Many snakes in Australia are capable of lethal bites. These include: taipans, brown snakes, tiger snakes, death adders, black snakes, copperhead snakes, rough scaled snakes and many sea snakes. Anti-venom is available for all venomous Australian snake bites.

Snake identification – Identification can be made from venom on clothing or the skin using a Venom Detection Kit. Do not wash or suck the bite or discard clothing. Do not kill the snake for identification purposes, you may get bitten yourself and medical services do not rely on visual identification of the snake species.

Signs and symptoms

• Two fang marks, however only a single mark or a scratch may be present (localised redness and bruising are uncommon in Australian snake bite)
• The bite may sometimes be painless and without visible marks
• Headache
• Nausea and vomiting
• Occasionally, initial collapse or confusion followed by partial or complete recovery
• Abdominal pain
• Blurred or double vision, or drooping eyelids
• Difficulty speaking, swallowing or breathing
• Swollen tender glands in groin or axilla of the bitten limb
• Limb weakness or paralysis
• Respiratory weakness or respiratory arrest

First aid

• Treat immediately, life-threatening effects may be seen in children within minutes
• Lie the casualty down, keep him/her still and provide reassurance
• Apply a pressure immobilisation bandage using pit
• If the bite is not on a limb, firm direct pressure over the bite site may be useful
• Transport the casualty to the hospital preferably by ambulance

The spinal cord is a mass of nerve fibres that enables signals to travel between the brain and the rest of the body. It runs down through the neck and is protected by the spinal column that consists of 33 vertebrae bones that have a spongy disc between each vertebra. The lower spinal bones are fused together. In an accident the vertebrae may be fractured or dislocated, causing injury to the spinal cord.

Symptoms

• Evidence of trauma
• Nausea, headache, dizziness
• Tenderness, pain
• Altered sensations such as numbness, tingling, pins and needles in the hands or feet
• Loss of movement to arms and/or legs

Signs

• Abnormal position of head or neck
• Head injury
• Altered conscious state
• Breathing difficulties
• Shock
• Change in muscle tone - flaccid or stiff
• Loss of function in limbs
• Loss of bladder or bowel control
• Priapism (erection in males)

Special considerations – The possibility of spinal injury must be considered for ALL trauma incidents.

• If the spinal cord is partially damaged, there may be loss of feeling or loss of normal movement below the injury site
• If the spinal cord is completely severed, there will be loss of movement below the injury site

First aid

Conscious casualty:

• Ensure that the casualty stays still and is not moved unless in immediate danger
• If there is no other choice and they must be moved, support the injured area and minimise movement of the spine
• Manually support the neck, this is vital
• Keep them comfortable and reassure until help arrives

Unconscious casualty:

• Immobilise the neck immediately with your hands, manual support is the best
• Airway management takes priority over a suspected spinal injury. It is acceptable to gently move the head into a neutral position to obtain a clear airway
• If breathing, with as much assistance as possible, gently roll the casualty onto their side and ensure an adequate airway

Soft tissue injuries may be sudden or get worse gradually. Further treatment depends on the type and severity of the injury. Always see your doctor if pain persists after a couple of days.

Causes – Sudden twists or jolts. The fibres overstretch beyond their capacity and tear. Bleeding from broken blood vessels causes the swelling.

A sprain – Joint injury - tearing of the ligaments and joint capsule. Common sites include the thumb, ankle and wrist.
A strain – Injury to muscle or tendons. Common sites include the calf, groin and hamstring.

Signs and symptoms

• Pain / tenderness
• Can’t stand on injured leg without pain
• Decreased function of the injured part
• Discolouration, swelling, stiffness

First aid

R.I.C.E

Rest - stop the activity; take casualty to the sideline or first aid room; stop movement.

Ice - for the first 24 to 48 hours, apply ice or cold packs for 15 minutes every 2 hours.

Compression - bandage the injured area firmly with a roller bandage, extend the wrapping above and below the injury. You may soak the compression bandage (crepe bandage) in cold water as it immediately reduces blood flow into the bruise which will assist the healing process.

Elevation - if injuries permit, elevate the injured area above the level of their heart and:

• Avoid heat, alcohol or massage, which can exacerbate the swelling
• If symptoms get worse in the first 24 hours, seek further medical investigation

A needle stick injury occurs when the skin is accidentally punctured by a used needle. Blood-borne diseases that could be transmitted by such an injury include Human Immunodeficiency Virus (HIV), Hepatitis B and Hepatitis C.

What to do

• Wash with soap and water
• Alternatively use alcohol-based hand rub
• If you are at work, notify your supervisor or workplace health and safety officer - fill out an incident report form
• Go straight to your doctor or hospital emergency department

First aid

If a needle stick injury occurs, seek medical advice. If you are at work, notify your supervisor or WHS officer. In many cases, treatment of the needle mark and counselling is all that is needed. You should receive support together with advice on the possible need for HIV and/or Hepatitis B/C testing, counselling, Hepatitis B and Tetanus vaccination and medication. Remember that the risk of catching a serious infection as a result of an accidental needle stick injury is very low.

Where to get help

• A doctor
• A workplace health and safety officer
• An infectious diseases physician
• An infectious diseases registrar at a hospital

Ways of reducing the risk of needle stick injuries

• Workers who may come in contact with blood or body fluids should be vaccinated
• Follow all safety procedures in the workplace
• Minimise your use of needles
• Remember that latex gloves don’t protect you against needle stick injuries
• Don’t bend or snap used needles
• Never re-cap a used needle
• Follow safety precautions and procedures for disposing of needles
• Place used needles into a clearly labelled and puncture-proof sharps approved container

Organisations may benefit from a nationally recognised training course such as 10340NAT Course in safe handling of sharps and infectious waste. Contact your trainer, or Allens Training Pty Ltd for more information about this course.

