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Part 15: First Aid

    Key Words:
  • emergency
  • injury
  • illness
  • first aid
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1
Introduction

There is a paucity of research in the field of first aid. Without research into first aid interventions, recommendations must be derived indirectly from hospital-based, animal, or, at best, emergency medical services (EMS) studies.

1.1
Definition of First Aid

We define first aid as helping behaviors and initial care provided to a person for an acute illness or injury.

The goals of a first aid provider include preserving life, alleviating suffering, preventing further illness or injury, and promoting recovery.

First aid can be initiated by anyone in any situation and includes self-care.

First aid assessments and interventions should be medically sound and based on scientific evidence or, in the absence of such evidence, on expert consensus.

First aid competencies include, at any level of training,

  • Recognizing, assessing, and prioritizing the need for first aid
  • Providing care by using appropriate knowledge, skills, and behaviors
  • Recognizing limitations and seeking additional care when needed

The scope of first aid is not purely scientific; it is influenced by both training and regulatory constraints. The definition of scope is therefore variable and should be defined according to circumstances, need, and regulatory requirements.

1.2
First Aid Education

Education and training in first aid can be useful to improve morbidity and mortality from injury and illness. (Class IIa, LOE C-LD) (2015 Part 15)

We recommend that first aid education be universally available. (Class I, LOE C-EO) (2015 Part 15)

2
Calling for Help

First aid interveners need to know:

  • how and when to access the EMS system (eg. by calling 911)
  • how to activate the site-specific emergency response plan, if there is one
  • how to contact the Poison Control Centre (1-800-222-1222 throughout North America)
  • that they should call for advanced care immediately, if warranted, and not be unduly delayed by providing care to the ill or injured
  • that threats to life that should take priority over calling for help, namely addressing airway, breathing and circulation or severe uncontrolled bleeding

3
Positioning the Ill or Injured

Generally, an ill or injured person should not need to be moved, especially when a pelvic or spine injury is suspected.

If the area is unsafe for the first aid provider or the person, move to a safe location if possible. (Class I, LOE C-EO) (2015 Part 15)

If a person is unresponsive and breathing normally, it may be reasonable to place him or her in a lateral side-lying recovery position. (Class IIb, LOE C-LD) (2015 Part 15)

Extend one of the person’s arms above the head and roll the body to the side so that the person’s head rests on
the extended arm. Once the person is on his or her side, bend both legs to stabilize the body.

If a person is unresponsive and not breathing normally, proceed with basic life support guidelines (see Part 5: Adult Basic Life Support)

If a person has been injured and the nature of the injury suggests a neck, back, hip, or pelvic injury, the person should not be rolled onto his or her side and instead should be left in the position in which they were found, to avoid potential further injury. (Class I, LOE C-EO) (2015 Part 15)

If leaving the person in the position found is causing the person’s airway to be blocked, or if the area is unsafe, move the person only as needed to open the airway and to reach a safe location. (Class I, LOE C-EO) (2015 Part 15)

4
Position for Shock

If a person shows evidence of shock and is responsive and breathing normally, it is reasonable to place or maintain the person in a supine position. (Class IIa, LOE C-LD) (2015 Part 15)

If there is no evidence of trauma or injury (eg, simple fainting, shock from nontraumatic bleeding, sepsis, dehydration), raising the feet about 6 to 12 inches (about 30° to 60°) from the supine position is an option that may be considered while awaiting arrival of EMS. (Class IIb, LOE C-LD) (2015 Part 15)

Do not raise the feet of a person in shock if the movement or the position causes pain. (Class III:Harm, LOE C-EO) (2015 Part 15)

5
Oxygen Use in First Aid

Despite the common use of supplementary oxygen in various medical conditions, there is little evidence to support its use in the first aid setting.

Administration of oxygen is not considered a standard first aid skill. However, oxygen may be available in some first aid environments and requires specific training in its use.

The use of supplementary oxygen by first aid providers with specific training is reasonable for cases of decompression sickness. (Class IIa, LOE C-LD) (2015 Part 15)

For first aid providers with specific training in the use of oxygen, the administration of supplementary oxygen to persons with known advanced cancer with dyspnea and hypoxemia may be reasonable. (Class IIb, LOE B-R) (2015 Part 15)

Although no evidence was identified to support the use of oxygen, it might be reasonable to provide oxygen to spontaneously breathing persons who are exposed to carbon monoxide while waiting for advanced medical care. (Class IIb, LOE C-EO) (2015 Part 15)

There is insufficient evidence to recommend routine use of supplementary oxygen by a first aid provider for victims complaining of chest discomfort or shortness of breath. (Class IIb, LOE C) (2010 Part 17)

6
Medical Emergencies

6.1
Bronchodilators for Asthma With Shortness of Breath

First aid providers will likely encounter persons with a previous diagnosis of asthma and prescribed inhaled medication who have acute difficulty breathing and/ or wheezing.

