CHAPTER - I

General Principles: (APPENDIX 1 & APPENDIX 2 (PAGES 1-3))

First aid is the immediate and on the spot care (treatment to the Casualty at or after calamity (distress), disaster
(great misfortune) or large-scale destruction)
It is first golden hour medical attendance to a stick, injured, disordered,
Biologically effected, chemically toxified or radiation mutilated.

Considering the ways of life of a seafarer or mariner has to understand that there are several reasons
other than physical and mental distress and there are many other great misfortunes, which affect the life of every
seaman. If we take for example and for one instance of hazard that many of the cargo we transport are such that
it needs expertise in terms of industrial safety.

On the other hand the marine (such as captain/chief engineer/electrical officer or part
authority) have their own difficult duties to perform and among other things may not be able give full time attention
and special shipping technical exportations support in terms handling and hence this adds to the chances of human
error.
A lower rank cargo handler has very little expertise in the matter of pollution, toxicology, poison and radiation and
it can not expected of him to give his full personal little importance personnel and social safety and then there is
the Act of “God & Nature” which becomes unpredictable and then again there are the dangers of human
error and engineering challenges.
First Aid is the emergency treatment given to the ill or injured before professional medical services can be
obtained. It is given to prevent death or further injury, to counteract shock, and to relieve pain. Certain
conditions, such as severe bleeding or asphyxiation require immediate treatment if the patient is to survive.
In such cases even a few seconds delay might mean the difference between life and death. However, the
treatment of most injuries or other medical emergencies maybe safely postponed for the few minutes required
to locate a crew member skilled in First aid or to locate suitable medical supplies and equipment.
All crew member should be prepared to administer first aid. They should have sufficient knowledge of first aid
to be able to apply true emergency measures and decide when treatment can be safely delayed until more
skilled personnel arrived. Those not properly trained must re-organize their limitations. Procedures and
techniques beyond the rescuers ability should not be attempted.
A badly managed casualty and denial of proper golden hour professionalism in the
knowledge of medical first aid can cause loss of human life.

Many an employment has come to end due to the disability suffered during employment.

Aims of First Aid:

 Preserve quality of life

 Prevent conditions leading to worsening
 Assist and promote early quality recovery
 Assist safer, faster and more accurate and programmed evaluation and proper evacuation of
casualty at sea.
 Taking into account the normal and abnormal situations arising in the tenure of employment of the
seafarer

Priorities:

On finding a casualty:

 Look to your safety, do not become the next casualty

 Raise the alarm or send someone for help
 If necessary remove the casualty from danger or remove danger from the casualty (not in an enclosed
space)
 If there are more than one casualty :
 Send for help
 Start giving appropriate treatment to the worst casualty in the following order or priorty : sever
bleeding, stopped breathing/heart; unconsciousness.
 If the casualty is in an enclosed space do not enter the enclosed space.
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OBJECTIVE
To effect and achieve.
 Preservation of life of the Victim
 Promote early and quality recovery.
 Prevent deterioration
 Golden hour care, record communication and effective transport viz a viz.
calamity at sea.

DUTIES
• Quickly, calmly and methodically assess the critical
situations
Decided an appropriate action
• Check closely the pulse and respiration
• Give proper CPR. immediately and correctly, when crises demand.
• Check and/or preventive, small or great bleeding.
• Effect rescue.
• Arrange for immediate specialized medical attendance

NORMAL or VITAL PARAMETER

HUMANBODY:
• Temperature 98.4°For37°C
• Pulse Rate 70 to 80 beat per minute
• Heart Rate 70 to 80 strokes per minute
• Blood Pressure 120/80mmHg.
• Respiratory 12 to 14 breaths per minute

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BODY STRUCTURE AND FUNCTIONS (REFER TO APPENDIX 1 & APPENDIX 2 (PAGES
53-60))

1. It is the hard tough with smaller amount of elastic material forming a skeleton of the
vertebrate humans.
2. It is specialized connective tissues composed of body tissues containing large amounts
of calcium salts and other organic and inorganic substances.

3. There are in the adult human body round about 206 bones.

The skeletal system gives natural form and gross structure of human frame.

It gives active support and protection to tissue and organs

It has marrow.
Marrow is where red blood cells are formed.
Resulting, decay infection, and death of bone results.
In diabetics the decay infection and the death of bone is a serious condition and one has to be very
careful in the control of diabetes, trench foot or/and vascular disease, etc.

SKULL: The flat bones of the vault of the skull protect the brain and besides thislhe temporal
bones on each side of a face play an equally important role.

In the case of injury sustained by the head, it is vitally important to examine the various functions of
the brain, very carefully and the Casualties, mental and physical thought during long duration of time
It is not always easy to remember all the names of the bones in the human body. It can very well do to
substitute, familiarize, summaries and locations point out aiid as later as time goes by you can get
used to the internationally codified names used to the purpose of expert medical attention.
MANDIBLES : Bone of the lower jaw, which helps in eating, taking and it also, gives shape to the face
among other things. You can feel it your own face.It can get easily brown next to bones
of the nose and cheek and can be easily given first aid.

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CLAVICLE : It is thus bone which you see under your shirt collar, one on each side, elongated,
slender, horizontal and curved. It is at the very upper part of the chest, just below the
neck, and chest join together. Its medial ends on either side are placed where a tie
knot is tied across the collar.

The importance of the shoulder bone is that it easily gets broken, It is also very easily treated and
where the risk to any Casualty can be overcome,

STERNUM Flat bone situated in the front of the chest wall Body mark where at some last time
you will be called on to identify and apply special knowledge of C.P.R. (also see
Cardiac arrest.)

RIBS Thin narrow curved bones felt in the chest in pairs of ribs that hold the lungs and
heart in this rib cargo (/cage of ribs)

SPINE or VERTEBRAL COLUMN

Supports, weight of: e

Skull
Upper extremities
Trunk

VERTEBRAE :

Cervical 07
Thoracic 12
Lumbar 05
Sacral 05
Coccygeal 01 to 04

SCAPULA : The pair of thin wide flat and spined triangular bone for the shoulder situated at the back of
the chest wall and connected to each ipsilateral clavicles and humerus bones.

EXTREMITY
(UPPER):
long bone of upper arm long bone
• Humerus of for arm long bone of for
• Radius arm 08-bones of wrist
• Ulra 05-bones of an arm bones
• Carpel of fingers and thumb
• Metacarpal
• Phalanges

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PELVIS :

It is formed by the two hip bones and its sacrum which support-abdominal organs including
intestines, urinary bladder and the uterus for a female body and other organs inside any
human abdomen.

EXTREMITY (LOWER):

Pelvis and him Broade bone of the skeleton. Originally composed 3

bones
Femur Long bone of thigh
Patella Knee cap
Tibia Long bone of lower leg.
Fibuls Long bone of lower leg
Talus Ankle bone
Tarsal 07 in number, in foot
Metatarsal 05 in number in foot
Phalanges Bones of the toes of the foot

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Page : 6
Joints, Muscle and Tendons:

In order for movement to occur, the muscles, bones, tendons and ligaments must all work together in
response to signals from the brain. If there is any disease or condition that interrupts the nerves'
signals or if there is any injury to any of these structures, movement can be hindered. To help keep the
body healthy and active it is important to understand what tendons, ligaments and muscles are, the
role they play in movement and how to prevent injury.

Tendons

Tendons are tough bands of connective tissue found in the joints. They connect muscles to bones.
Each muscle has tendons attached at each end. Tendons are designed to only stretch a small amount.
Their job is to transmit force between the bones and the muscles. For example, when the biceps
muscle on the front top of the arm contracts, the tendon attached to the biceps muscle and elbow bone
helps the muscle to pull on the elbow bones so the joint can bend.

Ligaments

Ligaments are made of the same material as tendons. Ligaments connect the bones to each other, and
are designed to help stabilize the joints and provide a structure for the bones. Since they have limited
stretching ability, they limit how far a joint moves to help protect against injury. As the elbow joint
bends, the ligaments stabilize the elbow bones so the arm can move with control.

Muscles

There are three main types of muscles: skeletal muscles, which can be voluntarily controlled,
involuntary smooth muscles, such as those that control breathing, digestion and other functions, and
involuntary cardiac muscles, which control the function of the heart. Skeletal muscles travel across
the length of joints and stretch between the bones. All muscles in the body contract or shorten when
they receive nerve signals initiated by the brain.

Considerations

All voluntary movement starts with an electrical impulse in the brain. The brain sends signals via the
nervous system that make the appropriate muscles respond. Some muscles contract and shorten, other
muscles relax and still others stabilize the movement. As a muscle contracts, the force travels through
the muscle and out through the tendon, which tightens and pulls on the bones that need to move.