A person may survive the initial impact of a motor vehicle accident, but other associated elements may cause death, such as airway obstructions whilst unconscious, or severe bleeding. The aim is to make the scene safe first, secondly, see who is injured, how many are injured and who requires treatment first, prioritise, then assist the injured.

Hazards can include – the vehicle position, on-coming traffic, broken glass, fallen power lines, leaking fuel, fire, people in a panic etc.

Signs and symptoms

For multiple cars and casualties, count the number of people that are injured. Check responses. Look for unconsciousness first, and those who are not breathing. Look for bleeding, and other injuries.

First aid

Call an ambulance. Special assistance may be required (e.g. fire brigade, electricity authorities, rescue organisations etc.).

Make the scene safe:

• Identify and assess dangers. Remove or minimise hazards. Provide protection
• Protect yourself and the casualties from further injury, e.g. Being hit by a car
• Position vehicles, use hazard lights, road triangles or torches
• Ask other people to warn the on-coming traffic
• Turn off the ignition in crashed cars and activate park brake or chock the wheels
• Look out for inactivated airbags
• Use head lights to light the area if dark
• Keep safe distance away from fallen power lines and ensure no one is smoking

Treat the casualties:

• Treat the unconscious first
• If the casualty in the vehicle is unconscious and not breathing normally, remove them from the vehicle and commence cpr immediately
• Manage the unconscious breathing within the vehicle if possible
• Open airways and check the breathing of each casualty
• Clear the airway of foreign material
• Maintain head tilt and jaw support, continuously reassess airways and breathing
• Try to be aware of spinal alignment at all times
• Stop any bleeding and immobilise fractures
• Make comfortable and provide reassurance, especially if a person is trapped
• Complete a verbal casualty assessment noting the injuries
• Move anyone lying on a road/railway line, etc. To safety
• Write down changes in condition and the time of the observations
• Monitor and treat as required until help arrives

A stroke is a life-threatening medical emergency. The longer untreated, the greater the degree of brain damage. When an artery to the brain blocks or ruptures, brain cells in the area die from lack of oxygen. Sometimes this can result in death.

Warning signs - Transient Ischaemic Attacks (TIAs), or mini strokes, can be an important warning sign that a stroke may occur in the future. TIAs generally last for no longer than 60 minutes.

Signs and symptoms

The signs of both stroke and TIA could be one or a combination of the following:

• A numb or weak feeling in the face, arm or leg
• Trouble speaking or understanding
• Unexplained dizziness
• Blurred or poor vision in one or both eyes
• Loss of balance, unexplained fall
• Difficulty swallowing
• Headache (usually severe or of abrupt onset), unexplained change in the pattern of headaches
• Confusion

FAST is a simple way to remember the signs of a stroke:

• Face Can the person smile? Has his/her mouth or eye drooped?
• Arms Arm weakness. Can the person raise both arms?
• Speech Is his/her speech slurred? Can they understand what you say?
• Time Is critical. If you see any of these signs call 000 straight away

First aid

• Call the ambulance immediately
• Stay with the casualty, reassure
• Do not give anything to eat or drink
• If conscious – place in position of comfort, a pillow behind the head is often helpful to maintain posture and balance
• If unconscious – place on side with the facial droop facing down, follow abcd
• Place on side if vomiting or if fluid comes from the mouth
• Monitor until ambulance arrives

In medicine and first aid the term ‘shock’ refers to a loss of effective circulating blood volume. This can be from severe bleeding, burns, diarrhoea and vomiting, sweating and dehydration (heat-stroke), severe infection, allergic reactions, or major or multiple fractures, spinal injury, heart disorder including a heart attack, abnormal dilation of blood vessels.

Signs and symptoms

• Dizziness
• Nausea
• Thirst
• Feeling cold
• Muscle weakness
• Shortness of breath
• Anxiety, restlessness
• Rapid pulse, fast heart rate
• Rapid breathing
• Cool sweating pale skin
• Collapse
• Confusion, deterioration of the level of consciousness
• Vomiting

First aid

Call the ambulance, send for resources. For the casualty:

• Rest comfortably, ideally lying down
• Control any bleeding
• Manage airways and unconsciousness
• If they vomit, place on their side
• Keep them warm and still
• Provide reassurance, monitor until the ambulance arrives

A seizure may occur when normal brain activity is disrupted which can cause changes in sensation, awareness, behaviour and level of consciousness. All or part of the body may be affected.

Causes can include head injury, stroke, meningitis, brain tumour, lack of oxygen, low blood sugar or pressure, poisons, drugs, epilepsy. In young children seizures may occur with a sudden rise in body temperature (known as febrile convulsions).

There are several types of seizures and they vary greatly. Not all seizures are considered Epilepsy.

Signs and symptoms

Non-convulsive seizure (focal or complex partial) – any or all of the following:

• Remains conscious, may be frightened, confused and vague
• Repetitive behaviour, fiddling with clothes
• Lips smacking or chewing
• Wandering aimlessly
• Jerking of a limb, facial twitching
• Usually lasts up to 3 minutes

Convulsive seizure (Tonic clonic) – all or part of the body may be affected.- any or all of the following:

• Muscle stiffness, if standing will fall to ground, jerking movements in head, arms and legs
• Shallow or intermittent breathing, a change of colour in lips or complexion
• Dribbling; faeces or urinary incontinence
• A change in or loss of consciousness
• Usually lasts up to 2 minutes followed by a period of confusion

Febrile seizure (or febrile convulsions) – usually occurs in children aged 6 months to 6 years due to a rapid rise in body temperature.

• Symptoms are similar to a convulsive seizure

First aid

For all seizures - provide safety and protect from injury, stay with them and monitor, reassure, tell them where they are and comfort, call an ambulance if concerned. Do not restrain unless in danger or place anything in their mouth.

Convulsive seizure - note the time the seizure starts and ends.

