Industrial Hygiene and Occupational Health > Chapter-5> First Aid > Define First Aid ,Purpose , Principles of First Aid, First Aid Roles & Responsibilities and Qualities

First Aid - Definition , Principles , Roles & Responsibilities, Qualities ,Statutory Requirements 

 

 

What is First Aid ? 

First Aid can be defined as an immediate treatment given to the victim of an accident or sudden illness, before -medical help is obtained.   It is a combination of simple but quite expedient, active measures to save the victim's life and prevent possible complications.  It needs to be immediate in severe accidents complicated by bleeding, shock and loss of consciousness. 

Aim of the First Aid- 

• To preserve life.            
• To promote or assist recovery.
• To prevent worsening or aggravation of the casualty's condition.
• To minimize complication and 
• To arrange transportation to hospital if necessary.

General Meaning of First Aid- 

1. First thing first. 
2. Inform the doctor. 
3. Reassure the victim.
4. Shock prevention or treatment. 
5. Tourniquet, control bleeding. 
6. Artificial respiration. 
7. Immobilize fracture.
8. Disposal, send victim to hospital.

The general rules or principles for first aid are as follows :

1. Reach the accident spot quickly. This will help to save life.

2. Be calm, methodical and quick. By doing so you can lessen the pain and the effects of the injuries which may save life.  Handling the casualty clumsily will only make the final recovery difficult.

3. Look for the following:  Is there failure of breathing? Is there severe bleeding?  Is the shock light or severe?

(1) Attend to these and then treat easily observable injuries.

(2) Start artificial respiration, if the casualty is not breathing.  It must being at once as every second gained is helpful. 

(3) Stop by pressing on the pressure point and press firmly on the bleeding area with a pad and keep up pressing on the bleeding area for at least a few minutes (minimum 3 minutes) by watch. Take help if needed.

(4) Treat for shock.

(5) Avoid handling the casualty unnecessarily. 

4. Priority of Treatment by a first aider should proceed in the following order : 

1. Examination and Diagnosis.

2  Cardio Pulmonary Resuscitation (every second counts). 

3  Control Bleeding.

4  Treat  Shock  and  special  care  of Unconscious cases. 

5  Fracture (Immobilization).

6  Burn-Cover with clear washed cloth/ dressing and treat shock.

7. Eye, Nose and Ear injuries. 

8. Multiple superficial injuries. 

9. Transportation and 

10. Follow up or After-care. 

5. Following formula for basic assessment of a serious case -

DR. ABC & Head-Foot Examination :

D  = Danger. Please check up first, if there is any sort of danger to the first aider or the patient or to the people around at the 'spot of the accident in form of poisonous gas, electric current, fire etc.

R  =  Response. Call the patient by his name or pinch him and see the response. If no

response, the patient is unconscious. Then immediately -

(A)  = Open the Airway by flitting his head to the back and chin up.

(B)  = Check Breathing 

(C) =  Check Circulation of blood by checking neck pulse. If the patient is not breathing but the neck pulse is present, give mouth to mouth breathing only. If neck pulse and breathing both absent start CPR (Cardio Pulmonary Resuscitation) 

Head Foot Exam = If both neck pulse and breathing are present and patient is responding, continue with head to foot examination. Look for injuries bleeding and fractures systematically.  Specially look for injuries on head, chest and abdomen.  They may not look important in beginning but may prove to be fatal in long term.

6.Use the First Aid equipment, if available.  All passenger trains, some Railway Stations, lorries and buses keep them. Make use of the material so obtained. On most occasions standard First' Aid equipment will not be available. You will have to depend on the material at hand and improvise them for your requirements.- In a factory, use the prescribed first aid box. 

7.Inspect the area.  Take the casualty away from live wires, fallen walls, beams, fire, broken gas chambers, moving machinery etc. to a safer place.

8.Clear the crowd with nice words.  Do not allow people to crowd around the casualty.  The casualty needs fresh air. If a doctor is present, he will guide you. Any other First Aider must be asked to help. Otherwise take the assistance of bystanders giving them correct instructions. 

9. Note the weather.  If it is fine, i.e. without rain or heat or a cold breeze, treat in the open. Otherwise move the casualty into an airy room. If no suitable house or a doctor's clinic is not nearby, it is best to protect the casualty with an umbrella or a sheet of cloth or even a newspaper.

10.Reassure, the  casualty.   Soft words  and encouraging talk will make the casualty take things easy and lie quietly.  These will help recovery.

11.Arrange for dispatch to the care of a doctor or to the Hospital.  At the same time intimate the relatives where the casualty is being taken to. 