Injuries

Muscles, tendons and ligaments can all suffer injuries as the result of a direct blow or or from overuse.
Ligaments can be overstretched; this is called a strain. A strain can involve just partial tears to the
ligament or a compete tear. Muscle and tendon injuries are called sprains and occur when they are
overworked or stretched too far. A strain can be either a partial or full tear. These injuries are common
in high-intensity sports and require treatment to avoid chronic problems. Tendons, ligaments and
muscles can all be stretched and strengthened to help avoid injuries.

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Major Organs:

Brain:

The human brain is the command center for the human nervous system. It receives input from the
sensory organs and sends output to the muscles. The human brain has the same basic structure as
other mammal brains, but is larger in relation to body size than any other brains.

Your brain contains billions of nerve cells arranged in patterns that coordinate thought, emotion,
behavior, movement and sensation. A complicated highway system of nerves connects your brain to
the rest of your body, so communication can occur in split seconds.
Parts of a brain in brief:

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  The cerebru
T um is the larrgest part off the brain and
a is compposed of righ ht and left
h
hemispheres s. It perform
ms higher funnctions likee interpretinng touch, vission and heaaring,
as well as sppeech, reasooning, emotiions, learninng, and finee control of movement.

 TThe cerebelllum is locaated under thhe cerebrum m. Its functioon is to coo

ordinate musscle
mmovements, maintain posture,
p and balance.
 TThe brainsttem includes the midbrrain, pons, anda medullaa. It acts as a relay centter
cconnecting the
t cerebrum m and cerebbellum to thhe spinal corrd. It perforrms many
aautomatic fuunctions succh as breathhing, heart raate, body teemperature, wake and sleep
s
ccycles, digesstion, sneezzing, coughiing, vomitinng, and swallowing. Teen of the tweelve
ccranial nervees originatee in the brainnstem.

Hearrt:

The human
h hearrt is an orgaan that pumpps blood thrroughout the body via the
t circulatoory system,,
supplying oxygeen and nutriients to the tissues and removing carbon
c dioxxide and other wastes.

"Thee tissues of tthe body need a constannt supply off nutrition inn order to bbe active," said Dr. Law
wrence
Philllips, a cardioologist at NYU
N Langonne Medical Center in NewN York. ""If [the hearrt] is not ablle to
supply blood to the organs and tissues,, they'll die.."

man heart aanatomy

Hum

In huumans, the heart

h is rougghly the sizee of a large fist
f and weighs betweenn about 10 to
t 12 ounces (280
to 3440 grams) inn men and 8 to 10 ouncces (230 to 280 2 grams) in women, according tot Henry Grray's
"Anaatomy of thee Human Boody."

The physiology
p of the heartt basically comes
c downn to "structuure, electricity and plum
mbing," Phiillips
told Live
L Sciencce. The hum man heart is about the size of a fist.

The human
h hearrt has four chambers:
c tw
wo upper chhambers (thhe atria) andd two lower ones (the
ventrricles), accoording to thee National Institutes
I off Health. Thhe right atriuum and righht ventricle
togetther make upu the "rightt heart," andd the left atrrium and lefft ventricle make up the "left heartt." A
wall of muscle ccalled the seeptum separrates the two sides of thhe heart.

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A double-walled sac called the pericardium encases the heart, which serves to protect the heart and
anchor it inside the chest. Between the outer layer, the parietal pericardium, and the inner layer, the
serous pericardium, runs pericardial fluid, which lubricates the heart during contractions and
movements of the lungs and diaphragm.

The heart's outer wall consists of three layers. The outermost wall layer, or epicardium, is the inner
wall of the pericardium. The middle layer, or myocardium, contains the muscle that contracts. The
inner layer, or endocardium, is the lining that contacts the blood.

The tricuspid valve and the mitral valve make up the atrioventricular (AV) valves, which connect the
atria and the ventricles. The pulmonary semi-lunar valve separates the right ventricle from the
pulmonary artery, and the aortic valve separates the left ventricle from the aorta. The heartstrings, or
chordae tendinae, anchor the valves to heart muscles.

The sinoatrial node produces the electrical pulses that drive heart contractions.

Lungs:

The lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax). The
trachea (windpipe) conducts inhaled air into the lungs through its tubular branches, called bronchi.
The bronchi then divide into smaller and smaller branches (bronchioles), finally becoming
microscopic.

The bronchioles eventually end in clusters of microscopic air sacs called alveoli. In the alveoli,
oxygen from the air is absorbed into the blood. Carbon dioxide, a waste product of metabolism,
travels from the blood to the alveoli, where it can be exhaled. Between the alveoli is a thin layer of
cells called the interstitium, which contains blood vessels and cells that help support the alveoli.

The lungs are covered by a thin tissue layer called the pleura. The same kind of thin tissue lines the
inside of the chest cavity -- also called pleura. A thin layer of fluid acts as a lubricant allowing the
lungs to slip smoothly as they expand and contract with each breath.

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Circulatory System:

All cells in the body need to have oxygen and nutrients, and they need their wastes removed. These
are the main roles of the circulatory system. The heart, blood and blood vessels work together to
service the cells of the body. Using the network of arteries, veins and capillaries, blood carries carbon
dioxide to the lungs (for exhalation) and picks up oxygen. From the small intestine, the blood gathers
food nutrients and delivers them to every cell.

Arteries

Oxygenated blood is pumped from the heart along arteries, which are muscular. Arteries divide like

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tree branches until they are slender. The largest artery is the aorta, which connects to the heart and
picks up oxygenated blood from the left ventricle. The only artery that picks up deoxygenated blood
is the pulmonary artery, which runs between the heart and lungs.

Capillaries

The arteries eventually divide down into the smallest blood vessel, the capillary. Capillaries are so
small that blood cells can only move through them one at a time. Oxygen and food nutrients pass from
these capillaries to the cells. Capillaries are also connected to veins, so wastes from the cells can be
transferred to the blood.

Veins

Veins have one-way valves instead of muscles, to stop blood from running back the wrong way.
Generally, veins carry deoxygenated blood from the body to the heart, where it can be sent to the
lungs. The exception is the network of pulmonary veins, which take oxygenated blood from the lungs
to the heart.

Heart Rate - Heart Beat - Pulse (minute to minute bases)

Normal Heart beat / Pulse around

The blood exerts pressure on the walls of the arteries into which viscous blood is pushed. The contraction
the heart is largely instrument in maintaining this pressure The pressure varies with periodic activity of
the heart, the person's the individual Blood pressure falls during sleep.

Blood Pressure in millimetres of mercury is around 120/80 mm Hg.

Person examined must be at rest both, mentally and physically
The blood pressure is generally examined in laying down position
Blood pressure is commonly examined at any upper arm

Otherwise Systolic: - 120 mm Hg.

Diastolic : - 80mm Hg.

BLOOD: The red viscid fluid filling the heart and the blood vessels and it consists of colorless fluid
called plasma and in which are suspended the red blood corpuscles or erythrocytes and
the whole which blood cells are the leukocytes and the platelets or thromobocytes. The
human body has a volume of 5 or 6 litres of blood.

Circulatory system consists of the heart, blood vessels and lymphatic system. Circulation

inside the different compartments of the heart. By the act of the valves of the veins pulling

the capillary blood back, blood reaches the heart with each cycle of circulating blood.

Oxygenated blood on its return enters the left atrium and then it then enters the left ventricle.

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CHAPTER II
CASUALTY:

DEFINITION: Any person, group, thing, etc., that is harmed or destroyed as a result of some act or
event OR a serious accident, especially one involving bodily injury or death

POSITIONING OF THE CASUALTY (REFER TO ALSO APPENDIX 1 &

APPENDIX 2 (PAGES 6))

It is necessary to perform a quick and efficient examination of the patient to diagnose his
condition & lo give effective first aid.
The history may be obtained from the patient himself or from on lookers if the patient is
unconscious. The complaints of the patient is taken as clue to the nature of injury sustained.
 PULSE - note the pulse for its rate, rhythm, volume and tension
 BREATHING - note if breathing is slow/fast, absent or gasping
 PALLOR - note Pallor or the degree of whiteness of tongue, conjunctiva & nails. This
indicates the severity of bleeding.

