FIRST AID LEVEL 1

LEARNER MANUAL

© R. MENKVELD
 CONTENTS

ABRIVIATIONS USED IN THE MANUAL……………………………………….. 1

ADMINISTRATION…………………………………………………………………. 2

MODULE 1: INTRODUCTION TO FIRST AID………………………………….. 5

MODULE 2: EMERGENCY SCENE MANAGEMENT………………………….. 9

MODULE 3: CARDIOVASCULAR EMERGENCIES…..……………………….. 16

MODULE 4: ADULT CHOKING…………….…………………………………….. 25

MODULE 5: SHOCK………………………..……………………………………… 28

MODULE 6: NEUROLOGICAL EMERGENCIES……..……………………….. 30

MODULE 7: WOUNDS AND BLEEDING….…………………………………….. 34

MODULE 8: BONE AND MUSCLE INJURIES..………………………………… 38

MODULE 9: BURN WOUNDS...………………………………………………….. 42

MODULE 10: HEAD AND SPINAL INJURIES.……..…………………………... 46

Appendix A: Adult CPR OSCE

REVISION HISTORY

Rev. Date Responsible Change Description Page

No Person

1. 15/01/2017 R. Menkveld New document All

2. 09/02/2017 I. Philbrick Technical revision All

3. 17/03/2017 R. Menkveld General editing All

4. 27/04/2017 R. Menkveld New photos All

5. 24/10/2020 R. Menkveld New 2020 policy All

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ABBREVIATIONS USED IN THIS MANUAL

ABBREVIATION EXPLANATION

AEA Ambulance Emergency Care Assistant

AED Automated External Defibrillator

ALS Advance Life Support

AR Artificial Respiration

BAA Basic Ambulance Assistant

BLS Basic Life Support

CCA Critical Care Assistant

CPR Cardio Pulmonary Resuscitation

ECP Emergency Care Practitioner

ECT Emergency Care Technician

EMC Emergency Medical Care

EMS Emergency Medical Services

HHH Hazards, Hello, Help

HPCSA Health Professions Council of South Africa

HTLC Head-Tilt-Chin-Lift

ILS Intermediate Life Support

PPE Personal Protective Equipment

PRF Patient Report Form

SAMPLE Symptoms, Allergy, Medication, Past medical history,

Last meal, Events leading

VF Ventricular Fibrillation

VT Ventricular Tachycardia

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ADMINISTRATION

Welcome to this First Aid Level 1 course. We hope to make your learning process an
enjoyable one. This learner manual will give you all the information you need to
become an effective First Aider. First Aid is a practical skill, which means this course
will mainly focus on your practical skills. The learner manual will focus mainly on
practical instructions. In the learner manual, we tried to focus on the most important
practical skills that you will need to save a patient’s life. We do not go into in-depth
theoretical knowledge in this learner manual, but you are more than welcome to ask
your instructor should you need more information. Your instructor will accommodate
your request to the best of his/her ability. Good luck and enjoy the course.

To ensure quality training only qualified instructors with operational experience and
an understanding of the emergency field are used. Your instructor for this course will
be:

COURSE AIM

The aim of this First Aid Level 1 course is to provide you with the basic First Aid
knowledge, skills and insights needed to be able to function in a safe manner when
treating a patient.

Personally, we would like you to understand the importance of the following three
lifesaving skills:

1. Following your “rhyme”

2. Calming and reassuring your patient
3. Placing your patient in the recovery position when needed

If you can achieve the above-mentioned three things during this course, you will be
able to save a life.

COURSE STRUCTURE

The course is practically orientated. Each module consists of an important theory

component, followed by a practical session that will give you the opportunity to
practice your newly acquired skills. At the end of each module, you will be assessed
on the practical skills acquired in that module before we move on to the next module.

To make the best of your training class participation is very important. Please
discuss with your instructor any medical problems that you may have which may
make it difficult for you to participate in the practical skills. Your instructor will find a
way to accommodate any restrictions, but practical participation will be compulsory.

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SCOPE OF THE COURSE

The course duration (contact time) will be 16 hours, as prescribed by our accrediting
body. Below is an indication of the different modules and the order of presentation.
The timeline below is a guideline for the course. With bigger groups, the objectives
of the course can take a little longer to reach. As the course is practically orientated,
we will only move on to the next module once everyone is practically competent in
the current module. This is done as the modules build on each other.

DAY 1 PROGRAM
Start time End Time Module Activity Type
09h00 09h30 Administration Admin
09h30 10h00 Introduction to First Aid Theory
10h00 13h00 Emergency Scene Management Theory
13h00 13h30 LUNCH BREAK
13h30 14h30 Emergency Scene Management Practical
14h30 16h00 Cardiovascular Emergencies Practical
16h00 17h30 Adult Choking Practical

DAY 2 PROGRAM
Start time End Time Module Activity Type
09h00 09h30 Shock Theory
09h30 10h30 Neurological Emergencies Theory
10h30 11h30 Wounds and bleeding Practical
11h30 13h00 Bone and muscle injuries Practical
13h00 13h30 LUNCH BREAK
13h30 14h30 Burn wounds Theory
14h30 15h30 Head and spinal injuries Practical
15h30 16h00 Theory evaluation Admin
16h00 17h00 Practical evaluation Admin
17h00 17h30 Final course admin Admin

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REQUIREMENTS TO OBTAIN YOUR CERTIFICATE

 Theory assessment. The theory assessment consists of a multiple-choice paper

with 20 questions (2 questions from each module). You need 75% to be found
competent in the theory assessment. This means you need to get 15 questions
or more correct to be competent.

 Practical assessment. During the course, you will be assessed on the following
practical skills:
1. Adult choking
2. Treating a bleeding wound
3. Treating a wound with an object in it
4. Treating a fractured arm or leg

You must be able to complete all the above skills successfully to get admission to the
final practical assessment.

 For the final practical assessment, you must be able to:

1. Demonstrate One Rescuer Adult CPR with an Automated External
Defibrillator (AED). The practical skills sheet can be found at the end of
this learner manual as Appendix A.

To receive a certificate for this course, you must be found competent in both the
theoretical and the practical components of the course. Please refer to the
Assessment Policy for information regarding remedial examinations (if you were not
yet competent during the final examination). This policy is available from your
instructor as well as the Language Policy, Moderation Policy, Training Philosophy
Policy and the Learner Appeals policy.

GENERAL RULES

 Please ask as many questions as you like. Also, feel free to share your
experiences as everyone can learn from this.
 All cell phones should be switched off completely. Please do not leave them on
or on silent mode.
 Feel free to bring your drink into the classroom, especially your bottle of water.
Take a sip during class time if you need to (keep awake).
 Your instructor will try and give you a 10-minute break every 40 minutes. If they
forget about the time, feel free to remind them.
 Your instructor will discuss the emergency plan for the specific venue where the
course will be presented.

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MODULE 1: INTRODUCTION TO FIRST AID

PICTURE COURTESY OF MORGUEFILE FREE PHOTO

AIM OF THE MODULE

To be able to function as a First Aider you need to understand a few things.

Questions like: “What is the aim of First Aid”; who can give First Aid and who will help
me; what does the law say about First Aid”, are all important questions to answer
before you can do First Aid training. In this module, all these questions will be
answered. You will also get a very good idea of the rules and regulations that govern
First Aid. Most of these rules are there to protect you and the patient.

WHAT IS FIRST AID?

First Aid is probably one of the most important skills that you can learn as you will be
able to use it everywhere you go. It does not matter where we are, at some stage
someone, somewhere will get hurt. With your First Aid skills, you will be able to help
them. Imagine a loved one getting injured and you don’t know what to do. There is
probably not a worse feeling than this. With this qualification, you will be able to
assist anyone in case of a medical emergency, including your loved ones. Research
has shown over and over that First Aiders can make a difference.

Remember, First Aid is easy, if you can stay calm and think logically. During this
course, we will teach you how to do this.

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Principles of First Aid

So, what is the aim, or principles of First Aid?

1. Preserve a life: You want to save a patient’s life.

2. Promote recovery: You want to make sure the patient recovers quickly.

3. Prevent further injury: You want to make sure you do not make the current
condition worse. Sometimes this might mean doing
nothing, but calming and reassuring the patient.