12.Do not attempt too much.  You are only a First Aider.  Give minimum assistance so that the condition does not become worse and life can be saved.

 

Statues related to First Aid-  

Section 45 of Factories act 1948 has dictated the following for First Aid-

First-aid appliances.— (1) There shall in every factory be provided and maintained so as to be readily accessible during all working hours first-aid boxes or cupboards equipped with the prescribed contents, and the number of such boxes or cupboards to be provided and maintained shall not be less than one for every one hundred and fifty workers ordinarily employed 1[at any one time] in the factory. 

(2) Nothing except the prescribed contents shall be kept in a first-aid box or cupboard. 

(3) Each first-aid box or cupboard shall be kept in the charge of a separate responsible person who holds a certificate in first-aid treatment recognized by the State Government and who shall always be readily available during the working hours of the factory.

(4) In every factory wherein more than five hundred workers are ordinarily employed there shall be provided and maintained an ambulance room of the prescribed size, containing the prescribed equipment and in the charge of such medical and nursing staff as may be prescribed and those facilities shall always be made readily available during the working hours of the factory. 

As per Section 45 each state has to made the rule under the section, So Maharashtra has made the rule 76- 

Rules prescribed under sub-section (1) of section 45 

Rule 76 -  First-aid appliance - The first aid boxes or cupboards shall be distinctively marked with a red cross on a white background and shall contain the following equipment:-

(A) For factories in which the number of persons employed does not exceed ten, or (in the case of factories in which mechanical power is not used) does not exceed fifty persons-Each first-aid box or cupboard shall contain the following equipment :-

(i) Six small size sterilized dressings

(ii) Three medium size sterilized dressings

(iii) Three large size sterilized dressings

(iv) Three large size sterilized burn dressings

(v) One (60 ml.) bottle of cetrimide solution (1 per cent) or a suitable antiseptic solution

(vi) One (60 ml.) bottle of mercurochrome solution (2 per cent) in water

(vii) One (30 ml.) bottle containing salvolatile having the doses and mode of administration indicated on the label.

(viii) One pair of scissors

(ix) One roll of adhesive plaster (2 cms. x 1 metre)

(x) Six pieces of sterilized eye-pads in separate sealed packets

(xi) A bottle containing 100 tablets (each of 5 grains) of aspirin or any other analgesic

(xii) Ointment for burns

(xiii) Polythene wash bottle (1/2 litre i.e. 500 c.c.) for washing eyes

(xiv) A snake-bite lancet

(xv) One (30 ml) bottle containing potassium permanganate crystals

(xvi) One copy of first-aid leaflet issued by the Directorate-General of Factory Advice Service and Labour Institutes, Government of India, Bombay. 

(B) For factories in which mechanical power is used and in which the number of persons employed exceed ten but does not exceed fifty. Each first-aid box or cupboard shall contain the following equipment:- 

(i) Twelve small size sterilised dressings

(ii) Six medium size sterilised dressings

(iii) Six large size sterilised dressings

(iv) Six large size sterilised burn dressings

(v) Six (15 gm) packets of sterilised cotton wool

(vi) One (120 ml.) bottle of cetrimide solution (1 per cent) or a suitable antiseptic solution.

(vii) One (120 ml.) bottle of mercurochrome solution (2 per cent) in water

(viii) One (60 ml.) bottle containing salvolatile having the dose and mode of administration indicated on the label.

(ix) One pair of scissors

(x) Two rolls of adhesive plaster (2 cms. x 1 metre)

(xi) Eight pieces of sterilised eye-pads in separate sealed packets

(xii) One tourniquet

(xiii) One dozen safety pins

(xiv) A bottle containing 100 tablets (each of 5 grains) of aspirin or any other analgesic

(xv) Ointment for burns

(xvi) One polythene wash bottle (1/2 litre i.e. 500 c.c.) for washing eyes

(xvii) A snake-bite lancet

(xviii) One (30 ml) bottle containing potassium permanganate crystals

(xix) One copy of the first-aid leaflet issued by the Directorate-General of Factory Advice Service and Labour Institutes, Government of India, Bombay.

(C) For factories employing more than fifty persons - Each first-aid box or cupboard shall contain the following equipment:- 

(i) Twenty-four small sterilised dressings

(ii) Twelve medium size sterilised dressings.

(iii) Twelve large size sterilised dressings.

(iv) Twelve large size sterilised burn dressings. 

