First aid is the immediate assistance provided to the sick or injured to preserve life until professional help arrives. It is a set of skills to ensure that the victim’s brain continuously receives oxygen to prevent brain death and that their injuries are managed for the best chance of recovery. Most Malaysians spend 40 hours and above at work each week. Learning first aid skills in the workplace ensures that employees have a better chance of survival should a medical emergency occur.
Cardiopulmonary resuscitation (CPR)
Cardiopulmonary resuscitation (CPR) is a combination of chest compression and mouth-to-mouth ventilation to maintain blood circulation and oxygen delivery to the brain. It should be continuously performed on a victim whose heart has stopped beating. These are the key points to take note of when performing CPR:
- One cycle of CPR takes 30 chest compressions followed by 2 rescue breaths.
- Chest compressions should be delivered at 100 to 120 compressions per minute. It is helpful to perform chest compression rates to songs with similar rhythms, such as Stayin’ Alive by Bee Gees.
- Each chest compression should be hard enough to be at least 2 inches deep and allow the chest to completely recoil (2 inches up) before the next compression.
Using an automated external defibrillator (AED)
An automated external defibrillator (AED) restores the heart rhythm of a sudden cardiac arrest victim to normal by delivering an electric shock upon analyzing a shockable rhythm. AED usage is an important skill because it increases the victim’s survival rate by at least 50%. These are the key points to take note of when using an AED:
- The AED chest pads must stick to the victim’s bare skin.
- No one should touch the victim when the AED analyses the heart rhythm or delivers the shock.
- Many AED models come with step-by-step voice prompts that are easy to follow.
Basic airway management
Maintaining smooth breathing with a clear airway is an important element of Basic Life Support (BLS), especially in unconscious victims. The airway of the victim can be obstructed by an object, blood, vomit, or even their tongue. These are the key points to take note of in basic airway management:
- If the victim is breathing, they should be placed in a recovery position (lying on their side) to prevent aspiration in case of vomiting and to avoid an obstructed airway due to the collapsing tongue.
- Tilting the victim’s head and lifting their chin is a commonly reliable way of opening their airway, especially during CPR.
- Using a bag valve mask is an advanced first aid skill in aiding the victim’s breathing during and after resuscitation.
Choking (foreign body airway obstruction) relief
The universal signs of choking are the inability to talk and cough, and cyanosis where the victim’s fingernails and lips turn blue. It is a silent threat that takes away the victim’s ability to breathe. Abdominal thrust, also known as the Heimlich maneuver, is performed to clear the obstruction. These are the key points to take note of in choking relief:
- For obese or pregnant victims whose abdomen is not accessible, chest thrust should be done instead.
- For infants under one year old, alternating sets of back slaps and chest thrusts should be performed. The back slaps are done using the heel of our palm while holding them face down in a slanting position followed by 2 fingers of our hand to be placed in the middle of the infant’s chest to perform the chest thrusts.
- Abdominal thrusts should be performed until the object dislodges from the airway or if the victim falls unconscious.
Wound care and bleeding control
The goal of wound care is to prevent life-threatening blood loss and infection. Applying direct pressure, hemostatic dressing, and tourniquet are effective methods of stopping bleeding. The wounds should be covered with bandages to minimize exposure to the surroundings. These are the key points to take note of in wound care and bleeding control:
- Impaled objects through the wounds should be stabilized using bulk dressing and not removed.
- If an organ is exposed through the wound, a wet dressing should be used to cover the organ and secured with a plastic sheet to keep the humidity without trying to put the organ back into the body.
- If there is an amputated body part, it should be kept dry and cool without direct contact with ice.
Recognizing and responding to hypovolemic shock
Hypovolemic shock, a state of organ failure due to inadequate circulation of blood in the body should be expected if the victim bleeds profusely. Signs of shock are thirst, rapid but weak pulse, increased respiration rate, pale clammy skin, nausea, and vomiting. These are the key points to take note of in responding to hypovolemic shock:
- To ease blood circulation, the victim should lie down with elevated legs.
- The victim should be kept warm by covering using a blanket.
Burn treatment
Direct contact with excessive heat, electricity, and chemicals can burn skin. The severity of burns can be assessed based on the depth of the skin affected, from epidermis (first-degree burn), and dermis (second-degree burn) to subcutaneous tissue (third-degree burn). The cause of the burn determines the immediate care that should be provided before covering the wound with a clean dry dressing. These are the key points to take note of in burn treatment:
- For thermal burns, cool the skin under running water for at least 10 minutes.
- For electrocution, once the danger is removed, cover the burn wound with a clean dry dressing.
- For chemical burns, remove the contaminated clothing and items before rinsing the chemicals off for at least 10 minutes (best to refer to the Safety Data Sheet)
- Hypovolemic shock should be expected if the surface area of the burn wound is large as the body loses water through evaporation.
Fracture and sprain management
Splinting using hard splint (planks, magazine rolls, etc.), soft splint (towel, bandage, etc.), or buddy splint (holding using our body parts) is the main fracture and sprain management to immobilize the injured limb and reduce pain. The aim is to prevent the injury from worsening, especially if the spine is involved. These are the key points to take note of in fracture and sprain management:
- Bleeding control should be prioritized if it is an open fracture.
- To immobilize the fractured part, the length of the splint applied should always cover 2 nearest joints.
- The tightness of the splinting can be checked through capillary refill time which is two seconds or less, with possible movement and no numbness at the edge of the limb.
- Compression using ice packs can reduce pain for sprain and strain injuries.
——-
Understanding the risks of medical emergencies in your workplace helps your first aiders or emergency response team members better prepare for any possible incidents. Besides the training modules mandated by the Department of Occupational Safety and Health (DOSH) under the Guidelines On First-Aid In Workplace, the first aid training conducted in your workplace should include elective modules such as emergency delivery, snake bites, and hypothermia to ensure the best preparation for medical emergencies.
