firstly, let’s answer the question, why learn first aid?

Knowledge of basic first aid can make the difference between life and death. A glance at some statistics from around the world shows why:

• Every year, around 735,000 people suffer a heart attack in the USA
• Road traffic accidents are one of the top ten causes of death worldwide, in Europe around 30,000 people die from road traffic accidents each year
• Sudden cardiac arrest is the leading cause of death, but many people wouldn’t know how to recognize cardiac arrest or commence resuscitation

Finally, we believe first aid is an important life skill. If you enjoy this online course, we strongly recommend you attend a hands-on first aid training session from a local training provider. This online course does not replace a practical first aid training session.

A simple way to remember the aims of first aid is to think of the “Three Ps”:

Preserve Prevent Promote

A first aider has a number of roles and responsibilities in an emergency situation but all first aiders should be aware of the key aims of first aid.

Preserve Life

Your first aim is to preserve life by carrying out emergency first aid procedures. For example, opening a victim’s airway or performing cardiopulmonary resuscitation (CPR).

Preserving life should always be the overall aim of all first aiders. Remember though, this includes your own life! You should never put yourself or others in danger.

This is why the first stage in assessing a victim is to conduct a risk assessment and check for any dangers to yourself or bystanders.

If a situation is too dangerous to approach, you should stay back and call for professional help.

Prevent Deterioration

The second aim of first aid is to prevent the victim’s condition from deteriorating any further. For example, asking a victim with a broken limb to stay still and padding around the injury will prevent the fracture from moving and causing further injury or pain.

In addition, this aim includes preventing further injuries. You should attempt to make the area as safe as possible and removing any potential dangers.

If removing danger is not possible you should attempt to remove the patient from the danger or call for specialist help. 

Promote Recovery

Finally, you can promote recovery by arranging prompt emergency medical help. In addition, simple first aid can significantly affect the long-term recovery of an injury. For example, quickly cooling a burn will reduce the risk of long-term scarring and will encourage early healing.

Incident management refers to the skills required to manage the scene of an emergency. First aiders may be ‘first on scene’ at an incident so need to know basic principles of incident management.

Your first actions when coming across the scene of an incident should be to:

• Check for any dangers to yourself or bystanders
• Manage any dangers found (if safe to do so)
• Ensure continuing safety of yourself and bystanders

Think about the following situation:

Imagine you came across this situation, think about the following questions:

1. What would your first action be?
2. What dangers could there be in this situation?
3. How would you manage these dangers?
4. Which other emergency services would be required?

In some situations it may be too dangerous for you approach the scene. In this situation you should remember that you are the most important person – stay back and call for professional assistance.

Calling for Emergency Help

In many first aid situations, help from the emergency services will be required.

Ensure you know which number to call!

– United States: 911

Give clear, precise information about:

– The location of the incident

– The number of victims / people involved

– The nature of their injuries

– In some cases, their age

– Any hazards at the incident (e.g: spilt fuel, fire, electricity)

If the area is remote/difficult to access, consider sending someone to meet the emergency services in a known location.

As a first aider, it is important to have a good understanding of infection control. Infection control is important for two reasons:

1. To protect yourself. Remember you are the most important person (think back to the incident management unit)
2. To protect the victim

Why is Infection Control Important?

Various diseases can be transmitted via blood and body fluids including HIV and Hepatitis B & C. The risk of infection can be reduced by following standard infection control precautions.

Infection Control Precautions

Hand Hygiene: Wash your hands with soap and running water whenever possible. Ensure any cuts/open injuries to your hands are covered with waterproof plasters or dressings. Keep nails short if possible.

If soap and running water is not available, alcohol hand gel can be used. However, alcohol hand gel will not clean visibly dirty hands. In addition, some bugs will not be killed by alcohol hand gel. 

Personal Protective Equipment (PPE): Always wear disposable latex or nitrile gloves when there is a risk of coming into contact with bodily fluids. However, this is not always practical so, in an emergency, you can improvise and use anything to create a barrier. e.g: a plastic carrier bag.

Personal Protective Equipment (PPE) also includes masks, aprons, and safety glasses. The purpose of PPE is to prevent blood and body fluids from reaching the first aider’s skin, mucous membranes, or personal clothing. PPE must create an effective barrier between the exposed first aider and any blood or other body fluids.

Clinical waste:  “Clinical waste” is waste which is contaminated with bodily fluids (for example a bloody dressing). This should be disposed of appropriately and not placed in general waste/rubbish. Normally this will involve being sealed in a separate bag and taken for incineration. You should always inform the ambulance crew of any clinical waste so it can be disposed of appropriately. Any used sharps should be placed in a sharps bin.

Video: How to wash your hands

Hand Hygiene resources

For more information on Hand Hygiene in infection control check out the World Health Organization’s website.

If you ever find yourself in an emergency situation where someone is ill or injured then you will need to perform a primary survey.

The primary survey is a quick way to assess a collapsed victim. It can easily be remembered by the letters DRAB. 

If you ever find yourself in an emergency situation then all you need to remember is DRAB and you will be able to systematically assess your patient and decide what to do.

D: Danger

Check to see if there are any dangers to yourself or the casualty (think back to module one). Try and make the scene as safe as possible, remember YOU are the most important person. If the area is too dangerous then stay back and call the emergency services.

R: Response

Attempt to wake the person up by shouting loudly in both ears and gently shaking the shoulders.

If you do not get a response, then the person is unconscious. So, what exactly does this mean?

“complete or near-complete lack of responsiveness”

“unaware of both self and external surroundings”

The difference between being asleep and being unconsciousness is that an unconscious person will not wake up. A key principle is that being unconsciousness is a medical emergency which requires immediate first aid intervention.

When someone goes unconscious, they lose muscle tone. This means they go all ‘floppy’ – like a rag doll. 

The tongue (a muscle) can block their airway when it loses muscle tone. This is known colloquially as “swallowing your own tongue”.

In addition, loss of control over their stomach muscles can cause stomach contents (vomit) to travel back up to the throat which can also block the airway.

A variety of medical conditions and traumatic injuries can cause someone to become unconscious. However, at this stage do not worry too much about trying to find out why they are unconscious, your immediate aim is to open their airway.

A: Airway

The airway is a series of tubes which carries air from your mouth & nose to your lungs. It can become blocked by the tongue and regurgitation of stomach contents. This will stop the victim from breathing and can quickly cause death.

You need to open the airway by tilting the head backwards and lifting the chin with two fingers as demonstrated in the picture below.

B: Breathing

Keep your hands on the person’s head & chin. Place your cheek above their mouth and look at their chest.

Look, listen and feel for regular breathing for up to 10 seconds.

You are assessing for normal breathing. The occasional gasping or snoring sound is not regular breathing and should be treated as no breathing. Once you’ve assessed whether the victim is breathing normally you can perform the appropriate first aid treatment.

If a victim is unconscious but breathing normally then you should place them into the recovery position in order to protect their airway.

The recovery position involves rolling the casualty onto their side with their head tilted back. By doing this, the tongue is kept clear of the airway and any vomit is able to drain and not obstruct the casualty’s airway.

The photo below demonstrates an example of the recovery position.

How to Place a Victim into the Recovery Position:

1. Kneel by the victim’s waist.

2. Place the hand closest to you at a right angle (so it looks like the victim is ‘waving’).

3. Grasp the hand furthest to you, place the back of their hand against their cheek closest to you.

4. Lift the leg furthest away from you at the knee and place their foot on the floor.

5. Using their knee as a lever, pull the person onto their side.

6. Ensure their head is still tilted back and they are on their side.

Once the victim is in the recovery position you should call for an ambulance/EMS if this hasn’t already been done. In addition, remember to recheck the victim’s breathing at regular intervals until further medical help arrives. 