• Protect their head, remove dangerous objects
• Maintain a clear airway, treat as for an unconscious casualty, as soon as possible roll on to his/her side
• Call an ambulance if a seizure lasts more than 5 minutes, injury occurs, another seizure occurs before the casualty has fully recovered from the first, or if they remain unconscious

Febrile seizure – will usually resolve without treatment; do not place in a bath, you can remove clothing to cool the child.

Cardiac arrest is a term used to describe a collapsed casualty who is unconscious, unresponsive, not breathing normally (or at all) and not moving.

A sudden cardiac arrest occurs suddenly and without warning. Not to be confused with a heart attack (which is caused by a blockage that stops blood flow to the heart) during a cardiac arrest the heart stops beating. The best way to increase the chance of saving sudden cardiac arrest casualties, outside of a hospital setting, is to follow every link in the chain of survival.

Signs and symptoms

• Loss of consciousness
  
• Little or no breathing
• No pulse

First aid - Chain of survival

When to stop CPR - A first aider should continue cardiopulmonary resuscitation until:

• The casualty responds or begins breathing normally
• It is impossible to continue (e.g. exhaustion)
• Someone else can take over CPR
• A health care professional directs CPR to be ceased

Hyperthermia is a ‘heat induced illness.’ Heat stress can cause mild conditions such as a rash or cramps, however serious and life-threatening conditions, such as heat stroke can worsen pre-existing medical conditions.

Signs and symptoms

• Muscle cramps
• Fatigue
• Headache
• Nausea
• Pale skin
• Sweating
• Thirst
• Fainting
• Dizziness
• Elevated body temperature
• Possible collapse and unconsciousness

First aid

• Call the ambulance, move to a cooler area such as shade
• Lie the casualty down, loosen and remove excessive clothing
• Remove the cause and assist the normal cooling mechanisms
• Cool and moisten skin with atomiser sprays, moist cloths, fans, fanning etc.
• Apply wrapped ice packs to neck, groin and armpits
• Give water to drink if fully conscious;
• Resuscitate if required (ABCD
• Monitor until help arrives

Dehydration is when there is not enough water in the body to function normally.

Signs and symptoms

• Headaches and lethargy
• Mood changes and slow responses
• Dry nasal passages
• Dry or cracked lips
• Dark-coloured urine
• Weakness, tiredness
• Confusion and hallucinations
• Cold skin
• A blue tinge to the skin as the circulation slows
• A baby may have a depressed fontanelle (the soft spot on top of a baby’s skull where the bones are yet to close)

First aid

Give fluids, monitor condition. Dehydration can be a life-threatening condition in children, call an ambulance immediately.

Poisoning may be accidental or deliberate. Most pharmaceuticals are poisonous, even lethal in overdose. If poisoning occurs in an industrial area, farm or laboratory setting, suspect particularly dangerous agents and take safety precautions. If more than one person simultaneously appears affected by a poison, there is a high possibility of dangerous environmental contamination.

A poison can enter the body by ingestion, injection, absorption, or inhalation.

Signs and symptoms

• Unconsciousness
• Nausea and vomiting
• Blurred vision
• Headache
• Burning pain in the mouth and throat
• Seizures
• Respiratory arrest or cardiac arrest

First aid

• Try to ascertain what has been taken, how much and when
• Obtain medical advice promptly
• Call the Australian poisons information centre on 13 11 26
• Monitor the casualty and manage as required until the ambulance arrives

Unconscious casualty:

• Place on his/her side, maintain an open airway
• If not breathing normally, or at all, wash the poison from the face of the casualty, use a facemask, commence resuscitation
• Perform compression only CPR if no protection is available

Enters the eye:

• Flood the eye with saline, or cold water from a running tap or a cup/jug
• Continue to flush for 15 minutes, holding the eyelids open

Skin contact:

• Remove contaminated clothing, taking care to avoid contact with the poison
• Flood skin with running cold water
• Wash gently with soap and water and rinse well

If swallowed:

• Give a sip of water to wash out their mouth
• DO NOT try to make them vomit
• DO NOT use Ipecac Syrup
  

If inhaled:

• Immediately get the casualty to fresh air, without placing yourself at risk
• Avoid breathing fumes (don’t go into an unsafe environment)
• If it is safe to do so, open doors and windows

Hyperventilation is deep or rapid breathing that can be caused by panic or anxiety.

Signs and symptoms

Symptoms:

• Light-headedness
• Shortness of breath
• Feeling of not getting enough air in
• Chest discomfort
• Feeling of panic, impending doom
• Rapid breathing and palpitations
• Blurred vision
• Tingling in the lips, fingers and toes
• Palpitations
• Severe anxiety
• Feeling of detachment and not in full control (depersonalisation)
  

Signs:

• Rapid breathing, occasional deep breath, sighing breathing
• Rapid pulse
• Altered level of consciousness
• Hand and finger spasms (fingers and wrists become claw-like, the thumb held stiffly across the palm)

First aid

• Be assertive provide calm reassurance, help them regain composure
• Instruct them to only breathe in and out through their nose slowly. This is difficult and makes the casualty concentrate on something else
• Continue assertive instructions until the casualty slows their breathing or reduces the amount of anxiety and reaction to the incident

 Causes – Downed power lines, faulty equipment, overloading power boards, lightning strike.

Signs and symptoms

• Check response;
• Electric shock may result in:

1. Respiratory arrest (not breathing);
2. Cardiac arrest (no response);
3. Burns; and
4. Shock.

Safety first

• Remember, metal and water conduct electricity and may be extremely hazardous, do not touch the casualty or
• Any conducting material touching them until:
• The supply of electricity is turned off, and if possible, the appliance is unplugged from the power supply;
• Or, with extreme caution, disconnect the casualty from the electricity supply using a dry non-conducting material (e.g. Wooden stick or dry clothing).