It is reasonable for first aid providers to be familiar with the available inhaled bronchodilator devices and to assist as needed with the administration of prescribed bronchodilators when a person with asthma is having difficulty breathing. (Class IIa, LOE B-R) (2015 Part 15)

6.2
Stroke Recognition

Early stroke recognition through the use of stroke assessment tools or systems decreases the interval between the time of stroke onset, identification of a possible stroke, and arrival at the hospital and definitive treatment. This reduced delay to treatment is associated with better outcomes, such as improved neurologic function.

The Face, Arm, Speech, Time (FAST) and Cincinnati Prehospital Stroke Scale (CPSS) stroke assessment systems are simple and easy to use, with high sensitivity for the identification of stroke.

If glucose measurement is available to the first aid provider, stroke assessment systems such as the Los Angeles Prehospital Stroke Screen (LAPSS), Ontario Prehospital Stroke Scale (OPSS), Recognition of Stroke in the Emergency Room (ROSIER), and Kurashiki Prehospital Stroke Scale (KPSS) show increased specificity.

The use of a stroke assessment system by first aid providers is recommended. (Class I, LOE B-NR) (2015 Part 15)

6.3
Chest Pain

It can be very difficult to differentiate chest pain of cardiac origin, such as a heart attack or myocardial infarction, from other origins.

Common warning signs of a possible heart attack include chest discomfort, discomfort in other areas of the upper body (including pain or discomfort in one or both arms, the back, neck, jaw or stomach), shortness of breath and other signs such as nausea, sweating (ie, breaking out in a cold sweat), and lightheadedness.

Aspirin has been found to significantly decrease mortality due to myocardial infarction in several large studies and is therefore recommended for persons with chest pain due to suspected myocardial infarction. (Class I, LOE B-R) (2015 Part 15)

Call EMS immediately for anyone with chest pain or other signs of heart attack, rather than trying to transport the person to a healthcare facility yourself. (Class I, LOE C-EO) (2015 Part 15)

While waiting for EMS to arrive, the first aid provider may encourage a person with chest pain to take aspirin if the signs and symptoms suggest that the person is having a heart attack and the person has no allergy or contraindication to aspirin, such as recent bleeding. (Class IIa, LOE B-NR) (2015 Part 15)

The suggested dose of aspirin is 1 adult 325-mg tablet, or 2 to 4 low-dose “baby” aspirins (81 mg each), chewed and swallowed. (2015 Part 15)

If a person has chest pain that does not suggest that the cause is cardiac in origin, or if the first aid provider is uncertain or uncomfortable with administration of aspirin, then the first aid provider should not encourage the person to take aspirin. (Class III: Harm, LOE C-EO) (2015 Part 15)

The decision to administer aspirin in these cases may be deferred to an EMS provider with physician oversight.

6.4
Anaphylaxis

Most allergic reactions do not require epinephrine, but a small portion of reactions can progress to anaphylaxis.

Epinephrine is recommended for anaphylaxis, and persons at risk are typically prescribed and carry an epinephrine autoinjector.

An anaphylactic reaction involves 2 or more body systems and can be life-threatening.

Symptoms may include:

  • respiratory difficulty (such as wheezing),
  • cutaneous manifestations (such as hives or swelling of the lips and eyes),
  • cardiovascular effects (such as hypotension, cardiovascular collapse, or shock),
  • gastrointestinal cramping and diarrhea.

People who suffer from anaphylactic reactions know their signs and symptoms and many carry a lifesaving epinephrine auto-injector.

With proper training, people can learn to correctly use an auto- injector to administer epinephrine in anaphylactic emergencies.

First aid providers should also know how to administer the auto-injector if the victim is unable to do so, provided that the medication has been prescribed by a physician and state law permits it. (Class IIb, LOE B) (2010 Part 17) The recommended dose of epinephrine is 0.3 mg intramuscularly for adults and children greater than 30 kg, and 0.15 mg intramuscularly for children 15 to 30 kg, or as prescribed by the person’s physician.

First aid providers should call 9-1-1 immediately when caring for a person with suspected anaphylaxis or a severe allergic reaction. (Class I, LOE C-EO) (2015 Part 15)

When a person with anaphylaxis does not respond to the initial dose, and arrival of advanced care will exceed 5 to 10 minutes, a repeat dose may be considered. (Class IIb, LOE C-LD) (2015 Part 15)

6.5
Seizures

The general principles of first aid management of seizures are to:

  • Ensure an open airway.
  • Prevent injury.

