Comprehensive First Aid Training Guide: Levels 1-3
Principles and Definitions of First Aid
First Aid is defined as the immediate care provided to an acutely ill or injured person until the next level of care arrives. It is a vital and versatile skill set frequently applied in environments such as the home, the workplace, or during leisure activities. For individuals working within healthcare environments, maintaining First Aid proficiency is a medico-legal necessity. It is considered far better to possess First Aid knowledge and never require its use than to find oneself in an emergency situation without the necessary skills to assist. While this guide serves as a fundamental resource, the primary responsibility lies with the first aider to maintain their active skills and knowledge.
There are three central principles of First Aid: to preserve life, to prevent a patient’s condition from getting worse, and to promote patient recovery. To preserve life, a first aider must ensure the casualty’s airway remains open, verify that the casualty is breathing, confirm that their heart is beating, and prevent further blood loss from any existing wounds. To prevent a condition from worsening, the first aider should immobilize injuries, take steps to prevent infection in wounds, place the casualty in the most comfortable position possible, and ensure they are transported correctly. To promote recovery, the patient must be treated for shock and protected from any further environmental injuries.
Ethical Considerations and Consent in Emergency Care
A first aider acts as a representative of the broader Healthcare system during an emergency. Because the public generally does not differentiate between various medical qualifications during a crisis, the behavior of a first aider shapes the perception of all medical professionals. Ethics in this context refers to the moral principles governing behavior within society. A first aider is expected to treat patients and their families with respect and dignity, respect patient confidentiality, provide their name and qualification upon arrival, and obtain necessary consent. Crucially, a first aider must only perform procedures that fall within their specific scope of practice.
Consent is the written, verbal, or implied permission required to assist a patient who is older than years of age. Whenever possible, informed consent should be obtained, which requires that the patient or their family understands and appreciates all risks involved with a procedure and its possible outcomes. In cases involving a minor younger than years of age, consent must be obtained from a legal guardian or parent. In many emergency situations where the patient is unable to communicate, consent is often implied based on the necessity of life-saving care.
Safety and Mitigation of Biological Hazards
Working with patients involves inherent risks of infection and injury due to biological hazards. To mitigate these risks, a first aider should practice consistent hand washing and utilize personal protective equipment (PPE) such as gloves, aprons, and masks. Any existing wounds on the first aider's own body should be covered, and personal vaccinations must be kept up to date to provide a defense against transmissible diseases.
Infectious Diseases: HIV, Cholera, and Malaria
The Human Immunodeficiency Virus (HIV) attacks the immune system, eventually leading to the clinical syndrome known as Acquired Immune Deficiency Syndrome (AIDS). Symptoms of HIV and AIDS are often nonspecific and may include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. Transmission occurs through unprotected vaginal, anal, or oral sex, as well as through breast milk, mother-to-child transmission, and the sharing of needles. First aiders can protect themselves by wearing gloves and eye protection, covering their own wounds (especially when dealing with arterial bleeding), and practicing mindful needle safety. If exposed, a short course of Antiretroviral (ARV) medication, such as Combivir, can be obtained post-exposure, though these medications are often unpleasant and costly if not covered by medical aid or an employer.
Cholera is an intestinal infection caused by the bacterium Vibrio Cholerae, typically resulting from poor sanitation and contaminated drinking water. Symptoms include profuse watery diarrhea often described as "rice-water stools," vomiting, rapid heart rate, loss of skin elasticity, dry mucous membranes, low blood pressure, thirst, muscle cramps, and irritability. Protection involves using clean tap water, boiling water before consumption, using purification tablets, and washing hands thoroughly. Food should be cooked thoroughly and eaten while hot, and all cutlery must be washed in clean water. Treatment focuses on eradicating bacteria and combating dehydration. If a patient is able to drink, a first aider can provide a rehydration mixture by boiling of water and mixing in teaspoon of salt and teaspoons of sugar. Once cooled, this mixture is administered to the patient. Severe cases require intravenous fluids and antibiotics. Oral vaccines like Dukoral, Shanchol, and Euvichol are available and require two doses for full protection.