Suspected neck or back injuries

If you suspect the victim may have sustained a neck or a back injury then moving them could worsen the injury. However, it is vital to maintain the victim’s airway so that they do not suffocate. If the victim’s airway is clear and there is no evidence of vomiting then keeping the victim still is advised until EMS arrive.

However, if you are unable to maintain their airway then the victim will need to be moved carefully into the recovery position. If additional rescuers are available, one person can support the victim’s head to minimize excessive movement.

Once the person has been placed in the recovery position you can start assessing and treating any other injuries which you’ve found.

If the casualty is not breathing, you should immediately call an ambulance/activate EMS and commence cardiopulmonary resuscitation (CPR). We will now look at CPR in more detail. 

How does CPR work?

All the cells in your body require oxygen to survive. They also require a good supply of nutrients and the rapid removal of waste products. Oxygen and nutrients are carried around the body in your blood, which is pumped by your heart.

In your lungs, oxygen enters your bloodstream and carbon dioxide (a waste product) is removed in a process known as gas exchange.

A “cardiac arrest” is when your heart stops beating. This is not the same as a “heart attack”, although a heart attack may lead to a cardiac arrest. There are numerous causes of cardiac arrests, including:

• A disturbance in the heart rhythm (arrhythmia)
• Drugs/poisoning
• Heart disease / a heart attack
• Traumatic injury / blood loss
• Anaphylaxis
• Breathing problems – eg Choking / Asthma attack

If a cardiac arrest occurs, blood will stop circulating around the body. Breathing will also cease as well though it may not stop completely for several minutes.

Without a supply of oxygen, the cells in the body start to die. Brain cells are incredibly sensitive, after about 4 – 5 minutes of no oxygen brain cells will begin dying leading to brain damage and death.

The purpose of CPR is to keep oxygenated blood flowing through the body to keep the vital organs alive. CPR itself will not restart someone’s heart, it just keeps them alive until a defibrillator arrives. A defibrillator is a device which delivers an electrical shock to the heart to restart it.

Victims of a cardiac arrest require prompt CPR and early use of a defibrillator in order to give them the best chance of survival. These steps make up a chain known as The Chain of Survival. The ‘links’ of the chain are as follows:

Early recognition and call for help

Early contact should be made to the emergency services after a cardiac arrest is recognized. In addition, serious conditions which may lead to a cardiac arrest (e.g: a heart attack) should be recognized and emergency medical help called for promptly.

Early CPR

Cardiopulmonary resuscitation (CPR) should be commenced immediately after a cardiac arrest has occurred (ie, the patient has stopped breathing). Anyone can perform CPR, and ideally, there should be no interruption in CPR before the ambulance arrives.

Early Defibrillation

A defibrillator is an electrical device which delivers a shock to the heart in an attempt to correct any abnormal electrical activity which has caused the cardiac arrest. 

Post-resuscitation care

Appropriate advanced post-resuscitation care in a hospital is essential to improving long-term survival for the patient. This care should be accessed as quickly as possible after the cardiac arrest has occurred.

CPR should be commenced as soon as possible once EMS has been activated. You do not need to check for a pulse, as this wastes valuable time. If a public defibrillator (AED) is available, then it should be sent for immediately.

Performing Chest Compressions

Once you’ve found a victim isn’t breathing normally, you should start CPR by administering 30 chest compressions. Chest compressions are the most important component of high-quality CPR.

To perform high-quality chest compressions, follow these steps:

1. Kneel by the side of the victim
2. Place the heel of one hand in the center of the victim’s chest
3. Place the heel of your other hand on top of the first hand
4. Interlock the fingers of your hands and ensure that pressure is not applied to the victim’s ribs. Do not apply any pressure over the upper abdomen or the bottom end of the sternum
5. Position yourself vertically above the victim’s chest and, with your arms straight, press down on the sternum approximately 5 – 6 cm
6. After each compression, release all the pressure on the chest without losing contact between your hands and the sternum
7. Repeat at a rate of 100 – 120 chest compressions per minute
8. Each compression and release should take an equal amount of time

If trained, you can attempt two rescue breaths after every 30 chest compressions.

Tilt the victim’s head backwards, make a seal over their mouth and blow in for approximately one second. Do not over inflate the victim’s lungs as this could cause vomiting.

If you are not performing rescue breaths then continue with chest compressions (this is known as ‘hands-only CPR’) alone.

When to Stop CPR

Only stop CPR if:

• The casualty shows signs of life: coughing, breathing etc.
• You are asked to stop by a healthcare professional (ambulance crew etc.)
• You become too exhausted to continue
• The situation suddenly becomes too dangerous

Ideally, you should only carry out CPR for only 2 minutes before swapping with someone else. This is to ensure that the chest compressions remain effective.

High-quality CPR is vital to ensure a victim of cardiac arrest has the best possible chance of survival. CPR is a practical skill, and surprisingly easy to make mistakes when performing. You should avoid performing these common CPR mistakes:

Inadequate chest compression depth

Chest compressions need to be at least 5cm (2inches) deep in order to be effective. A common mistake made during CPR is performing shallow, ineffective chest compressions. Often people underestimate the force required in order to compress an adult victim’s chest. In addition, some people are worried about causing harm to the victim (for example, rib fractures).

Shallow chest compressions will not provide enough force to pump blood around the victim’s body. Therefore, the brain will be starved of vital oxygen and a defibrillator is less likely to work when it is deployed.

It is common for ribs to be broken during CPR. One study found the prevalence of rib fractures in adult victims who received CPR was over 80. The rescuer may feel ribs break when they deliver chest compressions. This can be an unpleasant experience for the rescuer, but it is important to continue to deliver high-quality chest compressions.

Too slow or too fast chest compressions

Chest compressions should be given at a speed of around 100 – 120 a minute. Slow chest compressions are less likely to be effective, and fast chest compressions may not be deep enough in order to push blood around the body.

Leaning on the victim’s chest

Each chest compression should involve compressing the chest to a minimum of 5cm, followed by a full release of the chest wall. This is important to allow the heart to fill with blood. A common mistake new rescuers make is to ‘lean’ on the victim’s chest, especially when they become tired. This means there is not a complete release of the chest wall after each compression, reducing the effectiveness of the CPR.

Over-inflating the victim’s lungs

If trained and willing, rescue breaths can be performed in order to provide oxygen to a victim. However, it is important not to over-inflate the victim’s lungs. Over inflating the lungs will cause air to enter the stomach and increase the risk of the victim vomiting and blocking their airway. Therefore, each rescue breath should only last approximately one second.

Let’s start off this module by briefly looking at how blood moves around our body through the circulatory system.

The heart is a muscular pump responsible for pushing blood around the body. Blood travels in arteries, veins, and capillaries. Its purpose is to transport Oxygen and nutrients around the body and to remove waste products such as Carbon Dioxide. 

An average adult has around 5 liters of blood in their body.

The Different Types of Blood Vessels

The three types of blood vessel will cause different types of bleeding from a victim:

Arteries: Carry blood under high pressure away from the heart. Blood is likely to spurt out of a wound. 

Veins: Carry blood under low pressure back to the heart. Blood will flow steadily from the wound.

Capillaries: Carry blood to the individual cells and tissues, very small and very low pressures. Blood will ooze from the wound. 

Types of Wound

There are various different types of wound that a victim may sustain. 

Laceration: Tearing of the skin & tissue

Contusion: A bruise

Abrasion: Graze – loss of the superficial layer of skin

Incision: A straight clean wound

Puncture: Caused by a sharp object which may still be in the wound (foreign / embedded object)

Major bleeding is life-threatening and requires urgent first aid intervention to prevent further blood loss and the development of shock. 