Do not restrain the victim during a seizure. Do not try to open the victim’s mouth or try to place any object between the victim’s teeth or in the mouth. Placing an object in the victim’s mouth may cause dental damage or aspiration. (Class IIa, LOE C) (2010 Part 17)

It is not unusual for the victim to be unresponsive or confused for a short time after a seizure.

6.6
Hypoglycemia

Hypoglycemia can manifest as a variety of symptoms, including:

  • confusion,
  • altered behavior,
  • diaphoresis,
  • tremulousness.

Diabetics who display these symptoms should be assumed by the first aid provider to have hypoglycemia.

If the person is unconscious, exhibits seizures, or is unable to follow simple commands or swallow safely, the first aid provider should call for EMS immediately. (Class I, LOE C-EO) (2015 Part 15)

If a person with diabetes reports low blood sugar or exhibits signs or symptoms of mild hypoglycemia and is able to follow simple commands and swallow, oral glucose should be given to attempt to resolve the hypoglycemia. Glucose tablets, if available, should be used to reverse hypoglycemia in a person who is able to take these orally. (Class I, LOE B-R) (2015 Part 15)

It is reasonable to use dietary sugars* as an alternative to glucose tablets (when not available) for reversal of mild symptomatic hypoglycemia. (Class IIa, LOE B-R) (2015 Part 15)

    * Orange juice (unsweetened, from concentrate), Jelly beans, Sucrose candy (Skittles), Glucose 71%/oligosaccharides 29% candy (Mentos), Fructose (fruit leather, such as Stretch Island), Whole milk

For diabetics with symptoms of hypoglycemia, symptoms may not resolve until 10 to 15 minutes after ingesting glucose tablets or dietary sugars (Table 1).

First aid providers should therefore wait at least 10 to 15 minutes before calling EMS and re-treating a diabetic with mild symptomatic hypoglycemia with additional oral sugars. (Class I, LOE B-R) (2015 Part 15)

If the person’s status deteriorates during that time or does not improve, the first aid provider should call EMS. (Class I, LOE C-EO) (2015 Part 15)

Table 1: 2015 - Types of Food Representing 20 g of Carbohydrates and Number of People With Improvement in Hypoglycemia Within 15 Minutes (Based on Included Evidence)

6.7
Presyncope

Syncope is a transient loss of consciousness that results from global cerebral hypoperfusion. It can lead to falls and injuries. Many victims of syncope have recurrent episodes.

Vasovagal and orthostatic syncope are responsible (combined) for about one-third of all syncope. The underlying physiology of both conditions is decreased blood return to the heart, leading to decreased cardiac output, decreased global cerebral perfusion, and subsequent loss of consciousness.

The symptoms preceding loss of consciousness are known as presyncope and can last for a few seconds before onset of vasovagal and orthostatic syncope. Associated signs and symptoms include:

  • Pallor
  • Sweating
  • Lightheadedness
  • visual changes and
  • weakness

Presyncope presents recognizable signs and symptoms and a period during which rapid first aid treatment could improve symptoms or prevent syncope from occurring.

Victims of vasovagal and orthostatic syncope can be taught to recognize signs of presyncope and apply physical counter-pressure maneuvers (see Table 2), including handgrip, arm tensing, abdominal muscle tensing, leg crossing with tensing, squatting, and neck flexion. These maneuvers may reduce symptoms of presyncope and prevent syncope.

Table 2: Description of Recommended Physical Counterpressure Maneuvers

If a person experiences signs or symptoms of presyncope (including pallor, sweating, lightheadedness, visual changes, and weakness) of vasovagal or orthostatic origin, the priority for that person is to maintain or assume a safe position such as sitting or lying down. Once the person is in a safe position, it can be beneficial for that person to use physical counterpressure maneuvers to avoid syncope. (Class IIa; LOE C-LD) (2019 First Aid)

If a first aid provider recognizes presyncope of suspected vasovagal or orthostatic origin in another individual, it may be reasonable for the first aid provider to encourage that person to perform physical counterpressure maneuvers until symptoms resolve or syncope occurs. If no improvement occurs within 1 to 2 minutes or if symptoms worsen or reoccur, providers should initiate a call for additional help. (Class IIb; LOE C-EO) (2019 First Aid)

If there are no extenuating circumstances, lower-body physical counterpressure maneuvers are preferable to upper body and abdominal physical counterpressure maneuvers. (Class IIb; LOE C-LD) (2019 First Aid)

The use of physical counterpressure maneuvers is not suggested when symptoms of a heart attack or stroke accompany presyncope. (Class III: Harm; LOE C-EO) (2019 First Aid)

6.8
Exertional Dehydration

Vigorous exercise, particularly in hot and humid environments, can lead to significant dehydration with loss of water and electrolytes through sweat.

