SOURCE: http://www.sja.org.uk/sja/first-aid-advice/life-saving-procedures.aspx

Note: Phone number Varies.. Contact local emergency number..

Life saving procedures

As a first aider the priorities when dealing with a casualty are always the same:

• Airway
• Breathing
• Circulation.

A primary survey of a casualty will establish your priorities. When dealing with an unconscious casualty you should open and maintain their airway as your first priority. If the airway should become obstructed, possibly by the tongue falling to the back of the throat, then the casualty will be unable to breathe and this will lead to death if untreated.

If the casualty is breathing, the simple procedure of placing the casualty in to the recovery position should ensure that the airway will remain clear of obstructions.

If the casualty has stopped breathing you can assist them by performing a combination of chest compressions and rescue breaths. You breathe out enough oxygen to potentially keep the casualty alive until the emergency services arrive, the oxygen you breathe into the casualty will need to then be pumped around the body using chest compressions.

It is important to remember that in any life threatening situation the emergency services should be called as soon as breathing or absence of breathing has been identified.

1. The primary survey

Danger

Are you or the casualty in any danger? If you have not already done so, make the situation safe and then assess the casualty.

Response

If the casualty appears unconscious check this by shouting

‘Can you hear me?’, ‘Open your eyes’
and gently shaking their shoulders.

If there is a response:

· If there is no further danger, leave the casualty in the position found and summon help if needed.

· Treat any condition found and monitor vital signs - level of response, pulse and breathing.

· Continue monitoring the casualty either until help arrives or he recovers.

If there is no response:

· Shout for help.

· If possible, leave the casualty in the position found and open the airway.

· If this is not possible, turn the casualty onto their back and open the airway.

Airway

Open the airway by placing one hand on the casualty’s forehead and gently tilting the head back, then lift the chin using 2 fingers only.

This will move the casualty's tongue away from the back of the mouth.

Breathing

· Look, listen and feel for no more than 10 seconds to see if the casualty is breathing normally.

· Look to see if the chest is rising and falling. Listen for breathing.

· Feel for breath against your cheek.

If the casualty is breathing normally , place them in the recovery position.

· Check for other life-threatening conditions such as severe bleeding and treat as necessary.

If the casualty is not breathing normally or if you have any doubt whether breathing is normal begin CPR:

· CPR for adults

o If you have someone with you, send them to Dial 999 (or 112) for an ambulance immediately.

o If you are alone Dial 999 (or 112) for an ambulance immediately and then return to help the casualty.

· CPR for children (1 year to puberty)

o If you have someone with you, send them to Dial 999 (or 112) for an ambulance immediately.

o If you are on your own carry out CPR for 1 min before dialling 999 (or 112) for an ambulance.

· CPR for babies (birth to 1 year)

o If you have someone with you, send them to Dial 999 (or 112) for an ambulance immediately.

o If you are on your own carry out CPR for 1 min before dialling 999 (or 112) for an ambulance.

Agonal breathing

This is common in the first few minutes after a sudden cardiac arrest. It usually takes the form of sudden irregular gasps for breath. It should not be mistaken for normal breathing and if it is present chest compressions and rescue breaths (together called cardio-pulmonary resuscitation or CPR) should be started without hesitation.

Related topics

· CPR

· Recovery position

Please note:

These hints are no substitute for thorough knowledge of first aid! St John Ambulance holds first aid courses throughout the country.

2. Cardio-Pulmonary Resuscitation (CPR)

Adult

• If you have someone with you, send them to dial 999 (or 112) for an ambulance immediately.
• If you are alone dial 999 (or 112) for an ambulance immediately and then return to help the casualty.

Give 30 chest compressions

• Place heel of your hand in the centre of the chest.
• Place other hand on top and interlock fingers.
• Keeping your arms straight and your fingers off the chest, press down by 4-5cms. then release the pressure, keeping your hands in place.
• Repeat the compressions 30 times, at a rate of 100 per minute.

Give 2 rescue breaths.

• Ensure the airway is open.
• Pinch nose firmly closed.
• Take a deep breath and seal your lips around the casualty’s mouth.
• Blow into the mouth until the chest rises.
• Remove your mouth and allow the chest to fall.
• Repeat once more.

Continue resuscitation, 30 compressions to 2 Rescue Breaths.

Do not stop unless:

• Emergency help arrives and takes over.
• The casualty breathes normally or
• You become so exhausted that you cannot carry on

3. Cardio-Pulmonary Resuscitation (CPR)

Children

A child is considered to be between one year to puberty for the purposes of these instructions. It is neither necessary nor appropriate to check if a child has reached puberty.