First Aid Steps for Major Bleeding:

1. Expose injury and elevate above level of the heart
2. If there are no foreign objects, apply firm direct pressure over the wound
3. If there is an object, apply pressure around the foreign object
4. Call for emergency medical help

A useful mnemonic to help you remember the first aid steps for major bleeding is ‘PEEP‘.

P: Position – position the victim in a safe / comfortable position

E: Elevate limbs

E: Expose & examine the injury. Check for any embedded or foreign objects such as pieces of glass.

P: Pressure – apply direct pressure over the injury to control blood loss

Do not apply a tourniquet unless specifically trained to do so. Do not attempt to wash out a major wound – your aim is to control the bleeding as quickly as possible.  Watch for signs and symptoms of shock (next unit).

If you have access to first aid materials you may be able to apply a sterile bandage to a wound. Applying a bandage provides direct pressure and reduces the risk of infection. The following video demonstrates how to apply a sterile bandage:

A puncture wound occurs when an object pierces the skin and enters into a tissue of the body. This creates an open wound which is painful and may be bleeding. Punctures may occur due to any sharp objects such as glass, scissors, knives, pins, nails, wood splinters and sharp stones.

The object may remain embedded in the wound or may have passed clean through the body part involved.

1. Do not remove the object unless it is very small (for example a small splinter)
2. Stop the bleeding by applying pressure around the wound – take care not to dislodge the object
3. If possible, elevate the limb to prevent further blood loss
4. Seek urgent medical attention

It is important to keep the object as still as possible to prevent further injury to the deeper structures below the skin. Whilst it is tempting sometimes to attempt to remove the object, this can actually worsen the situation by causing further bleeding and tissue damage. Removal of embedded objects should only be carried out by a medical professional. 

What is shock?

“A lack of oxygen and essential nutrients reaching the tissues”

Shock is a medical emergency which can be caused by severe blood loss. The casualty does not receive enough oxygen and other essential nutrients due to the loss of blood.

Remember that blood is the major transport mechanism in the body for oxygen and vital nutrients. If you’ve lost half your blood volume (on the floor in a puddle) then that blood isn’t available to transport oxygen and nutrients to your important organs. 

Medical shock is not the same as emotional shock

Many people are confused about what shock actually means. The mass media use the term ‘shock’ to refer to people who have been emotionally affected by a traumatic incident. 

However – this is not the same as medical shock. Medical shock is a life threatening medical emergency. There are various different causes of shock, major blood loss will cause hypovolemic shock. Hypovolemic means low blood volume. 

How to recognize shock

Signs & symptoms of shock include:

• Pale, cold and clammy skin
• Confusion
• Drowsiness (reducing level of consciousness)
• Fast, weak pulse
• Fast, shallow breathing

If a casualty has lost a lot of blood, you should be actively looking for signs and symptoms of shock.

First aid treatment for shock

If you suspect a casualty is suffering from shock then you should:

1. Control any external blood loss (think PEEP from the last unit)
2. Lie the casualty down and raise their legs if possible
3. Cover the casualty with a coat or blanket to keep them warm
4. Call for emergency medical help

Do not give the casualty anything to eat or drink! Stay with them until medical help arrives. If the casualty becomes unconscious / unresponsive then you should place them into the recovery position. If they stop breathing normally then commence CPR.

The key skill for a first aider is being able to recognize shock developing early and call for prompt medical assistance. 

This video goes into a bit more depth about the different types of shock.

Nearly all of us will have suffered a minor wound at some point in our lives. There are some simple first aid steps you can take if someone has suffered a minor wound:

1. Wash your hands and wear gloves
2. Clean the wound thoroughly with antiseptic wipes or clean running water
3. Cover the wound using a clean dressing (plaster, non-adherent pad etc.). 

Caution: Do not remove any embedded objects (e.g: glass) – seek medical advice if there are any objects in a wound. 

Most minor wounds will heal with time and these simple first aid steps. However, sometimes they can become infected. You should watch out for signs and symptoms of an infected wound:

• Increasing pain
• Area around the wound become red, swollen and warm to touch
• The wound starts producing discharge / pus
• The casualty develops a temperature / fever

Below is an example of an infected minor wound (click on the photo to enlarge). You can clearly see the area around the wound has become red and swollen. The wound is also producing a yellow discharge.

If you suspect a minor wound has become infected then you should seek urgent medical attention.

Burn injuries can be classified by their type and depth. The size of burns is expressed as a percentage of total body area.

Types of burn

• Scald – caused by a hot liquid
• Friction – caused by rough surfaces, e.g: carpet
• Radiation/sunburn
• Electrical – will have an entry burn and an exit burn
• Chemical
• Dry – touching hot objects, e.g: a cooker.

Depths of burn

Superficial (1st degree) – this is when only the top layer of skin has been damaged. These are the most minor burns. Often the only sign is a reddening of the skin. Minor sunburn falls into this category of burns.

Partial thickness (2nd degree) – these burns cause blisters in the skin due to the damaged tissue releasing fluid.

Full thickness (3rd degree) – this is the most serious type of burn. In a full thickness burn, every layer of the skin has been affected and the underlying bone, muscle or fat may have also been damaged.

Assessment of burn size

Correctly estimating the size of the burn is important. Burn area is measured as a percentage of total body surface area. 

There are two techniques which can be used:

• Palm of hand: roughly speaking, the palm of the victim’s hand will be approximately 1% of their body surface area
• Rule of nines (see image)

Burns in the region of 10% of body area are serious and may produce severe shock. 

Minor burns are incredibly common household injuries. Our homes are full of items which can cause burns – hair straighteners, kettles, toasters, electric heaters. The list is endless. Generally, burns are caused by touching something hot which damages the skin. However, they can also be caused by radiation (for example, from the sun), chemicals, electricity and friction. As well heat, burns can also be caused by the extreme cold – these are known as freeze or ice burns.

First aid for a minor burn

Step 1: Immediately run the burn under cold running water for a minimum of 10 minutes. If running cold water is not available then improvise! You can use other non-toxic liquids such as drinks. Your aim is to cool the burn.

Step 2: Expose the affected area and if possible remove anything that could be constricted (watches, jewelry etc.). Do not remove clothing sticking to the burn, instead cool through the clothing.

Step 3: After cooling the burn, cover with a non-fluffy dressing/covering. If you have access to a first aid kit, use a non-fluffy sterile dressing. If not then improvise with whatever is available (plastic bag, kitchen clingfilm, tea towel etc.). Be careful not to constrict the burn!

Step 4: Seek medical advice for anything except the most minor of burns. Call an ambulance if serious or if the burn is near the face/neck.

What not to do

• Do not try to remove clothing sticking to a burn, instead cool through the clothing.
• Do not apply toothpaste / butter / creams to a burn. Running water is the most effective cooling method.
  • Exception: “Aftersun” lotion is useful for sunburn.
• Do not burst any blisters.
• Do not stop cooling before 10 minutes is up!

Chemical burns

There are a wide variety of chemicals and substances which can cause chemical burns. These can range from household chemicals such as bleach, cleaning products, pesticides to strong industrial chemicals used in the workplace. Chemical burns can be incredibly serious as the chemical will keep damaging the skin and tissue until it is removed.

Step 1: Check for any dangers to yourself. The chemicals that caused the casualty’s injuries could also pose a danger to you. Try to establish what caused the burn and how safe the chemicals are. If you are in an enclosed area, move the casualty outside or open windows to prevent the build up of fumes. Wear disposable gloves.

Step 2: Cool the burn with copious running water for at least 15 – 20 minutes. Ensure that you do not come into contact with the water used to cool the burn as it may contain the harmful chemical.