First aid

• Call an ambulance and keep bystanders back;
• Treat any other injuries that may be present;
• Use water to cool any entry or exit wounds and burns;
• Promptly refer all casualties of electric shock for medical assessment;
• The same treatment applies for people who have been struck by lightning;
• If in cardiac arrest commence CPR.

Envenomation is caused when a venomous creature bites or stings another creature to inject venom.

Signs and symptoms

These vary depending on the type creature that injected the venom.

First aid

Pressure Immobilisation Technique (PIT)

A simple pressure bandage over the bitten area and immobilisation of the limb slows the flow of the venom through the lymphatic system. The lymphatic system is a network of tubes that drains fluid (lymph) from the body’s tissues and empties it back into the bloodstream. Venom may produce pain and/or tissue damage.
Bandaging the wound firmly, tends to squash the nearby lymph vessels which helps to prevent the venom from leaving the puncture site. If you don’t have any bandages at hand, use whatever is available, including clothing, stockings or towels. Firmly bandage the wound but not tight enough to cause numbness, tingling or any colour change to the extremities.
PIT is useful for some bites and stings, but not all.

PIT IS RECOMMENDED for bites and stings by the following creatures:

• All Australian venomous snakes, including sea snakes;
• Funnel web spider;
• Blue ringed octopus;
• Cone shell.

PIT IS NOT RECOMMENDED for bites and stings by the following creatures:

• Other spiders including redback spider;
• Jellyfish stings;
• Fish stings including stone fish;
• Bites or stings by bees, wasps, ticks, ants, scorpions, centipedes or beetles.

Advice on all types of envenomation is available from:

• Australian Venom Research Unit: avru.org
• Poisons Information Centre on: 13 11 26
• Australian Resuscitation Council: resus.org.au

A sudden blockage of one of the coronary arteries that supplies blood to the heart muscle resulting in an immediate life-threatening risk. If not corrected quickly there is a risk of serious permanent heart muscle damage or death. Urgent medical care is required so the casualty can receive clot-dissolving medications that clear the blocked artery, restore blood supply to the heart muscle and limit damage to the heart – “every minute counts”.

A heart attack is different from, but may lead to, cardiac arrest. Not all heart attacks are accompanied by pain, some casualty’s simply look and feel unwell, and some may dismiss their symptoms as ‘indigestion’.

Signs and symptoms

• Constant dull heavy pain or discomfort in the centre of the chest
• Pain may come on suddenly, or start slowly and may be - 1) described as tightness, heaviness, fullness or squeezing, 2) severe, moderate or mild and 3) radiating into jaw, neck, throat, shoulders, arms, wrists and hands
• Nausea, dizziness and/or shortness of breath
• Skin very pale and sweaty, does not look well

Warning signs – Remember, if the warning signs are severe, get worse quickly, or last longer than 10 minutes, an ambulance must be called immediately.

First aid

Call an ambulance immediately. If possible, stay with the person and call for assistance to get medications:

• Keep the casualty still, discourage any physical activity, make comfortable
• Stay with them until the ambulance arrives
• If prescribed medication such as a tablet or oral spray to treat chest pain or angina, assist them to take as directed
• Give aspirin (300 mg) if directed. The Australian Resuscitation Council states that this is considered to be a reasonable approach if the casualty does not have a history of anaphylaxis or bleeding disorder

Causes of ear injury include:

• Foreign objects – insects, debris or dirt
• Trauma – blows when playing sport or in accidents
• Ruptured eardrum – Inserting cotton swabs, toothpicks, pins etc
• Illness – Ear infection, wax build up, infected piercing etc
  

Signs and symptoms

• Bleeding from the ear
• Loss of hearing or noises in the ear
• Dizziness, nausea and vomiting
• Earache or severe pain
• Swelling, bruising, redness
• Clear liquid coming out of the ear
• Sensations of an object in the ear
• Visible object in the ear
• Rise in temperature (may indicate infection)

First aid

For ruptured ear drums, if part of the ear has been cut off, or if fluid is coming out of the ear:

• Call the ambulance, reassure and monitor
• DO NOT block any drainage coming from the ear
• DO NOT try to clean or wash the inside of the ear canal
• DO NOT put any liquid into the ear

Asthma is a disorder affecting the airways, (the tubes that carry air in and out of the lungs). In people with asthma, the airways are particularly sensitive and they can have difficulty getting air into and out of their lungs. If exposed to certain triggers their airways will narrow, making it hard for them to breathe.

Asthma action plan

Doctors provide a written asthma action plan for people with asthma, which includes the most effective asthma medications to treat individual symptoms and what medications to take and how. This should be followed when providing first aid.

What is an asthma attack?

An asthma attack is when symptoms start up or get worse compared to usual, enough to cause the person distress. Asthma attack symptoms can come on gradually or quite quickly and they won't go away by themselves. An asthma attack can become life-threatening if not treated properly, even in someone whose asthma is usually mild or well controlled. Quick action may help prevent an asthma attack from becoming an asthma emergency.

Signs and symptoms – May vary. A person may not show all signs during an asthma attack. Young children may appear restless, be unable to settle, become drowsy, and have severe coughing and vomiting. A child may have problems eating or drinking due to shortness of breath.

Symptoms and treatment

The eye can be injured by a chemical, foreign object or direct blow. There will usually be pain and redness associated with an eye injury. There may also be bleeding, tearing, sensitivity to light, swelling and/or discolouration. Eye injuries may be due to:

• Trauma: being struck by an object or falling and banging the eye, cuts and bruises
• Burns to the eye
• Smoke in the eyes
• Major foreign bodies: splinter, embedded object etc.
• Welding injuries
  

Signs and symptoms

• Pain
• Redness
• Swelling
• Bruising
• Tearing
• Cuts and bleeding
• Sensitivity to light
• Discolouration
• Blurred vision
• Burns around eye area
• Embedded or floating foreign objects

First aid

Any first aid provided must be extremely gentle and careful. Ice packs may reduce pain and swelling. Gentle washing or flushing may remove foreign objects; however embedded objects should only be removed by a medical professional. Padding should be used to control any bleeding. An ambulance should be called for serious injuries.