(v) Twelve (15 gm.) packets of sterilised cotton wool

(vi) One (200 ml.) bottle of cetrimide solution (1 per cent) or suitable antiseptic solution

(vii) One (200 ml.) bottle of mercurochrome solution (2 per cent) in water

(viii) One (120 ml.) bottle of salvolatile having the dose and mode of administration indicated on label.

(ix) One pair of scissors

(x) One roll of adhesive plaster (6 cms. x 1 metre)

(xi) Two rolls of adhesive plaster (2 cms. x 1 metre)

(xii) Twelve pieces of sterilised eye-pads in separate sealed packets

(xiii) A bottle containing 100 tablets (each 5 grains) of aspirin or any other analgesic

(xiv) One polythene wash bottle (500 c.c.) for washing eyes.

(xv) Twelve roller bandages 10 cms. wide.

(xvi) Twelve roller bandages 5 cms. wide.

(xvii) Six triangular bandages.

(xviii) One tourniquet

(xix) A supply of suitable splints

(xx) Two packets of safety pins

(xxi) Kidney tray

(xxii) A snake-bite lancet

(xxiii) One (30 ml) bottle containing potassium permanganate crystals

(xxiv) Ointment for burns

(xxv) First-aid leaflet issued by the Directorate General of Factory Advice Service and Labour

Institutes, Bombay:

Provided that items (xiv) to (xxi) inclusive need not be included in the standard first-aid box or

cupboard (a) where there is a properly equipped ambulance room, or (b) if at least one box

containing such item and placed and maintained in accordance with the requirements of section 45 is separately provided.

(D) In lieu of the dressings required under items (i) and (ii), there may be substituted adhesive wound dressings approved by the Chief Inspector of Factories and other equipment or medicines that may be considered essential and recommended by the Chief Inspector of Factories from time to time. 

Regarding First Aid facility Maharashtra state has made the rule for notice of the First Aid- Under the section 45  sub-section (4) 

Rule 77- Notice regarding first-aid - A notice containing the names of the persons working within the precincts of the factory who are trained in first-aid treatment and who are in-charge of the first-aid boxes or cupboards shall be pasted in every factory at a conspicuous place and near each such box or cupboard. The notice shall also indicate work-room where the said person shall be available. The name of the nearest hospital and its telephone number shall also be mentioned prominently in the said notice. 

What is Rule of Nine ? 

The rule of nines is a method used to estimate Total Body Surface Area (TBSA), or the percentage of the body surface burned. 

Upon intake of a new burn patient, healthcare professionals will assess the patient for severe trauma that needs to be addressed before the burns and stabilize the patient. If there are no other traumatic injuries that need to be prioritized, then the burn care team will begin to treat the burn injuries. One of the first steps in emergency burn care is using the rule of nines to estimate the TBSA. The rule of nines is not used for every burn patient. It is typically used for calculating the most severe burn injuries, such as second-, third- and fourth-degree burns. 

The degrees of burns indicate the degree of damage to the tissues. There are five degrees of burns:

First Degree : When the skin is reddened

Second Degree : When there are blisters on the skin, and

Third Degree : When there is destruction of deeper tissues and of charring.

Fourth Degree : Steam blebs

Fifth Degree : Carbonization

Percentage of Burn :

The danger from burns depends on the area i.e. percentage of the body part of the burns rather than

the degree. Superficial burns over a large area of the body are more dangerous than the complete carrying of a part of the limb. It must be noted that in the same person, different parts of the body may show different degrees of burns. Any burn of over 30% irrespective of deep degree - should be hospitalized as priority. More than 50% burns are more serious.

Above figure shows the percentage (extent) of burns. It follows the rule of 9. For more area, add the percentage appropriately. For example, burns of both hands and both legs indicate 9+18 = 27% burns. 

Techniques of the First Aid for various types of Injuries- 

1) First Aid for Burns- 

First Aid of minor Burns and Scalds:

In the case of minor burns:

1. Clean the area gently with clean water.

2. Submerge the burned area in cold water.

3. Apply a solution of salt and water (one teaspoonful to a pint of water) in out of the way places.

4. Cover with dry dressing.

5. Do not apply cotton wool direct to the burnt.

6. Do not apply any greasy substance.

7. Give warm drinks for example sweetened tea or coffee. 

First Aid of Serious Burns and Scalds : 

Immediate attention that required in serious burns are: 

1. Keep the casualty quiet and reassure him.

2. Wrap him up in clean cloth.

3. Do not remove adhering particles of charred clothing.

4. Cover burnt area with sterile or clean dressing and bandage. In case of burns covering a large part of the body, it is sufficient to cover the area with a clean sheet or towel.