Ingestion of 5% to 8% carbohydrate-electrolyte solutions facilitates rehydration after exercise-induced dehydration and is generally well tolerated.

In the absence of shock, confusion, or inability to swallow, it is reasonable for first aid providers to assist or encourage individuals with exertional dehydration to orally rehydrate with carbohydrate electrolyte drinks. (Class IIa, LOE B-R) (2015 Part 15)

For individuals with severe dehydration with shock, confusion or symptoms of heat stroke, immediately activate the EMS system then begin immediate cooling, preferably by immersing the victim up to the chin in cold water. Heat stroke requires emergency treatment with intravenous fluids. Do not try to force the victim to drink liquids. See Heat Emergencies, below.

Other beverages, such as coconut water and 2% milk, have also been found to promote rehydration after exercise-associated dehydration, but they may not be as readily available. If these alternative beverages are not available, potable water may be used. (Class IIb, LOE B-R) (2015 Part 15)

6.9
Toxic Eye Injury

It can be beneficial to rinse eyes exposed to toxic chemicals immediately and with a copious amount of tap water for at least 15 minutes or until advanced medical care arrives. (Class IIa, LOE C-LD) (2015 Part 15)

If tap water is not available, normal saline or another commercially available eye irrigation solution may be reasonable. (Class IIb, LOE C-LD) (2015 Part 15)

First aid providers caring for individuals with chemical eye injury should contact their local poison control center or, if a poison control center is not available, seek help from a medical provider or 9-1-1. (Class I, LOE C-EO) (2015 Part 15)

7
Trauma Emergencies

7.1
Bleeding

Control of bleeding is an important first aid skill.

7.1.1
Direct Pressure

The use of pressure points or elevation of an extremity to control external bleeding is not indicated. (Class III: No Benefit, LOE C-EO) (2015 Part 15)

The standard method for first aid providers to control open bleeding is to apply direct pressure to the bleeding site until it stops. Control open bleeding by applying direct pressure to the bleeding site. (Class I, LOE B-NR) (2015 Part 15)

7.1.2
Localized Cold Therapy

There are limited data from the hospital setting demonstrating a benefit from application of localized cold therapy compared to direct pressure alone to closed bleeding, such as a bruise or hematoma.Local cold therapy, such as an instant cold pack, can be useful for closed bleeding, such as a bruise or hematoma, to an extremity or scalp. (Class IIa, LOE C-LD) (2015 Part 15)

Cold therapy should be used with caution in children because of the risk of hypothermia in this population. (Class I, LOE C-EO) (2015 Part 15)

7.1.3
Tourniquets

Because the rate of complications is low and the rate of hemostasis is high, first aid providers may consider the use of a tourniquet when standard first aid hemorrhage control does not control severe external limb bleeding. (Class IIb, LOE C-LD) (2015 Part 15)

A tourniquet may be considered for initial care when a first aid provider is unable to use standard first aid hemorrhage control, such as during a mass casualty incident, with a person who has multisystem trauma, in an unsafe environment, or with a wound that cannot be accessed. (Class IIb, LOE C-EO) (2015 Part 15)

Note the time that a tourniquet is first applied and communicate this information with EMS providers.

It is reasonable for first aid providers to be trained in the proper application of tourniquets, both manufactured and improvised. (Class IIa, LOE C-EO) (2015 Part 15)

Specifically designed tourniquets appear to be better than ones that are improvised, but tourniquets should only be used with proper training. (Class IIa, LOE B) (2010 Part 17)

7.1.4
Hemostatic Dressings

Hemostatic dressings may be considered by first aid providers when standard bleeding control (direct pressure with or without gauze or cloth dressing) is not effective for severe or life-threatening bleeding. (Class IIb, LOE C-LD) (2015 Part 15)

Hemostatic dressings are likely of greatest use:

  • for severe external bleeding in locations where standard hemorrhage control is not effective,
  • when a tourniquet cannot be applied (trunk or junctional areas such as the abdomen or axilla/groin),
  • when a tourniquet is not available,
  • when a tourniquet is not effective to stop bleeding.

Proper application of hemostatic dressings requires training. (Class I, LOE C-EO) (2015 Part 15)

7.2
Superficial Non-thermal Wounds and Abrasions

Superficial wounds and abrasions should be thoroughly irrigated with a large volume of warm or room temperature potable water with or without soap1-6 until there is no foreign matter in the wound. (Class I, LOE A) (2010 Part 17)

Cold water appears to be as effective as warm water, but it is not as comfortable. If running water is unavailable, use any source of clean water.