Levels of qualification

What is First Aid? First Aid is the first line of treatment that any patient will receive
before qualified medical personnel arrive. The First Aider is thus the link between the
patient and the Emergency Services. The importance of this link has been
demonstrated over the years and research has shown that a First Aider can make a
big difference to a patient’s outcome, especially if the patient is not critically injured.

It is important for you to understand the different levels of emergency medical care
training. This gives you the understanding of where you fit into the system, but also
who the Emergency Medical Service (EMS) member is and their scope of practice
when they identify themselves. Below is a table with the various levels of emergency
care workers.

Level Qualification Training System Registration

period with
1 First Aid 2 Days Current HWSETA
2 First Aid 4 Days Current HWSETA
3 First Aid 5 Days Current HWSETA
BLS Basic Ambulance Assistant (BAA) 4 Weeks Old HPCSA
ILS Ambulance Emergency Care 4 Months Old HPCSA
Assistant (AEA)
ALS Critical Care Assistant (CCA) 9 Months Old HPCSA
ALS Diploma in EMC (ECT) 2 Years New HPCSA
ALS National Diploma in EMC (NDip) 3 Years Old HPCSA
ALS Degree in EMC (ECP) 4 Years New HPCSA
ALS Master’s Degree in EMC 2 Years New HPCSA

ETHICS IN FIRST AID

As a First Aider, you will be helping others. Although you will do your best, First
Aiders cannot be expected to give perfect help every time. This implies that every
incident will not turn out perfectly (ask anyone who works in EMS). A First Aider
should however always act in the best interest of the patient and do what they do to
the best of their ability. There are however a few things to keep in mind when
treating a patient.

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 Patient rights – A patient can refuse treatment

Any person has the right to refuse First Aid. If treated against their will, a patient
can bring a charge of assault / battery against the First Aider.

 Consent – You must obtain permission to give First Aid

Before treating a patient, you need to get their permission or consent to do this.
This is usually done when you arrive on the scene by introducing yourself and
asking if you can assist. Consent can then be given verbally by the patient.
Competent adult patients can refuse treatment or withdraw their consent once
given. There are three types of consent:

1. Informed consent: The patient gives you verbal permission to help him/her.

2. Implied consent: In an emergency, if the patient is unconscious, it is implied

that the injured person would have given their permission for treatment.

3. Minor consent: In the case of a minor (below the age of 12) the consent of a
parent should be obtained. In the case of an emergency, the First Aider can
take “reasonable actions” even without formal consent from a parent.

 Duty of care – Under the law you have NO legal duty of care
This becomes especially applicable if the scene seems unsafe for you to
approach. In this case, don’t help, but do inform the emergency services of the
incident.

There is however an exception to this rule. If you have been trained as a First
Aider for your workplace, you will have an obligation to render assistance if
needed in the workplace.

 Abandonment – Once you have started treatment you can’t walk away
Although a First Aider has no duty to care, once you have started treatment of a
patient you are not allowed to leave the patient until you have handed over the
patient to a person with a similar or higher qualification than you.

 Negligence – You did not do what you were trained to do

A legal case of negligence can be established against a First Aider who does not
give the standard of care needed to a patient, within their scope of practice, and
thus causes further injury. This can also happen if the First Aider has gone
beyond their level of training.

If further injuries occur in the process of removing a patient from an immediate

danger to save their life, you would have met your duty to care by undertaking a
reasonable act in good faith.

 Reasonable person – What would someone else do in the same situation

The reasonable person law will be applied in most situations to determine if a
First Aider was negligent. The question will be asked: “What would any other
person, with the same qualifications, have done in the same situation”. It is
expected of all First Aiders to use reasonable care in assessing the priority of the
situation, to call for medical assistance and to keep the patient stable until

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medical help arrives. It is also expected to follow recommended First Aid

guidelines and not to misrepresent yourself or take undue risks.

 Recording – Write down what was done

One of the best ways to protect yourself is to write down what you did. A patient
report form can be used for this. The patient report form will also remind you of
what you need to do.

 Confidentiality – All patient information is confidential

Any information given to you by a patient should be treated as confidential. This
includes your patient report form. Patient information can only be shared with
another care giver.

 Medication – A First Aider is not allowed to issue any medication

As a First Aider, you are not allowed to administer any medication to a patient.
This would include something like headache tablets.

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MODULE 2: EMERGENCY SCENE MANAGEMENT

AIM OF THE MODULE

If you don’t know what to do when you arrive at a scene of a medical emergency, you
will not be of any help to anyone (which can also include friends or family members).
It is very important when arriving at a scene, that any First Aider must have a system
according to which they work. In this module, the basic system of what to do when
you arrive at a medical scene is explained.

SCENE MANAGEMENT

Scene Management takes practice. The more you do it the easier it becomes.
Although every scene will be different, the management of the scene will stay exactly
the same. Scene Management is divided into three main areas:

1. Primary Survey
2. Secondary Survey
3. Ongoing Patient Care

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1. PRIMARY SURVEY

When arriving at a scene the first thing to do is the Primary Survey. The aim of the
Primary Survey is to ensure that the scene is safe for you and the patient and to
evaluate the patient for any life-threatening injuries. The Primary Survey should be
done as soon as possible so that the First Aider can call for help and start with life
saving care.

The Primary Survey consists of HHH (on your level).

You: Wear gloves and a mask to protect yourself

against blood products and COVID.

The scene: Look for any hazards on the scene that can be of
danger to you. Examples of hazards can be
vehicles, fire and falling objects. Approach the

H Hazards
patient only if it is safe to do so.

The patient: Look for any hazards that can injure the patient.
Should there be any hazards that could injure the
patient, try and remove the hazards. If the
hazards cannot be removed, the patient must be
moved. Do this only as a last resort.

ID yourself: As you arrive, identify yourself to the

bystanders and the patient by indicating who
you are and what qualification you have.
Ask permission to treat the patient.

Get a history: Ask the bystanders and the patient what

H Hello
happened to be able to get a background of
the event. Ask the patient what his chief
complaint (main problem) is.

Check breathing: If the patient is unconscious, tap him on the

shoulder and try to wake the patient up while
keeping your face as far away from the
person as possible. If there is no reaction,
scan for 5 to 10 seconds to see if the patient
is breathing normally.

Call for help: If you are alone, call for someone to assist
you.

H Help Call EMS: If you have an assistant request him/her to

call the Emergency Medical Services or call
from a cell phone if available.

Immobilization: If the patient has a suspected spinal or head

injury, get someone to immobilize the
patient’s head for you.

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Calling the emergency medical services (EMS)

To ensure there is no delay when you phone the emergency services, you need to
ensure that you do the following:

1. Appoint someone to phone or phone yourself. Never assume that someone has
called or will call.

2. Dial the correct number. Don’t assume people know what number to call, tell
them what number to dial. The following are options:

Company Number Company Number

Provincial service 10177 ER24 084 124
National number 112 Netcare 082 911

The best option however is to have the direct number of your local ambulance
service on your phone.

3. Tell the caller what is wrong with the patient and what you are doing so that they
can relay this information to the dispatcher in the EMS control room.

4. Instruct the person who made the call to report back to you and tell you what the
EMS dispatcher told him/her. By doing this you can ensure that the person did
call.

The following is common information that an Emergency Service Dispatcher will ask
you and the order in which they usually ask the questions:

Information needed Reason why information is needed

The caller’s name To be able to call back.
The caller’s phone number To be able to call back.
What is wrong with the patient To know whom to send (BLS/ILS/ALS) and how
urgent the call is.
Information about the incident This could be information like how many patients,
any dangers at the scene
The address of the incident To know where to send the emergency vehicle to.
Any landmarks in the area To make it easier to find the scene.

2. SECONDARY SURVEY

The Secondary Survey is done after the Primary Survey has been completed and all
life-threatening injuries have been treated. Life threatening injuries are:

 No breathing

 Serious external bleeding

 Unconsciousness

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Once the above injuries have been treated, the First Aider can start with the
Secondary Survey. The Secondary Survey consists of three components:

a. Vital signs

b. History

c. Head-to-Toe Survey

When doing the Secondary Survey, the order in which the three components are
done does not matter. You might do the Head-to-Toe Survey first on an unconscious
patient and then get a history, while you might first get a history on a conscious
patient and then do a Head-to-Toe Survey.