Malaria is a preventable and curable disease that causes over a million deaths annually. It is transmitted via the bite of an infected female malaria mosquito. Once in the body, sporocytes spread from the liver, causing hepatic failure, widespread destruction of red blood cells, and subsequent anemia. Symptoms, which may only appear days after the bite, include fever (constant or intermittent), chills, profuse sweating, malaise, muscle and joint pain, headache, confusion, nausea, loss of appetite, diarrhea, abdominal pain, and cough. Protection involves covering the body between dusk and dawn, using screen covers on doors and windows, applying insect repellents, burning mosquito coils at night, and sleeping under mosquito netting. Travelers are advised to use chemoprophylaxis to suppress the blood stage of the infection.
The Generic Approach to Emergency Action
To prevent confusion and the neglect of vital steps during a frightening emergency, first aiders utilize a generic approach structured by the mnemonic: Hazards, Hello, Help, Circulation, Airway, and Breathing.
Hazards represent any harmful conditions to the responder or the patient. A first aider should only treat a patient when it is safe to do so. Examples of hazards include rare but high-mortality infectious diseases like Ebola, toxic gasses or fumes (which should be ventilated), and car accidents. At an accident scene, one must keep an eye on traffic. If first on the scene, the responder should, if safe, apply the parking brake, roll down windows, switch the vehicle off, and place the keys on the dashboard. Electrical hazards require switching off power at the main board or notifying authorities for downed power lines. In fire situations, the patient should be removed only if it is safe for the responder.
Hello involves greeting the patient to establish ethical care while simultaneously assessing their mental status and level of consciousness. If the patient can speak, they have a patent airway, as sound production requires air movement. This initial contact also allows for an assessment of the patient's perfusion state. Help should be summoned once a level of seriousness is established or if the responder feels uncomfortable. Essential emergency numbers include (Netcare 911), (ER 24), (City of Johannesburg EMS), and (Universal emergency line). When calling, stay calm, state your name and contact details, provide the exact location with landmarks, describe the incident, state the number of casualties and their injuries, and detail any scene hazards.
Circulation is assessed by palpating a pulse for at least seconds. The carotid pulse is preferred for cardiac arrest, while the radial pulse is used for conscious patients. The first aider must assess the rate (beats per minute), rhythm (regularity), and quality (full, weak, or bounding). If the pulse is absent, cardiopulmonary resuscitation (CPR) must commence immediately. Airway assessment involves ensuring the passage is not blocked by foreign objects or swelling (such as from burns). Breathing is assessed by inspecting the chest for movement and feeling for air movement. The breaths taken per minute must be counted and recorded.
Multiple Casualty Incidents and Triage Systems
A multiple casualty incident involves more than one patient and can appear chaotic. Responders must only approach if safe and should immediately report to the Incident Commander (IC). The IC oversees the entire scene, and their permission is required before assisting. First aiders can perform vital roles such as gathering patient details or moving equipment from a staging area. Triage, meaning "to sort," is used to categorize patients by priority. South Africa typically uses a color-coded or code-numbered system. Red (Priority 1) indicates the most severe patients who require immediate treatment and transport. Orange (Priority 2) cases require treatment but can wait until Red cases are managed. Green (Priority 3) refers to the "walking wounded" with minor injuries. Black (Priority 4) indicates patients who have already passed away.
Secondary Survey: Vital Signs and Medical History
The secondary survey is a step-by-step physical assessment, vital signs check, and history taking performed after the generic approach. Responders must stop and treat any abnormality detected before continuing the assessment. The circulatory system is evaluated by pulse measurement and blood pressure (BP). A blood pressure reading consists of a systolic value (the higher number) and a diastolic value. Normal adult BP is a systolic of and a diastolic of . Hypertension is defined as a systolic above , while hypotension is below . The respiratory system is assessed by counting breaths; normal adult respiration is .
