first aid first aid first aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. first aid is generally performed by someone with basic medical training. mental health first aid is an extension of the concept of first aid to cover mental health, while psychological first aid is used as early treatment of people who are at risk for developing ptsd. conflict first aid, focused on preservation and recovery of an individual's social or relationship well-being, is being piloted in canada. the universal first aid symbol a us navy corpsman gives first aid to an injured iraqi citizen. there are many situations that may require first aid, and many countries have legislation, regulation, or guidance, which specifies a minimum level of first aid provision in certain circumstances. this can include specific training or equipment to be available in the workplace (such as an automated external defibrillator), the provision of specialist first aid cover at public gatherings, or mandatory first aid training within schools. generally , 5 steps are associated with first aid , them being: assess the surrounding areas. move to a safe surrounding (if not already. example: road accidents are unsafe to be dealt with on roads.) call for help. (both professional medical help and people nearby who might help in first aid such as giving compression during cpr). perform suitable first aid depending on the injury suffered by the casualty. evaluate your casualty for any fatal signs or danger , or possibility of performing the first aid again. early history and warfare skills of what is now known as first aid have been recorded throughout history, especially in relation to warfare, where the care of both traumatic and medical cases is required in particularly large numbers. the bandaging of battle wounds is shown on classical greek pottery from c. 500 bc, whilst the parable of the good samaritan includes references to binding or dressing wounds. there are numerous references to first aid performed within the roman army, with a system of first aid supported by surgeons, field ambulances, and hospitals. roman legions had the specific role of capsarii, who were responsible for first aid such as bandaging, and are the forerunners of the modern combat medic. further examples occur through history, still mostly related to battle, with examples such as the knights hospitaller in the 11th century ad, providing care to pilgrims and knights in the holy land. formalization of life saving treatments during the late 18th century, drowning as a cause of death was a major concern amongst the population. in 1767, a society for the preservation of life from accidents in water was started in amsterdam, and in 1773, physician william hawes began publicizing the power of artificial respiration as means of resuscitation of those who appeared drowned. this led to the formation, in 1774, of the society for the recovery of persons apparently drowned, later the royal humane society, who did much to promote resuscitation. napoleon's surgeon, baron dominique-jean larrey, is credited with creating an ambulance corps, the ambulance volantes, which included medical assistants, tasked to administer first aid in battle. in 1859, swiss businessman jean-henri dunant witnessed the aftermath of the battle of solferino, and his work led to the formation of the red cross, with a key stated aim of "aid to sick and wounded soldiers in the field". the red cross and red crescent are still the largest provider of first aid worldwide. esmarch bandage showing soldiers how to perform first aid in 1870, prussian military surgeon friedrich von esmarch introduced formalized first aid to the military, and first coined the term "erste hilfe" (translating to 'first aid'), including training for soldiers in the franco-prussian war on care for wounded comrades using pre-learnt bandaging and splinting skills, and making use of the esmarch bandage which he designed. the bandage was issued as standard to the prussian combatants, and also included aide-memoire pictures showing common uses. in 1872, the order of saint john of jerusalem in england changed its focus from hospice care, and set out to start a system of practical medical help, starting with making a grant towards the establishment of the uk's first ambulance service. this was followed by creating its own wheeled transport litter in 1875 (the st john ambulance), and in 1877 established the st john ambulance association (the forerunner of modern-day st john ambulance) "to train men and women for the benefit of the sick and wounded". also in the uk, surgeon-major peter shepherd had seen the advantages of von esmarch's new teaching of first aid, and introduced an equivalent programme for the british army, and so being the first user of "first aid for the injured" in english, disseminating information through a series of lectures. following this, in 1878, shepherd and colonel francis duncan took advantage of the newly charitable focus of st john, and established the concept of teaching first aid skills to civilians. the first classes were conducted in the hall of the presbyterian school in woolwich (near woolwich barracks where shepherd was based) using a comprehensive first aid curriculum. first aid training began to spread through the british empire through organisations such as st john, often starting, as in the uk, with high risk activities such as ports and railways. aims the primary goal of first aid is to prevent death or serious injury from worsening. the key aims of first aid can be summarized with the acronym of 'the three ps': preserve life: the overriding aim of all medical care which includes first aid, is to save lives and minimize the threat of death. first aid done correctly should help reduce the patient's level of pain and calm them down during the evaluation and treatment process. prevent further harm: prevention of further harm includes addressing both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent worsening of the condition, such as applying pressure to stop a bleed from becoming dangerous. promote recovery: first aid also involves trying to start the recovery process from the illness or injury, and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound. it is important to note that first aid is not medical treatment and cannot be compared with what a trained medical professional provides. first aid involves making