What is first aid?

Introduction

In 2005, the American Red Cross and the American Heart Association created the National First Aid Science Advisory Board (NFASAB) to review scientific literature on first aid. The board’s review found few published studies on first-aid practices and concluded that most of them are based on professional experience and expert opinion. The board then published evidence-based first-aid guidelines that can be used to update training programs.

First aid administered at the scene of an accident can be lifesaving. As a general rule, a victim should not be moved if spinal injury is suspected. Advanced first-aid training should include the proper use of immobilization devices for suspected spinal injuries.

Common first-aid breathing emergencies include asthma attacks, allergic anaphylaxis, seizures, and choking. A first-aid responder to an asthma
attack can assist a victim in administering his or her prescribed medication, usually an inhaler, while waiting for professional aid. For anaphylaxis due to allergies to insect stings or food, first-aid responders should be trained to administer epinephrine in an emergency, if state law permits, or to assist a victim in self-administering. Seizure treatment should focus on preventing injury and keeping the airway open. Restraining a victim during a seizure is not recommended, as it can cause bruising or injury. Placing an object in the mouth can damage teeth or obstruct airways and is also not recommended. Choking can occur in adults and children when an object gets stuck in the throat and cuts off air. First-aid techniques for choking include using the heel of the hand to administer five firm blows between a person’s shoulder blades and, if that fails to dislodge the object, administering the Heimlich maneuver. Both techniques can injure a person if not done correctly. Standard first-aid training should include common breathing emergency techniques.

Common injury-related first aid includes bleeding control and wound management. Excessive bleeding should be controlled by applying pressure over the area until the bleeding stops. Gauze or other clean, soft material can be placed over the wound while applying pressure and should not be removed prematurely. The use of pressure points and the elevation of a limb to help control excessive bleeding are not well studied and should not be used instead of the proven method of applying pressure to the wound. The safety and effective use of tourniquets is also under review.

Cuts, scrapes, and puncture wounds
should all be cleaned with cool water. Soap and a soft cloth should be used to clean around the wound, and sterile tweezers should be used to remove any dirt that remains in the wound after rinsing with water. Bleeding can help clean out a shallow wound and usually stops in a few minutes. Deeper cuts may require gentle, firm pressure with gauze or other sterile material. If the wound is on the leg or arm, after bleeding has been controlled, raising it above the patient's head may help, but this should not be used if it interferes with the application of pressure. The wound should be covered if it will get dirty or rub against something; otherwise a shallow wound can remain uncovered to help it dry and heal faster. Large-area scrapes need to be kept moist and covered to avoid scarring. Bandages should be changed at least every day. Antibiotic cream can help prevent infections; triple antibiotic cream is recommended as the most effective.

First-aid training for burns includes how to identify first-, second-, and third-degree burns. Serious burns can result from exposure to fire, heat sources, the sun, electricity, chemicals, or radiation. A serious burn can be any burn more than several inches in diameter or one that turns the skin white or looks charred. Stabilizing treatment includes soaking the burned area in cool water (five minutes for a first-degree burn, fifteen minutes for a second-degree burn), then treating with a skin ointment such as aloe or antibacterial cream and covering the burn area with loose gauze to keep air off and keep the area clean. Over-the-counter pain or anti-inflammatory medicine may help reduce pain and swelling. Direct application of ice cubes to skin is not recommended. Burn blisters should not be popped or removed.

First aid for muscle injuries includes applying a cold pack for no more than twenty minutes to the injury to reduce hemorrhage, edema, pain, and disability. Use of a compression bandage to reduce edema has not been well studied. If an injured extremity is blue or extremely pale, then immediate medical care is needed.

There are many toxic or poisonous substances in the home and workplace. First-aid training includes instruction in emergency procedures for different classes of poisons. Government-sponsored poison-control centers are a good resource. Poisoning can occur by swallowing a poisonous substance, breathing in poisonous air, or contacting a poisonous substance with bare skin. Poison-control centers can provide advice. First-aid training for poison response includes strategies for stabilizing the victim, identifying the poison, and minimizing the responder’s exposure to poisonous substances. For ingested poisons, some commonsense approaches or older methods are no longer recommended. Inducing vomiting with syrup of ipecac is not recommended, nor is administering charcoal. If poisons have been inhaled, then removing the person to a place with fresh air as fast as possible is essential.

Standard first aid includes recognition and treatment of insect, snake, and animal bites. Some insect bites or stings, such as from bees, wasps, yellow jackets, and fire ants, can cause localized pain and swelling; if a person is allergic, they can cause more serious reactions, including life-threatening swelling of airway passages (anaphylaxis). Only a small number of spiders cause serious reactions in nonallergic people; chief among these are the black widow and the brown recluse. First-aid training should cover treatment for insect bites or stings, including tick bites, as well as animal bites. The latter should also feature assessment of the possibility of rabies
infection. Poisonous snakebites are a medical emergency. First-aid recommendations focus on limiting the spread of venom in the bloodstream by not moving the affected area. It is not advised to try to suck out the venom or cut out the bitten area.