History taking utilizes two mnemonics: AMPLE and OPQRSTA. AMPLE stands for Allergies, Medication, Past medical history (such as Diabetes, Epilepsy, TB, or Heart conditions), Last meal, and Events leading to the injury. OPQRSTA stands for Onset (when the pain started), Provocations (what makes it better or worse), Quality (type of pain), Radiation and Region (location and spread), Severity (rated on a scale from to ), Timing (constant or intermittent), and Associated signs (any other symptoms).
Respiratory Emergencies: Asphyxia and Choking
Asphyxia occurs when the body is deprived of oxygen or experiences an extreme decrease in oxygen concentration accompanied by an increase in carbon dioxide, leading to unconsciousness or death. The causes are remembered by the mnemonic GONE: Gas (displacing oxygen in lungs or hemoglobin, like Nitrogen or Carbon Monoxide), Obstruction (foreign objects or swelling), Nerves (neuromuscular disorders affecting respiratory muscles), and Electricity (dysfunction of respiratory nerve centers). General symptoms include difficulty breathing, anxiety, restlessness, gurgling sounds, cyanosis (blueness) of tissues, confusion, and eventually the absence of breathing. Treatment involves removing the cause, assessing CABs (Circulation, Airway, Breathing), and arranging rapid transport.
Specific types of asphyxia include suffocation (physical blockage like hanging or strangulation), carbon monoxide poisoning (accompanied by pink skin and black oral residue), and drowning. In drowning or near-drowning, water either displaces air or washes away the pulmonary surfactant; treatment requires removing water from the airway. A flail chest occurs when more than one rib is broken in more than two places, causing paradoxical chest wall movement. Choking involves an upper airway obstruction, frequently in pediatric or geriatric populations, and is characterized by an inability to speak or cry.
Shock: Types and Immediate Treatment
Shock is a state of inadequate tissue perfusion, resulting in insufficient oxygen and nutrient delivery and poor waste removal. The three primary causes are heart failure (inability to pump), decrease in blood volume (often due to bleeding), and dilation of blood vessels (lowering blood pressure). Types of shock include septic (bacterial infection), anaphylactic (severe allergic reaction to stings, food, or medicine), cardiogenic (heart damage), hypovolemic (severe blood or fluid loss), and neurogenic (spinal cord injury damaging blood vessel control nerves). To treat shock, let the patient lie down, elevate their legs to , cover them with a blanket to prevent heat loss, monitor CABs every minutes, and call for emergency services.
Unconsciousness and Seizure Management
Unconsciousness is a state where a patient is partly or completely unresponsive to verbal or painful stimuli. The level of consciousness is assessed using the AVPU scale: Alert (responds normally), Verbal (responds to being spoken to), Pain (responds only to painful stimuli), and Unresponsive. Causes are remembered by HAS FAINTED: Head injury, Asphyxia, Shock/Stroke, Fainting, Alcohol, Infantile convulsions, Narcotic poisons, Temperature (hot/cold), Epilepsy/Electric shock, and Diseases (Diabetes/Kidney failure). Specific conditions include cerebral herniation (brain shifting due to swelling), concussion (confusion and headache without anatomical abnormalities), and fainting (lack of substrate or perfusion reaching the brain).
Seizures are abnormal, uncoordinated neuronal discharges resulting in neurological deficits and involuntary muscle contractions. Epilepsy is a major cause and is divided into Petit Mal (small seizures, often in children, featuring lip-smacking or eyelid jerking) and Grand Mal (loss of consciousness, muscle rigidity, and rhythmic contractions, followed by confusion). Febrile convulsions occur in infants with high temperatures. In all seizure cases, the first aider should remain calm, remove dangerous objects from the environment, and call for help. For febrile convulsions, cooling the patient is necessary. Once seizing stops, assess CABs and monitor AVPU every minutes.