Head injuries may cause loss of consciousness, bleeding, neck or spinal injury, damage to the brain, eyes, ears, teeth, airways and mouth, or other structures. A severe blow may cause unconsciousness, however a casualty may sustain a significant head injury without loss of consciousness, or loss of memory (amnesia), Severe trauma and injuries may lead to death or permanent brain damage.

Signs and symptoms

Specific to concussion: (caused by trauma to the head)

• Headache or dizziness
• Loss of memory, particularly of the event
• Confusion
• Altered state of consciousness
• Wounds on the head (face and scalp)
• Nausea and vomiting

Other head injury symptoms

• Drowsy or vague   
• Agitated or irritable
• Lack of coordination
• Speech problems
• Headache or giddiness
  

First aid

• Always seek further medical assistance after loss of consciousness or altered consciousness, no matter how brief. Follow ABCD protocol. Conscious head injury
• A thorough assessment to rule out cervical or spinal damage
• If no spinal injury is found, keep the casualty lying down at rest
• Check carefully the neck, eyes and ears, and if bleeding from an ear, turn the casualty with the injured side facing down to aid the draining process
• Control bleeding and treat wounds as required

The most important consequence of drowning is interruption of the oxygen supply to the brain. Early rescue and resuscitation are the major factors in survival.

The rescue – Do not attempt a water rescue beyond your swimming ability.

• If the casualty is conscious and can move, consider using devices such as a stick, umbrella, rope or towel to rescue them. A buoyant aid such as a life jacket, Esky lid or kickboard may assist the casualty to stay afloat until a safe rescue can be attempted.
• If the casualty is conscious but paralysed or can’t move due to neck pain, or altered sensations in the fingers and toes, enter the water if you feel
• safe and confident, support the casualty’s neck and maintain spinal alignment as much as possible.
• If unconscious, turn casualty face up and remove the casualty from the water as soon as possible before any attempts at revival. CPR in deep water should only be attempted by an appropriately trained rescuer using floating devices.

Signs and symptoms

• Altered state of consciousness;
• Abnormal breathing or not breathing at all
• Vomiting and regurgitation
• Stomach distension
• Liquid in the airway
• Spinal injury
• Trauma or other injuries
• Possible hypothermia

First aid

After retrieval from the water, position the casualty on his/her back and assess:

• If unconscious and not breathing normally or at all, immediately start CPR
• If the airway is obstructed (water or blood, sand, debris, vomit etc.), promptly roll the casualty on to his/her side to drain and clear the airway, then reassess
• If not breathing, return casualty to his/her back and continue CPR
• If breathing commences, leave on his/her side with head tilt
• Monitor to detect a possible relapse into unconsciousness
• Treat other injuries as required
• Consider possible spinal injuries, maintain spinal alignment where possible
• Ignore a distended stomach, do not attempt to empty with external pressure
• Administer oxygen if available and trained to do so
• Call an ambulance for all immersion incidents, late deterioration is common

A fracture is the breaking of a bone or a bend in a bone which always has associated damage to the soft tissue around the broken bone. There are different types of fractures, however they all require medical treatment.

Signs and symptoms

For the injured area:

• Pain  
• Tenderness, can’t move the limb without pain
• Shortening of the limb
• Deformed limbs swelling, at an odd angle and possibly rotated
• Bones piercing through skin
  

Other associated injuries:

• Cuts and abrasions
• Bruises
• Muscle or soft tissue damage
• Organ damage
• The extremity of the injured arm or leg is numb or bluish at the tip
• Severe bleeding
• Shock

First aid

• Do not move the casualty unless there is immediate danger
• Control any bleeding and cover any wounds
• Ask the casualty not to move the injured limb
• Do not try to straighten broken bones or dislocations
• For a limb, provide support and comfort such as a pillow under the lower leg or forearm, but do not cause further pain or unnecessary movement of area
• Do not let them eat or drink anything until they are seen by a doctor, in case they need surgery
• Reassure and keep him/her warm
• If required - treat for shock or unconsciousness, protecting the limb as you do
• If a bone is protruding, apply pressure around the edges of the wound
• If medical aid will be delayed and you have been trained, apply a splint* to support the limb with the fracture. Immobilise above and below the fracture
• Keep an arm area from moving by applying a sling
• Monitor until ambulance arrives, check and adjust splints or bandages if cutting off circulation

A variety of situations such as vehicle entrapment, falling debris, industrial accident, mining accidents and cave-ins or by prolonged pressure to a part of the body due to their own body weight in an immobile casualty.

Possible injuries – Lacerations, fractures, bleeding, bruising, spinal injury and in severe cases where a large portion of the body is crushed, crush syndrome may develop.
The casualty may have no pain and there may be no external signs of injury. They may go into shock or become unconscious. An ambulance should be called immediately. All casualties who have been subjected to crush injuries should be taken to hospital for immediate investigation.

Signs and symptoms

• A crushing force
• The casualty may not complain of pain and there may be no external signs of injury
• Any other injuries caused by the impact of the force
• Wounds and bleeding
• Embedded objects
• Bruising
• Fractures and dislocations
• Shock
• Head injury, concussion, spinal injury
• Conscious or unconsciousness

First aid

For small injuries, e.g. crushing a finger in a car door:

• Run under cold water and/or apply an ice pack to reduce swelling and bruising
• Bandage or cover wounds or split skin
• See a doctor if stitching is required or the injury does not get better

For large injuries:

• Call an ambulance
• If it is safe and physically possible, all crushing forces should be removed from the casualty as soon as possible
• Control any bleeding
• Keep casualty warm and still
• Make comfortable, use padding and pillows for fractures or dislocations
• Monitor the casualty’s condition and vital signs until ambulance arrives
• Do not leave the casualty except if necessary to call an ambulance
• Do not use a tourniquet for the first aid management of a crush injury

Choking is the result of the lodgement of a foreign object in the casualty’s airway. In some instances, the object lodges at the entry to the airway (partial obstruction), but does not enter the airway itself. This will cause the casualty to start coughing which is the body’s way of trying to expel the object out.