 Blueness of tongue, lips, ear lobe and nail - Indicates lack of oxygen

 Bleeding from any part of body -

 Swelling

A head to toe examination should be done

HEAD:
 Observe skin color, wound, contusion and facially symmetry

 Assess level of consciousness

 Check pupils

 Palpate for depression of skull

 Check ears & nose for fluid or blood

 Check mouth for bleeding & any foreign body & dentures

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NECK :
Observe and palpate for areas of tenderness & deformity

ARMS:
 Palpate entire length for pain, wounds, deformity & sensation
 Ask about paid, tingling, numbness & movement

CHEST:
 Palpate clavicles & shoulders

 Observe for wounds & whether chest expands normally upon inspiration
 Press gently on sternum & ribs to check integrity

ABDOMEN
• Observe for distention or wounds
• Palpate for rigidity & tenderness

PELVIS
 Palpate iliac crest & pubis for pain

 Observe for incontinence of bladder & bowel

SPINE :
• Palpate for tenderness, wounds & deformity

LEG:
 Palpate entire length for pain, deformity, wound & sensation
 Ask about pain, tingling, numbness & movement

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 TREATMENT :
TO PRESERVE LIFE
 Maintain a clear airway by positioning casualty correctly
 Begin resuscitation if there is no pulse & respiration
 Control bleeding

TO PREVENT THE CONDITION WORSENING

 Dress wounds
 Immobilize fractures
 Nurse the patient in correct positions in consistent with the treatment

TO PROMOTE RECOVERY :
 Reassure the casualty & relieve anxiety & fears

 Relieve pain and discomfort

 Handle casualty gently

 Protect the casualty from cold & wetness

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VARIOUS POSITION OFTHE PATIENT:
1. Recovery position
2. Prone position
3. Positioning in shock
4. Fowlers position
5. Resuscitation Position (Supine Position)

 The Recovery position

If a person is unconscious but is breathing and has no other life-threatening conditions, they
should be placed in the recovery position.

Putting someone in the recovery position will keep their airway clear and open. It also ensures that any
vomit or fluid won't cause them to choke.

The video on this page shows a step-by-step guide to putting someone in the recovery position.

Or you can follow these steps:

 with the person lying on their back, kneel on the floor at their side
 place the arm nearest you at a right angle to their body with their hand upwards, towards
the head
 tuck their other hand under the side of their head, so that the back of their hand is touching
their cheek
 bend the knee farthest from you to a right angle
 carefully roll the person onto their side by pulling on the bent knee
 the top arm should be supporting the head and the bottom arm will stop you rolling them
too far
 open their airway by gently tilting their head back and lifting their chin, and check that
nothing is blocking their airway
 stay with the person and monitor their condition until help arrives

Spinal injury:

If you think a person may have a spinal injury, don't attempt to move them until the emergency
services reach you.

If it's necessary to open their airway, place your hands on either side of their head and gently lift their
jaw with your fingertips to open the airway. Take care not to move their neck.

You should suspect a spinal injury if the person:

 has been involved in an incident that's directly affected their spine, such as a fall from height
or being struck directly in the back
 complains of severe pain in their neck or back
 won't move their neck
 feels weak, numb or paralyzed

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  has lost control of their
limbs, bladder or bowels

 Prone position (/pro�n/) is a body position in which

one lies flat with the chest down and the back up. In
anatomical terms of location, the dorsal side is up, and
the ventral side is down. The supine position is the 180°
contrast.

 Shock Position: The shock position is the position of a person who is lying flat on his or
her back with the legs elevated approximately 8-12
inches. This is used when a patient is showing signs of
shock. The shock position is also used for patients
experiencing heat related emergencies

 Fowlers’ Position: There are several types of Fowler's

positions: Low, Semi, Standard, and High Fowler's. Low
Fowler's position is when the head of bed is elevated 15-30
degrees, Semi-Fowler's position is 30-45 degrees, Standard
Fowler's is 45-60 degrees, and High Fowler's position is
80-90 degrees.

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  Resuscitation Position (Supine Position):
The patient lies with his or her back
(face-up).

This is the most natural position for the

body at rest and best used for CPR.

USED FOR:
Procedures of the anterior body such as:

 abdominal
 thoracic
 facial
 anterior upper and lower
extremity procedures
 CPR

POSITIONING STEPS:

1. Make sure there is a draw sheet on the OR table, and that it extends over the sides of the bed
with enough material to tuck the arms or wrap the sheet around the patient if needed. This is
also useful to assist in moving the patient.
2. The patient is transferred from the stretcher to the bed with assistance, and lays with his or her
back resting on the OR table (face up position).
3. Legs are extended and maintained in the long axis of the body, uncrossed at the ankles, with
feet slightly apart. A blanket or pillow may be placed under the knees to relieve lumbar strain,
with a small pillow or roll under the ankles, or egg crate under the heels, to relieve any
pressure from this area.
4. The head is positioned neutrally with c-spine alignment to prevent instability and nerve
damage. Careful attention is given to the back of the head, eyes, ears, and nose to prevent
compression injuries. Consider using a foam donut for underneath of the head. The chin
should be 2-3 fingerbreadths from the torso.
5. The patient is secured to the table with safety belt or wide 3 Inch Tape over a pad, across the
thighs, mid-thigh, to 2 inches above the knees. This is suitable for upper torso, lower
abdominal or groin surgery.
6. The patient can also be secured to the table by placing the belt or tape across the hips, between
the iliac crests and head of the femurs, so as not to cause aseptic necrosis - of the femur
head. This is suitable as an exception to the usual placement, in cases where surgery on the
extremities is being performed, or in cases where the belt cannot be placed at the thighs.
7. The arms are padded and positioned to prevent nerve stretch or compression, in a specific
positioning manner as dictated by the surgery and patient situation. Always check with
surgeon before final positioning.

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 THE UNCONCIOUS CAUSALTIES : (REFER TO APPENDIX 1 & APPENDIX 2
(PAGES 3-6))
 DEFINITION
Unconsciousness is a state of complete loss of consciousness and the casualty is totally
unresponsiveness to any painful stimulus. He is unaware of surroundings and his body muscles are in
a complete state of relaxation.
 Unconsciousness is due to interference with the functions of the brain.
 Seriousness can be determined by testing the casualty's response to stimuli such as sound or
touch or pain.

CAUSES OF UNCONSCIOUSNESS:
 Brain injuries
 Fits or convulsion
 Syncope or lack of cerebral circulation
 Infection of the coverings of the brain or tissues of brain
 Brain tumors
 Exposure to extreme cold
 Exposure to extreme heat
 Severe infections
 Severe injuries
 Severe burns
 Severe reaction
 Electric shock
 Failure of liver or kidney
 Poisoning with chemical gas or alcohol
 Severe heart attack
 Drowning
 Diabetes or over does of insulin
 Severe bleeding of fluid loss

LEVELS OF RESPONSIVENESS
There are the stage through which person may pass during progression from
consciousness to unconsciousness or vice versa.
Stage I - He may respond normally to questions and conversations
Stage II - He answers direct questions

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Stage III - He responds vaguely to questions
Stage IV - He obeys commands
Stage V - He responds to pain only
Stage VI - He does not respond at all

Administering First Aid

If you see a person who has become unconscious, take these steps:

 Check whether the person is breathing. If they are not breathing, have someone call 911
immediately. If they are breathing, position the person on their back.
 Raise the person’s legs at least 12 inches above the ground.
 Loosen any restrictive clothing or belts.
 Check the person’s airway to make sure there’s no obstruction.
 Check again to see if the person is breathing, coughing, or moving. These are signs of positive
circulation. If these signs are absent, perform cardiopulmonary resuscitation (CPR) until
emergency personnel arrive.

CPR Instructions

Cardiopulmonary resuscitation (CPR) is a way to treat someone when they stop breathing or their
heart stops beating.

 Lay the person on their back on a firm surface.

 Kneel next to the person’s neck and shoulders.
 Place the heel of your hand over the center of the person’s chest. Put your other hand directly
over the first one and interlace your fingers. Make sure that your elbows are straight and move
your shoulders up above your hands.
 Using your upper body weight, push straight down on the person’s chest at least 1.5 inches for
children, or 2 inches for adults. Then release the pressure. Repeat this procedure again up to
100 times per minute. These are called chest compressions.

To minimize potential injuries, only those trained in CPR should perform rescue breathing. If you
haven’t been trained, perform chest compressions until medical help arrives.

If you are trained in CPR, tilt the person’s head back and lift the chin to open up the airway.

 Pinch the person’s nose closed and cover their mouth with yours, creating an airtight seal.
 Give two one-second breaths and watch for the person’s chest to rise.
 Continue alternating between compressions and breaths — 30 compressions and two breaths
— until help arrives or there are signs of movement.

How Is Unconsciousness Treated?

If unconsciousness is due to low blood pressure, a doctor will administer medication by injection to
increase blood pressure. If low blood sugar level is the cause, they may need something sweet to eat or
a glucose injection.

Medical staff should treat any injuries that caused the person to become unconscious.

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Complications of Unconsciousness

Potential complications of being unconscious for a long period of time include:

 coma
 brain damage

If you received CPR while unconscious, you may have broken or fractured ribs from the chest
compressions.