Step 3: If any clothing has come into contact with the chemical, it should be removed providing it isn’t sticking to the burn. Try to identify the chemical involved and its container.

Step 4: Cover the burn with a sterile, non-fluffy first aid dressing. If no dressing is available, then improvise. Good items to use include cling-film and plastic bags.

If the burn is serious, the casualty shows signs of shock or the casualty becomes drowsy/looses consciousness then call an emergency ambulance immediately. If a large chemical spill has occurred then also ensure the fire brigade and police have also been informed.

If you become exposed to the chemical involved then you should seek medical advice immediately.

An emergency first aider has various roles and responsibilities. It is important first aiders take these roles and responsibilities seriously as first aid is potentially lifesaving in an emergency situation.

The role of a first aider is to provide immediate, lifesaving, medical care before the arrival of further medical help. This could include performing procedures such as:

• Placing an unconscious casualty into the recovery position
• Performing Cardiopulmonary resuscitation (CPR)
• Using an automated external defibrillator
• Stopping bleeding using pressure and elevation

A first aider’s overall aim should be to preserve life. In addition, a first aider should prevent worsening of the condition and promote recovery.

These aims are sometimes referred to as the ‘three Ps’. A first aider has various responsibilities when dealing with an emergency situation.

A first aider should:

Any first aider will know that documentation is incredibly important. There is no ‘set’ way to document a patient, however below is a suggested guide based around basic abbreviations used in the medical world. It might not always be appropriate for all patients, however certainly for more complicated patients it provides a useful framework that you can use.

These abbreviations are universally recognized, so you don’t need to write them all out on your forms.

PC: Presenting complaint – what is the problem? Why has the patient sought medical attention?

HPC: History of Presenting Complaint – when did the problem start? Have you had it before? What events led up to the problem occurring?

O/A: On Arrival – what did you find when you arrived at the scene (not always applicable)

O/E: On Examination – what did you find when you examined / looked at the patient?

PMH: Past (relevant) Medical History

Meds: Medication (past and present)

Allergies: Any known allergies?

Imp: Your impression of the patient / problem – suspected diagnosis

Tx: Specific treatment carried out by you

Plan: What’s the plan for this patient? Handover? Transport?

Other common ‘shorthand’ abbreviations:

This is by no means comprehensive, but just guide to a few common abbreviations you may see on patient report forms.

LoC: loss of consciousness

DHx: Drug history

Ca: Cancer

IDDM: Insulin Dependent Diabetes Mellitus

NIDDM: Non-insulin Dependent Diabetes Mellitus

MoI: Mechanism of Injury

D&V: Diarrhea and vomiting

#: Fracture

?: Query / suspected

SoB: Short of breath

DiB: Difficulty in breathing

AF: Atrial Fibrillation

MI: Myocardial Infarction

COPD: Chronic Obstructive Pulmonary Disease

CVA: Cerebrovascular Accident

NFR: Not for resuscitation

UTI: Urinary tract infection

VF: Ventricular fibrillation

Observations You should also record any observations performed on your patient. In the last three units we have discussed pulse rate, respiratory rate and the Glasgow Coma Scale. When recording observations, you should document the time the observation was taken.

Taking a pulse is an important first aid skill which allows you to monitor the condition of a casualty.

What is a pulse?

When you heart beats (contracts) it produces a pressure wave. This pressure wave can be detected and counted in order to provide information on the heart rate which is measured in beats per minute (bpm).

To feel (palpate) a pulse it is normally necessary to compress an artery against a bone. This is why a pulse can normally only be felt at specific locations on the body.

Why should I take a pulse?

A pulse can provide important information about the condition of a casualty. Various medical conditions and illnesses can speed up or slow down a person’s heart rate.

How do I take a pulse?

There are three main places where you can take a pulse:

1) The radial artery in the wrist
2) The brachial artery in the elbow crease
3) The carotid artery in the neck

To take a pulse you should use two fingers to compress the artery. It may take some practice before you are able to find pulses quickly and accurately.

After you’ve found the pulse you need to count in order to determine the heart rate in beats per minute. You can either count for a full minute (this is the most accurate method) or count for 30 seconds and multiply by 2.

As well as the number you should also feel for the pulse rhythm – is it regular or irregular? Also take note of the strength of the pulse, is it strong or weak?

The best way to learn how to take a pulse is to practice practice practice! Find your own pulse first, then start practicing on other people (with their permission of course!)

Normal pulse rates

Most adults have a resting heart rate of 60 – 100 beats per minute (bpm). The fitter you are, the lower your resting heart rate is likely to be. For example, athletes may have a resting heart rate of 40 – 60 bpm or lower. Children generally have faster pulse rates:

The respiratory rate is the number of breaths a person takes per minute.

The rate is usually measured when a person is at rest and involves counting the number of breaths for one minute. This is often done by counting how many times the chest rises. To save time, this can be done over 30 seconds and then the result doubled however this is a less accurate method.

Respiratory rates may increase with fever, illness, and with other medical conditions. For example, an asthma attack is likely to significantly increase the respiratory rate. When checking respiratory rate, it is important to also note whether a person has any difficulty breathing or if there are any sounds during breathing (for example, a wheeze).

Normal respiratory rates

Normal respiratory rates for an adult person at rest range from 12 to 20 breaths per minute. Children have faster respiratory rates:

Top tip: An effective way to take a respiratory rate is to combine it with taking the pulse rate. Explain to the person that you are going to take their pulse for a minute. Count the pulse for the first 30 seconds, and then count the respiratory rate for the second 30 seconds. This avoids the person changing their breathing pattern subconsciously.

The Glasgow Coma Scale (commonly shortened to GCS) is a measurement of a patient’s level of consciousness, ie how awake the patient is. 

As the name suggests, the scale was first designed in Glasgow for patients who had suffered a head injury. It is now used across the world by emergency medical staff and first aiders to assess a patient’s level of consciousness. 

The Glasgow Coma Scale contains three measurements: Eyes, Verbal and Motor. Each measurement is assigned a score and the GCS is the total of the three scores combined. The minimum GCS score is 3 (completely unconscious) and the maximum is 15 (fully alert).

The following table lists the individual components of the Glasgow Coma Scale and how the individual measurements are scored.

A GCS of less than 8 is generally considered a serious medical emergency due to problems with the airway. Patients who have a GCS less than 8 are unlikely to be able to protect their airway and are at risk of hypoxia (lack of oxygen). 

When recording a Glasgow Coma Scale score you should identify the individual components as well as the overall score. e.g: E4 S4 M6 = GCS 14

It is important to remember that GCS scores can fluctuate minute-by-minute, especially in critically unwell patients. 

Issues with the Glasgow Coma Scale

The Glasgow Coma Scale does have problems however. It can be quite difficult to learn and also people can interpret the scoring system in different ways.

In addition, various factors such as alcohol & drugs can ‘mask’ a casualty’s true level of consciousness, especially in a head injury situation. However, despite this the Glasgow Coma Scale is still widely used by emergency medical services and hospitals across the world.

The GCS can be a very complicated scale to use. This entertaining video explains the GCS in a slightly different way and may be more memorable than a boring table! 

According to the World Health Organization, Coronary Heart Disease (CHD) is the leading cause of death worldwide. Heart attacks make up a significant proportion of these.

What is a heart attack?

The heart is a muscle which pumps blood around the body. Like every other muscle in the body, it requires a good blood supply to ensure enough oxygen & nutrients are delivered and waste metabolic products (such as Carbon Dioxide) are removed.

The heart receives its blood supply from the coronary arteries which branch off from the aorta (the main artery in your body).