A. Vital signs

A vital sign is a measurement that you can see, hear, feel or smell on the patient.
Vital signs give you an indication of the health of a patient. Once you have a set of
the same vital signs, you can determine if a patient’s condition is getting better or
worse. Vital signs should be taken at least every 15 minutes. There are various
vital signs, but you only need to know the six main vital signs.

VITAL SIGN NORMAL VALUE ABNORMAL

Skin  Pink finger nail bed and  Red – Heat
Colour mucous membranes  White / pale – Shock
(mouth)  Blue – Lack of oxygen
 Yellow – Liver disease
Skin  Warm and dry  Cool, pale, clammy – Shock
Condition  Hot, sweaty – Fever
Pupils  Equal in size and reacting  Different position – Head injury
to light (PEARL)  Unequal size – Head injury
 Not reacting – Head injury
Respiration  Rate between 12 and 20  Too slow or fast
 Regular rhythm  Irregular / Gasping
 Deep breathing (depth)  Shallow breathing
Pulse  Between 60 and 100  Too slow or fast
Rate  Regular  Irregular, weak
 Check carotid or radial
Level of  Alert (AVPU)  Voice response
Consciousness  Pain response
 Unconscious

B. History

History is a very important part of the Secondary Survey. There can be various
sources of history. You can obtain a history from looking at the environment. What
do you see around you? You can also get a history from talking to people.
Bystanders and family can give you a history and the patient as well, if he/she is

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conscious. The more sources you use to gather a history, the more accurate the
history will be. Remember to write down the obtained history on your Patient Report
Form (PRF). You need to get the following history with your SAMPLE history from
each patient.

Name The patient’s name and surname for record purposes

Age The patient’s age to determine age appropriate vital signs
Chief Complaint What the main problem is. Why the patient called for help
S – Symptoms This is what the patient is complaining about. Symptoms are
not as reliable as signs, as you cannot measure it.
A - Allergy Does the patient have any allergies?
M – Medication Does the patient use any medication and what is it for?
P - Past medical Any medical or surgical history
L - Last meal When was the patient’s last meal
E - Events leading What led up to the current situation

C. Head-to-Toe Survey

The third component of the Secondary Survey is the Head-to-Toe Survey. The
Head-to-Toe Survey is a systematic evaluation from the patient’s head to their toes to
look and feel for any abnormalities or injuries.
Head Feel with both hands firmly across the skull for indentations.
Look for blood and fluids (especially from the nose and ears).
Neck Feel from the sides of the neck and gently press in moving
down. Look for signs of pain, tenderness and deformity.
Chest Feel for deformity on the shoulders and chest area with one
hand. Look for deformity, equal movement of the chest and
wounds. Use discretion with females.
Abdomen Feel with your flat hand. Gently push on the abdomen feeling
if it is hard. Look for discolouration and pain.
Pelvis Feel by placing a hand on each hip and firmly compressing
inwards. There should be no movement or pain.
Lower extremities Feel with both hands, running them down each leg. Look for
shortening or rotation of the legs, bleeding or discolouration.
Upper extremities Feel with both hands down one arm at a time, looking for
deformity or pain.

There will be no need to undress a patient when doing a Secondary Survey. Clothes
can be moved in such a manner to protect the patient’s dignity when doing this
examination.

3. AFTER CARE

The third and last component of Scene Management is After Care. You did your
Primary and Secondary Survey to determine what is wrong with the patient. You
treated all obvious injuries and now you are waiting for the emergency services to
arrive. The component After Care refers to the actions that you undertake while you
are waiting for the ambulance to arrive. Some of the steps of After Care could

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already have been done, but due to their importance, you will continue doing them.
There is not a specific order for the steps and they are done as needed, but it is
important to make sure you do all of them at some stage.

 Patient positioning
If not already done, you should position the patient in the best position according
to their injury. Below is a table with the various positions for injured patients.

Type of injury Position Description

Head injury Supine Flat on the back with the head immobilised
Spinal injury Supine Flat on the back with the head immobilised
Chest injury Semi sitting Respiratory and heart problems
Pelvic injury Supine Flat on the back
Shock Shock position Flat on the back with the feet elevated
Unconscious HAINES recovery High Arm IN Endangered Spine,
position preferably on the left side.

 Calm and reassure the patient

This is probably THE SINGLE MOST IMPORTANT THING a First Aider can do
for a patient. This should be an ongoing action from when you arrive at the
scene and introduce yourself to the patient, until you hand the patient over.

 Keep the patient comfortable

Try to keep the patient as comfortable as possible. You can do this by regulating
their temperature. If the patient is cold, keep him/her warm. If the patient is hot,
cool them down.

This will also include asking patients if they are comfortable and trying to do what
you can to make them more comfortable. Positioning of the patient will also play
a big role here. Most patients (except patients with head and spinal injuries) can
be placed in the position of most comfort, which will usually be the positions
mentioned above. For example, if a patient with chest injuries is uncomfortable
in the semi sitting position, place them in a position of most comfort.

 Monitor vital signs every 15 minutes

Continue to monitor and record the six vital signs at least every 15 minutes.

 Nil per mouth

The patient should not eat or drink anything.

 Ensure the safety of the patient’s property

Ensure that the patient’s property is in a safe place. The safest place is with the
patient. Do not let anyone take their property, unless the patient asks someone
to keep it. Make a note of this and make sure to record the person’s name on
your PRF.

 Complete the Patient Report Form (PRF)

If it is not written down, it was not done. Make sure you write down everything
you do. Below is an example of an easy to use Patient Report Form (PRF). You
can make copies of it and keep it in your first aid box. The completed PRF
should be kept for at least 5 years, for legal reasons.

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PATIENT REPORT FORM

DATE & TIME OF
INCIDENT
WHERE DID THE
INCIDENT HAPPEN
PATIENT NAME &
SURNAME
PATIENT PHONE
NUMBER
CHIEF
COMPLAINT
A - ALLERGIES

M – MEDICATIONS
USED
P – PAST MEDICAL
HISTORY
L – LAST MEAL

E – EVENTS
LEADING
VITAL SIGNS: TIME: TIME: TIME: TIME: TIME: TIME:

SKIN
COLOUR
SKIN
CONDITION
PUPILS EQUAL AND
REACTING
RESPIRATION
RATE
PULSE
RATE
LEVEL OF
CONSIOUSNESS
ANY
VALUABLES
GENERAL NOTES:
TREATMENT GIVEN ………………………………………………………………………………...

………………………………………………………………………………...

………………………………………………………………………………...

………………………………………………………………………………...

………………………………………………………………………………...

HANDED OVER TO

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MODULE 3: CARDIOVASCULAR EMERGENCIES

AIM OF THE MODULE

Cardiovascular emergencies are becoming a common occurrence in our society due

to our unhealthy lifestyle habits. People are developing cardiovascular disease at a
younger age and more frequently. It is important for you to know how to treat a
cardiovascular emergency. The aim of this module is to teach you how to do that.

ANATOMY OF THE CARDIOVASCULAR SYSTEM

The cardiovascular system is an organ

system that permits blood to circulate. It
includes the:
 Heart
The heart is the pump that moves the
blood through the body.
 Blood vessels
The blood vessels are the containers
for blood.
 Blood
The blood transports oxygen and
nutrients that the body needs.
PICTURE COURTESY OF DREAMTIME

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CARDIOVASCULAR DISEASE

Diseases affecting the cardiovascular system are called cardiovascular diseases.

Many of these diseases are called “lifestyle diseases” because they develop over
time and relate mainly to a person’s lifestyle choices. Cardiovascular disease is
currently the leading cause of death in the developing world. Most of the
cardiovascular diseases are caused by either a plaque build up in the walls of the
arteries, or due to the creation of a clot that blocks blood flow in the arteries, or a
combination of the two. The following are risk factors associated with cardiovascular
disease:

Non-modifiable risk factors Modifiable risk factors

Family history Eating habits
Age Lack of exercise
Gender (Males at greater risk) Smoking
Ethnicity (Africans at greater risk) Excessive alcohol
High blood pressure
High cholesterol

During this course we will look at two main cardiovascular diseases:

1. Angina
2. Heart attack

1. ANGINA

Angina is a pain in the chest

caused by a decreased blood
supply to the heart muscle due
to narrowed blood vessels.
The heart is supplied with
blood by blood vessels, just as
the rest of the body (as can be
seen in the picture).