Choking can also occur during unconsciousness. Food or liquid may have blocked your airway. This
is particularly dangerous and could lead to death if it isn’t remedied.

Position of an Unconscious Casualty:

 Breathing Unconscious Casualty

 Unconscious Casualty not Breathing:

Carry on giving 30 chest compressions followed by two rescue breaths for as long as you can, or
until help arrives. If the casualty starts breathing normally again, stop CPR and put them in the
recovery position.

 Unconscious Casualty with Cardiac Arrest: A cardiac arrest occurs when the heart
suddenly stops pumping blood around the body. Someone who is having a cardiac arrest will
suddenly lose consciousness and will stop breathing or stop breathing normally. Unless
immediately treated by CPR this always leads to death within minutes or by using a device
called a defibrillator.

 NO FOOD OR LIQUID OR ANY OTHER SUBSTANCE SHOULD BE

ADMINISTERED TO AN UNCONSCIOUS CASUALTY.

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 CHAPTER III

RESUSCITATION: (REFER TO APPENDIX 1 & APPENDIX 2 (PAGES 6-14))

 Definition: to revive (someone) from unconsciousness or apparent death.

Cardiopulmonary resuscitation, commonly known as CPR, is an emergency procedure that

combines chest compression often with artificial ventilation in an effort to manually preserve intact
brain function until further measures are taken to restore spontaneous blood circulation and
breathing in a person who is in cardiac arrest. It is indicated in those who are unresponsive with no
breathing or abnormal breathing, for example, agonal respirations. According to the International
Liaison Committee on Resuscitation guidelines, CPR involves chest compressions for adults
between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120 per minute. The
rescuer may also provide artificial ventilation by either exhaling air into the subject's mouth or nose
(mouth-to-mouth resuscitation) or using a device that pushes air into the subject's lungs
(mechanical ventilation). Current recommendations place emphasis on high-quality chest
compressions over artificial ventilation; a simplified CPR method involving chest compressions
only is recommended for untrained rescuers. In children only doing compressions may result in
worse outcomes.

 CPR alone is unlikely to restart the heart; Its main purpose is to restore partial flow of
oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend
the brief window of opportunity for a successful resuscitation without permanent brain
damage. Administration of an electric shock to the subject's heart, termed defibrillation, is
usually needed in order to restore a viable or "perfusing" heart rhythm. Defibrillation is
effective only for certain heart rhythms, namely ventricular fibrillation or pulseless
ventricular tachycardia, rather than a-systole or pulseless electrical activity. CPR may
succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued
until the person has a return of spontaneous circulation (ROSC) or is declared dead.
 A universal compression to ventilation ratio of 30:2 is recommended

How do you do chest compressions?

Place the heel of your hand on the mid chest (lower half breastbone/sternum). Then place
your other hand on top. With shoulders back, straighten your arms, lean directly over the
person, and lock your elbows. Use straight-down pressure through both arms to push
breastbone down toward the spine, at least 2 in./5 cm

What is the ratio of compressions to rescue breaths?

After every 30 chest compressions at a rate of 100 to 120 per minute, give two breaths. Continue
with cycles of 30 chest compressions and two rescue breaths until they begin to recover or
emergency help arrives.

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 Function of Reclined Position of head: Basic airway management are a set of medical
procedures performed in order to prevent airway obstruction and thus ensuring an open
pathway between a patient’s lungs and the outside world. This is accomplished by clearing
or preventing obstructions of airways, often referred to as choking, cause by the tongue, the
airways themselves, foreign bodies or materials from the body itself, such as blood or
aspiration. Contrary to advanced airway management; minimal-invasive techniques does
not rely on the use of medical equipment and can be performed without or with little
training. Airway management is a primary consideration in cardiopulmonary resuscitation,
anesthesia, emergency medicine, intensive care medicine and first aid.

 Mouth to Mouth Resuscitation:

MOUTH TO MOUTH To perform mouth-to-mouth ventilation, take the following steps:

1. Clear the victim’s mouth of obstructions (false teeth and foreign matter).

2. Place the heel of one hand on the victim’s forehead, and use the other hand placed
under the chin to tilt back the head to open the airway.

3. Using the thumb and index finger, pinch the nostrils shut. 4. Take a deep breath, cover
the victim’s mouth with your own, and blow. 5. Then remove your mouth from the victim
to allow him or her to exhale. Observe the victim’s chest for movement. If the victim hasn’t
started to breathe normally, start artificial ventilation with four quick ventilations in
succession, letting the lungs inflate only partially. If the victim still doesn’t respond, then
you must fully inflate the victim’s lungs at the rate of 12 to 15 ventilations per minute, or
one breath every 5 seconds.

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  MOUTH TO NOSE : Mouth-to-nose ventilation is effective when the victim has
extensive facial or dental injuries or is very young. Mouth-to-nose ventilation creates an
effective air seal. To administer this mouth-to-nose ventilation—
1. Place the heel of one hand on the victim’s forehead and use the other hand
to lift the jaw.
2. After sealing the victim’s lips, take a deep breath, place your lips over the
victim’s nose, and blow.
3. Observe the chest for movement and place your ear
next to the victim’s nose to listen for or feel air exchange. Again, you
must continue your efforts at the rate of 12 to 15 ventilations per minute, or one
breath every 5 seconds, until the victim can breathe without assistance. Sometimes
during artificial ventilation air enters the stomach instead of the lungs. This
condition is called gastric distention. It can be relieved by moderate pressure
exerted with a flat hand between the navel and the rib cage. Before applying
pressure, turn the victim’s head to the side to prevent choking on the stomach
contents that are often brought up during the process.

 In case of Cardiac Arrest Resuscitation should be done in way of CPR.

Complications

Complications of CPR include the following:

 Fractures of ribs or the sternum from chest compression (widely considered uncommon)
 Gastric insufflation from artificial respiration using noninvasive ventilation methods (eg,
mouth-to-mouth, BVM); this can lead to vomiting, with further airway compromise or
aspiration; insertion of an invasive airway (eg, endotracheal tube) prevents this problem

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CHAPTER IV

BLEEDING

INTRODUCTION: (REFER TO APPENDIX 1 & APPENDIX 2 (PAGES 14 -17) AND

PAGES ( 40-42))
The human body contains approximately 5 liters of blood. A healthy adult can loose up to half
a liter or blood without harmful effects but the loss of more than this can be threatening to life.

DEFINITION
Bleeding (Hemorrhage) is an escape of blood from the blood vessels or hemorrhage or bleeding is
a flow of blood from an artery vein or capillary.

EFFECTS OF BLEEDING (HAEMORRHAGE)

Hemorrhage from major blood vessel of the arms, neck and thigh may occur so rapidly and
extensively that death occurs is a few minutes so hemorrhage must be controlled immediately to present
excessive loss of blood.

 The loss of red blood cells causes a lack of oxygen to the body systems.
 A decrease in blood volume causes a decrease in blood pressure.
 The heart's pumping rate increases to compensate for reduced blood pressure.
 The force of the heart beat as reduced since there is less blood to pump

TYPES OF BLEEPING
There are three different types of hemorrhage or bleeding.

1. ARTERIAL BLEEDING

 Blood is bright red in colour

 It spurts at each contraction of heart
 Flow is pulse tile.

2. VENOUS BLEEDING
 Bleeding is form the veins, which carries impure blood to heart
 Blood is dark red is color
 It does not spurt
 Steady flow of blood.

3. CAPILLARY BLEEDING
 Blood is red in colour
 It does not spurt

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  Slow but even flow

4. EXTERNAL AND INTERNAL BLEEDING

Bleeding may occur externally following an injury to the outside of the body or internally from
an injury in which blood escapes into tissue spaces or the body cavity.

(A) EXTERNAL BLEEDING

If the bleeding is from the surface of the body it is called external bleeding.

(i) Evidence of major external blood loss

(ii) Symptoms and signs or shock

 Casualty complains of thirst

 Blurring of vision
 Fainting and giddiness
 Face and lips becomes pale
 Skin feels cold
 Pulse becomes faster but weaker
 Restlessness and sweating
 Breathing becomes shallow
 Unconsciousness

(B) INTERNAL BLEEDING

If the bleeding is with in the chest skull or abdomen etc. It is called internal bleeding because
this can not be seen immediately but later the blood may ooze out through the nose or ear or
coughed up from the lungs or vomited from stomach.

 History of sufficient injury to cause internal bleeding

 Wounds that have penetrated the skull
 Wound that have penetrated chest or abdomen.
 History or Medical condition, which may cause internal bleeding, like ulcer etc.
 Pain and swelling around the affected area
 Signs of shock
 Blood may appear from one of the body orifices as nose, ear, mouth rectum
urethra, vagina etc.