If a coronary artery becomes blocked (e.g: due to a clot), then the heart muscle beyond the point of the blockage will not receive an adequate blood supply. This will result in death of the heart muscle.

The medical term for a heart attack is ‘myocardial infarction’ (myocardium means heart muscle, infarction is tissue death due to lack of oxygen)

How do I recognize a heart attack?

Common signs & symptoms include:

• Central chest pain, which may spread to the arms/jaw/back/abdomen. Does not ease or go away.
• Shortness of breath
• Casualty becomes pale and sweaty
• Fear and anxiety
• Irregular or weak pulse

Not all of these symptoms may be present. In fact, some heart attacks can be ‘silent’ with very little pain which is often mistaken for indigestion. There has been some research which suggests ‘silent’ MIs are more common amongst women and diabetic patients.

If you have any reason to suspect a heart attack, you should treat for one. It’s always better to be ‘safe than sorry’.

First aid treatment

Step 1: Call an ambulance/emergency medical help, say that you suspect someone is having a heart attack.

Step 2: Make the person comfortable, if possible ask them to sit on the floor. The best position is known as the “W” position, this involves the person sitting up with something under their knees to raise them. This reduces the strain on the heart.

Step 3: If you are able to, ask the casualty to chew on a 300mg (big) aspirin. If they have any other medication for their heart (a spray etc.) which a doctor has told them to use, then let the casualty use it.

The casualty may lose consciousness before the ambulance arrives. Try to be reassuring and calm, the casualty will be incredibly frightened and anxious which could aggravate their condition.

Be prepared that the casualty may suffer a cardiac arrest (the heart stops beating) and you may have to perform Cardiopulmonary Resuscitation.

Most of us are allergic to something whether it be pets, pollen in the air or certain foods. Normally, our allergic reaction consists of mild discomfort and irritation and doesn’t cause severe problems.

However, an increasing number of people suffer from a serious allergy known as anaphylaxis. This is a life-threatening whole-body allergic reaction. There can be a whole range of triggers such as peanuts, shellfish, latex etc.

When the body detects this allergen, it reacts by releasing a large amount of inflammatory substances such as histamine. These substances cause blood vessels throughout the body to widen, leading to a drop-in blood pressure, and airways in the lungs to constrict and secrete mucus causing severe difficulty in breathing.

This often happens very quickly, possibly even seconds after coming into contact with the allergen. However, the reaction can in rare cases be delayed up to 24 hours after the initial contact.

How do I recognize anaphylaxis?

First of all, the person may tell you that they are allergic to something. Otherwise they may wear a bracelet around their wrist/neck/ankle with details of the nature and severity of their allergy. 

The following are signs & symptoms of anaphylaxis. Remember each reaction will be different, and a person may not display all of these signs.

• Difficulty in breathing & speaking
• Generalized rash and swelling over the whole body
• Swollen tongue
• Feeling faint/dizzy possibly leading to collapse
• Nausea and vomiting
• Signs of shock – pale/cold/clammy/weak pulse

The difficulty in breathing is caused by constriction of the person’s airway. In addition, they can suffer a severe drop in blood pressure leading to them feeling faint and possibly collapsing.

First aid for anaphylaxis

Step 1: Call an ambulance immediately.

Step 2: If the casualty is carrying any medication, such as an auto-injector containing adrenaline, assist them to use it. The most common auto-injector is the EpiPen however there are a variety of other brands in existence.

Step 3: If the casualty starts showing signs of shock, then lie them down with their legs raised to increase blood flow to the brain and vital organs. Otherwise, keep the casualty in the most comfortable position to help with their breathing.

Step 4: Reassure the casualty as they may be very anxious and frightened. Be prepared that they may collapse and stop breathing. If they do then you should commence Cardiopulmonary resuscitation (CPR) immediately.

How to use an auto-injector

This video demonstrates how to use an auto-injector containing adrenaline, in this case an ‘EpiPen’.

On average, one person every 40 seconds has a stroke in the United States. Early medical treatment can significantly improve the outcome of a stroke, therefore being able to recognize the signs & symptoms is incredibly important.

What is a stroke?

A stroke (or ‘CVA’ – cerebrovascular accident) is a problem with the blood supply to the brain. The brain has a large and complex system of arteries and veins supplying it with blood.

Broadly, there are two types of stroke:

Ischemic stroke: A clot blocks an artery in the brain causing death of brain tissue.

Hemorrhagic stroke: An artery in the brain ruptures causing bleeding. For more information, take a look at this excellent animation from NHS choices.

Recognizing a stroke

If you suspect a stroke, there is a simple test you can use – The FAST test:

Face: Does the person have any facial weakness? Can they smile evenly? Does one side of their face appear to droop?

Arms: Can the person raise both arms?

Speech: Can the person speak clearly?

Time: Time to call an ambulance if the person fails any of the above tests. You should not delay in calling an ambulance if you suspect a stroke.

Video: How to recognize a stroke using the FAST test

This excellent video walks you through how to recognize a stroke using the FAST test.

Diabetes is a common medical condition affecting an estimated 220 million people worldwide (Source: World Health Organization). Many of us will know a person (friend / family member) who has diabetes.

But what exactly is diabetes? And why do first aiders need to know about it?

Introduction

Broadly speaking, diabetes is a problem with the body’s control of blood sugar levels. The body produces a variety of hormones to control blood sugar. The most important is insulin which is released by the pancreas. Insulin acts to reduce blood sugar levels.

There are two main types of diabetes:

Type 1: In this case, the body fails to produce enough insulin. Typically, onset occurs in childhood however this is not always the case. Type 1 diabetes is often called Insulin Dependent Diabetes Mellitus (IDDM).

Type 2: In type 2 diabetes, the pancreas produces enough insulin however cells in the body become resistant to insulin so its effects are reduced.  Type 2 diabetes is more common in later life, and may be affected by various lifestyle factors such as diet and exercise.

In both cases, the body has trouble regulating its blood sugar levels. An undiagnosed diabetic will often first present with high blood sugar (Hyperglycemia)

What is Hyperglycemia?

High blood sugar, or hyperglycemia often occurs in undiagnosed diabetics or diabetics who have not taken the correct medication.

The signs and symptoms of high blood sugar are:

• Increased thirst and urination
• Drowsiness and fatigue
• Dry and warm skin
• A ‘fruity’ smell on the breath
• Unconsciousness

Hyperglycemia may develop over several days and weeks. If you suspect someone has high blood sugar, you should urge them to seek medical attention. If they become very drowsy or unconscious then phone for an emergency ambulance and place them into the recovery position to protect their airway.

What is Hypoglycemia?

Low blood sugar is known as hypoglycemia. This can occur in diabetics who take too much insulin, or do not eat enough to keep their blood sugar at normal levels. Hypoglycemia can develop very quickly.

The signs and symptoms of low blood sugar (hypoglycemia) are:

• Irritability
• Confusion / irrational behavior which is out of character
• Weakness and drowsiness
• Clammy skin
• Reducing level of consciousness

The person may tell you they have diabetes, or be wearing a medical alert bracelet with details of their medical condition.

If you suspect someone is suffering from low blood sugar, you should attempt to raise the blood sugar by offering something sweet such as a sugar cube / sugary drink / sugary snack. The casualty may be carrying snacks for such a situation.

If the casualty has a reduced level of consciousness, or does not respond to the treatment above, you should call an emergency ambulance.

If someone is unconscious, don’t try to put anything in their mouth (such as a sugar cube) to attempt to raise their blood sugar as this could be a choking risk.

