In an accident where many people have been injured at once or within quick succession of each other, it’s very important to know which ones need treatment first. When a patient has multiple injuries, breathing, heartbeat and bleeding should be given priority.
- Assess the injuries and handle them in this order:
- Restore and maintain regular breathing and heartbeat
- Stop any bleeding
- Dress wounds and burns
- Immobilize and secure and fractures
- Treat shock
Note: Before approaching any injured person, check the surrounding area for any danger to yourself and protect yourself from it. Beware or electrical cables, gas pipes, falling debris, dangerous structures or wreckage. Give initial treatment without moving the patient, if possible, but – if there is continuing danger in the area – move the patient and yourself to a safer location.
Remove From Danger
First, reduce any immediate danger to you and the patient by moving them to safety. In the case of a road accident, stop the traffic. In the case of electrocution, switch off the current before attempting to approach or assist the patient. If you can’t, stand on dry, non-conductive material and push or lever the patient from the power source with a dry, non-conductive pole or stick BEFORE touching them. If gas or poisonous fumes are threatening, turn them off at the source and remove all patients to fresh air.
There is always a risk in moving a patient with unknown injuries because you could aggravate them. However, if they are further threatened by immediate danger, they must be moved to have a chance of survival. People with spinal injuries are at the greatest risk when moved – the spinal cord could be severed. The only safe way to move them requires several people (see Fracture Of The Spine).
Breathing But Unconscious
If the patient is breathing and does not appear to have any spinal injuries, check that there is no obstruction in their mouth, deal with any serious bleeding, and place them in recovery position:
Recovery Position: Move the arm and leg on one side of the body outwards to stop the patient from lying flat. The elbow and knee should both be bent. Turn the head in the same direction as the elbow and knee. Lay the other arm down along the other side of the patient. Allow the other leg to bend slightly. Pull the jaw forward to check that the tongue is at the front of the mouth and not blocking the airway.
Warning: Do NOT place a patient with a suspected spinal injury in the recovery position. Use an artificial airway to maintain their respiration and as a way to administer mouth-to-mouth resuscitation. CHECK BREATHING AND HEARTBEAT!
If lying on the back you will need to gently turn the casualty on one side, usually most easily done by grasping clothing at the hip. This produces a stable position so that any liquids or vomit produced from the stomach or nose will not enter or block the lungs and the tongue will not fall back and block the airway.
Breathing And Pulse
Normal breathing is quiet and easy. Noisy breathing, froth around the nose or lips and blueness around the lips and ears are all signs of difficult or obstructed breathing. Check breathing regularly by listening carefully near the nose and mouth. Remove obstructions and, in the absence of breathing, give artificial respiration. Check at nose or wrist for pulse.
Cessation Of Breathing
This dire emergency may be caused by:
- Blockage of upper air passages caused by face and neck injuries or foreign bodies
- Drowning or electric shock
- Choking
- Inflammation and spasm of air passages cause by inhalation of smoke, gases or flame
- Lack of Oxygen
- Compression of the chest
Choking And Blockages
If breathing has stopped, immediately remove any obstruction in the airway and give artificial respiration. Clear the airway of any foreign matter: weed, vomit, false teeth or food. Sweep the mouth with a finger and ensure the tongue has not fallen back to obstruct the breathing passages.
If someone appears to be choking, but can breathe and cough, their own coughing is more effective than your aid. A blow on the back may sometimes help. If the victim can not speak, use the Heimlich maneuver with adults, but see other methods for special cases.
Heimlich Maneuver: Stand or kneel behind the patient, arms around them. Clench one hand over the other, thumb side of fists pressing between the waist and bottom of ribs. Apply pressure and jerk quickly upwards four times.
IF THIS DOES NOT WORK: Give four sharp blows to the back between the shoulder blades to loosen the object and then perform four more “hugs”. Stop when victim starts breathing or coughs loudly.
REPEAT if this does not work at first. DO NOT GIVE UP! Be ready to give artificial respiration, if the blockage is removed, but the patient does not start breathing. Lay an unconscious patient on their back, kneel to the side, place your hands, one on top of the other, with the heels resting above the navel, and make quick thrusts up to the center of the rib cage. If the blockage does not appear to shift, quickly roll the patient on to their side and strike four times between the should blades. Repeat as necessary.