An Angina attack usually

happens during exercise or in
a time of stress.

Angina is not life-threatening,

but is an indication that the
person is at risk of a heart
attack or stroke.

Usually the pain will go away

with rest or with the use of own
medication.

PICTURE COURTESY OF MORGUEFILE FREE PHOTO

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The following can be signs and symptoms of an Angina attack:

 Chest pain that may radiate to the left arm or jaw

 Shortness of breath
 Anxiety

If you suspect that someone is having an Angina attack you can do the following:

 HHH
 Let the patient stop all activity
 Let the patient sit down (semi sitting)
 Calm and reassure the patient
 Make the patient comfortable
 If the patient has their own Angina medication, assist them to take it
 If the pain does not go away after 5 minutes, presume it is a heart attack and call
the Emergency Services
 Continue to give After Care

2. HEART ATTACK

A heart attack (myocardial infarction) occurs when there is an obstruction of the

blood supply to a part of the heart muscle in such a way that part of the heart muscle
is unable to function properly or dies off. The severity of the heart attack will depend
on the location of the blockage. Lots of people make a full recovery from a heart
attack, but immediate recognition and treatment of a heart attack is critical.

The most common signs and symptoms of a heart attack are:

 Pressure like chest pain (Can be absent in females and diabetics)

 Radiating to the left arm OR jaw
 Pale skin
 Sweating
 Shortness of breath
 Nausea and vomiting
 Anxiety

If you suspect that someone is having a heart attack, you can do the following:

 HHH
 Call the Emergency Services
 Let the patient sit down (semi sitting)
 Calm and reassure the patient
 Make the patient comfortable
 If the patient has his/her own heart medication, assist him/her to take it
 Continue to give After Care

If the damage to the heart muscle is big enough, a heart attack can lead to cardiac
arrest. Cardiac arrest is when the heart stops pumping effectively.

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The signs of cardiac arrest are:

1. The patient is unconsciousness / no signs of life

2. The patient has no or abnormal breathing

CARDIO PULMONARY RESUSCITATION

You need to act immediately, assuming that the patient is in cardiac arrest. The
treatment for cardiac arrest is called Cardio Pulmonary Resuscitation (CPR). CPR is
a manual method of pumping blood through a patient’s body when they have
suffered a cardiac arrest. CPR is not designed to restart the heart, but rather to keep
the blood circulating so that the heart and brain cells do not die due to a lack of
oxygen.

When doing CPR, the First Aider needs to give the patient rescue breaths and chest
compressions. We will start by looking at the respiratory system and rescue
breathing.

ANATOMY OF THE RESPIRATORY SYSTEM

PICTURE COURTESY OF MORGUEFILE FREE PHOTO

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The respiratory system consists of the following components:

 Mouth and nose

As we breathe, air will enter the nose or mouth and move through it to the airway
passage.

 Airway passage (trachea, bronchi)

The air moves from the nose and mouth to the trachea. The trachea filters the
air that we inhale. The trachea branches into the bronchi, the two tubes that
carry the air into each lung.

 Lungs
The lungs are sponge like structures where air exchange takes place.

 Respiratory muscles (diaphragm, intercostal muscles)

The main respiratory muscle is the diaphragm. This is a dome shaped muscle at
the bottom of the lungs. The intercostal muscles also help with respiration,
especially during exercise.

BREATHING

Breathing is a normal process that takes place without us even thinking about it.
Breathing consists of inhalation (moving of air into the lungs to supply the body with
oxygen) and exhalation (moving of air out of the lungs to expel carbon dioxide).

During inhalation (active process) the diaphragm will contract and move down. This
creates a negative pressure in the chest and air will move into the lungs. During
exhalation the diaphragm relaxes, which pushes the air out of the lungs.

Normal respiration (or effective breathing) should thus be:

 Effortless without any pain

 It should be quiet
 At an even, steady rhythm

Ineffective breathing due to a problem with the respiratory system will result in the
following signs:

 Slow breathing at a rate less than 10 breaths per minute

 Fast breathing at a rate of more than 30 breaths a minute
 Noisy breathing, usually due to some sort of obstruction in the airway
 A blue discolouration of the skin, especially seen around the lips, which is an
indication of a lack of oxygen to the body
 This can eventually lead to the patient becoming unconscious

Ineffective breathing (and other causes) can lead to abnormal breathing or a

breathing emergency. The following will be signs of a breathing emergency
indicating that you will have to assist the patient:

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 Absent breathing (No air or chest movement)

 Agonal Gasping (Seizure like activity)

ARTIFICIAL RESPIRATION

In the event of a breathing emergency, you will have to give the patient oxygen. This
can be done by the way of artificial respiration. The air we breathe in contains 21%
oxygen. We use approximately 5 – 6% of the oxygen that we inhale and thus exhale
15% oxygen. We can therefore use the air we breathe out to give patient oxygen.

HEAD-TILT-CHIN-LIFT (HTCL)

The Head-Tilt-Chin-Lift (HTCL) manoeuvre is used to open the airway of a patient

without any spinal injuries. Figure 1 gives an illustration of this. If the head is not
tilted back the tongue may block the throat. The tilting method moves the tongue
away from the back of the throat and opens the airway. In figure 2, diagram A, the
airway is not open. The tongue is blocking the airway. In figure 2, diagram B the
HTCL was used to open the airway. In this diagram it can be seen that the airway is
now open.

If you open the airway by HTCL and you see water or mucus in the throat you should
first turn the patient on his / her side to permit the fluid to run out of the mouth and
then continue again.

Figure 1: Head-Tilt-Chin-Lift Manoeuvre

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Figure 2: Closed vs open Airway PICTURE COURTESY OF MORGUEFILE FREE PHOTO

COMPLICATIONS OF ARTIFICAL RESPIRATION

Gastric distention Occurs when the stomach fills with air if artificial respirations are
too explosive or too full
Vomiting Gastric distention will lead to vomiting as the stomach will fill
with air and push the stomach content out

ONE RESCUER ADULT CPR WITH AN AED

ACTIVITY ACTION
Hazards 1. Ensure your own and the patient’s safety. Put on any
available Personal Protective Equipment
Hello 2. Check unresponsiveness and SCAN the patient for
breathing (> 5 sec but < 10 sec) from as far away as possible.
Help 3. Breathing absent or abnormal, Call for assistance/EMS

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4. Ask someone to get an AED. If one is available, use it

immediately, or as soon as it arrives
5. Place a towel over the patients mouth and nose (to prevent
the spread of COVID) and expose the patient’s chest for hand
placement
6. Correct hand placement of 2 hands on the lower half of the
breastbone (sternum)
CPR 7. Start with 30 chest compressions in < 10 sec
< 2 minutes
8. Deliver 30 compressions at correct hand position (1st cycle)
9. Open airway and deliver 2 breaths of 1 sec each if safe to do
so. If it is not safe continue with hands only CPR.
10. Deliver 30 compressions with adequate depth (5-6 cm) and
full chest recoil
11. Open airway and deliver 2 breaths of 1 sec each if safe to
do so.
12. Deliver 30 compressions at a rate of 100 – 120 per minute
(≤18 seconds but ≥15 seconds)
13. Open airway and deliver 2 breaths of 1 sec each if safe to
do so
14. Deliver 30 compressions (4th cycle)
15. Open airway and deliver 2 breaths of 1 sec each in < 10 sec
16. Deliver 30 compressions (5th cycle)
17. Open airway and deliver 2 breaths, 1 sec each if safe to do
so
18. Switch AED on
19. Select and place the AED pads on the patient’s chest
AED use 20. Clear to analyse
< 60 seconds 21. Clear to shock
22. Press the shock button
23. Continue with CPR immediately

If you are alone with no mobile phone, leave the victim to activate the emergency
response system and get an AED before beginning with CPR.