• If you have someone with you, send them to dial 999 (or 112) for an ambulance immediately.
• If you are on your own carry out CPR for 1 min before dialling 999 (or 112) for an ambulance.

Give 5 rescue breaths

• Ensure the airway is open.
• Seal your lips around the child’s mouth while pinching the nose.
• Blow gently into the lungs, looking along the chest as you breathe. Take shallow breaths and do not empty your lungs completely.
• As the chest rises, stop blowing and allow it to fall.
• Repeat four more times then check for circulation.

Give 30 chest compressions

• Place 1 or 2 hands in the centre of the chest (depending on the size of the child.
• Use the heel of that hand with arms straight and press down to a third of the depth of the chest.
• Press 30 times, at a rate of 100 compressions per minute.
• After 30 compressions, give 2 rescue breath.

Continue resuscitation (30 compressions to 2 rescue breaths) without stopping until help arrives.

4. Cardio-Pulmonary Resuscitation (CPR)

Infants

A baby is considered to be less than 1 year old for the purposes of these instructions.

• If you have someone with you, send them to dial 999 (or 112) for an ambulance immediately.
• If you are on your own carry out CPR for 1 min before dialling 999 (or 112) for an ambulance.

Give 5 rescue breaths:

• Ensure the airway is open.
• Seal your lips around the baby’s mouth and nose.
• Blow gently into the lungs, looking along the chest as you breathe. Fill your cheeks with air and use this amount each time.
• As the chest rises, stop blowing and allow it to fall.
• Repeat this 5 times.

Give 30 chest compressions:

• Place the baby on a firm surface.
• Locate a position in centre of the chest.
• Using 2 fingers, press down sharply to a third of the depth of the chest.
• Press 30 times, at a rate of 100 compressions per minute.
• After 30 compressions, give 2 Rescue Breath.
• Continue resuscitation (30 compressions to 2 rescue breath) without stopping until help arrives.

5. The recovery position

Baby

A baby is considered to be less than 1 year old for the purposes of these instructions.

For a baby less than a year old, a modified recovery position must be adopted.

Cradle the infant in your arms, with his head tilted downwards to prevent him from choking on his tongue or inhaling vomit.

Monitor and record vital signs - level of response, pulse and breathing until medical help arrives.

Child/adult

Anyone over the age of 1 year old for the purpose of these instructions.

An unconscious casualty who is breathing but has no other life- threatening conditions should be placed in the recovery position.

• Turn casualty onto their side.
• Lift chin forward in open airway position and adjust hand under the cheek as necessary.
• Check casualty cannot roll forwards or backwards.
• Monitor breathing and pulse continuously.
• If injuries allow, turn the casualty to the other side after 30 minutes.

6. Choking

A foreign object that is stuck at the back of the throat may block the throat or cause muscular spasm.

Young children especially are prone to choking. A child may choke on food, or may put small objects into their mouth and cause a blockage of the airway.

If the blockage of the area airway is mild, the casualty should be able to clear it; if it is severe they will be unable to speak, cough, or breathe, and will eventually lose consciousness.

Recognition

Mild obstruction

• Casualty able to speak, cry, cough or breathe.

Severe obstruction

• Casualty is unable to speak, cry, cough or breathe.
• Casualty will eventually become unconcious without assistance.

Treatment for adult or child

Your aims are to remove the obstruction and to arrange urgent removal to hospital if necessary.

If the obstruction is mild

• Encourage them to continue coughing.
• Remove any obvious obstruction from the mouth.

If the obstruction is severe

• Give up to 5 Back blows.
• Check the mouth and remove any obvious obstruction.

If the obstruction is still present:

• Give up to 5 abdominal thrusts.
• Check the mouth and remove any obvious obstruction.

If the obstruction does not clear after three cycles of back blows and abdominal thrusts:

• Dial 999 (or 112) for an ambulance.
• Continue until help arrives.

Treatment for infants

Your aims are to remove the obstruction and to arrange urgent removal to hospital if necessary.

If the infant is distressed, is unable to cry cough, or breathe:

• Lay them face down along your forearm, with their head low, and support the back and head.
• Give up to 5 back blows, with the heel of your hand.
• Check the infant's mouth; remove any obvious obstructions.
• Do not do a finger sweep of the mouth.

If the obstruction is still present:

• Turn the infant onto his back and give up to 5 chest thrusts.
• Use two fingers, push inwards and upwards (towards the head) against the infants breastbone, one finger's breadth below the nipple line.
• The aim is to relieve the obstruction with each chest thrust rather than necessarily doing all five.
• Check the mouth.

If the obstruction does not clear after three cycles of back blows and chest thrusts:

• Dial 999 (or 112) for an ambulance.
• Continue until help arrives.