Not Breathing And No Pulse
Drowning:
Symptoms: Can occur through fluid blockages but generally patient will be in water or have face in liquid. The face, especially the lips and ears will appear livid (dark bluish gray) and congested. There will possibly be fine froth at the mouth and nostrils – it is the froth that is blocking the air passage.
Do not attempt to remove liquid from the lungs – you can’t. Begin artificial respiration as soon as possible. If still in water, support the floating body and begin mouth-to-mouth resuscitation after quickly removing any mouth obstructions.
Electrocution:
Symptoms: The cause will usually be obvious. Electrocution may stop the heart and muscle spasms may throw the victim some distance. Electrical burns will be much deeper than their appearance suggests.
Never touch the victim until the current is turned off or contact is broken. If an appliance is involved, it may be possible to break the contact by pulling on the insulated cable. But beware of any liquids which will conduct current – victims may urinate. Give artificial respiration and treat for cardiac arrest if necessary before treating burns. TAKE NO RISKS!
Lightning:
Symptoms: Another form of electrocution – the victim is usually stunned and falls unconscious. Clothing may catch fire and the patient may have electrical burns. The burns will be more severe where metal objects, like watches, jewelry, rings, buckles are worn.
Give artificial respiration if necessary and treat burns. Prolonged resuscitation may be needed. Recovery is often delayed.
Heart Attack:
Symptoms: Severe pain in the chest, shortness of breath, patient feeling giddy, possibly collapsing to the ground and often anxious. Heavy sweating, irregular pulse, blueness of lips or skin. If breathing fails, give artificial respiration and, if pulse stops, give external heart compression.
Artificial Respiration
Mouth-to-Mouth (‘Kiss of Life’)
When attempting to assist an injured individual who is not breathing, this is the fastest and most effective method. Begin applying as soon as the airway is clear. Normal recovery is relatively rapid, except in the case of electric shock, drugs and carbon monoxide poisoning. In these cases, the nerve and muscles are paralyzed or oxygen in the blood has been replaced by carbon monoxide – be prepared to carry on for a long time. If the face is injured, or poison or chemical burns are suspected use the Silvester Method (see below).
Artificial Respiration: With Facial Injury
Silvester Method: This form of resuscitation is recommended when poisoning or facial injury prevents the use of the normal mouth-to-mouth method. This method is especially useful when the patient may need cardiac compression (which can be done by the same first-responder).
To use this method, place the casualty on their back, raise the shoulders with a pad or folded blanket or clothing. Kneel astride the casualty’s head. Place hands flat over lower ribs and rock forward to press steadily downwards.
REPEAT rhythmically about 12 times for an adult. If there is no improvement, turn the patient on their side and strike briskly between the shoulders to remove any obstruction before continuing the cycle.
DON’T GIVE UP! Resuscitation techniques have saved the lives of victims of drowning, hypothermia, and electrocution after three hours without spontaneous breathing.
Artificial Respiration: Face Down
Holger Nielsen method: This technique is recommended for resuscitating a drowning victim if mouth-to-mouth is not practical, or if the patient can not be turned on their back. In this form, the patient lies face down so liquids can flow freely from the mouth and not cause choking.
Place the head turned to one side, arms bent with the forehead resting on the hands. Loosen any tight clothing and ensure the tongue is brought forward. Make sure the mouth is clear of any obstructions.
Face the casualty, kneeling on one knee at the head, placing your hands over the shoulder blades, thumbs touching and fingers spread. Perform the following process:
- Counts 1-3: Rock forward with arms straight, producing gentle, even, increasing pressure (about 2 sec)
- Count 4: Rock back, sliding hands to grasp patient’s upper arms (0.5 – 1 sec)
- Counts 5-7: Pull and raise patients arms gently by rocking further backwards (2 sec). Avoid raising patient’s trunk or disturbing the head too much.
- Count 8: Lower the patient’s arms to ground and slide the hands back to the initial position (0.5 – 1 sec)
AFTER NORMAL BREATHING IS RESTORED, place the patient in recovery position (see above) – after ALL forms of resuscitation. But NOT in cases of spinal injuries.
For more in-depth emergency medical instruction, I recommend this training. In these situations, nothing takes the place of confidence in your own knowledge and abilities.