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

The most common initial rhythm in cardiac arrest is Ventricular Fibrillation (VF) or
Ventricular Tachycardia (VT). If the heart muscle got damaged due to a lack of
oxygen, it is not working as it should and starts to “vibrate”. This condition is called
Ventricular Fibrillation or Ventricular Tachycardia. There is still electrical activity in
the heart, but it is uncoordinated as the heart is irritated. This does not allow the
heart to pump and circulate blood. The treatment for Ventricular Fibrillation and
Ventricular Tachycardia is early defibrillation.

Defibrillation happens when you send an electrical shock through the heart with an
external device. The aim of this shock is to stop all electrical activity in the heart in
the hope that the normal electrical activity in the heart will continue after the shock.
The less time it takes the better, because research has shown that there is a 10%
decrease in the success rate of defibrillation for every minute that passes after the

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heart went into Ventricular Fibrillation or Ventricular Tachycardia. For this reason,
early recognition and treatment of the two conditions, is critical.

The device used to deliver the shock is called a defibrillator. As a First Aider you will
make use of an Automated External Defibrillator (AED). This device will analyse the
heart rhythm automatically (vs manual defibrillators) and is connected externally to
the chest with pads. An AED is a portable device that is available in most major
shopping centres, airports and other areas, where you find large groups of people. It
is critical to ask for an AED as soon as possible. If an AED is available, it should be
connected to the patient’s chest immediately after the primary survey if the patient is
unconscious without (effective) breathing present. If an AED is not present, the First
Aider should start with CPR and connect the AED as soon as it arrives.

The AED will analyse the heart rhythm automatically and, if the patient is in
Ventricular Fibrillation of Ventricular Tachycardia, it will advise the First Aider to push
the shock button to defibrillate the patient. If the patient is not in Ventricular
Fibrillation or Ventricular Tachycardia, the AED will advise the First Aider to continue
with CPR. The AED will count down two minutes. After two minutes it will advise the
First Aider to clear the patient so that it can analyse the heart rhythm again. The
First Aider will continue to follow the instructions of the AED until CPR is stopped.

Special considerations
Hairy chest  Use both pads to pull the hair off
 Use a new pair of pads on the clean area
 You can also shave the chest
Water on patient  Dry the chest area well
 Use the AED following the instructions
Implanted pacemaker  Can be seen as a bulging area on the right side of the
upper chest
 Move the AED pad to the side
Medical patch  Remove the medical patch
 Apply the AED pads
Injury on chest  Place the pads on the opposite side of the chest or on
the back

WHEN TO STOP CPR

You can stop with CPR if:

1. The patient recovers and the patient is breathing; turn the patient in the recovery
position and give After Care.

2. When someone takes over from you. This should be someone with the same or
higher qualification than you.

3. When you are too tired to continue to do effective CPR.

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MODULE 4: ADULT CHOKING

AIM OF THE MODULE

Breathing is important as our bodies need the oxygen in the air to survive. Without
oxygen our cells will die, which can lead to permanent damage or death. After about
four minutes without oxygen our brain cells start dying. Choking prevents breathing.
In 2013 choking, due to a foreign object, caused 162,000 deaths in America. The
aim of this module will be to teach you how to assist the choking patient.

CLASSIFICATION OF CHOKING

Choking is when a person is unable to breathe due to a complete obstruction in the

throat or windpipe. This airway obstruction can be caused by various objects and
can be sudden (food) or gradual (swelling), depending on the cause. The following
are some of the causes of choking:

Cause Treatment
The tongue falling back Head Tilt Chin Lift
Vomitus in the throat Recovery position
Internal swelling (Allergy, burns) ALS medication
Trauma ALS intervention
Inhaled foreign body (Food) Abdominal/Chest thrusts

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Choking can be partial or complete. With a partial airway obstruction there is some,
although inadequate, flow of air to the lungs. With a total airway obstruction there is
no flow of air. Below is a table outlining the difference between a partial airway
obstruction and a total airway obstruction.

PARTIAL AIRWAY OBSTRUCTION TOTAL AIRWAY OBSTRUCTION

Patient can breathe Patient cannot breathe
Patient can speak Patient cannot speak
Patient can cough Patient cannot cough
May hear noisy breathing No breathing sounds
Extreme anxiety Extreme anxiety
Pale or blueish skin colour Pale or blueish skin colour
The patient is holding his/her throat The patient is holding his/her throat

ADULT CHOKING

First aid treatment for a patient with a partial airway obstruction is as follow:

 HHH
 Never give back slaps as this can cause a foreign object to move and become a
total airway obstruction
 Ask the patient if they are choking, to assess the type of obstruction. If the
patient is talking, breathing and coughing you know it is a partial airway
obstruction
 Encourage the patient to cough and expel the object
 If the obstacle is not relieved, call the Emergency Services

The table below describes the First Aid for a conscious patient with a total airway
obstruction. This procedure is called abdominal thrusts.

CONSCIOUS ADULT WITH A TOTAL AIRWAY OBSTRUCTION

ACTIVITY ACTION
Hazards 1. Ensure your own and the patient’s safety
Hello 2. Ask the patient if he/she is choking and confirm that it is a
total airway obstruction
Help 3. Breathing absent, Call for assistance/EMS
4. Stand behind the patient with your strongest leg between their
legs
5. Wrap your arms around the patient’s waist and make a fist
Abdominal with one hand
thrusts 6. Position your fist slightly above the patient’s navel
7. Tip the patient slightly forward
8. Grasp your fist with the other hand and press hard into the
abdomen with a quick, upward thrust
9. Continue this process until the object comes out
10. Due to possible internal injuries, the patient needs to go to a
medical facility

In the case of a pregnant woman you will not be able to do the abdominal thrust, as
you will injure the unborn child. You will then position your hands higher, on the base
of the breastbone. As with abdominal thrusts you will press hard, but now into the

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chest and not the abdomen, with a quick thrust. Repeat this process until the object
comes out. The chest thrusts can also be done on an obese patient if you cannot get
your arms around his/her abdomen.

If you are not successful with the abdominal / chest thrusts your patient will become
unconscious due to the lack of oxygen. Below is the procedure to follow when your
patient becomes unconscious.

UNCONSCIOUS ADULT WITH A TOTAL AIRWAY OBSTRUCTION

ACTIVITY ACTION
1. Lower the patient onto their back on the floor
2. Do a HTCL and look for the object in the mouth
3. If you can see the object, turn the patient on their side
4. Use your finger to sweep the object out. Be careful not to
push the object further into the airway
5. If you cannot see the object or it remains lodged, start CPR
CPR
6. Start with 30 chest compressions. The chest compressions
may dislodge the object
7. After 30 compressions do a HTCL and see if the object is
visible
8. If you cannot see the object give a ventilation to see if the
airway is still blocked
9. If the chest does not rise continue with CPR
10. Continue with this process until the object gets dislodged or
until medical help arrives
11. If the object gets dislodged, remove it and see if the patient
is breathing
12. If the patient is not breathing, continue with CPR
After Care 13. If the patient starts breathing, turn them on their side into the
recovery position
14. Stay with the patient and give After Care

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MODULE 5: SHOCK

AIM OF THE MODULE

Everybody dies of shock. Shock is a life-threatening condition and a medical

emergency. Shock can be divided into several types and the treatment of the shock
will depend on the cause of the shock. The aim of this module is to provide you with
the necessary knowledge, skills and insight to be able to recognise and treat shock.

SHOCK

Shock is a condition caused by a lack of oxygen to the body, due to a problem with
the cardiovascular system. The heart, blood vessels and blood work together to
circulate oxygen through the body. Should there be a problem with any one of these,
you will go into shock.

Shock can be caused by:

 Heart conditions
 Severe bleeding (Internal or external)
 Dehydration
 Infection
 Allergic reaction
 Spinal injuries

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 Burns
 Persistent vomiting or diarrhoea

The most common signs and symptoms of shock are:

 Cold, pale, clammy skin

 Dilated pupils
 Fast, shallow, breathing
 Fast, weak pulse
 Decreased Level of Consciousness
 Dizziness
 Weakness and tired
 Anxiety
 Nausea and vomiting

The treatment for shock is:

 HHH
 Treat the cause
 Calm and reassure the patient
 Loosen tight clothing
 Place in the correct position according to the injury
 Preserve body temperature
 Nil per mouth
 Secondary Survey
 Continue to give After Care

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MODULE 6: NEUROLOGICAL EMERGENCIES

PICTURE COURTESY OF MORGUEFILE FREE PHOTO

AIM OF THE MODULE

Neurological emergencies affect millions of people yearly. If not diagnosed and

treated quickly it can lead to long-term disability and even death. The aim of this
module is to give you a basic insight into the treatment of some of the most common
neurological emergencies.