Wounds heal better with less infection if they are covered with an antibiotic ointment or cream and a clean occlusive dressing. (Class IIa, LOE A) (2010 Part 17)

Apply antibiotic ointment or cream only if the wound is an abrasion or a superficial injury and only if the victim has no known allergies to the antibiotic.

7.3
Open Chest Wounds

Management of an open chest wound in out-of-hospital settings is challenging and requires immediate activation of EMS.

Improper use of a dressing or device could lead to air trapping in the lung and fatal tension pneumothorax.

We recommend against the application of an occlusive dressing or device by first aid providers for individuals with an open chest wound. (Class III-Harm, LOE C-EO) (2015 Part 15)

In the first aid situation, it is reasonable to leave an open chest wound exposed to ambient air without a dressing or seal. (Class IIa, LOE C-EO) (2015 Part 15)

If a nonocclusive dressing, such as a dry gauze dressing, is applied for active bleeding, care must be taken to ensure that saturation of the dressing does not lead to partial or complete occlusion.

7.4
Concussion

The classic signs of concussion after head trauma include feeling stunned or dazed, or experiencing:

  • headache,
  • nausea,
  • dizziness and unsteadiness (difficulty in balance)
  • visual disturbance,
  • confusion, or loss of memory (from either before or after the injury)

The various grades and combinations of these symptoms make the recognition of concussion difficult.125

Changes in symptoms may be subtle and yet progressive.

First aid providers are often faced with the decision as to what advice to give to a person after minor head trauma: an incorrect decision can have long-term serious or even fatal consequences.

Any person with a head injury that has resulted in a change in level of consciousness, has progressive development of signs or symptoms as described above, or is otherwise a cause for concern should be evaluated by a healthcare provider or [by] EMS personnel as soon as possible. (Class I, LOE C-EO) (2015 Part 15)

Using any mechanical machinery, driving, cycling, or continuing to participate in sports after a head injury should be deferred by these individuals until they are assessed by a healthcare provider and cleared to participate in those activities. (Class I, LOE C-EO) (2015 Part 15)

7.5
Spinal Motion Restriction

The terms spinal immobilization and spinal motion restriction have been used synonymously in the past. Because true spinal immobilization is not possible, the term spinal motion restriction is now being used to describe the practice of attempting to maintain the spine in anatomical alignment and minimize gross movement, with or without the use of specific adjuncts such as collars.

With a growing body of evidence showing more actual harm and no good evidence showing clear benefit, we recommend against routine application of cervical collars by first aid providers. (Class III-Harm, LOE C-LD) (2015 Part 15)

If a first aid provider suspects a spinal injury, he or she should have the person remain as still as possible and await the arrival of EMS providers. (Class I, LOE C-EO) (2015 Part 15)

7.6
Musculoskeletal Trauma

7.6.1
Sprains and Strains

Soft-tissue injuries include joint sprains and muscle contusions.

Cold application decreases hemorrhage, edema, pain, and disability, and it is reasonable to apply cold to a soft-tissue injury.

Cooling is best accomplished with a plastic bag or damp cloth filled with a mixture of ice and water; the mixture is better than ice alone.

Refreezable gel packs do not cool as effectively as an ice-water mixture.

To prevent cold injury, limit each application of cold to periods ≤20 minutes. If that length of time is uncomfortable, limit application to 10 minutes. Place a barrier, such as a thin towel, between the cold container and the skin. (Class IIb, LOE C) (2010 Part 17)

It is not clear whether a compression bandage is helpful for a joint injury.

Heat application to a contusion or injured joint is not as good a first aid measure as cold application.

7.6.2
Suspected Long Bone Fractures

Long bone fractures may at times be severely angulated.

In general, first aid providers should not move or try to straighten an injured extremity. (Class III-Harm, LOE C-EO) (2015 Part 15)

Based on training and circumstance (such as remote distance from EMS or wilderness settings, presence of vascular compromise), some first aid providers may need to move an injured limb or person. In such situations, providers should protect the injured person, including splinting in a way that limits pain, reduces the chance for further injury, and facilitates safe and prompt transport. (Class I, LOE C-EO) (2015 Part 15)

If an injured extremity is blue or extremely pale, activate EMS immediately. (Class I, LOE C-EO) (2015 Part 15)

7.7
Burns

7.7.1
Thermal Burns: Cooling

Burns can come from a variety of sources such as hot water (scalds) and fire. It is known that applying ice directly to a burn can cause tissue ischemia.