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FIRST AID MANAGEMENT
AIM
 Control of bleeding as soon as possible
 Keep the wound clean and dress it to minimize blood loss and to prevent infection

GENERAL MANAGEMENT
 Place the person in such a position that he/she will be least affected by the loss of
blood.
 Lie the person down and raise his legs in semi flexed position
 Control the bleeding
 Maintain airway
 Prevent the loss of body heat by putting blankets under and over the person
 Keep him at rest as movement will increase heart action, which causes the blood to
flow faster and perhaps interfere with clot formation.

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Page : 28
Dangers of Using a Torniquet:

Nerve Injury

Nerve injury is the most common complication from the use of tourniquets during upper - extremity
surgery, and can also occur in thigh and lower leg cuff applications. It was first recognized more than 100
years ago. The extent of nerve injury can range from a mild transient loss of function to permanent,
irreversible damage. Symptoms of nerve injury include an inability to detect pain, heat, cold, or pressure
over the skin along the source of the nerve; and a sluggishness or inability to move large or small muscles
upon command.

Limb paralysis is also referred to as nerve paralysis or tourniquet paralysis syndrome. When this occurs,
all motor nerves distal to the cuff are affected, resulting in a temporary or permanent inability to move the
extremity. The radial nerve is the most common nerve affected. Symptoms of tourniquet paralysis are:
motor paralysis and loss of the sense of touch, pressure, and proprioceptive responses.

Paralysis can produce considerable disability and psychological stress in affected persons. Medical
personnel may be subject to legal action from the injured party.

 Gangrene from excessive period of Tourniquet

 Dangers from Ischemia
 Dangers from Exsanguinations
 Dangers from pressure in Tourniquet
 Dangers from Bleeding after closer of wound
 Dangers from failing to remove tourniquet

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 Chapter V

Management of Shock(PLEASE REFER TO APPENDIX 1 & APPENDIX 2 (PAGES 17-18))

What is shock?

Shock is a life-threatening medical condition as a result of insufficient blood flow throughout the body.
Shock often accompanies severe injury or illness. Medical shock is a medical emergency and can lead to
other conditions such as lack of oxygen in the body's tissues (hypoxia), heart attack (cardiac arrest) or
organ damage. It requires immediate treatment as symptoms can worsen rapidly.

Medical shock is different than emotional or psychological shock that can occur following a traumatic or
frightening emotional event.

What are the types of shock?

Septic shock results from bacteria multiplying in the blood and releasing toxins. Common causes of this
are pneumonia, urinary tract infections, skin infections (cellulitis), intra-abdominal infections (such as a
ruptured appendix), and meningitis.

Anaphylactic shock is a type of severe hypersensitivity or allergic reaction. Causes include allergy to
insect stings, medicines, or foods (nuts, berries, seafood), etc.

Cardiogenic shock happens when the heart is damaged and unable to supply sufficient blood to the body.
This can be the end result of a heart attack or congestive heart failure.

Hypovolemic shock is caused by severe blood and fluid loss, such as from traumatic bodily injury, which
makes the heart unable to pump enough blood to the body, or severe anemia where there is not enough
blood to carry oxygen through the body.

Neurogenic shock is caused by spinal cord injury, usually as a result of a traumatic accident or injury.

What are the symptoms of shock?

Low blood pressure and rapid heart rate (tachycardia) are the key signs of shock.

Symptoms of all types of shock include:

 Rapid, shallow breathing

 Cold, clammy skin
 Rapid, weak pulse
 Dizziness or fainting
 Weakness

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Depending on the type of shock the following symptoms may also be observed:

 Eyes appear to stare

 Anxiety or agitation
 Seizures
 Confusion or unresponsiveness
 Low or no urine output
 Bluish lips and fingernails
 Sweating
 Chest pain

What is the treatment for shock?

Depending on the type or the cause of the shock, treatments differ. In general, fluid resuscitation
(giving a large amount of fluid to raise blood pressure quickly) with an IV in the ambulance or
emergency room is the first-line treatment for all types of shock. The doctor will also administer
medications such as epinephrine, norepinephrine, or dopamine to the fluids to try to raise a
patient's blood pressure to ensure blood flow to the vital organs.

Septic shock is treated with prompt administration of antibiotics depending on the source and type of
underlying infection. These patients are often dehydrated and require large amounts of fluids to increase
and maintain blood pressure.

Anaphylactic shock is treated with diphenhydramine (Benadryl), epinephrine (an "Epi-pen"), steroid
medications methylprednisolone (Solu-Medrol), and sometimes a H2-Blocker medication (for example,
famotidine [Pepcid], cimetidine [Tagamet], etc.).

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Cardiogenic shock is treated by identifying and treating the underlying cause. A patient with a heart
attack may require a surgical procedure called a cardiac catheterization to unblock an artery. A patient
with congestive heart failure may need medications to support and increase the force of the heart's beat. In
severe or prolonged cases, a heart transplant may be the only treatment.

Hypovolemic shock is treated with fluids (saline) in minor cases, but may require multiple blood
transfusions in severe cases. The underlying cause of the bleeding must also be identified and corrected.

Neurogenic shock is the most difficult to treat. Damage to the spinal cord is often irreversible and causes
problems with the natural regulatory functions of the body. Besides fluids and monitoring, immobilization
(keeping the spine from moving), anti-inflammatory medicine such as steroids, and sometimes surgery are
the main parts of treatment.

Treatment Onboard:

 While waiting for help or on the way to the emergency room, check the person's airway, breathing
and circulation (the ABCs). Administer CPR if you are trained. If the person is breathing on his or
her own, continue to check breathing every 2 minutes until help arrives.
 Do NOT move a person who has a known or suspected spinal injury (unless they are in imminent
danger of further injury).
 Have the person lie down on his or her back with the feet elevated above the head (if raising the
legs causes pain or injury, keep the person flat) to increase blood flow to vital organs. Do not raise
the head.
 Keep the person warm and comfortable. Loosen tight clothing and cover them with a blanket.
 Do not give fluids by mouth, even if the person complains of thirst. There is a choking risk in the
event of sudden loss of consciousness.
 Give appropriate first aid for any injuries.
 Direct pressure should be applied to any wounds that are bleeding significantly.
 No smoking
 No alcohol Consumption
 NO active re-warming

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 Chapter - VI

BURNS AND SCALDS AND ACCIDENTS CAUSED BY ELECTRICITY

(PLEASE REFER TO APPENDIX 1 & APPENDIX 2 (PAGES 18-19))

An electrical burn is a burn that results from electricity passing through the body causing rapid injury.
Approximately 1,000 deaths per year due to electrical injuries are reported in the United States, with a
mortality rate of 3-5%.[1] Electrical burns differ from thermal or chemical burns in that they cause much
more subdermal damage.[2] They can exclusively cause surface damage, but more often tissues deeper
underneath the skin have been severely damaged. As a result, electrical burns are difficult to accurately
diagnose, and many people underestimate the severity of their burn. In extreme cases, electricity can cause
shock to the brain, strain to the heart, and injury to other organs.[3]

For a burn to be classified as electrical, electricity must be the direct cause. For example, burning a finger
on a hot electric steam iron would be thermal, not electrical. Electricity passing through resistance creates
heat, so there is no current entering the body in this type of burn. Likewise, a fire that is ruled to be
"electrical" in origin, does not necessarily mean that any injuries or deaths are due to electrical burns.
Unless someone was injured at the exact moment that the fire began, it is unlikely that any electrical burns
would occur.

Low-Voltage Electric Burns

Low-voltage electric burns almost exclusively involve either the hands or oral cavity. [15] In either injury,
hospitalization is recommended to treat the local burn injury and monitor for systemic sequelae. The most
common cause of low-voltage electric burns of the hand is contact with an extension cord where the
insulating material has worn off either from wear or misuse. Most of these patients are children aged 5
years or younger. A low-voltage burn of the hand usually consists of a small deep burn that may involve
vessels, tendons, and nerves. These burns involve a small area in the hand, yet they may be severe enough
to require amputation of a finge

High-Voltage Electric Burns

Burns due to contact with high-voltage electric circuits conform to 2 general types.

Burns from an electric arc

In burns from an electric arc, the current courses external to the body from the contact point to the ground.
[8]
Circumscribed burns occur where the portions of the arc contact the patient. These contact points may
be multiple, single, or diffuse and vary in their depths. The most common contact points for the current are
the hands and skull, while the most common ground areas are the heels. Entry points on the flexor surfaces
often produce "kissing" entry lesions, resulting from severe tetanic muscle contractions and causing
extensive tissue damage. The most common of these lesions is the circumscribed deep wound on the volar
surface of the forearm in association with contact wounds of the palm. A flame may complicate this burn
injury if the flashes of an arc ignite the victim's clothing.