There are numerous reasons why someone may have a seizure (convulsion / fit). One of the most well-known causes is a medical condition called Epilepsy where the electrical activity in the brain is disturbed. However, there can be a variety of other causes including:

• Head injuries
• Drugs / Alcohol
• Poisoning
• Low blood sugar (Hypoglycemia)
• In infants, high temperatures.

Seizures are often characterized by a loss of consciousness followed by uncontrolled muscle contractions. They can be quite frightening for those who haven’t witnessed a seizure before. Sometimes a seizure is preceded by a warning sign known as an “aura”.

First aid for a seizure

Step 1: Remove any objects from around the casualty (chairs, tables etc.) to prevent them injuring themselves. Make the area as safe as practically possible

Step 2: Protect the casualty’s head by padding around it and underneath the neck. Don’t place bulky padding underneath the casualty’s head as this could tilt their head forwards and close their airway.

Step 3: Try and establish a cause for the seizure. Are they a known to suffer from Epilepsy? Do they have Diabetes? Have they had an injury recently? Look for medical alert bracelets on the casualty’s wrists/ankles/neck which may contain details of any medical conditions.

Step 4: Call an ambulance unless the casualty is known to have seizures regularly and doesn’t normally go to hospital.

Step 5: Note how long the seizure lasts for, and whether there are any gaps.

Step 6: When the seizure stops, open the casualty’s airway by tilting their head backwards and check for normal breathing for up to 10 seconds. If they are breathing then roll them onto their side to protect their airway. If they are not breathing then commence cardiopulmonary resuscitation.

Remember to protect and maintain the casualty’s dignity throughout. Move on any crowds of people and try to offer some privacy. Although the person having the seizure is unconscious, they may still be able to hear or have an awareness of people around them. When the casualty wakes up they may be very confused. Speak slowly and clearly and explain what has happened.

Seizure video

This great video from the British Red Cross shows a typical seizure and the correct first aid treatment.

In 2009, an estimated 17.5 million adults in the United States suffered from asthma. Most of us have heard of this common medical condition, but what exactly is it?

What is Asthma?

The body has a system of tubes (known as airways) to carry air from our mouth/nose to our lungs. The largest of these is our trachea (known as windpipe). This then splits into two bronchi which then split into a network of tiny bronchioles. This network of bronchioles delivers air to the tiny sacs where gas exchange takes place (known as alveoli).

Asthma is an inflammatory condition of the smallest airways – the bronchioles. These tiny tubes can become inflamed and secrete excessive amounts of mucous causing severe difficulty in breathing. This is known as an asthma attack. The cause of asthma is thought to be a combination of environmental and genetic factors.

An asthma attack is normally triggered by something, whether it be an allergen (e.g: pollen, dust, vehicle emissions, soot etc.) or an environmental condition such as cold air. Normally, an asthma attack is characterized by the following symptoms:

• A wheezing sound when breathing
• Difficulty in breathing
• Unable to complete a full sentence
• Hyperventilation
• Anxiety and panic
• Reducing levels of consciousness

Remember not all of these signs and symptoms may be obvious.

The casualty may wear a bracelet on their wrist/ankle/neck with details of their asthma. Also, they may carry their medication with them.

First aid for an asthma attack

Step 1: Sit the casualty down in the position they find most comfortable for their breathing.

Step 2: Find their medication, which is normally an inhaler (possibly with a spacer device) containing a drug such as Salbutamol.

Step 3: Assist the casualty to use their medication. They should know how many doses to take and how to use the inhaler.

Step 4: Provide reassurance and help calm the person’s breathing if they are hyperventilating.

If the medication does not have any effect, the casualty starts to become drowsy/exhausted or if they have forgotten their medication then you should call an emergency ambulance immediately.

If the casualty becomes unconscious, then open their airway by tilting their head back and check for normal breathing. If they are breathing then roll them onto their side to protect their airway. If they are not breathing then commence cardiopulmonary resuscitation (CPR).

Asthma attacks can appear frightening but you should make every effort to remain calm and in-control of the situation.

What is a fracture?

A fracture is the same as a broken bone and the two terms can be used interchangeably. A fracture can occur for many reasons, often due to trauma or excess force being placed on the bone. Some rare medical conditions can also lead to an increased risk of fractures.

Generally, you can have several different types of fractures in first aid:

> Open fracture: This is where the bone has pierced the skin and caused an open wound which may bleeding. There is a high risk of infection with these injuries

> Closed fracture: A fracture which has not caused an open wound

> Complicated fracture: A fracture which damages nerves and blood vessels, this can cause permanent nerve damage or loss of blood supply to a limb.

> ‘Greenstick‘ fracture: Common in children as their bones are more “bendy”, therefore their bones are less likely to fully break. Instead the bone splinters.

Signs and symptoms of fractures

If someone has a fracture / broken bone, you may see any of the following:

• Pain
• Loss of movement of the limb / area
• Angulation
• Swelling & bruising (this may not occur immediately)
• Tenderness over the area

Fractures may not always be incredibly painful; the pain may take a few hours to develop. Sometimes a fracture can be mistaken for a sprain or a strain.

First aid for fractures

If you suspect someone has a fracture, then you should follow the first aid steps below:

1) Keep the area as still as possible, ask the person not to move it

2) Expose the site of injury to check for any bleeding or open wounds. If there is a bone through the skin then do not move it, instead cover with a sterile dressing if available. If the wound is bleeding then apply gentle pressure around the wound.

3) Pad around the injured area with blankets / clothing. If the person has hurt their arm then ask them to hold it in the most comfortable position possible

4) Quickly arrange transport to the nearest hospital.

Call an emergency ambulance if:

• You cannot move the person (for example, because they have hurt their leg)
• They have fractured a limb and it is turning blue / cold, this indicates a loss of blood supply to the limb which needs correcting urgently
• The casualty is in severe pain
• You suspect they may have other serious injuries
• You are unsure

We’ve all had them, simple cuts and grazes are a common first aid problem. The medical term for a graze is an ‘abrasion’ where only the superficial layers of the skin are damaged.

First aid for cuts and grazes

Step 1: Stop any bleeding. You can elevate the wound or apply direct pressure using a sterile gauze swab/pad.

Step 2: Clean the wound using running water or antiseptic wipes. Dry with a sterile gauze swab/dressing.

Step 3: Ensure the area around the wound is clean (no dirt, grit etc.)

Step 4: Cover with a sterile dressing/plaster. Remember some people might be allergic to regular plasters!

Your main aim is to stop the wound becoming infected, so cleaning the area thoroughly is important. Infected wounds are often very red, swollen, painful and may have pus. As the infection develops you may develop a fever. If you see any of these signs you should seek medical advice urgently.

One of the infection risks in any open wound is Tetanus. Tetanus is caused by Clostridium tetani, a bacterium which lives in soil which can lead to muscle spasms, fever and sweating. There is a vaccine course available so make sure you’ve had all your jabs. For more information take a look at NHS Choices.

If you’re unsure about anything, always seek medical advice. Large cuts and grazes will require medical attention to avoid scarring and infection.

Dogs are not always man’s best friend! Dog bites can produce nasty injuries, especially in young children and babies. As well as the obvious injury caused, dog bites carry an extra risk from infection. One of the most well-known diseases carried by dogs is rabies, carried in infected animals’ saliva. You can learn more about Rabies from the World Health Organization.

First aid for a dog bite

You can treat a dog bite by following the simple first aid advice below.

Step 1: Using clean water (with soap/an antiseptic product if possible) wash the wound thoroughly. Make sure to clean the area around the wound as well.

Step 2: Cover the wound with a sterile wound dressing. If the bleeding is severe, apply direct pressure and call for an ambulance.

Step 3: If there is a risk of infection (i.e. you are in a rabies risk area) or the wound appear serious, then seek medical advice immediately. The casualty may require an injection to protect them from the rabies virus.