Don’t apply ice directly to a burn; it can produce tissue ischemia. (Class III, LOE B) (2010 Part 17)

Cool thermal burns with cool or cold potable water as soon as possible and for at least 10 minutes. (Class I, LOE B-NR) (2015 Part 15)

If cool or cold water is not available, a clean cool or cold, but not freezing, compress can be useful as a substitute for cooling thermal burns. (Class IIa, LOE B-NR) (2015 Part 15)

Care should be taken to monitor for hypothermia when cooling large burns. (Class I, LOE C-EO) (2015 Part 15) This is particularly important in children, who have a larger body surface area for their weight than adults have.

7.7.2
Burn Dressings

After cooling of a burn, it may be reasonable to loosely cover the burn with a sterile, dry dressing. (Class IIb, LOE C-LD) (2015 Part 15)

Leave blisters intact because this improves healing and reduces pain.

Loosely cover burn blisters with a sterile dressing but leave blisters intact because this improves healing and reduces pain. (Class IIa, LOE B) (2010 Part 17)

After cooling of a burn, in general, it may be reasonable to avoid natural remedies, such as honey or potato peel dressings. (Class IIb, LOE C-LD) (2015 Part 15)

In remote or wilderness settings where commercially made topical antibiotics are not available, it may be reasonable to consider applying honey topically as an antimicrobial agent. (Class IIb, LOE C-LD) (2015 Part 15)

7.7.3
Burns: When Advanced Care is Needed

Burns associated with or involving (1) blistering or broken skin; (2) difficulty breathing; (3) the face, neck, hands, or genitals; (4) a larger surface area, such as trunk or extremities; or (5) other cause for concern should be evaluated by a healthcare provider. (Class I, LOE C-EO) (2015 Part 15)

7.8
Electric Injuries

Cardiopulmonary arrest is the primary cause of immediate death from electrocution.

Cardiac arrhythmias, including ventricular fibrillation, ventricular asystole, and ventricular tachycardia that progresses to ventricular fibrillation, may result from electric injuries.

Respiratory arrest may result from electric injury to the respiratory center in the brain or from tetanic contractions or paralysis of respiratory muscles.

When current traverses the body, thermal burns may be present at the entry and exit points and along its internal pathway.

Do not place yourself in danger by touching an electrocuted victim while the power is on. (Class III, LOE C) (2010 Part 17)

Turn off the power at its source; at home the switch is usually near the fuse box.

Immediately notify the appropriate authorities (eg, 911 or fire department) in case of high-voltage electrocutions caused by fallen power lines,

Do not enter the area around the victim or try to remove wires or other materials with any object, including a wooden one, as all materials conduct electricity if the voltage is high enough. Wait to approach the victim until the power has been turned off by knowledgeable personnel.

Once the power is off, assess the victim, who may need CPR, defibrillation, and treatment for shock and thermal burns.

All victims of electric shock require medical assessment because the extent of injury may not be apparent.

7.9
Human and Animal Bites

Irrigate human and animal bites with copious amounts of water. (Class I, LOE B) (2010 Part 17)

7.9.1
Snakebites

Do not apply suction as first aid for snakebites. (Class III, LOE C) (2010 Part 17)

Suction has no clinical benefit and it may aggravate the injury.

Applying a pressure immobilization bandage with a pressure between 40 and 70 mm Hg in the upper extremity and between 55 and 70 mm Hg in the lower extremity around the entire length of the bitten extremity is a reasonable way to slow the dissemination of venom by slowing lymph flow. (Class IIa, LOE C) (2010 Part 17)

For practical purposes, pressure is sufficient if the bandage is comfortably tight and snug but allows a finger to be slipped under it.

7.9.2
2010
Jellyfish Stings

First aid for jellyfish stings consists of preventing further nematocyst discharge and pain relief.

To inactivate venom load and prevent further envenomation, jellyfish stings should be liberally washed with vinegar (4% to 6% acetic acid solution) as soon as possible for at least 30 seconds. (Class IIa, LOE B) (2010 Part 17)

If vinegar is not available, a baking soda slurry may be used instead.