Burns from an electric current

The other burn injury is from an electric current that passes between the power source and the anatomic
point of contact (entrance wound), and between the patient (exit wound) and the grounding mechanism,
causing hidden destruction of deeper tissues. Such electrically conductive burns are simply thermal

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injuries occurring when the electric energy is converted to thermal energy. The extent of the electric burn
is related to the magnitude, frequency, and duration of the current flow and the volume and resistance of
the tissue.

Resistance

Resistance of living tissue changes as the current flows. Skin represents an initial barrier to flow of current
and serves as insulation to the deeper tissues. Once an electric current contacts skin, the amperage rises
slowly, followed by an abrupt and rapid climb. This change in flow coincides with a progressive decline in
skin resistance. Once this skin resistance breaks down, current enters the underlying tissue whose internal
tissue resistance, with the exception of bone, is negligible to current flow. Within seconds, electric current
in tissue peaks and then falls precipitously to zero. Current ceases to flow when the heat-producing tissue
carbonization (eschar) volatilizes tissue fluid. Termination of current flow is signaled by the appearance
of an arc or flash.

Current pathways

Low-voltage current generally follows the path of least resistance (ie, nerves, blood vessels), yet
high-voltage current takes a direct path between entrance and ground. The volume of soft tissue through
which current flows behaves as a single uniform conductor, thus is a more important determinant of tissue
injury than the internal resistance of the individual tissues. Current is concentrated at its entrance to the
body, then diverges centrally, and finally converges before exiting. Consequently, the most severe
damage to the tissue occurs at the sites of contact, which are commonly referred to as the entrance and exit
wounds.

Entry and exit wounds

High-voltage electric entry wounds are charred, centrally depressed, and leathery in appearance, while
exit wounds are more likely to "explode" as the charge exits. High-voltage electrical burns often leave a
black metallic coating on the skin that is mistaken for eschar, from vaporization of the metal contacts and
electroplating of the conductive skin surface. Cleansing of the coating usually reveals only superficial skin
injury. Electric current chooses the shortest path between the contact points and involves the vital
structures in its pathway. Fatalities are high (nearly 60%) in hand-to-hand current passages and are
considerably lower (20%) in hand-to-foot current passages. Severity of damage to the tissue is greatest
around the contact sites.

Consequently, anatomic locations of the contact sites are critical determinants of injury. Most of this
underlying tissue damage, especially muscle, occurs at the time of initial insult and does not appear to be
progressive. Microscopic studies of electric burns demonstrate that this initial destruction of tissues is not
uniform. Areas of total thermal destruction are mixed with apparently viable tissue. Between the entrance
and exit points of the electric current, widespread anatomic damage and destruction may be seen. An
electric current can injure almost every organ system.

Is it a minor Electric burn or a major Electric burn?

If it's not clear what level of care is needed, try to judge the extent of tissue damage, based on the
following burn categories:

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1st-degree burn

A first-degree burn is the least serious type, involving only the outer layer of skin. It may cause:

 Redness
 Swelling
 Pain

You can usually treat a first-degree burn as a minor burn. If it involves much of the hands, feet, face, groin,
buttocks or a major joint, seek emergency medical attention.

2nd-degree burn

A second-degree burn is more serious. It may cause:

 Red, white or splotchy skin

 Swelling
 Pain
 Blisters

If the second-degree burn is no larger than 3 inches (7.6 centimeters) in diameter, treat it as a minor burn.
If the burned area is larger or covers the hands, feet, face, groin, buttocks or a major joint, treat it as a
major burn and get medical help immediately.

3rd-degree burns

The most serious burns involve all layers of the skin and underlying fat. Muscle and even bone may be
affected. Burned areas may be charred black or white. The person may experience:

 Difficulty breathing
 Carbon monoxide poisoning
 Other toxic effects, if smoke inhalation also occurred

What should your first action be when treating an electrical burn?

Take these actions immediately while waiting for medical help:

1. Turn off the source of electricity if possible. ...

2. Begin CPR if the person shows no signs of circulation, such as breathing, coughing or movement.
3. Try to prevent the injured person from becoming chilled.
4. Apply a bandage.

Procedure for Treating Electric Burns:

1. Remove clothing or jewelry at the site of the burn. ...

2. Rinse the burned area under cool water until the pain stops. ...
3. Wash your hands. ...
4. Do not break any blisters. ...

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 5. Wash the burn site. ...
6. Pat the area dry. ...
7. Apply an antibiotic ointment. ...
8. Apply a bandage.

Measures for accidents caused by Electric Current:

 Hazards to rescuers: In case of an electric shock it becomes very difficult for the rescuers as the
casualty is still in touch with power source. Do not intend to touch the personnel as another
casualty will take place.
 Isolation of the casualty from the power source- Firstly and fore mostly incase of such a
situation we need to isolate/switch off power and isolate the person from the power source.
 Protection from collapse/Shock- incase of an electric shock we need to restrict the person from
falling also from collapse
 Controlling the vital functions- it is utmost importance to control the vital functions of the
casualty and seek medical radio advice

Procedure to be applied for Chemical Burn:

Begin basic first aid, any shortness of breath, chest pain, dizziness, or other symptoms throughout the
body. If you are aiding an injured person with these symptoms, lay the person down and immediately call
for help. Protect yourself and make sure that you are not exposing yourself to the same chemical.

 Remove yourself or the injured person from the accident or exposure area. Take appropriate care
not to cause further injury to the patient.
 Remove any contaminated clothing.
 Wash the injured area to dilute or remove the substance, using large volumes of water. Wash for at
least 20 minutes, taking care not to allow runoff to contact unaffected parts of anyone's body.
Gently brush away any solid materials, again avoiding unaffected body surfaces.
 Especially wash away any chemical in the eyes. Sometimes the best way to get large amounts of
water to the eyes is to take a shower. If there is an eye wash station nearby (usually fond at work
sites), follow the simple instructions to rinse out the eyes.
 Follow the MSDS provided onboard the vessel and check for treatment as the same is mentioned,
example of the same is below:

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Procedures for treatment for chemical burns of eyes:

 Please refer to the MSDS of the Contaminating Chemical.

 Flush the eyes out with water for at least 15 minutes.
 As you rinse, use your fingers to hold your eye open as wide as possible and roll your eye to ensure
the greatest coverage.

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Chapter VII:

RESCUE: (REFER TO APPENDIX 1 & APPENDIX 2 (PAGES 44-48)

Rescue and transport of Casualty:

A basic principle of first aid is to treat the casualty before moving him. However, adverse situations or
conditions may jeopardize the lives of both the rescuer and the casualty if this is done. It may be necessary
first to rescue the casualty before first aid can be effectively or safely given. The life and/or the well-being
of the casualty will depend as much upon the manner in which he is rescued and transported as it will
upon the treatment he receives. Rescue actions must be done quickly and safely. Careless or rough
handling of the casualty during rescue operations can aggravate his injuries and possibly cause death.

B-2. Principles of Rescue Operations

a. When faced with the necessity of rescuing a casualty who is threatened by hostile action, fire, water, or
any other immediate hazard, DO NOT take action without first determining the extent of the hazard and
your ability to handle the situation. DO NOT become a casualty.

b. The rescuer must evaluate the situation and analyze the factors involved. This evaluation involves three
major steps:

 Identify the task.

 Evaluate circumstances of the rescue.
 Plan the action.

B-3. Task (Rescue) Identification

First determine if a rescue attempt is actually needed. It is a waste of time, equipment, and personnel to
rescue someone not in need of rescuing. It is also a waste to look for someone who is not lost or needlessly
risk the lives of the rescuer(s). In planning a rescue, attempt to obtain the following information:

 Who, what, where, when, why, and how the situation happened?
 How many casualties are involved and the nature of their injuries?
 What is the tactical situation?
 What are the terrain features and the location of the casualties?
 Will there be adequate assistance available to aid in the rescue/evacuation?
 Can treatment be provided at the scene, will the casualties require movement to a safer location?
 What equipment will be required for the rescue operation?
 Will decon procedures and equipment be required for casualties, rescue personnel and rescue
equipment?

B-4. Circumstances of the Rescue

a. After identifying the job (task) required, you must relate to the circumstances under which you must
work. Do you need additional people, security, medical, or special rescue equipment? Are there
circumstances such as mountain rescue or aircraft accidents that may require specialized skills? What is
the weather like? Is the terrain hazardous? How much time is available?

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b. The time element will sometimes cause a rescuer to compromise planning stages and/or treatment
which can be given. A realistic estimate of time available must be made as quickly as possible to
determine action time remaining. The key elements are the casualty's condition and the environment.

c. Mass casualties are to be expected on the modern battlefield. All problems or complexities of rescue are
now multiplied by the number of casualties encountered. In this case, time becomes the critical element.