If the object is firmly lodged in the airway (complete obstruction), coughing at least keeps it high in the windpipe, though it will not necessarily expel it.

Signs and symptoms 

• Persistent cough 
• Inability to breathe, speak, cry or cough 
• Clutching at the throat 
• Anxiety, restlessness 
• Collapse and unconsciousness

First aid

• If partial blockage – encourage the casualty to keep coughing 
• If complete blockage – call for medical assistance urgently 
• Position the casualty – adults on their side, children heads lower than their body 
• Deliver up to five sharp back blows between the shoulder blades, and clear any obstructions that may have come out. 
• If back blows are unsuccessful perform five chest thrusts ( the same as if delivering CPR chest compressions). 
• If the casualty has stopped breathing commence CPR

Anaphylaxis is a severe form of allergic reaction that can develop rapidly and is potentially life-threatening. It must be treated as a medical emergency requiring immediate treatment. More than one body system may be involved, however the most dangerous allergic reactions involve the respiratory system and/or cardiovascular system.

Signs and symptoms

• Difficulty/noisy breathing
• Swelling of face and tongue
• Swelling/tightness in throat
• Persistent dizziness/loss of consciousness and/or collapse
• Difficulty talking and/or hoarse voice
• Wheeze or persistent cough
• Pale and floppy (in young children)
• Abdominal pain and vomiting
• Hives, welts and body redness
• Signs of envenomation

First aid

• Arrange for the ambulance to be called, obtain action plans and auto-injectors
• Lay casualty flat, don’t let them stand or walk, if breathing is difficult allow to sit
• Prevent further exposure to trigger agent/allergen if possible (e.g. flick out stings remove food items)
• Confirm anaphylaxis due to signs and symptoms
• If possible, consult and implement the individual’s action plan
• Administer adrenaline via an auto-injector immediately
• Further adrenaline should be given if no response is seen after 5 minutes
• Casualty may benefit from the administration of oxygen and/or asthma medication

if required;

• If breathing stops, commence CPR and seek urgent medical aid

Abrasion wounds: the surface layers of the skin is broken or grazed.

Incised wounds: cut or slice into the skin.

Signs and symptoms

Check responses:

• Look for foreign objects and dirt particles
• Punctured blood vessels or severed arteries
• Check how deep the wound is and bleeding severity
• Look for infection (red, inflamed around edges, puss)

First aid

• Clean according to severity. For minor wounds
• Avoid breathing, coughing or sneezing over the wound
• Clean with a non-fibre shedding material or sterile gauze soaked in normal saline or clean water (do not use cotton wool or material that will fray or leave fluff)
• Don’t scrub embedded dirt, this can traumatise the site even more
• See a doctor if dirt cannot be removed to reduce the chance of infection
• Apply an antiseptic
• Cover with a non-stick sterile dressing such as a Band-Aid or a non-adhesive dressing held in place with a non-allergenic tape, (try not to touch the dressing’s surface before applying it)
• Change the dressing according to the manufacturer’s instructions (some may be left in place for several days to a week)

A a  wound that fails to heal, heals slowly or heals but tends to recur is a chronic wound. See a doctor immediately for symptoms such as bleeding, increasing pain, pus or discharge, and/or fever.

Chest injuries can be caused in a variety of different situations such as vehicle entrapment, falling debris, industrial accident, mining accidents and cave-ins.

Signs and symptoms

• Possible blood loss, internal or external
• Anxiety / restlessness
• Rapid pulse / shock

Rib injury:

•     Trouble breathing
•     Shallow breathing, short, rapid, gasping
•     Tenderness at site of injury
•     Deformity & bruising of chest
•     Pain upon movement/deep breathing/coughing
•     Decreased chest movement
•     Dusky or blue lips or nail beds
•     May cough up blood
•     Crackling feeling upon touching casualty’s skin (like "rice bubbles")

First aid

• Call an ambulance immediately, the casualty can deteriorate very quickly
• Keep the casualty sitting upright, lean the injured side down
• Conduct a verbal secondary survey i.e. Ask the casualty about their pain
• Do not remove any embedded objects, pad around the object to control bleeding
• Cover any wounds with a dressing
• Escaping air wound – place a ‘flutter valve’ over wound
• Get some sort of plastic that is bigger than the wound
• Tape the plastic patch over the wound on only 3 sides. The 4th side is left open, allowing blood to drain and air to escape. This opening should be at the bottom (as determined by the casualty’s position)
• When the casualty inhales, the bag will be sucked in, but when the casualty exhales, the air will exit through the un-taped side
• If a flail segment is suspected, tightly secure a bulky dressing (such as a tightly folded hand towel) to help stabilise the injury
• Treat for shock as required and monitor carefully until help arrives

Diabetics don’t produce insulin properly, which makes their blood glucose (sugar) levels higher. They need to regulate the amount of glucose in their body by medication or diet.

Many have a medical alert bracelet, necklet or warning card and carry sugar, lollies, glucose or a ready-made ‘Hypo’ pack in case of an emergency.