Wilderness first aid requires some additional skills and supplies. Stabilizing an injured person and assisting them in evacuating a remote area are critical skills. Components of wilderness first-aid training can include how to treat hyperthermia, hypothermia, frostbite, and altitude sickness; specific knowledge of marine hazards, such as stinging jellyfish; emergency treatment for diarrhea and dehydration; and how to make splints and other supports from available materials. Hikers and explorers should learn specifics about first aid for the area where they will be traveling.

Discussion

First-aid training is often available through local Red Cross chapters or local community or health centers. Key components of first-aid training should include knowing how to get help, knowing how to position a victim, and knowing how to handle medical emergencies. Key medical emergencies include breathing difficulties, anaphylaxis, and seizures. Key injury emergencies include bleeding; wounds and abrasions; burns; spine injuries; musculoskeletal injuries such as sprains, strains, and fractures; and dental injuries. Key environmental emergencies include hypothermia, drowning, poisoning, and snakebites. More complex first-aid training may include safe handling of blood-borne pathogens and administration of oxygen and cardiopulmonary resuscitation (CPR). Specific first-aid training, such as wilderness first aid and travel first aid, are offered by a number of organizations.

The most common first-aid courses offer home first-aid training for parents and other caregivers. Basic first-aid training for the home includes how to respond to common illnesses and conditions such as croup, stroke, angina, asthma, diabetes, epilepsy, meningitis, anaphylaxis, heart attack, and febrile convulsions. It can also include how to identify and respond to common household poisonings, eye injury, head injury, crush injury, spinal injury, and the effects of temperature extremes. Other topics include how to respond to minor injuries and illness such as fever, cramps, blisters, fainting, earache, vomiting, headache, diarrhea, toothache, sore throat, abdominal pain, crushed fingers, burns and scalds, allergic reactions, stings, splinters, and small wounds and grazes.

First-aid kits are a key component of any first-aid effort. First-aid kits should be available in every home, school, work site, and vehicle. A standard kit should include a first-aid manual; bandages, including elastic bandages and sterile gauze; adhesive tape; disinfectants, such as antiseptic wipes or solutions; antibiotic ointment; over-the-counter pain and anti-inflammatory medicine, such as acetaminophen and ibuprofen; various tools, such as tweezers, sharp scissors, and safety pins; a thermometer; and plastic gloves.

Perspective and Prospects

First aid has been a part of organized Western medicine since the mid-nineteenth century, when it was expanded from efforts to tend to wounded soldiers. It began as basic training for soldiers to tend war casualties. The term “first aid” was coined from the terms “first response” and “National Aid” (the precursor to the British Red Cross) in 1878 by British Army officer and doctor Peter Shepherd, who, together with fellow officer Francis Duncan, introduced the concept of training civilians in first aid. Participants in these training courses received a certificate and volunteered to help care for wounded soldiers.

First aid became an established form of emergency care in the late nineteenth century. In Great Britain, the St. John Ambulance Brigade was established in 1873 to provide first aid to the public, and the St. John Ambulance Association was established in 1877 to train civilians in first-aid care. The primary focus was on providing aid to industrial workers. As part of the St. John Ambulance Association program, first-aid volunteers also helped in public disaster response. Both these groups have their roots in the Order of St. John, a religious order that provided medical services to soldiers as early as the twelfth century. St. John Ambulance remains one of the largest providers of first aid worldwide, operating in thirty-nine countries.

At about the same time that the Order of St. John was establishing first-aid classes, the International Red Cross committee was working to provide humanitarian aid to soldiers worldwide. In 1863, Henry Dunant founded the International Committee of the Red Cross as a reaction to the mass war casualties that he witnessed during a business trip to Italy and the lack of medical and humanitarian care available to wounded soldiers. This was the beginning of international efforts to establish Red Cross societies around the world. In the United States, Clara Barton, a nurse and teacher, became president of the American Red Cross in 1881. She expanded basic first-aid training for soldiers to include training for industrial accidents and disaster relief. Today, national Red Cross societies exist in most countries.

Bibliography

American Red Cross and Kathleen A. Handal. The American Red Cross First Aid and Safety Handbook. Boston: Little, Brown, 1992.

“First Aid.” MedlinePlus, May 28, 2013.

Krohmer, Jon R., ed. American College of Emergency Physicians First Aid Manual. 2d ed. New York: DK, 2004.

Subbarao, Italo, Jim Lyznicki, and James J. James, eds. The American Medical Association Handbook of First Aid and Emergency Care. Rev. ed. New York: Random House Reference, 2009.

Weiss, Eric A. Wilderness and Travel Medicine: A Comprehensive Guide. 4th ed. Seattle: Mountaineers, 2012.