Cardiac Disorders: Angina and Heart Attack
Angina Pectoris occurs when muscles surrounding the coronary arteries spasm, narrowing the vessel and decreasing blood flow. It typically presents with chest pain behind the sternum that moves to the left jaw and arm, usually brought on by exertion and relieved by rest. Acute Myocardial Infarction (a heart attack) involves a complete blockage of a coronary artery. It presents similarly to angina, but the pain does not subside with rest and instead progresses. Treatment involves placing the patient in a semi-seated position, keeping them calm, minimizing physical or emotional exertion to reduce oxygen demand, and performing CPR if cardiac arrest occurs.
Wound Care and Hemorrhage Control
Blood is transported away from the heart by arteries and toward the heart by veins. Serious vessel damage leads to hypoxia and tissue necrosis, especially affecting the heart, brain, and kidneys. Symptoms of severe hemorrhage include pale, clammy skin, an initially increased heart rate that later slows, thready peripheral pulses, restlessness, blurred vision, and thirst. Treatment includes applying direct pressure to the wound, indirect pressure to major supplying arteries, and elevating the limb above the heart.
Specific hemorrhage types include nosebleeds, where the patient should lean forward while pressure is applied to the soft tissues of the nose. Scalp wounds bleed profusely and require direct pressure. Varicose vein ruptures involve high-pressure venous bleeding and should be bandaged from the inferior (bottom) to superior (top) part of the limb. Amputations involve severe bleeding; the limb should be managed with direct pressure (or a ligature if necessary), and the amputated part should be placed in a plastic bag on ice. For abdominal wounds with protruding organs, do not remove objects or push organs back in; instead, cover the area with sterile gauze dampened with saline and elevate the legs.
Burn Classification and Management
Burns are caused by temperature extremes or pH imbalances. They are classified by cause: Dry (fire), Wet (steam/fluid), Chemical (acids/alkalis), Electrical (lightning), Cold (dry ice/compressed gas), and Radiation (sunburn). Severity is graded in three levels. Superficial burns involve only the epidermis and are red and tender. Partial thickness burns involve the epidermis and dermis, presenting with blisters, swelling, and extreme pain. Full thickness burns involve all layers of the skin, appearing black and charred; while the charred area is painless, the surrounding tissue experiences severe pain. Treatment involves cooling with sterile water, applying sterile wet dressings or burnshield, and covering the patient with a blanket.
Bites, Stings, and Envenomation
Snake venom in South Africa is categorized into three types. Cytotoxic venom (found in Adders, Vipers, and Puff Adders) causes significant local tissue damage and large dark blisters. Hemotoxic venom (found in Boomslangs) interferes with blood clotting, with symptoms often delayed. Neurotoxic venom (found in Cobras, Mambas, and Rinkhals) affects the central nervous system, causing neurological deficits. If venom is sprayed into the eyes, rinse immediately with water. Treatment for bites involves assessing CABs, preventing the patient from moving, and immobilizing the limb. Do not use a ligature, hunt the snake, or suck the wound.
Dangerous spider bites include the Black Widow (neurotoxic) and the Violin spider (cytotoxic). Treatment for both involves standard CAB assessment. Bee stings are generally harmless unless an anaphylactic reaction occurs, requiring shock treatment. A stinger can be removed by scraping it off with a rigid plastic card. Human and animal bites carry a high risk of infection and should be treated for bleeding and referred for medical care.
Environmental Conditions: Heat and Cold
Normal body temperature is approximately . Heat exhaustion results from high sodium loss through sweat, presenting with headache, dizziness, and cool, clammy skin. Treatment involves lying down with legs raised and slow rehydration. Heat stroke is a medical emergency with high body temperature and red, hot, dry skin; patients must be cooled slowly with lukewarm water and transported immediately. Hypothermia occurs when temperature drops below normal due to cold exposure, causing shivering, confusion, and numbness. Treatment involves moving the patient to a warm environment, replacing wet clothing with one thick layer, and placing warm water bottles in the groin and armpits.