B-5. Plan of Action

a. The casualty's ability to endure is of primary importance in estimating the time available. Age and
physical condition will differ from casualty to casualty. Therefore, to determine the time available, you
will have to consider--

 Endurance time of the casualty.

 Type of situation.
 Personnel and/or equipment availability.
 Weather.
 Terrain.

b. In respect to terrain, you must consider altitude and visibility. In some cases, the casualty may be of
assistance because he knows more about the particular terrain or situation than you do. Maximum use of
secure/reliable trails or roads is essential.

c. When taking weather into account, ensure that blankets and/or rain gear are available. Even a mild rain
can complicate a normally simple rescue. In high altitudes and/or extreme cold and gusting winds, the
time available is critically shortened.

d. High altitudes and gusting winds minimize the ability of fixed-wing or rotary wing aircraft to assist in
operations. Rotary wing aircraft may be available to remove casualties from cliffs or inaccessible sites.
These same aircraft can also transport the casualties to a medical treatment facility in a comparatively
short time. Aircraft, though vital elements of search, rescue or evacuation, cannot be used in all situations.
For this reason, do not rely entirely on their presence. Reliance on aircraft or specialized equipment is a
poor substitute for careful planning

Proper Handling of Casualties

a. You may have saved the casualty's life through the application of appropriate first aid measures.
However, his life can be lost through rough handling or careless transportation procedures. Before you
attempt to move the casualty--

 Evaluate the type and extent of his injury.

 Ensure that dressings over wounds are adequately reinforced.
 Ensure that fractured bones are properly immobilized and supported to prevent them from cutting
through muscle, blood vessels, and skin. Based upon your evaluation of the type and extent of the
casualty's injury and your knowledge of the various manual carries, you must select the best
possible method of manual transportation. If the casualty is conscious, tell him how he is to be
transported. This will help allay his fear of movement and gain his cooperation and confidence.

b. Buddy aid for chemical agent casualties includes those actions required to prevent an incapacitated
casualty from receiving additional injury from the effects of chemical hazards. If a casualty is physically
unable to decontaminate himself or administer the proper chemical agent antidote, the casualty's buddy
assists him and assumes responsibility for his care. Buddy aid includes--

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  Administering the proper chemical agent antidote.
 Decontaminating the incapacitated casualty's exposed skin.
 Ensuring that his protective ensemble remains correctly emplaced.
 Maintaining respiration.
 Controlling bleeding.
 Providing other standard first aid measures.
 Transporting the casualty out of the contaminated area.

B-8. Transportation of Casualties

a. Transportation of the sick and wounded is the responsibility of medical personnel who have been
provided special training and equipment. Therefore, unless a good reason for you to transport a casualty
arises, wait for some means of medical evacuation to be provided. When the situation is urgent and you
are unable to obtain medical assistance or know that no medical evacuation facilities are available, you
will have to transport the casualty. For this reason, you must know how to transport him without
increasing the seriousness of his condition.

b. Transporting a casualty by litter is safer and more comfortable for him than by manual means; it is also
easier for you. Manual transportation, however, may be the only feasible method because of the terrain or
the combat situation; or it may be necessary to save a life. In these situations, the casualty should be
transferred to a litter as soon as one can be made available or improvised.

Casualties carried by manual means must be carefully and correctly handled, otherwise their injuries may
become more serious or possibly fatal. Situation permitting, evacuation or transport of a casualty should
be organized and unhurried. Each movement should be performed as deliberately and gently as possible.
Casualties should not be moved before the type and extent of injuries are evaluated and the required
emergency medical treatment is given. The exception to this occurs when the situation dictates immediate
movement for safety purposes (for example, it may be necessary to remove a casualty from a burning
vehicle); that is, the situation dictates that the urgency of casualty movement outweighs the need to
administer emergency medical treatment. Manual carries are tiring for the bearer(s) and involve the risk of
increasing the severity of the casualty's injury. In some instances, however, they are essential to save the
casualty's life. Although manual carries are accomplished by one or two bearers, the two-man carries are
used whenever possible. They provide more comfort to the casualty, are less likely to aggravate his
injuries, and are also less tiring for the bearers, thus enabling them to carry him farther. The distance a
casualty can be carried depends on many factors, such as--

 Strength and endurance of the bearer(s).

 Weight of the casualty.
 Nature of the casualty's injury.
 Obstacles encountered during transport.

1. One-man Carries:
 In the support carry (Figure B-2), the casualty must be able to walk or at least hop on one leg, using
the bearer as a crutch. This carry can be used to assist him as far as he is able to walk or hop.

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 

2. Arms carry (081-831-1040). The arms carry is used when the casualty is unable to walk. This
carry (Figure B-3) is useful when carrying a casualty for a short distance and when placing him on
a litter.

3. Saddleback carry (081-831-1040). Only a conscious casualty can be transported by the

saddleback carry (Figure B-4), because he must be able to hold onto the bearer's neck.

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How to use a Neil Robertson Stretcher :

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Transportation Using a Chair:

Transportation using a Triangular Cloth:

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 Chapter VIII

Other topics:

Bandaging: (REFER TO APPENDIX 2 (PAGES 23- 28,39,40))

A bandage is a piece of material used either to support a medical device such as a dressing or splint, or on
its own to provide support to or to restrict the movement of a part of the body. When used with a dressing,
the dressing is applied directly on a wound, and a bandage used to hold the dressing in place. Other
bandages are used without dressings, such as elastic bandages that are used to reduce swelling or provide
support to a sprained ankle. Tight bandages can be used to slow blood flow to an extremity, such as when
a leg or arm is bleeding heavily.

Bandages are available in a wide range of types, from generic cloth strips to specialized shaped bandages
designed for a specific limb or part of the body. Bandages can often be improvised as the situation
demands, using clothing, blankets or other material. In American English, the word bandage is often used
to indicate a small gauze dressing attached to an adhesive bandage.

Types of bandages

Gauze bandage (common gauze roller bandage)

The most common type of bandage is the gauze bandage, a simple woven strip of material, or a woven
strip of material with a Telfa absorbent barrier to prevent adhering to wounds. A gauze bandage can come
in any number of widths and lengths, and can be used for almost any bandage application, including
holding a dressing in place.

Compression bandage

The term 'compression bandage' describes a wide variety of bandages with many different applications.

Short stretch compression bandages are good for protecting wounds on one's hands, especially on one's
fingers.

Short stretch compression bandages are applied to a limb (usually for treatment of lymphedema or
venous ulcers). This type of bandage is capable of shortening around the limb after application and is
therefore not exerting ever-increasing pressure during inactivity. This dynamic is called resting pressure
and is considered safe and comfortable for long-term treatment. Conversely, the stability of the bandage
creates a very high resistance to stretch when pressure is applied through internal muscle contraction and
joint movement. This force is called working pressure.

Long stretch compression bandages have long stretch properties, meaning their high compressive
power can be easily adjusted. However, they also have a very high resting pressure and must be removed
at night or if the patient is in a resting position.

Triangular bandage

Also known as a cravat bandage, a triangular bandage is a piece of cloth put into a right-angled triangle,
and often provided with safety pins to secure it in place. It can be used fully unrolled as a sling, folded as
a normal bandage, or for specialized applications, as on the head. One advantage of this type of bandage is
that it can be makeshift and made from a fabric scrap or a piece of clothing. The Boy Scouts popularized

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use of this bandage in many of their first aid lessons, as a part of the uniform is a "neckerchief" that can
easily be folded to form a cravat.

Tube bandage

A tube bandage is applied using an applicator, and is woven in a continuous circle. It is used to hold
dressings or splints on to limbs, or to provide support to sprains and strains, so that it stops bleeding.

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 2. Enclosed Spaces: (PLEASE REFER TO APPENDIX 2 (PAGES 43))

A Confined Space and its Atmosphere

Confined spaces on a ship are those which, because of their configuration, hinder the access of crew,
and which present dangers because of the potential for an unsafe atmosphere within them. This can
arise because the atmosphere is either oxygen deficient or because of the presence of gases or vapours
hazardous to human health.
Frequently, unsafe atmospheres have no detectable odours present, making them all the more difficult
to identify.It is therefore of paramount importance that before entry into any confined space is
permitted, it should
be thoroughly ventilated and the atmosphere checked ether by a competent person on board, or by a
chemist to determine the oxygen level present and that it is free from toxic gases before crew entry is
permitted.
The space should also remain well ventilated and lit throughout the period when crew are within it.
Oxygen deficient atmospheres are the leading cause of fatalities occurring within confined spaces.
Normal atmospheric conditions have an oxygen content of approximately 21%. An oxygen deficient
atmosphere is one in which the oxygen content is less than 19.5%

Lack of adequate ventilation is the primary cause of most hazardous atmospheres within confined
spaces.
Oxygen within a space may be depleted by a variety of causes; for example displacement by the
introduction of inert gases such as carbon dioxide, nitrogen, argon, or by the ship’s inert gas or fire
fighting systems. Oxygen within a confined space can also be consumed by corroding metal, the
effects of
drying paint or other coatings, and combustion or bacterial activity.
No crew member should ever be allowed to enter a confined space before the atmosphere within it has
been tested, re-checked as necessary after corrective action, and the results
logged to determine that the space is safe to enter.