Signs and symptoms

Onset symptoms:

• Weakness, trembling or shaking
• Sweating; headache
• Light headedness
• Dizziness
• Lack of concentration
• Tearful/crying irritable
• Hunger
• Numbness around lips and fingers

Progressive symptoms:

• Loss of coordination
  
• Confusion
  
• Slurred speech
  
• Loss of consciousness
  
• Fitting

First aid

Conscious casualty:

• Make them comfortable
• If they can safely swallow, give high-energy foods, sugar or honey, or a glucose tablet
• The casualty will respond quickly if low blood sugar levels are the cause
• When they recover he/she may be a little confused
• Make sure they eat a normal meal immediately

Unconscious, drowsy or unable to swallow: THIS IS AN EMERGENCY

• Place them on their side, clear their airway and call an ambulance immediately (dial 000) stating a ‘diabetic emergency
• Do not give them any food or drink
• Wait with them until the ambulance arrives

A burn causes the partial or complete destruction of skin. There are two layers of the skin. Once the skin is burnt, the extent of damage can be minimised by effective immediate first aid treatment.

Signs and symptoms

• Pain around the burnt area
• Localised blistering to the skin
• Red to black marks around the area burnt
• Evidence of inhalation burns, e.g. Burns to face, nasal hairs eyebrows or blackness around nose and mouth, coughing, hoarse voice and breathing difficulty
• Significant burns (large area or severe skin damage)

First aid

Important - Airway, breathing, circulation, take precedent over caring for the burn. An ambulance must be called if the casualty is a child or for significant or severe burns.

• Ensure safety – i.e. Do not enter a burning building or toxic atmosphere. If still on fire – stop, drop, cover and roll, smother flames with a blanket
• Assess responsiveness, shock and vital signs, check for other injuries, prioritise and treat
• If waiting for an ambulance, keep the casualty at rest, warm and monitor. Watch for cardiac arrest, be prepared for CPR

The human body requires the correct amount of blood and fluid to be transported around the body in order to function properly. The blood transports oxygen to every cell in the body and then transports the waste products away from the cell.

Bleeding is the loss of blood from the circulatory system. The loss can be from external or internal bleeding, ranging from minor through to severe or massive. First aid for any type of severe bleeding is critical. The aim is to limit the loss of blood until emergency medical aid arrives. Always call Triple Zero (000).

Internal bleeding

Signs and symptoms

The signs and symptoms will depend on where the bleeding is inside the body:

• Visible internal bleeding: bruising or blood coming from a body opening
• Bright red and/or frothy blood coughed up from the lungs
  
• Vomiting blood which may be bright red or dark brown
  
• Blood-stained urine
  
• Rectal bleeding
  
• Vaginal bleeding
  

Concealed internal bleeding: bleeding that remains contained within the body

• Pain, tenderness, swelling at the affected site
  
• Swollen, tight abdomen
  
• Nausea and vomiting
  
• Pale tongue, and pale, clammy, sweaty, cold skin
  
• Breathlessness, dizziness, rapid shallow breathing
  
• Extreme thirst
  
• Rapid but weak pulse, e.g. pulse rate greater than 100 in adults
  
• Unconsciousness
  

First aid

Prompt medical help is vital:

• Check response
• Conduct a verbal survey and listen carefully to what the person tells you about their injury
• Lay them down and keep them still
• Look for signs of shock
• Cover with a blanket or something to keep them warm
• Casualty’s knees may be flexed, which may help reduce the pain
• Don’t give the person anything to eat or drink
• Offer reassurance and manage any other injuries
• If the casualty vomits blood, place on their side to help eliminate
• If they becomes unconscious, place them on their side
• Monitor until the ambulance arrives

External bleeding

Signs and symptoms

• Capillary bleeding: small lacerations or abrasions that is oozing.
• Venous bleeding: lacerations bleeding freely but can be adequately controlled.
• Arterial bleeding: severe laceration spurting vigorously because the artery has been sliced causing the heart to pump out the blood with each contraction.
• Look for evidence of shock; unconsciousness; abnormal breathing; cardiac arrest.

First aid

Minor bleeding: small cuts and abrasions that are not bleeding excessively can be treated as a ‘basic wound’.

Nose bleeding: bleeding from the nose is usually not severe.

• Sit the casualty upright
• Ask them to tilt their head forward to avoid blood flowing down throat
• Using the thumb and forefinger, ask the casualty to squeeze the nostrils shut, applying direct pressure over soft part of nostrils below bridge of nose
• Remain seated and hold for at least 10 minutes
• On hot days or after exercise, it might be necessary to maintain pressure for at least 20 minutes
• Release the hold gently and check for bleeding. If the bleeding has stopped, avoid blowing your nose or picking at it for the rest of the day
• If bleeding does not stop after 20 minutes, seek medical assistance

The abdominal cavity contains solid organs like the liver and the spleen and hollow organs.

Different organs react in different ways when subjected to trauma, thus presenting different symptoms.

Signs and symptoms

Trauma related injury:

• No wound
• Possible internal bleeding, pale, cold, clammy skin
• Pain in the stomach
• Feeling sick in the stomach
• Nausea or vomiting
• Pale, cold skin
• Red flushed skin – infection
• Evidence of bleeding or obvious injury, embedded objects, protruding organs
  

Non trauma related:

• Right lower abdominal pain, evidence of mild fever – appendix
• Right upper abdominal pain – gallstones
• Referred back pain – kidneys
  
• Severe tearing mid/upper abdominal pain - artery tear
  
• Severe right or left lower abdominal pain in a female casualty - possible ectopic pregnancy

First aid

Check responses, assess for shock.

Call an ambulance and monitor until the ambulance arrives for the following:

• For shock: lay casualty down, keep still and warm.
• For severe pain: assist casualty into a comfortable position, flexed knees may help reduce pain, do not allow to eat or drink, even though they may feel extreme hunger or thirst.
• No wound: if the abdominal injury does not cause an open wound, lie the casualty flat with knees bent and treat as for shock until medical help arrives.
• Bleeding: control bleeding using direct pressure or bandages.
• Embedded object: leave it in place, pad around the object.
• Protruding organs.
• Do not push back into the abdominal cavity.
• Lie the casualty flat with their knees bent.
• Cover the organs with a moist, sterile dressing composed of material that will not stick to the affected organs.
• Plastic wrap may be used if no alternative.