Toxicology and Poisoning Management
Poisons enter the body through ingestion, injection, inhalation, or absorption. Common clinical findings include unconsciousness, impaired breathing, vomiting, and abdominal pain. A first aider should assess the patient and attempt to identify the poison but must never induce vomiting or give the patient anything to eat or drink. Netcare 911 operates a poison center that can provide specific treatment guidance. Toxicology cases often involve recreational substance abuse or suicide attempts through various administration routes.
Dressings, Bandages, and Soft-Tissue Injuries
A dressing is a sterile, porous, and absorbent covering placed directly on a wound. A bandage secures the dressing, applies pressure, and provides support. A bandage is too tight if the patient experiences pins and needles, loss of sensation, or if the peripheral tissues become cold, red, blue, or pale. A pulse distal to a tight bandage will be weak.
Sprains involve ligaments and soft tissue near a joint, while strains involve muscles and tendons. Both are treated using the RICE mnemonic: Rest (prevents further injury), Ice (causes vasoconstriction to decrease inflammation), Compression (decreases swelling), and Elevation (assists in moving lymphatic fluid away). Because they are often indistinguishable, all such injuries should be referred for diagnostic imaging.
Orthopedic and Spinal Emergencies
Fractures are breaks in bone continuity caused by direct or indirect force, resulting in pain, swelling, deformity, and unusual movement. Dislocations involve the displacement of articulating surfaces within a joint, causing severe deformity and an inability to move the joint. The primary treatment for both is splinting. Spinal cord injuries result from direct or penetrating trauma to the spinal column. Symptoms include motor or sensory dysfunction and palpable deformities ("step in" or "step out"). Treatment requires advising the patient not to move and immobilizing the cervical spine. A unit lift or log roll must be used for movement, and transport requires appropriate equipment.
Emergency Child Birth and Neonatal Assessment
Childbirth is a natural process divided into three stages. The first stage lasts hours, from the first contraction to full cervix dilation. The second stage lasts minutes to hours, ending in the delivery of the baby; signs include crowning and severe pain. The third stage is the delivery of the placenta, occurring within minutes of birth. The placenta must be taken to the hospital for examination.
The baby is assessed at and minutes using the APGAR scoring system. Activity: for absent, for flexed limbs, for active. Pulse: for absent, for below , for over . Grimace: for floppy, for minimal response, for prompt response. Appearance: for blue/pale, for pink body with blue extremes, for entirely pink. Respirations: for absent, for slow/irregular, for a vigorous cry. Post-partum hemorrhage is a serious complication requiring abdominal massage and rapid transport.
Questions & Discussion
Question 1.1: Name the principles of first aid and give examples of each.
Question 1.2: Give examples of how a first aider could practice ethically.
Question 1.3: What is informed consent?
Question 1.4: How can a first aider mitigate the risk of infection transmission?
Question 2.1: How is HIV/AIDS transmitted?
Question 2.2: How can a first aider protect himself against cholera?
Question 2.3: What precautions could one take to protect oneself from malaria?
Question 3.1: List the generic approach to an incident and give a short description of each.
Question 3.2: When should a first aider call for help?
Question 3.3: What should you remember when phoning for help?
Question 4.1: To whom to you report at a multiple casualty scene?
Question 4.2: List the triage classifications of a triage system used in South Africa.
Question 5.1: For how long should the first aider assess both a pulse and respiratory rate during the secondary survey?
Question 5.2: A blood pressure consists of two readings. Name the two readings.
Question 5.3: What are the normal values for an adult blood pressure?
Question 5.4: What are the normal values for an adult respiratory rate?
Question 5.5: List the AMPLE mnemonic.