For the treatment of pain, after the nematocysts are removed or deactivated, jellyfish stings should be treated with hot-water immersion when possible. (Class IIa, LOE B) (2010 Part 17)

Instruct the victim to take a hot shower or immerse the affected part in hot water (temperature as hot as tolerated, or 45°C if there is the capability to regulate temperature), as soon as possible, for at least 20 minutes or for as long as pain persists. If hot water is not available, dry hot packs or, as a second choice, dry cold packs may be helpful in decreasing pain but these are not as effective as hot water. (Class IIb, LOE B) (2010 Part 17)

Topical application of aluminum sulfate or meat tenderizer, commercially available aerosol products, fresh water wash, and papain, an enzyme derived from papaya used as a local medicine, are even less effective in relieving pain. (Class IIb, LOE B) (2010 Part 17)

Pressure immobilization bandages are not recommended for the treatment of jellyfish stings because animal studie7,8 show that pressure with an immobilization bandage causes further release of venom, even from already fired nematocysts. (Class III, LOE C) (2010 Part 17)

7.10
Dental Avulsion

Dental avulsion injury can damage both the tooth and the supporting soft tissue and bone, resulting in permanent loss of the tooth.

Immediate reimplantation of an avulsed tooth is believed to result in the greatest chance of tooth survival.

In situations that do not allow for immediate reimplantation, it can be beneficial to temporarily store an avulsed tooth in a variety of solutions shown to prolong viability of dental cells. (Class IIa, LOE C-L) (2015 Part 15)

The following solutions have demonstrated efficacy at prolonging dental cell viability from 30 to 120 minutes, and they may be available to first aid providers (listed in order of preference):

  • Hank’s Balanced Salt Solution (containing calcium, potassium chloride and phosphate, magnesium chloride and sulfate, sodium chloride, sodium bicarbonate, sodium phosphate dibasic and glucose),
  • propolis,
  • egg white,
  • coconut water,
  • Ricetral, or
  • whole milk.

If none of these solutions are available, it may be reasonable to store an avulsed tooth in the injured persons saliva (not in the mouth) pending reimplantation. (Class IIb, LOE C-LD) (2015 Part 15)

Viability of an avulsed tooth stored in any of the above solutions is limited. Reimplantation of the tooth within an hour after avulsion affords the greatest chance for tooth survival.

Following dental avulsion, it is essential to seek rapid assistance with reimplantation. (Class I, LOE C-EO) (2015 Part 15)

8
Environmental Emergencies

8.1
Cold Emergencies

8.1.1
Hypothermia

Hypothermia is caused by exposure to cold. The urgency of treatment depends on the length of exposure and the victim’s body temperature.

Begin rewarming a victim of hypothermia immediately by moving the victim to a warm environment, removing wet clothing, and wrapping all exposed body surfaces with anything at hand, such as blankets, clothing, and newspapers.

If the hypothermia victim is far from definitive health care, begin active rewarming, although the effectiveness of active rewarming has not been evaluated. (Class IIa, LOE B) (2010 Part 17)

Active rewarming should not delay definitive care.

Potential methods of active rewarming include placing the victim near a heat source and placing containers of warm, but not hot, water in contact with the skin.

8.1.2
Frostbite

Frostbite usually affects an exposed part of the body such as the extremities and nose.

In case of frostbite, remove wet clothing and dry and cover the victim to prevent hypothermia.

Transport the victim to an advanced medical facility as rapidly as possible.

Do not try to rewarm the frostbite if there is any chance that it might refreeze or if you are close to a medical facility. (Class III, LOE C) (2010 Part 17)

Minor or superficial frostbite (frostnip) can be treated with simple, rapid rewarming using skin-to-skin contact such as a warm hand.

Severe or deep frostbite should be rewarmed within 24 hours of injury and this is best accomplished by immersing the frostbitten part in warm (37° to 40°C or approximately body temperature) water for 20 to 30 minutes. (Class IIb, LOE C) (2010 Part 17)

Chemical warmers should not be placed directly on frostbitten tissue because they can reach temperatures that can cause burns. (Class III, LOE C) (2010 Part 17)

Following rewarming, efforts should be made to protect frostbitten parts from refreezing and to quickly evacuate the patient for further care.

8.2
Heat Emergencies

Heat-induced symptoms, often precipitated by vigorous exercise, may include heat cramps, heat exhaustion, and heat stroke.

Heat cramps are painful involuntary muscle spasms that most often affect the calves, arms, abdominal muscles, and back. First aid for heat cramps includes rest, cooling off, and drinking an electrolyte-carbohydrate mixture, such as juice, milk, or a commercial electrolyte-carbohydrate drink. Stretching, icing, and massaging the painful muscles may be helpful. Exercise should not be resumed until all symptoms have resolved.

Heat exhaustion is caused by a combination of exercise-induced heat and fluid and electrolyte loss through sweat. Signs and symptoms may start suddenly and include:

  • nausea,
  • dizziness,
  • muscle cramps,
  • feeling faint,
  • headache,
  • fatigue,
  • heavy sweating.

Heat exhaustion is a serious condition because it can rapidly advance to heat stroke which can be fatal.