Precautions - gauze can stick if it is dry - be careful to keep normal gauze moist if used. Avoid paper products like paper towel or toilet paper they will turn to pulp, causing major complications.

Mild to moderate allergic reactions are not generally life-threatening. Small singular welts, an itch, or a small localised rash, is relatively harmless. However, some mild to moderate reactions may develop further into anaphylaxis and so careful monitoring is needed.

Signs and symptoms

• Swelling and redness of the skin where the substance has had contact 
• Swelling of the throat, lips, tongue or around the eyes 
• Nausea, vomiting, dizziness 
• Itching 
• Breathing difficulty, coughing or wheezing. This may progress to an obstructed airway as the tongue and throat swell

First aid

If possible, stay with the person and ask others to get medications, action plans, adrenaline auto-injector to use if they develop anaphylaxis.

• For insect allergy, flick out the sting if it can be seen or remove ticks
• The casualty may consider self-administering their own antihistamines for relief
• If symptoms progress to anaphylaxis then adrenaline auto-injector is the only suitable medication
• Contact parent/guardian or other emergency contact
• Watch for signs of anaphylaxis

Unconsciousness is when a person is breathing, but they cannot be woken from what looks like a sleep, they are unaware of their surroundings, and no purposeful response can be obtained.

Signs and symptoms

• Does not respond, cannot answer you or wake up but is breathing
• A casualty showing only a minor response, such as groaning without opening their eyes, should be treated as being unconscious

First aid

• Assess response, e.g. (talk and touch) “open your eyes”, “squeeze my hand”, grasp and squeeze the shoulders firmly to try to get a response
• Call an ambulance
• Open the airway and check for breathing, (breathing or not breathing normally)
• Turn onto their side, keep airway open
• Control any bleeding and other injuries if required
• Monitor for changes in condition

Bandages

How to apply a roller bandage:

1. The injured person should sit or lie down
2. Position yourself in front of the casualty on their injured side
3. Support the injured body part in position before starting
4. The casualty may be able to help by holding the padding in place
5. Wrap the ‘tail’ of the bandage one full turn around the limb to anchor it
6. If there is no assistance and there is padding over a wound, wrap the ‘tail’ of the bandage directly around the padding
7. Roll upwards continuing to unwind the bandage around the limb
8. Overlap the bandage by about two thirds its width as you unwind and secure the end with tape (alternatively bandage in a ‘figure eight’ fashion)
9. Make sure the bandage isn’t too tight. Check by pressing on a fingernail or toenail of the injured limb. If the pink colour returns within a couple of seconds the bandage isn’t affecting the circulation. If the nail remains white for some  time, loosen the bandage. Keep checking and adjusting the bandage, especially if swelling is a problem

How to fold a triangular bandage:

1. Place an open triangular bandage on a clean flat surface
2. To create a broad bandage for splinting fractures of the upper legs - fold again in the same direction
3. To create a narrow fold bandage for lower leg fractures - fold one more time in the same direction
4. To create a sling - fold from the (point) to the middle of the bandage

Slings

Upper arm sling:

1. Support the injured arm in a ‘V’ so that it is held in front of their body and bent at the elbow with the hand resting in the hollow where the collarbone meets the shoulder
2. With the point of the triangular bandage positioned at the elbow, place the bandage over the top of the arm; tuck the upper point under the casualty’s fingertips
3. Pass the base of the bandage up under the forearm to create a cradle or hammock
4. Join the bandage together at the elbow and twist towards the casualty into a long spiral
5. Bring the long spiral around and then up the person’s back
6. Tie the two ends together firmly at the person’s fingertips
7. Secure at the elbow with a pin, tape or twist
8. Check circulation to the arm, wrist and fingers
9. Secure additional bandages to support the sling, if needed

Lower arm sling:

1. Support the injured forearm parallel to the ground
2. With the point of the triangular bandage at the elbow, place under the arm
3. Extend the upper point of the triangular bandage over the shoulder on the uninjured side
4. Bring the lower end of the bandage up to meet the other end and tie in the hollow of the neck just above the collarbone on the uninjured side to avoid any pressure on the neck;
5. Check for circulation to the arm and fingers

The DRSABCD action plan can be followed for all illnesses, injuries and conditions that require first aid. Adapt each step in accordance to the incident, type of injuries and the condition of the casualty.

1. Provide safety: (D)

Dangers - Ensure safety for yourself, the casualty and bystanders. Identify, assess and remove or minimise hazards. Follow infection control principles and procedures, including use of standard precautions and PPE such as gloves and masks.

2. Look for: (R)

Response - Look for a response, assess their signs and symptoms. Make a decision about their condition and what to do next. Look for evidence and obtain a history from the scene, bystanders, witnesses or the casualty if they are conscious.

3. Send for help: (S)

Arrange for the ambulance to be called and send someone to obtain resources, such as a first aid kit, as per the situation and the casualty’s condition. If there is no-one else to assist, call the ambulance yourself and assist the casualty using available resources at the scene. 

4. First aid: (ABCD)

Obtain consent. Provide first aid according to the injury or illness and within your own skills and limitations. 

Always use appropriate behaviour, respect privacy, dignity and confidentiality.  Be ethical, use cultural awareness.  Be confident and reassuring. Provide comfort.

After the incident - Communicate the details of the incident to emergency response services or the person assisting the casualty after your treatment.  Report details of incident as required. Evaluate your own performance. Be aware of the possible psychological impacts to oneself and others involved in critical incidents. Use stress management techniques, support from others and participate in debriefing as required.