5. Keep him warm but do not overheat him.

6. If the hands are involved, keep them above the level of the victim's heart.

7. Keep burned feet or legs elevated.

8. If victim's face is burnt, sit up or prop him up and keep him under continuous observation for breathing difficulty. If respiratory problems develop, an open airway must be maintained.

9. Do not immerse the extensive burned area or apply ice-water over it because cold may intensify the shock reaction. However, a cold pack may be applied to the face or to the hands or feet.

10. Shift the casualty to the nearest hospital if he is fit to be moved.

11. If you cannot take him to a hospital, wait for the doctor to arrive.

12. Do not open blisters.

13. Keep him wrapped up in clean cloth.

14. Treat for shock.

15. Remove quickly from the body anything of a constricting nature like rings, bangles, belt and boots. If this is not done early, it would be difficult to remove them later as the limb begins to swell.

16. If medical help or trained ambulance personnel cannot reach the scene for an hour or more and the victim is conscious and not vomiting give him a weak solution of salt and soda at home and enroute :- One level tea-spoonful of salt and half level tea-spoonful of baking soda to each quart of water, neither hot not cold. Allow the casualty to sip slowly. Give above four ounces to adult over a period of 15 minutes: two ounces to a child between 1 and 12 years of age and about one. Ounce to an infant under one year of age. Discontinue fluid if vomiting occurs. Do not apply ointment or any form of grease or other home remedy. 

2) First Aid for Artificial Respiration- 

Treatment when not breathing : 

1. Loosen all clothing at waist, chest and neck.

2. Tilt the head backwards, while supporting the back of neck with your palm. This will lift the

tongue to its normal position. Thus the air passage will be cleared and the casualty may begin to breath after a gasp.

3. If breathing does not begin after the above treatment, help movements of chest and lungs four or five times. This will be usually enough to start breathing. If breathing does not start even now, mouth to mouth (- to -nose) breathing should be begun. 

Mouth-to-Mouth breathing :

1. Place the casualty on his back. Hold his head tilted back.

2. Take a deep breath with mouth open widely.

3. Keep nostrils of casually pinched.

4. Cover the mouth of the casualty with your mouth smugly.

5. Watching the chest, blow into his lungs, until the chest bellows up. Withdraw your mouth. Note the chest falls back (It is hygienic to cover the mouth of casualty with your handkerchief or some clean cloth).

6. Repeat the above 15 to 20 times a minute.

7. If casualty is young (baby or child) the operations are as above, but your open mouth should cover both the mouth and nose of the casualty and blow gently.

8. If the chest does not rise (as in 5 above) look for an obstruction.

- Turn the casualty to a side and thump his back. This will make the obstructing material

come to the front of throat. Open the mouth and remove it with your finger covered with a

piece of the cloth.

- If a child, hold it up by the feet and thump the back.

9. Use mouth-to-nose respiration if mouth to-mouth is not possible, but now the casualty's mouth should be closed by the First Aider's thumb.

10. If heart is working, continue artificial respiration until normal breathing occurs. Send for

Ambulance. 

11. If the heart is not working, you will notice:

- The face is blue or pale.

- Pupils are dilated.

- Heart beats and pulse at the root of neck (carotid) are not felt.

Then treat as follows : 

(a) Place the casualty flat on his back on a hard surface (bench, table etc.)

(b) Give a smart hit with the edge of your hand on the lower and left angle of the sternum. 

This usually stimulates the heart to work. 

(c) In case the heart does not work, persist the striking for 10-15 seconds at the rate of one stroke a second. Feel for the pulse at the root of neck all the time. If the pulse becomes regular and continuous, stop beating, all the while artificial respiration has to go on. 

First Aid for Fracture-

• Stop bleeding, especially in the case of open fracture where the skin is torn, by wrapping the wound with a sterile bandage or a clean cloth.
• Avoid moving the affected area; any movement can result in serious complications—especially in the case of neck and back fractures.
• Cool the affected area by applying and ice pack or ice cubes wrapped in a clean cloth.
• Treat the patient's shock : help them get into a comfortable position, encourage them to rest, and reassure them. Cover them with a blanket or clothing to keep them warm.
• Call the ambulance, and help the patient get to the emergency department for examination and treatment.​​ 

Spine Fracture: 

Move the patient on a hard surface like table or bench etc.

1. Do not allow to sit, stand or walk

2. Tarn the patient by log rolling

3. Shift the patient to hospital. 

Backbone (Spinal) Fracture: 

1. Transport on a rigid frame. This frame may be improvised by using available boards or a door.

2. The rigid frame may be placed on a stretcher for transportation.

3. If a firm frame cannot be improvised, transport patient on abdomen on a stretcher made of canvas or blanket.

4. In neck fracture cases it is much better to get a doctor to the scene because danger to the life is great.

5. Immediate hospitalization is necessary. 

CPR :

Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful in many emergencies, such as a heart attack or near drowning, in which someone's breathing or heartbeat has stopped. 