If you are concerned about rabies, you can find a map of areas at risk online.

If you are concerned that the dog may still be in the vicinity and poses a danger to yourself then call the police immediately. Do not try to capture or calm the dog down, as this may result in further injury to yourself or others.

The advice above can also apply to any animal / human bites, not just dogs.

Most of us will have experienced a faint at some point in our lives, but what exactly causes this phenomenon?

What is a faint?

A faint is a brief and sudden loss of consciousness, normally due to a reduction in the blood flow to the brain. Normally, a faint results in a person falling to the floor.

The brain requires a constant supply of Oxygen and Nutrients, this supply is provided by the blood. There are numerous things that can interrupt this supply. For example, blood tends to pool in the legs during periods of inactivity (e.g: standing or sitting for long periods of time). If you suddenly stand up, the heart has to work harder to pump this blood upwards against gravity. This can cause a “head rush” in some people, with a feeling of dizziness. However, in other people, this interruption in the blood supply to the brain causes them to lose consciousness – a faint.

Generally, once a person has fainted and fallen to the floor, they regain consciousness very quickly. This is because when lying down, the heart finds it easier to pump blood to the brain as it isn’t working against gravity.

There are some tell-tale signs that someone is going to faint. They may go very pale/white, and look unsteady on their feet. Also, they may complain of feeling ‘light headed’ or ‘funny’.

Treatment for a faint

If someone complains of feeling faint you should sit them down on the floor if possible until they feel better. This is to prevent any injuries occurring if they do fall.

If someone has fainted, you should:

• Raise their legs to improve the blood supply to the brain.
• If they’ve fallen, check for any injuries such as fractures or head injuries.
• Once they recover, help them sit up gradually. Don’t let the casualty stand up straight away as they may just faint again!

If they casualty does not wake up, you should open their airway by tilting their head backwards and check to see if they’re breathing. If they are, roll them onto their side and call an ambulance.

If the casualty recovers fully and hasn’t suffered any injuries, there is no need to call an ambulance. If they are not sure what caused the faint, or haven’t fainting before then it is advisable for them to seek medical attention. Occasionally, a faint can be the sign of a more serious underlying medical condition.

If someone is fainting on a regular without any known cause, they should be encouraged to seek urgent medical advice.

Every parents favorite! The official medical name for a nosebleed is “epistaxis“.

The nose has an abundant blood supply to help warm and moisten air when we breathe in. However, this makes it vulnerable.

There are countless causes for nosebleeds, some common ones include:

• Trauma
• High blood pressure (hypertension)
• Blood thinning medication (e.g: Warfarin)
• Foreign bodies (fingers!)
• Inflammation

Treatment of a nosebleed

Step 1: Ask the person to tilt their head forwards and pinch the soft part of their nose for ten minutes. Encourage them not to pick at their nose or sniff. Ask them to breathe through their mouth.

Step 2: After 10 minutes release the pressure and see if the bleeding has stopped. If it hasn’t, reapply the pressure. You can also try placing something cool on the nose (ice pack etc.) to constrict the blood vessels.

Step 3: Once the bleeding has stopped, clean up any blood from around the face/mouth. Tell the person not to sneeze/pick at their nose/sniff for several hours as this could cause the bleeding to start again.

It can be very difficult to get a child to sit still and hold their nose, so try your best. In some cases, you might have to hold their nose for them.

If the bleeding does not stop (after around 20 – 30 minutes), you should seek medical advice. In addition, if the cause of the nosebleed is unclear or they are recurring you should also seek advice.

A nosebleed after a head injury can be the sign of a more serious injury, therefore urgent medical assistance should be sought.

I thought someone with a nosebleed should tilt their head backwards?

A common misconception is that you should tilt head backwards. This isn’t recommended as blood will travel back down into your mouth and into your stomach. This can make you feel sick. 

The first aid for a wasp sting is incredibly simple

1) Watch for any signs of a serious allergic reaction known as ‘anaphylaxis’ – things to watch out for include difficulty in breathing, severe swelling and redness over the whole body (anaphylaxis was discussed in the medical conditions module of this course). If you suspect they are having an allergic reaction then call an ambulance immediately.

2) If the ‘stinger’ is still visible in the skin then try to remove it. It’s best to try to brush the stinger away using a credit card / fingernail rather than using tweezers.

3) Cool the area using an ice pack / bag of frozen peas / cold compress. This will help reduce the swelling and the pain.

If you are concerned at all about the sting then seek medical attention. If you suspect someone may be having a severe allergic reaction then you should call an ambulance immediately. Be wary of stings to the mouth / tongue as these can obstruct a person’s breathing, always seek medical attention.

Welcome to our online pediatric first aid course.

This course has been developed in response to requests from our visitors who wanted more specific information on emergencies and medical conditions affecting children and babies.

We will cover:

• How to assess a collapsed child / baby using the ‘primary survey’ (DRAB)
• The recovery position for children and babies
• Performing CPR on children and babies
• Common medical conditions

We strongly recommend you complete our basic online first aid course before moving onto this pediatric course.

If you ever find yourself in an emergency situation where a child or baby is ill or injured then you will need to perform a primary survey.

The primary survey is a quick way to assess casualties. It can easily be remembered by the letters DRAB. If you ever find yourself in an emergency situation then all you need to remember is DRAB and you will be able to systematically assess your patient and decide what to do.

D: Danger

Check to see if there are any dangers to yourself or the casualty. Try and make the scene as safe as possible, remember YOU are the most important person.

If the area is too dangerous then stay back and call the emergency services.

R: Response

For children: shout loudly in both ears and tap them on the shoulders

For babies/infants: flick the bottom of the foot

If you do not get a response, then the child / baby is unconscious. So what exactly does this mean?

“complete or near-complete lack of responsiveness”

“unaware of both self and external surroundings”

The difference between being asleep and being unconsciousness is that an unconscious child / baby will not wake up.

A key principle is that being unconsciousness is a medical emergency which requires immediate first aid intervention.

When someone goes unconscious, they loose muscle tone. This means they go all ‘floppy’ – like a rag doll. The tongue (a muscle) can block their airway when it looses muscle tone. This is known colloquially as “swallowing your own tongue”.

In addition, loss of control over their stomach muscles can cause stomach contents (vomit) to travel back up to the throat which can block the airway

A variety of medical conditions and traumatic injuries can cause someone to become unconscious. However at this stage do not worry too much about trying to find out why they are unconscious, your immediate aim is to open their airway.

A: Airway

The airway is a series of tubes which caries air from your mouth & nose to your lungs. It can become blocked by the tongue and regurgitation of stomach contents. This will stop the casualty from breathing and can quickly cause death.

For children: You need to open the airway by tilting the head backwards and lifting the chin with two fingers as demonstrated in the picture below.

For babies: You should ensure the baby’s head is in the ‘neutral’ position. This means the head is not tilted forwards or backwards, instead the baby should be looking at the ceiling. Then use your finger tips to lift the chin. See the photo below for an example of an open airway

B: Breathing

Keep your hands on the child / baby’s head & chin. Place your cheek above their mouth and look at their chest.

Look, listen and feel for regular breathing for up to 10 seconds. You are assessing for normal breathing. The occasional gasping or snoring sound is not regular breathing and should be treated as no breathing.

Once you’ve assessed whether the child / baby is breathing normally you can perform the appropriate first aid treatment. Move onto the next units to find out more…

If the child / baby is breathing then you need to protect their airway by placing them in the recovery position.

The recovery position involves rolling the casualty onto their side with their head tilted back. By doing this, the tongue is kept clear of the airway and any vomit is able to drain and not obstruct the child or baby’s airway.