ANATOMY OF THE NERVOUS SYSTEM

The nervous system is responsible for coordinating the actions of the body. The
nervous system consists of the brain, spinal cord and the nerves.

The spinal cord and the brain make up the central nervous system. The various
nerves together make up the peripheral nervous system.

The brain is the center of the nervous system and the most complex organ in the
human body. The brain is housed in the skull which gives it protection.

The spinal cord connects the brain to the rest of the body. The spine is made up of
the:

 Spinal cord

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 The bones that protect the spinal cord (vertebrae)

 The disc’s tissue between the vertebrae
 The surrounding muscle
 The nerves that branches off it

UNCONSCIOUSNESS

Unconsciousness is a condition where there is a loss of sensory perception. The

ability to react to external stimulation is depressed.

The following can be causes of unconsciousness:

 Head injury
 Lack of oxygen to the brain (Stroke, Heart attack)
 Drug overdose
 Diabetes
 Convulsions

The treatment for an unconscious patient is:

 HHH
 CPR if needed
 Treat the cause
 Recovery position
 Secondary Survey
 Continue to give After Care

FAINTING

Fainting is a temporary loss of consciousness, usually due to an insufficient supply of

oxygen to the brain.

The following can be causes of fainting:

 Unknown
 Pain
 Anxiety and fear
 Hyperventilation
 Environmental conditions (Hot, crowded area)
 Pregnancy

The treatment for fainting is:

 HHH
 Treat the cause
 Shock position
 Secondary Survey
 Continue to give After Care

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STROKE

Stroke is the result of a lack of

oxygen to a specific part of
the brain, usually caused by a
clot in a blood vessel
(ischemic stroke) that stops
blood from passing through to
the brain tissue. Stroke can
also be caused by a burst
blood vessel in the brain
(haemorrhagic stroke).

Full recovery is possible if this

condition is recognised at an
early stage and hospital care
together with the correct drug
treatment is readily available.

PICTURE COURTESY OF DREAMSTIME

The Cincinnati Prehospital Stroke Scale is a system used to diagnose a potential

stroke in a pre-hospital setting. It tests three signs for abnormal findings which may
indicate that the patient is having a stroke. If any one of the three tests shows
abnormal findings, the patient may be having a stroke. It uses the first three letters of
STRoke:

 S – Ask the patient to Smile

 T – Ask the patient to Talk, repeat a phrase
 R – Ask the patient to Raise both arms

If a patient cannot perform any one of the above acts a stroke should be suspected.
If you suspect that someone had a stroke, you can do the following:

 HHH
 Call the Emergency Services
 Monitor vital signs
 Place the patient in a comfortable position
 Calm and reassure the patient
 Secondary Survey
 Continue to give After Care

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SEIZURES

A seizure can be described as an “electrical malfunctioning” of the brain.

Symptoms that indicate a seizure is in progress can include:

 Having a strange taste in the mouth

 Clenching of the teeth
 Losing consciousness
 Having uncontrolled muscle spasms
 Drooling or frothing from the mouth
 Falling down
 Biting the tongue
 Having sudden rapid eye movements

The treatment for seizures is:

 HHH
 Clear the area of hard objects
 Do not restrict seizures
 Loosen tight clothing
 Do not put anything in the mouth

When the seizure stops:

 Primary Survey
 Place the patient in the recovery position
 Secondary Survey
 After Care

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MODULE 7: WOUNDS AND BLEEDING

LILY-MARIE

AIM OF THE MODULE

Bleeding is the term used to describe blood loss. It can refer to blood loss inside the
body (internal bleeding) or outside the body (external bleeding). External bleeding
can be through a natural opening, like the nose, or through a break in the skin. Blood
loss of more than 15% of a person’s total blood volume, will generate changes in the
vital signs and can lead to shock and death if not treated correctly. The aim of this
module is to provide you with the necessary knowledge, skills and insight to know
how to treat bleeding.

DRESSINGS AND BANDAGES

To be able to stop bleeding a First Aider will make use of dressings and bandages.
A dressing is a covering that is placed directly over a wound to help absorb blood,
prevent infection and to protect the wound from further injury. Dressings should be:

 As clean as possible
 Large enough
 Compressible
 Thick
 Soft

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In First Aid we use gauze as a dressing, if available.

A bandage is any material used to hold a dressing in place, maintain pressure over a
wound, support a limb, immobilise parts of the body or to secure a splint. The
following are all different types of bandages:

 Roller bandage
 Crepe bandage
 Trauma bandage
 Triangular bandage

The triangular bandage is a very versatile bandage that can be used for all the
purposes of a bandage. Sometimes a First Aider will not have a First Aid kit with
him/her that contains dressing and bandages. Clothing can be used as improvised
dressings and bandages. If this is done, use the cleanest available material.

Sometimes ropes can also be used as an improvised bandage. If this is done

padding should be used under the rope to prevent the rope from cutting off the blood
supply due to pressure over that area.

EXTERNAL BLEEDING

External bleeding is usually easy to recognize as the First Aider will be able to see
the blood. External bleeding is divided into three types according to the blood vessel
that was damaged:

PICTURE COURTESY OF DREAMSTIME

Arterial bleeding Venous bleeding Capillary bleeding
From artery From vein From capillary
Blood spurts out Flows out Blood oozes out
Bright red Dark red Most common type
Serious type of bleeding Easier to control Can clot and stop itself

Regardless of the type of bleeding or the type of wound the First Aid procedure
applied will stay the same. The aim will be to stop the bleeding. When treating a
patient who is bleeding, your personal safety to wear your gloves and other
protective gear is of paramount importance. If you don’t have gloves you can use
clean cloths, plastic wrap or even a plastic bag to protect yourself. The table below
summarises how to control external bleeding.

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EXTERNAL BLEEDING CONTROL

ACTIVITY ACTION
Hazards 1. Ensure your own (PPE) and the patient’s safety
Hello 2. Identify yourself and ask the patient if you can help and what
happened
Help 3. Call for assistance/EMS
4. Pressure on the wound. The patient can assist with this
5. Elevation of the injured part above the heart level
6. Rest the patient to slow down heart rate
Bleeding control 7. Pack gauze and do not remove
8. Pressure bandage over the gauze
9. Secondary Survey
10. After Care
Check distal 11. Check for slow capillary refill
circulation 12. Check for weak / no distal pulse
13. Check for cold limb
14. Check for needles and pins

It is important to keep on monitoring the patient’s blood flow to ensure that the
bandage is not too tight. You do not want to cut off the circulation. On this level you
should not use a tourniquet at all. Tourniquets are rarely needed and can damage
nerves and blood vessels that can lead to a patient losing their limb. The use of an
uncontrolled tourniquet can lead to the forced amputation of an extremity.

IMPALED OBJECT

Sometimes direct pressure cannot be applied as in the case with a protruding bone,
a skull fracture or an impaled object. In this case the First Aider will make use of a
doughnut-shaped (ring) pad to control the bleeding. This ring pad can be made by
folding a triangular bandage into a narrow bandage and then rolling it into a ring
around your hand. The steps for treating an impaled object, as explained below, will
be exactly the same as for external bleeding control, except that the ring pad will now
be placed over the wound.

BLEEDING CONTROL IMPALED OBJECT

ACTIVITY ACTION
Hazards 1. Ensure your own (PPE) and the patient’s safety
Hello 2. Identify yourself and ask the patient if you can help and what
happened
Help 3. Call for assistance/EMS
4. Pressure around the wound
5. Elevation of the injured part above the heart level
6. Rest the patient to slow down heart rate
Bleeding control 7. Pack gauze around the object and do not remove
8. Support the object with a ring bandage
9. Secure the ring bandage with a pressure bandage
10. Secondary Survey
11. After Care
Distal circulation 12. Continue to check distal circulation

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NOSE BLEED

Bleeding from the nose is a very common occurrence. Most nose bleeds are from
blood vessels at the very front part of the nose. Nose bleeds are most common in
children 2 to 10 years and in adults over 50 years. Nose bleeds can be caused by:

 Trauma (a blow to the nose)

 Trauma from picking the nose
 Extreme heat
 High blood pressure

The treatment of a nose bleed is very easy. The patient should sit with the head bent
forward, so that the blood can drain. If the patient tilts his/her head backwards the
blood will flow into the mouth, which will cause the patient to swallow it and cause
vomiting. Below are the steps for treating a nose bleed.