There are two main stages to CPR: the preparation stage and the CPR stage.

Preparation steps-

Before performing CPR on an adult, use the following preparation steps:

Step 1. Call Ambulance

First, check the scene for factors that could put you in danger, such as traffic, fire, or falling masonry. Next, check the person. Do they need help? Tap their shoulder and shout, “Are you OK?”

If they are not responding, call Ambulance or ask a bystander to Ambulance before performing CPR. 

Step 2. Place the person on their back and open their airway

Place the person carefully on their back and kneel beside their chest. Tilt their head back slightly by lifting their chin.

Open their mouth and check for any obstruction, such as food or vomit. Remove any obstruction if it is loose. If it is not loose, trying to grasp it may push it farther into the airway.

Step 3. Check for breathing

Place your ear next the person’s mouth and listen for no more than 10 seconds. If you do not hear breathing, or you only hear occasional gasps, begin CPR.

If someone is unconscious but still breathing, do not perform CPR. Instead, if they do not seem to have a spinal injury, place them in the recovery position. Keep monitoring their breathing and perform CPR if they stop breathing.

CPR steps

Use the following steps to perform CPR:

Step 4. Perform 30 chest compressions

Place one of your hands on top of the other and clasp them together. With the heel of the hands and straight elbows, push hard and fast in the center of the chest, slightly below the nipples.

Push at least 2 inches deep. Compress their chest at a rate of least 100 times per minute. Let the chest rise fully between compressions. 

Step 5. Perform two rescue breaths

Making sure their mouth is clear, tilt their head back slightly and lift their chin. Pinch their nose shut, place your mouth fully over theirs, and blow to make their chest rise.

If their chest does not rise with the first breath, retile their head. If their chest still does not rise with a second breath, the person might be choking. 

Step 6. Repeat

Repeat the cycle of 30 chest compressions and two rescue breaths until the person starts breathing or help arrives. If an AED (automated external defibrillator) arrives, carry on performing CPR until the machine is set up and ready to use. 

First Aider- Roles ,Responsibility , Duties 

A first aider is a person trained to take care of individuals involved in an emergency.

Particularly, first aiders look after injured or ill patients who need immediate medical care.

They also ensure that their patients are safe and away from further harm.

They have certificates to validate their skills and knowledge in first aid which guarantees that the person in charge knows how to properly apply first aid.

Nominated first aiders are mostly needed in the workplace. An employer seeks to have a first aider on-site to comply with specific regulations. 

Roles of the First Aider- 

As a first aider, you’re responsible for providing immediate, lifesaving medical care to an ill or injured person.

You are on the hook for treating minor conditions, like a wound, external bleeding, or injury, for example.

First aiders are vital in ensuring the patient’s safety, especially before further medical help arrives. Or before bringing the casualty to the hospital.

These are a few tasks that you may be expected to perform as a first aider:

• Maintaining the airway of an unconscious person by placing them in a recovery position
• Performing cardiopulmonary resuscitation CPR or using an automated external defibrillator (AED) and other equipment
• Applying pressure to stop external bleeding
• Supporting an injured limb
• Your main role is to prevent risk, save lives, and ensure the health and safety of casualties.

A first aider has various responsibilities when dealing with an emergency situation. A first aider should:

• Manage the incident and ensure the continuing safety of themselves, bystanders and the casualty
• Assess casualties and find out the nature & cause of their injuries
• Arrange for further medical help or other emergency services to attend (e.g: the fire service)
• If trained, prioritize casualties based upon medical need
• Provide appropriate first aid treatment as trained
• If able, make notes/observations of casualties
• Fill out any paperwork as required
• Provide a handover when further medical help arrives 

Duties of First Aider- 

1) Assessing the situation

2) Protecting themselves & Individual 

3) Prevent Infection

4) Comfort and Reassurance 

5) Assessing the individual 

6) Summoning help if needed

7) Assisting the employer with their first aid needs assessments

8) Assist with accident and incident reports and investigations

9) If the first aider is trained in mental health first aid, they can carry out these responsibilities.

Reference- 

• https://www.medicalnewstoday.com/articles/322872
• Factories Act 1948,Maharashtra Factory Rule 1963
• Fundamentals of Industrial Safety and Health By - K.U.Mistry 
• Google.com