Safe Entry Procedure to Confined Space

Before entry is made to any confined space, the following steps should be
taken:-
(i) A meeting should be held with all parties involved to discuss the safety
measures that will be necessary for the task that requires entry to the confined space.
(ii) All actual or potential hazards should be identified, recorded and rectified where possible.
(iii) All safety and permit to work requirements must be fully complied with and the crew entering the
confined space and those on standby at the entrance must know exactly
what to do should any emergency arise. It is particularly important that no one should enter the space to
attempt a rescue without breathing apparatus. It is a natural and
understandable human reaction to promptly attempt to assist another who is in difficulty. However,
entering a confined space without the proper safety equipment in such
circumstances generally results in the rescuer also becoming a casualty. Far too many lives have been lost
unnecessarily in the past as the result of such actions.
(iv) No crew should ever be permitted to enter a confined space alone and un-tethered, and crew should
never be left in a confined space without back up assistance positioned outside the space they are in.
(v) Crew providing back-up assistance should have radio equipment and breathing apparatus on station at
the entrance to the enclosed space, and should be fully familiar with
emergency response procedures if any of the crew in the space find themselves in difficulty.
(v) Warning signs should be displayed to alert others to the fact that crew are working within the confined
space.

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(vi) Any equipment or systems that could affect conditions within the confined space whilst crew are
within it should be disabled and tagged to warn that crew are working in the space it serves.

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 3. Infectious Diseases: Infectious diseases are disorders caused by organisms — such as
bacteria, viruses, fungi or parasites. Many organisms live in and on our bodies. They're
normally harmless or even helpful, but under certain conditions, some organisms may
cause disease

When you give first aid, it is important to protect yourself (and the casualty) from infection as well
as injury. Take steps to avoid cross infection - transmitting germs or infection to a casualty or
contracting infection yourself from a casualty.
Remember, infection is a risk even with relatively minor injuries. It is a particular
concern if you are treating a wound, because blood-borne viruses, such as hepatitis B or C and
Human Immunodeficiency Virus (HIV), may be transmitted by contact with yours through a cut or
graze.
Usually, taking measures such as washing your hands and wearing disposable gloves
will provide sufficient protection for you and the casualty. There is no known evidence of these
blood-borne viruses being transmitted during resuscitation. If a face shield or pocket mask is
available, it should be used when you give rescue breaths.

MINIMISING THE RISK OF CROSS INFECTION:

 Do wash your hands and wear latex-free disposable gloves. If gloves are not available, ask the
casualty to dress his or her own wound, or enclose your hands in clean plastic bags.
 Do cover cuts and grazes on your hands with waterproof dressings.
 Do wear a plastic apron if dealing with large quantities of body fluids and wear plastic glasses to
protect your eyes.
 Do dispose of all waste safely.
 Do not touch a wound with your bare hands and do not touch any part of a dressing that will come
into contact with a wound.
 Do not breathe, cough and sneeze over a wound while you are treating a casualty.

CAUTION: To help protect yourself from infection you can carry protective equipment such as:

1. Pocket mask or face shield.

2. Latex-free disposable gloves.
3. Alcohol gel to clean your hands.

THOROUGH HAND WASHING:

If you can, wash your hands before you touch a casualty, but if this is not possible, wash them as soon
as possible afterwards. For a thorough wash, pay attention to all parts of the hands - palm, wrists, fingers,
thumbs and fingernails, or rub your hands with alcohol gel.

1. Wet your hands under running water. Put some soap into the palm of a cupped hand. Rub
the palms of your hands together.
2. Rub the palm of your left hand against the back of your right hand, then rub the right palm
on the back of your left hand.
3. Interlock the fingers of both hands and work the soap between them.
4. Rub the back of the fingers of your right hand against the palm of your left hand,, then
repeat with your left hand in your right palm.
5. Rub your right thumb in the palm of your left hand, then your left thumb in the right palm.

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 6. Rub the fingertips of your left hand in the palm of your right hand and vice versa. Rinse
thoroughly, then pat dry with a disposable paper towel.

USING PROTECTIVE GLOVES:

Disposable gloves should only be used to treat one casualty. Put them on just before you approach a
casualty and remove them as soon as the treatment is completed and before you do anything else.
When taking off the gloves, hold the top edge of one glove with your other gloved hand and peel it off
so that it is inside out. Repeat with the other hand without touching the outside of the gloves. Dispose them
in a biohazard hag.
CAUTION: Always use latex-free gloves. Some people serious allergy to latex, and this may cause
anaphylactic shock. Nitrite gloves (often blue or purple) are recommended.

PUTTING ON GLOVES:

1. Ideally, wash your hands before putting on the gloves. Hold one glove by the top and pull it
on. Do not touch the main part of the glove with your fingers.
2. Pick up the second glove with the gloved hand. With your fingers under the top edge, pull it
on to your hand. Your gloved fingers should not touch your skin.

How to dispose of blood and body fluids:

 Always use gloves when handling body fluids and waste.

 Urine and faeces should be flushed down the toilet.
 Blood can also be flushed down the toilet.
 Any items contaminated with body fluids, such as bed linen, should be rinsed in the laundry sink
with cold water before being washed with hot water in the washing machine. The items should be
washed separately from other washing, or dealt with according to your organisation’s policies and
procedures.
 Sharps such as needles should be disposed of in a sharps box. All consumers who use sharps
should have a sharps disposal box.
 Catheters, colostomy bags and other medical waste should be put in a plastic bag, sealed and then
put in the rubbish bin, or dealt with according to your organisation’s policies and procedures.
 Dressings and other items which may be infected should be put in a plastic bag, sealed and then put
in the rubbish bin, or dealt with according to your organisation’s policies and procedures.

Managing exposure to blood or other body substances

If any person has contact with blood or body fluids, the following procedures should be observed:

 remove contaminated clothing

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 if blood or body fluids get on the skin, irrespective of whether there are cuts or abrasions, wash
well with soap and water
 if the eyes are splashed, rinse the area gently but thoroughly with water while the eyes are open
 if blood or body fluid gets in the mouth, spit it out and rinse the mouth with water several times,
spitting the water out each time.

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 4.Peronal Health and Hygiene

Personal hygiene may be described as the principle of maintaining cleanliness and grooming of the
external body. People have been aware of the importance of hygiene for thousands of years. The ancient
Greeks spent many hours Bathing, using fragrances and make up in an effort to beautify themselves and
be presentable to others.

Personal Hygiene products are a billion dollar business in the commercial market, with many high profile
celebrities endorsing products that aim to keep us looking our best. In fact, hygiene is actually a scientific
study.

Maintaining a high level of personal hygiene will help to increase self-esteem and confidence, while
minimising the chances of developing imperfections.

Poor Personal Hygiene

Failure to keep up a standard of hygiene can have many implications. Not only is there an increased risk of
getting an infection or illness, but there are many social and psychological aspects that can be affected.

Poor Personal Hygiene, in relation to preventing the spread of disease is paramount in preventing
epidemic or even pandemic outbreaks. To engage in some very basic measures could help prevent many
coughs and colds from being passed from person to person.

Social Embarrassment
Social aspects can be affected, as many people would rather alienate themselves from someone who has
bad personal hygiene than to tell them how they could improve. Bullies may use bad personal hygiene as
a way of abusing their victims, using social embarrassment as a weapon.

Poor personal hygiene can have significant implications on the success of job applications or the chance of
promotion; no company wants to be represented by someone who does not appear to be able to look after
themselves.

Many sufferers of mental illnesses like dementia or depression may need extra support and
encouragement with their personal hygiene. Their carers should make sure that they have everything they
need and assist them when permitted and when possible.

Food Hygiene
Probably the most important aspect of all, food hygiene is very closely associated with personal hygiene.
Poor personal cleansing can have a very significant effect on the start and spread of many illnesses
through contact with nutritional consumables, some that can be potentially lethal.
Aspects of Personal Hygiene
There are many contributory factors that make up personal hygiene with the main ones being washing,
oral care, hair care, nail care, wound care, cleansing of personal utensils and Preventing Infection.

Personal hygiene is as it says, personal. Everybody has their own habits and standards that they have been
taught or that they have learnt from others. It is essentially the promotion and continuance of good health.

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