First Aid
First aid kits for the treatment of minor injuries should be available. Except for minor injuries, the services of a physician should be obtained. A person qualified to administer first aid should be present on each shift on “on-site” jobs.
Prior to starting “on-site” jobs, telephone communications should be available and tested to summon medical assistance if required. Each “on- site” job should have the telephone number of the closest hospital and medical personnel available.
Shock
Shock occurs when there is a severe injury to any part of the body from any cause. Every injured person is potentially a patient of shock and should be regarded and treated as such, whether symptoms of shock are present or not.
Proper treatment of shock is as follows:
Keep the patient warm and comfortable, but not hot. In many cases, the only first aid measure necessary and possible is to wrap the patient underneath as well as on top to prevent loss of body heat.
Keep the patient’s body horizontal or, if possible, position him or her so that the feet are 12–18 in. higher than the head. In any case, always keep the patient’s head low. The single exception to this positioning is the case of a patient who obviously has an injury to the chest, and who has difficulty in breathing. This patient should be kept horizontal with head slightly raised to make breathing easier.
Do not let the patient sit up, except as indicated in chest injury or where there is a nose bleed. If there is a head injury and perhaps a fracture of the skull, keep the patient level and do not elevate his feet.
If the patient is conscious, you may give him or her hot tea, coffee, or broth in small quantities since the warmth is valuable in com- bating shock.
Proper transportation practice is never more imperative than in the case of a person who may develop shock. It is the most important single measure in the prevention and treatment of shock. Use an ambulance, if possible. If other means must be used, follow the above points as closely as possible.
Resuscitation
• Seconds count. Begin artificial respiration as soon as possible. In electric shock cases, do not rush and become a casualty yourself. Safely remove victim from electrical contacts before starting artificial respiration. Do not move victim unless necessary to remove him or her from danger or to place him or her in the proper position for artificial respiration.
• Attempt to stop any hazardous flow of blood.
• Clear victim’s mouth of false teeth or any foreign objects or fluids with your fingers or a cloth wrapped around your finger. Watch victim closely to see that mucus or stomach contents do not clog air passages.
• If help is available, have the following taken care of while applying artificial respiration:
Call a doctor and ambulance.
Loosen victim’s clothing about neck, chest, and waist.
Keep victim warm during and after resuscitation. Use ammonia inhalants.
Do not give liquids while victim is unconscious.
• Continue uninterrupted rescue breathing until victim is breathing with out help or until pronounced dead.
• The change of operators, when necessary, shall be done as smoothly as possible without breaking the rhythm. If necessary to move victim, continue resuscitation without interruption.
• Watch victim carefully after he revives. Do not permit him to exert himself.
Resuscitation—Mouth-to-Mouth (Nose) Method
Place victim on his back. Place his head slightly downhill, if possible. A folded coat, blanket, or similar object under the victim’s shoulders will help maintain proper position. Tilt the head back so chin points straight upward.
Grasp the victim’s jaw and raise it upward until the lower teeth are higher than the upper teeth; or place fingers on both sides of the jaw near the ear- lobes and pull upward. Maintain jaw position throughout resuscitation period to prevent tongue from blocking air passage.
Pinch victim’s nose shut with thumb and forefinger, take a deep breath and place your mouth over victim’s mouth making airtight contact; or close victim’s mouth, take a deep breath and place your mouth over victim’s nose making airtight contact. If you hesitate at direct contact, place a porous cloth between you and victim.
Blow into the victim’s mouth (nose) until his chest rises. Remove your mouth to let him exhale, turning your head to hear out rush of air. The first 8 to 10 breaths should be as rapid as the victim will respond; thereafter, the rate should be slowed to about 12 times a minute.
Important Points to Remember
If air cannot be blown in, check position of victim’s head and jaw and recheck mouth for obstructions; then try again more forcefully. If chest still does not rise, turn victim face down and strike his back sharply to dislodge obstruction. Then repeat rescue breathing procedure.
Sometimes air enters victim’s stomach, evidenced by swelling of stomach. Expel air by gently pressing down on stomach during exhalation period.
Two-Victim Method of Resuscitation— Mouth-to Mouth (Nose)
In those rare instances where two men working together are in shock, both require resuscitation, and only one worker is available to rescue them, the following method may be used:
Place two victims on their backs, with their heads almost touching and their feet extended in a straight line away from each other.
Perform the mouth-to-mouth resuscitation method as described in Section 13.8.3. Apply alternately to each victim. The cycle of inflation and exhalation does not change so it will be necessary for rescuer to work quickly in order to apply rescue breathing to both victims.
External Heart Compression
Perform heart compression only when indicated: After rescue breathing has been performed for about half a minute, if bluish or gray skin color remains and no pulse can be felt, or if pupils of the eyes are dilated, heart compression should be started. Heart compression is always accompanied by rescue breathing. If only one rescuer is present, interrupt compression about every 10 to 15 compression cycles and give victim three or four breaths.
• Place victim on his back on a firm surface.
• Put hands on breastbone. Place heel of one hand on lower third of breastbone with other hand on top of first.
• Press downward. Apply pressure until breastbone moves 1–1.5 to 2 in.
• Lift hands and permit chest to return to normal.
• Repeat compression 60 times per minute.
Heart compression should not be performed in the following instances:
• When victim has a pulse
• When his pupils do not remain widely dilated
• When his ribs are broken