Treat heat exhaustion vigorously by having the victim lie down in a cool place, take off as many clothes as possible, cooling with a cool water spray, and encouraging the victim to drink cool fluids, preferably containing carbohydrates and electrolytes.

Heat stroke includes all the symptoms of heat exhaustion plus signs of central nervous system involvement, including dizziness, syncope, confusion, or seizures.

Immediately activate the EMS system and begin immediate cooling, preferably by immersing the victim up to the chin in cold water.

Heat stroke requires emergency treatment with intravenous fluids. Do not try to force the victim to drink liquids.

8.3
Drowning

Methods of preventing drowning include:

  • isolation fencing around swimming pools (gates should be self-closing and self-latching)
  • use of personal flotation devices (life jackets) while in, around, or on water
  • never swimming alone
  • avoiding swimming or operating motorized watercraft while intoxicated.

Outcome following drowning depends on the duration of the submersion, the water temperature, and how promptly CPR is started.

Remove the victim rapidly and safely from the water, but do not place yourself in danger.

If you have special training, you can start rescue breathing while the victim is still in the water,  providing that it does not delay removing the victim from the water.

Do not waste time trying to remove water with abdominal or chest thrusts as there is no evidence that water acts as an obstructive foreign body. In addition, the abdominal thrusts may result in expulsion of stomach contents that can be aspirated. In addition, the expelled stomach contents can obstruct the upper airway, interfering with delivery of rescue breaths.

Start CPR and, if you are alone, continue with about 5 cycles (about 2 minutes) of chest compressions and breaths before activating EMS.

If 2 rescuers are present, send 1 rescuer to activate EMS immediately, and retrieve emergency equipment, including an AED, if one is nearby.

9
Poison Emergencies

If the patient exhibits any signs or symptoms of a life-threatening condition, (eg, sleepiness, seizures, difficulty breathing, vomiting) after exposure to a poison, activate the EMS immediately.

9.1
Poison Control Centers

The Poison Help hotline of the American Association of Poison Control Centers (1-800-222-1222) is an excellent resource in the United States for information about treating ingestion of, or exposure to, a potential poison.

Further information is available at www.aapcc.org.

When phoning a poison control center or other emergency medical services, know the nature and time of exposure and the name of the product or toxic substance.

9.2
Chemical Burns

Brush powdered chemicals off the skin with a gloved hand or piece of cloth.

Remove all contaminated clothing from the victim, making sure you do not contaminate yourself in the process. In case of exposure to an acid or alkali on the skin or eye, immediately irrigate the affected area with copious amounts of water. (Class I, LOE B) (2010 Part 17)

For chemical injuries to the eye, see “Toxic Eye Injuries,” above.

9.3
Ingested Poisons

9.3.1
Treatment With Milk or Water

Do not administer anything by mouth for any poison ingestion unless advised to do so by a poison control center or emergency medical personnel because it may be harmful. (Class III, LOE C) (2010 Part 17)

9.3.2
Activated Charcoal

Do not administer activated charcoal to a victim who has ingested a poisonous substance unless you are advised to do so by poison control center or emergency medical personnel. (Class IIb, LOE C) (2010 Part 17) There is no evidence that activated charcoal is effective as a component of first aid.

9.3.3
Ipecac

Do not administer syrup of ipecac for ingestions of toxins. (Class III, LOE B) (2010 Part 17) It may produce intractable vomiting that can delay or complicate treatment in a healthcare facility.

10
Authorship and Disclosures

10.1
2015 Writing Group

Eunice M. Singletary, Chair; Nathan P. Charlton; Jonathan L. Epstein; Jeffrey D. Ferguson; Jan L. Jensen; Andrew I. MacPherson; Jeffrey L. Pellegrino; William “Will” R. Smith; Janel M. Swain; Luis F. Lojero-Wheatley; David A. Zideman

Table 3: Part 15: First Aid: 2015 Guidelines Update Writing Group Disclosures

10.2
2010 Writing Group

David Markenson, Co-Chair*; Jeffrey D. Ferguson, Co-Chair*; Leon Chameides; Pascal Cassan; Kin-Lai Chung; Jonathan Epstein; Louis Gonzales; Rita Ann Herrington; Jeffrey L. Pellegrino; Norda Ratcliff; Adam Singer

Table 4: 2010 - Guidelines Part 17: First Aid: Writing Group Disclosures

 

11
Footnotes

The American Heart Association and the American Red Cross request that this document be cited as follows:

American Heart Association and American Red Cross. Web-based Integrated Guidelines for First Aid. firstaidguidelines.heart.org.

© 2015 American Heart Association, Inc., and The American National Red Cross.

12
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