common sense decisions in the best interest of an injured person. setting the priorities protocols such as atls, batls, safe-point are based on the principle of defining the priorities and the procedure where the correct execution of the individual steps achieves the required objective of saving human life. basic points of these protocols include: catastrophic bleeding (massive external bleeding) airway (clearing airways) breathing (ensuring respiration) circulation (internal bleeding) disability (neurological condition) exposure (overall examination, environment) a major benefit of these protocols is that they require minimum resources, time and skills with a great degree of success in saving lives under conditions unfavourable for applying first aid. abcde method airway (clearing airways): if the patient responds in a normal voice, then the airway is patent. airway obstruction can be partial or complete. signs of a partially obstructed airway include a changed voice, noisy breathing (e.g., stridor), and an increased breathing effort. with a completely obstructed airway, there is no respiration despite great effort (i.e., paradox respiration, or "see-saw" sign). a reduced level of consciousness is a common cause of airway obstruction, partial or complete. a common sign of partial airway obstruction in the unconscious state is snoring. untreated airway obstruction can rapidly lead to cardiac arrest. all health care professionals, regardless of the setting, can assess the airway as described and use a head-tilt and chin-lift maneuver to open the airway. with the proper equipment, suction of the airways to remove obstructions, for example, blood or vomit, is recommended. if possible, foreign bodies causing airway obstruction should be removed. in the event of a complete airway obstruction, treatment should be given according to current guidelines. in brief, to conscious patients give five back blows alternating with five abdominal thrusts until the obstruction is relieved. if the victim becomes unconscious, call for help and start cardiopulmonary resuscitation according to guidelines. importantly, high-flow oxygen should be provided to all critically ill persons as soon as possible. breathing (ensuring respiration): in all settings, it is possible to determine the respiratory rate, inspect movements of the thoracic wall for symmetry and use of auxiliary respiratory muscles, and percuss the chest for unilateral dullness or resonance. cyanosis, distended neck veins, and lateralization of the trachea can be identified. if a stethoscope is available, lung auscultation should be performed and, if possible, a pulse oximeter should be applied. tension pneumothorax must be relieved immediately by inserting a cannula where the second intercostal space crosses the midclavicular line (needle thoracocentesis). bronchospasm should be treated with inhalations. if breathing is insufficient, assisted ventilation must be performed by giving rescue breaths with or without a barrier device. trained personnel should use a bag mask if available. circulation (internal bleeding): the capillary refill time and pulse rate can be assessed in any setting. inspection of the skin gives clues to circulatory problems. color changes, sweating, and a decreased level of consciousness are signs of decreased perfusion. if a stethoscope is available, heart auscultation should be performed. electrocardiography monitoring and blood pressure measurements should also be performed as soon as possible. hypotension is an important adverse clinical sign. the effects of hypovolemia can be alleviated by placing the patient in the supine position and elevating the patient's legs. an intravenous access should be obtained as soon as possible and saline should be infused. disability (neurological condition): the level of consciousness can be rapidly assessed using the avpu method, where the patient is graded as alert (a), voice responsive (v), pain responsive (p), or unresponsive (u). alternatively, the glasgow coma score can be used.16 limb movements should be inspected to evaluate potential signs of lateralization. the best immediate treatment for patients with a primary cerebral condition is stabilization of the airway, breathing, and circulation. in particular, when the patient is only pain responsive or unresponsive, airway patency must be ensured, by placing the patient in the recovery position, and summoning personnel qualified to secure the airway. ultimately, intubation may be required. pupillary light reflexes should be evaluated and blood glucose measured. a decreased level of consciousness due to low blood glucose can be corrected quickly with oral or infused glucose. exposure (overall examination, environment): signs of trauma, bleeding, skin reactions (rashes), needle marks, etc., must be observed. bearing the dignity of the patient in mind, clothing should be removed to allow a thorough physical examination to be performed. body temperature can be estimated by feeling the skin or using a thermometer when available. key skills in case of tongue fallen backwards, blocking the airway, it is necessary to hyperextend the head and pull up the chin, so that the tongue lifts and clears the airway. certain skills are considered essential to the provision of first aid and are taught ubiquitously. particularly the "abc"s of first aid, which focus on critical life-saving intervention, must be rendered before treatment of less serious injuries. abc stands for airway, breathing, and circulation. the same mnemonic is used by emergency health professionals. attention must first be brought to the airway to ensure it is clear. obstruction (choking) is a life-threatening emergency. following evaluation of the airway, a first aid attendant would determine adequacy of breathing and provide rescue breathing if necessary. assessment of circulation is now not usually carried out for patients who are not breathing, with first aiders now trained to go straight to chest compressions (and thus providing artificial circulation) but pulse checks may be done on less serious patients. some organizations add a fourth step of "d" for deadly bleeding or defibrillation, while others consider this as part of the circulation step simply referred as disability. variations on techniques to evaluate and maintain the abcs depend on the skill level of the first aider. once the abcs are secured,