BLEEDING CONTROL OF A NOSE BLEED

ACTIVITY ACTION
Hazards 1. Ensure your own (PPE) and the patient’s safety
Hello 2. Identify yourself and ask the patient if you can help and what
happened
Help 3. Call for assistance
4. Assist the patient to sit with their head bent forward
Bleeding control 5. Apply pressure under the nasal bone for 10 minutes (time it)
6. Let the patient spit out any blood in the mouth

INTERNAL BLEEDING

Internal bleeding is usually caused by damage to a blood vessel, where the skin is
not broken and blood cannot be seen. This is usually due to trauma. The amount of
internal bleeding will depend on the severity of the force applied during the trauma.
Internal bleeding is usually difficult to recognise and is life threatening. The history of
the event can give you an indication that the patient might have internal bleeding,
especially if the patient’s condition is deteriorating quickly and you don’t know why.

The symptoms of internal bleeding vary, depending on what part of the body or what
organ system, is involved. Symptoms may develop gradually or immediately. The
signs and symptoms for internal bleeding will be the same as for shock. The
following specific signs and symptoms can be seen, depending on the area of injury:

 Bright red blood from body openings

 Pain, tenderness or swelling
 Bruising, a purple / blue discolouration under the skin

The treatment for internal bleeding will be the same as for shock. The main aim for
this type of condition will be to get the patient to hospital as quickly as possible, as
they will need surgical intervention to stop the internal bleeding. Expect vomiting with
internal bleeding and prepare to turn the patient into the recovery position should
they start to vomit.

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MODULE 8: BONE & MUSCLE INJURIES

PICTURE COURTESY OF MORGUEFILE FREE PHOTO

AIM OF THE MODULE

Bone and muscle injuries are very common. About half of all women over 50 years
of age will break a bone. Muscle injuries are very common, especially while doing
strenuous activities. Usually this type of injury is very painful. Fractures can also be
life threatening depending on what bone has been broken. The correct treatment of
bone (and muscle) injuries is very important as it can save a life. The aim of this
module is to provide you with the necessary knowledge, skills and insight to be able
to treat bone and muscle injuries effectively.

ANATOMY OF THE MUSCULOSKELETAL SYSTEM

The musculoskeletal system is the system that gives humans the ability to move. It is
made up of the bones of the skeleton and soft tissue.

The adult human skeletal system consists of 206 bones (there are about 270 bones
at birth) as well as connective tissue. The longest bone in the body is the femur and
the smallest bone is in the ear. The following are the major functions of the human
skeletal system that enables us to survive:

 Framework for the body

 Allows for movement to take place

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 Protects vital organs

 Produce blood cells in the bone marrow
 Storage of minerals like calcium

Soft tissue consists of connective tissue and muscles. Connective tissue includes
tendons, ligaments and cartilage that connect the bones.

There are three types of muscles in the body:

 Cardiac muscle (in the heart)

 Skeletal muscle (attached to bones and responsible for movement)
 Smooth muscle (used to control flow of substances in hollow organs)

STRAINS AND SPRAINS

Strains and sprains are common injuries which affect the soft tissue around joints.
These injuries often occur during sport. Injuries happen when the tissue is stretched,
twisted or torn. A sprain is an injury to a ligament and a strain is a damaged muscle.

The most common signs and symptoms of strains and sprains are:

 Pain
 Tenderness
 Difficulty moving
 Swelling
 Bruising

The treatment for any strain or sprain is called RICE. This is necessary to minimise
swellings. Below are the procedures for dealing with sprains and strains.

FIRST AID FOR SPRAINS AND STRAINS

ACTIVITY ACTION
Hazards 1. Ensure your own and the patient’s safety
Hello 2. Identify yourself and ask the patient if you can help and what
happened
Help 3. Call for assistance/EMS
4. Rest – Get the patient to sit or lie down
5. Ice – To cool the area apply an ice pack or cold pad. This will
help to reduce swelling, bruising and pain. Do not leave on for
R.I.C.E. more than twenty minutes and never place ice directly onto the
skin
6. Compression – Wrap a compression bandage around the
area to assist with swelling and to give support. Make sure it is
not too tight
7. Elevation – Elevate the injured limb as soon as possible. This
will also help with swelling and pain management
8. Secondary Survey
9. Continue with Patient Care

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DISLOCATION

A dislocation happens when bones are partly or completely pulled out of their normal
position. The most common joints that dislocate are the shoulder, knee or fingers. It
is usually difficult to distinguish between a dislocation and a fractured bone as the
signs and symptoms are the same. As a result, dislocations and fractures are
treated in the same way. Never try to pull a dislocated bone back into its socket.

FRACTURES

A fracture is defined as a break or a crack in a bone. A bone may be completely

fractured or partially fractured in many ways (crosswise, lengthwise, multiple pieces).
Bones are rigid but they can bend somewhat when an outside force is applied.
Sometimes when this force is too great the bone will break. The severity of the
fracture will depend on the force that causes the break. This could be from a bone
cracking to shattering. The best way to diagnose a fracture is by X-ray.

Fractures are classified into three groups:

 Closed fractures
A closed fracture is when there is a clean break in the bone that does not tear
through the skin. The damage to the bone is thus under the skin.

 Open fractures
An open fracture is when the skin has been broken by the bone in such a way
that bone fragments stick out through the skin. It can also be a blow that breaks
the skin at the time of fracture. The bone may or may not be visible in the
wound. This type of fracture is serious due to the possibility of infection.
 Complicated fractures
A complicated fracture is any fracture in which the bone or bones that have been
broken causes damage to other organs or structures. Examples of a
complicated fracture could be where the pelvis is fractured and damage is
caused to the bladder or where ribs are fractured with damage to the lungs.
The following can be signs and symptoms of fractures:

 Pain
 Swelling
 Deformity
 No or limited movement
 Shortening of the limb
 Discolouration
 Tenderness
 Wounds with bone ends
 Bleeding
 Crepitus

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IMMOBILISATION

The treatment for any fracture is immobilisation. Immobilisation is the effective

stabilisation and support of a fractured limb. The aim of immobilisation is to:

 Ease pain
 Control internal and external bleeding
 Lessen damage
 Shorten hospitalization
 Shorten healing time

To immobilize a fractured bone a First Aider will make use of a splint. Most of the
time First Aiders will have to improvise a splint. When doing this the First Aider
needs to ensure the splint has the following characteristics:

 Must be long enough to immobilize both joints

 Must be firm
 Must be light
 Must be broad enough
 Must be soft / padded
 Should allow you to evaluate distal circulation

The principle of immobilizing a fracture stays the same, no matter what bone was
broken. Below are the generic actions to immobilize a broken bone.

FIRST AID FOR FRACTURES

ACTIVITY ACTION
Hazards 1. Ensure your own and the patient’s safety
Hello 2. Identify yourself and ask the patient if you can help and what
happened
Help 3. Call for assistance/EMS
4. Check distal circulation
Immobilization 5. Immobilize the joints at both ends of the fracture
6. Re-check distal circulation
7. Secondary Survey
8. Continue Patient Care

All patients with suspected fractures need to go to a hospital for further investigation.
The only way of ruling out a fracture is by means of an X-ray. Always remember: if
the patient thinks he/she has a fracture, treat it as such. There is no need for a First
Aider to cause a patient more pain by evaluating the fracture to “make sure” it is a
fracture. Keep any suspected fracture as still as possible and transport the patient to
a medical facility as soon as possible after immobilization of the effected limb.

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MODULE 9: BURN WOUNDS

PICTURE COURTESY OF MORGUEFILE FREE PHOTO

AIM OF THE MODULE

A burn wound is a very common everyday household occurrence. Most of us have

burned ourselves with hot water, the stove or steam before. Burn wounds are one of
the easiest injuries to treat, but also the injury that is treated wrongly most of the
time. The aim of this module is to provide you with the necessary knowledge, skills
and insight to know what to do when someone has a burn wound.