Children

For children, the recovery position technique is the same as for adults. See our basic online first aid course for how to place someone into the recovery position.

Babies / infants

Hold the baby on their side with the head tilted downwards. Ensure you have fully supported the head.

If the baby / child is not breathing, you should call an ambulance and start rescue breaths and chest compressions immediately.

You do not need to check for a pulse, as this often wastes valuable time. If a public defibrillator (AED) is available, then it should be sent for immediately.

Children

1) First deliver five rescue breaths

Open the child’s airway using the head tilt / chin lift technique. Pinch the nose and deliver five rescue breaths. Each breath should only last around a second, be cautious not to over inflate the child’s lungs.

2) Then give thirty chest compressions

Place the palm of one hand in the center of the child’s chest on the breastbone (sternum). Give thirty chest compressions at a rate of 100 – 120 minute

3) After thirty chest compressions, deliver another two rescue breaths

4) Repeat the cycle of thirty chest compressions to two rescue breaths (30:2)

Babies

1) First deliver five rescue breaths

Ensure the baby’s head is in the neutral position. Cover their mouth and nose with your mouth and deliver five rescue breaths.

Each breath should only need a ‘puff’ of air from your cheeks.

2) Then give thirty chest compressions

Use two fingers to compress the baby’s chest on the breastbone (sternum) at a rate of 100 – 120 chest compressions per minute.

3) After thirty chest compressions, deliver another two rescue breaths

4) Repeat the cycle of thirty chest compressions to two rescue breaths (30:2)

Choking is a common cause of death in children and babies. Children aged under five years old are most at risk. It is vital to know the first aid steps to help a choking child or baby

Children

1. Give up to five back blows

Hit the child using the palm of your hand in the center of their back. Your aim is to create vibrations to dislodge the object from the airway

2. Give up to five abdominal thrusts

Stand / kneel behind the child. Place a fist just above their belly button. With your other hand, grasp the fist and pull sharply inwards and upwards

3. Repeat the cycle of five back blows and five abdominal thrusts until help arrives

Babies

A baby who is choking will be distressed and may be unable to cry, cough or breathe.

1. Give up to five back blows

Lay the baby face down across your thigh or forearm (ensure the head is supported). Give up to five firm blows using the palm of your hand in between the baby’s shoulder blades.

2. Give up to five chest thrusts

Turn the baby over so that they are on their back. Using two fingers, deliver five firm chest thrusts inwards and upwards towards the head.

3. Repeat the cycles of back blows and chest thrusts until further help arrives.

Meningitis is a serious infection of the membranes with cover the brain and spinal cord (known as the meninges). Meningitis is especially common in babies and young children so it’s important to know the signs and symptoms of this disease.

Signs and symptoms of meningitis:

• Fever
• Vomiting and refusing to feed
• Irritability / confusion
• Drowsy / floppy / unresponsive
• Rapid breathing rate
• Unusual high-pitched or moaning cry
• Pale, blotchy skin, and a red rash that doesn’t fade when a glass is rolled over it
• Stiff neck
• Avoid bright lights (photophobia)
• Seizures

Most people are aware of the rash with accompanies meningitis. The rash which occurs is a non-blanching rash, this means if you roll a glass over it the rash doesn’t disappear. This is sometimes known as the ‘glass tumbler test’.

IMPORTANT: A rash only develops once meningitis is advanced and in some cases may not occur at all. If you are concerned then do not wait for a rash to appear. If you see a rash then you should seek emergency medical attention (call an ambulance).

First aid steps

Meningitis is a life-threatening medical condition which requires hospital treatment. If you suspect meningitis then do not delay in calling for emergency help.

Meningitis video

This module is very similar to the asthma module contained in our Advanced Online First Aid course. We’ve included here however as asthma is such a common medical condition affecting children.

In 2009, an estimated 6.8 million children in the United States suffered from asthma.

What is Asthma?

The body has a system of tubes (known as airways) to carry air from our mouth/nose to our lungs. The largest of these is our trachea (known as windpipe). This then splits into two bronchi which then split into a network of tiny bronchioles. This network of bronchioles delivers air to the tiny sacs where gas exchange takes place (known as alveoli).

Asthma is an inflammatory condition of the smallest airways – the bronchioles. These tiny tubes can become inflamed and secrete excessive amounts of mucous causing severe difficulty in breathing. This is known as an asthma attack. The cause of asthma is thought to be a combination of environmental and genetic factors.

An asthma attack is normally triggered by something, whether it be an allergen (e.g: pollen, dust, vehicle emissions, soot etc.) or an environmental condition such as cold air. Normally, an asthma attack is characterised by the following symptoms:

• A wheezing sounds when breathing
• Difficulty in breathing
• Unable to complete a full sentence
• Hyperventilation
• Anxiety and panic
• Reducing levels of consciousness

Remember not all of these signs and symptoms may be obvious.

The casualty may wear a bracelet on their wrist/ankle/neck with details of their asthma. Also, they may carry their medication with them.

First aid for an asthma attack

Step 1: Sit the child down in the position they find most comfortable for their breathing.

Step 2: Find their medication, which is normally an inhaler (possibly with a spacer device) containing a drug such as Salbutamol.

Step 3: Assist the child to use their medication. They should have been trained in how to administer the inhaler. Most children should use a device known as a spacer with their inhaler. A spacer makes it easier for the child to take the medication.

Step 4: Provide reassurance and help calm the person’s breathing if they are hyperventilating.

If the medication does not have any effect, the casualty starts to become drowsy/exhausted or if they have forgotten their medication then you should call an emergency ambulance immediately.

If the casualty becomes unconscious, then open their airway by tilting their head back and check for normal breathing. If they are breathing  then roll them onto their side to protect their airway. If they are not breathing then commence cardiopulmonary resuscitation (CPR).

Asthma attacks can appear frightening but you should make every effort to remain calm and in-control of the situation. Do not delay in calling for emergency help if you are concerned. 

Croup is a viral infection of the airways in children. It is most common between the ages of 6 months and 3 years although it can occur in older children and rarely adults.

The infection causes mild swelling in the throat which leads to problems with the child’s breathing.

Signs and symptoms:

• Characteristic barking cough – click here for an example
• Hoarse / croaky voice
• Difficulty in breathing
• Cold like symptoms: fever, cough etc.

These symptoms often are worse at night.

First aid treatment

Mild croup can often be managed at home. However, if you are concerned or the child has significant difficulty in breathing then you should seek urgent medical attention.

1. Seek medical attention. The child may require medicines to help with the swelling in the throat
2. Use simple painkillers such as Paracetamol (if allowed) to reduce any fever and pain
3. Monitor regularly and ensure the child remains adequately hydrated

A febrile seizure, or febrile convulsion, is a fit/seizure which happens when a child’s body temperature is raised. Febrile seizures are common and often affect children aged between 18 months and 3 years.

Most febrile seizures occur when the child has a common illness such as an ear infection or cold.

Signs and symptoms

The child will have a seizure, which may involve:

• The child becomes unresponsive
• The body becomes stiff and may start jerking/twitching
• They wet themselves

Most febrile seizures only last for around 5 minutes.

First aid treatment

1) Record the time the seizure started

2) Place the child on their side, preferably on a soft surface

3) Remove any hazards from around the child

4) Remove any excessive clothing to help cool the child

Do not place anything in the child’s mouth whilst they are having the seizure

You should seek routine medical advice after each seizure.

You should seek emergency medical help if:

• You are concerned
• The seizure lasts longer than 5 minutes
• The child has multiple seizures
• The child has abnormal breathing or an obstructed airway
• There are signs of a serious illness such as meningitis

Video: First aid for febrile seizures