Question 5.6: List the OPQRSTA mnemonic.
Question 6.1: Provide a suitable definition for asphyxia.
Question 6.2: List the causes of Asphyxia as per the GONE pneumonic.
Question 6.3: List the general signs and symptoms of asphyxia.
Question 6.4: What should the first aider generally do in the case of asphyxiation?
Question 6.5: Identify a specific cause of asphyxia and describe the signs and symptoms as well as the treatment thereof.
Question 7.1: Provide a definition for shock.
Question 7.2: List the three primary causes of shock.
Question 7.3: List the different types of shock and give a brief description of each.
Question 7.4: What should the First aider do if a Pt presents with shock?
Question 8.1: Provide a suitable definition of unconsciousness.
Question 8.2: What does each letter in the AVPU assessment resemble?
Question 8.3: What are the causes for unconsciousness?
Question 8.4: How can a first aider treat unconsciousness?
Question 8.5: Discuss a specific cause of unconsciousness.
Question 9.1: Provide a suitable definition for seizures.
Question 9.2: What are the causes of seizures?
Question 9.3: Provide a suitable definition for Epilepsy.
Question 9.4: Differentiate between Petite Mal and Grand Mal seizures.
Question 9.5: Define Febrile convulsions and provide a treatment specific to the condition.
Question 9.6: What can a first aider do if a Pt presents with seizures?
Question 9.7: What should a first aider do if a Pt that was seizing, stops having seizures?
Question 10.1: Provide a suitable definition for Angina Pectoris.
Question 10.2: List the signs and symptoms of Angina Pectoris.
Question 10.3: Provide a suitable definition for Acute Myocardial Infarction.
Question 10.4: Describe the chest pain felt with cardiac conditions.
Question 10.5: How can a first aider treat cardiac conditions?
Question 11.1: Provide a suitable definition of an artery.
Question 11.2: Provide a suitable definition of a vein.
Question 11.3: List the signs and symptoms of severe hemorrhage.
Question 11.4: What can a first aider do if a Pt is bleeding?
Question 12.1: Provide a suitable definition of a burn.
Question 12.2: List the types of burns and give an example of what could cause such a burn.
Question 12.3: List the three levels of burns.
Question 12.4: What could the first aider do for a burn victim?
Question 13.1: What types of venom does snakes have?
Question 13.2: How is a snake bite treated?
Question 13.3: What should the first aider never do with regards to snake bites?
Question 13.4: How are bee stings treated?
Question 14.1: List the signs and symptoms of heat stroke.
Question 14.2: How can a first aider treat heat stroke?
Question 14.3: List the signs and symptoms of hypothermia.
Question 14.4: How can the first aider treat hypothermia?
Question 15.1: Provide a suitable definition for poison.
Question 15.2: Via which routes can poison enter the body?
Question 15.3: List the common clinical findings for poison.
Question 15.4: How can the first aider treat a poison victim?
Question 15.5: Briefly discuss substance abuse and list the common routes of administration thereof.
Question 16.1: Provide a suitable definition for a dressing.
Question 16.2: Provide a suitable definition for a bandage.
Question 16.3: List the functions of a bandage.
Question 16.4: List the signs and symptoms of a bandage that has been applied too tightly.
Question 17.1: Provide a suitable definition for a fracture.
Question 17.2: List the signs and symptoms of a fracture.
Question 17.3: Provide a suitable definition for a dislocation.
Question 17.4: List the signs and symptoms of a dislocation.
Question 18.1: Provide a suitable definition for a sprain.
Question 18.2: How can a first aider treat a sprain or a strain?
Question 18.3: Provide a suitable definition for a strain.
Question 19.1: List the signs and symptoms of a spinal injury.
Question 19.2: How can the first aider treat a spinal cord injury?
Question 20.1: Describe the stages of labour.
Question 20.2: Tabulate the APGAR scoring system.
Question 20.3: List a complication of birth.