ANATOMY OF THE SKIN

The layers of the skin:

Epidermis: Outside layer

Dermis: Tissue & hair follicles

Hypodermis: Fat tissue

PICTURE COURTESY OF DREAMSTIME

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The skin is the largest organ of the body. The skin protects us from microbes and
the elements, helps to regulate temperature and permits sensation.

The skin has three layers:

 Epidermis
The epidermis is a tough protective layer that produces melanin, which absorbs
UV radiation from the sun to protect the skin. The epidermis also provides a
waterproof layer.

 Dermis
The dermis is the thickest layer of the skin. The primary function of the dermis is
to support the epidermis and to regulate temperature. The dermis contains
tissue, blood vessels, hair follicles, sweat glands and nerve endings.
 Hypodermis
The hypodermis is a fatty layer of tissue. Its function is to insulate the body,
conserving the body’s heat and as a shock absorber, protecting the inner organs.

The muscles and bone lies beneath the three layers of the skin.

BURN WOUNDS

A burn wound is defined as damage to the skin and underlying tissue due to extreme
temperatures, chemicals, electricity or radiation.

Burn wounds are described according to the causing agent. The four causes of burn
wounds are:

 Thermal burn wounds, e.g. fires

 Chemical burn wounds, e.g. acids
 Electrical burn wounds, e.g. electricity
 Radiation burn wounds, e.g. the sun

The depth of a burn wound determines the signs and symptoms associated with the
burn. Below the classifications of burn wounds with their signs and symptoms:

Superficial
(1st degree)

 Only epidermis
involved

 Red skin
 Painful
 Swollen
 E.g. sunburn

PICTURE COURTESY OF DREAMSTIME

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Partial-thickness
(2nd degree)

 Epidermis & dermis

involved

 Red skin
 Blisters
 Painful
 Blotchy appearance
 E.g. fire
PICTURE COURTESY OF DREAMSTIME

Full-thickness
(3rd degree)

 Skin & muscle

involved

 Wound white or black

 Wound is dry
 Wound is painless
 Wound can be
charred
 E.g. electricity
PICTURE COURTESY OF DREAMSTIME

It does not matter what the cause of the burn wound was or the depth of the burn
wound, the treatment will stay exactly the same. In the table below the treatment of
burn wounds is explained.

FIRST AID FOR BURNS

ACTIVITY ACTION
Hazards 1. Ensure you’re own and the patient’s safety. Remove the
cause of the burn or remove the patient from the cause
Hello 2. Identify yourself and ask the patient if you can help and what
happened
Help 3. Call for assistance/EMS
4. If you have Burnshield place it over the entire area
immediately and leave on
5. If you don’t have Burnshield, administer normal running water
Burns treatment over the area until the pain goes away
6. Remove any jewellery over the affected area as soon as you
can
7. Once the pain goes away cover with a damp dressing / or
leave the Burnshield on
8. Secure the dressing / Burnshield with cling wrap
9. Transport the patient to hospital

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There are certain things that you should NEVER DO for burn wounds:

 NEVER remove anything stuck to the burn wound, like clothing

 NEVER break blisters
 NEVER apply any lotions
 NEVER apply ice to the wound
 NEVER apply any foreign objects like butter, polish, toothpaste, syrup, etc.
 NEVER cover with a fluffy material, like cotton balls or dry material

PERCENTAGE OF BURNS

As a First Aider you might be asked the percentage of burns that a patient present
with. This helps the EMS dispatcher to estimate the seriousness of the burn. Any
burn that covers more than 10% of the body surface is seen as serious. There are
two methods to determine the percentage of burns.

Rule of Palm:
The palm of the patient who has burned (not fingers or wrist area) is about 1% of their
body surface. You can thus use the patients palm size to measure the body surface
area that has burned. It will be easier to use the Rule of Nines if a patient has large
burn wounds.

Rule of Nines:
You can estimate the body surface of an adult that has burned by using multiples of 9.
As can be seen from the picture below the body is divided into 9% areas. Thus if a
patient has burned the whole arm there would be 9% burns. If it is a whole arm and a
leg it would be 27% burns.

Rule of Nines:

9% Front and back of head and neck

9% Front and back of each arm and hand

9% Chest area

9% Stomach area

9% Upper back

9% Lower back

18% Front and back of each leg and foot

1% Groin area

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MODULE 10: HEAD & SPINAL INJURIES

AIM OF THE MODULE

All head injuries are potentially serious injuries due to the damage that can be
caused to the brain. The most common head injuries are concussion, compression
and skull fractures. A First Aider must always assume that a patient has a spinal
injury if they have a head injury. The correct treatment of a patient with a head or
spinal injury can determine the long term outcome of the patient. The aim of this
module is to provide you with the necessary knowledge, skills and insight to be able
to recognize and treat head and spinal injuries.

CONCUSSION

A concussion is a brief period of unresponsiveness, usually caused by a blow to the

head or neck. A patient with a concussion will be confused, but only for a short
while. They usually recover completely. In concussion injuries caused by sport, the
patient is usually booked off for six (6) weeks as a precautionary measure.

Signs and symptoms of a concussion can include:

 Partial or short loss of consciousness

 “Seeing stars”
 Dazed and confused

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 Slurred speech
 Headache
 Dizziness
 Repetitive questioning

The First Aid treatment for concussion is as follows:

 HHH
 Immobilize the spine
 Secondary Survey
 Let the patient rest
 Call for an ambulance if the condition does not get better; it could be a cerebral
compression.

CEREBRAL COMPRESSION

A cerebral compression is usually caused by a severe blow to the head. It can cause
bleeding or swelling inside the skull. This can press on the brain and causes excess
pressure on some part of the brain due to a buildup of fluids in the brain. This
condition is life threatening.

A patient with cerebral compression will have general signs and symptoms of shock.
Specific signs and symptoms of a cerebral compression can include:

 Decreased level of consciousness

 Nausea and projectile vomiting
 Unequal sized pupils
 Bruising behind the ears (Battle signs)
 Blue eyes (Raccoon eyes)
 Unconsciousness

The first aid treatment for cerebral compression will be:

 HHH
 Immobilize the spine
 Treat life threatening injuries
 Secondary Survey
 After Care

A patient with head injuries should be kept as still as possible. If the patient starts
vomiting instruct your assistant next to the patient’s head to support the head and
turn the patient into the recovery position. This would be a case of “life over limb” as
the patient can aspirate if left on their back after vomiting.

SPINAL INJURIES

The most common cause of a spinal injury is extreme force. Suspect a spinal injury if
there is a history of:

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 Falling from a height

 Diving into water
 Motor vehicle accident (driver, passenger or pedestrian)
 Unconscious patient with an unknown history
 Contact sport
 Head or facial injury

Assume a patient has spinal injuries if there is:

 Pain in the neck or back

 Inability to move limbs
 Loss of sensation in the body, or weakness
 Head injury

The treatment for spinal injuries is to keep the patient as still as possible to prevent
further injuries. These could cause permanent paralysis. Below is a table explaining
the First Aid procedures for a patient with spinal injuries.

FIRST AID FOR SPINAL INJURIES

ACTIVITY ACTION
Hazards 1. Ensure your own and the patient’s safety
Hello 2. Identify yourself and ask the patient if you can help and what
happened
3. Call for assistance. Show your assistant how to immobilize
Help the head by doing in line immobilization
4. Call EMS
5. Do a Secondary Survey
6. Provide ongoing Patient Care
7. While waiting for EMS you can immobilize the legs with two
Immobilization triangular bandages around the patient’s ankles and knees
8. Assist EMS to logroll the patient onto the spine board
9. Assist EMS to secure the head blocks and spider harness
10. Assist EMS to move the patient

As a First Aider you will not make use of a cervical collar. “2015 (Updated): With a
growing body of evidence showing harm and no good evidence showing clear
benefit, routine application of cervical collars by first aid providers is not
recommended. A first aid provider who suspects a spinal injury should make sure the
injured person remains as still as possible while awaiting arrival of EMS providers”.
Highlights of the 2015 American Heart Association Guidelines Update for CPR and
ECG, page 32.

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