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Part 17: First Aid
2010 American Heart Association and American Red Cross Guidelines for
First Aid
David Markenson, Co-Chair*; Jeffrey D. Ferguson, Co-Chair*; Leon Chameides; Pascal Cassan; Kin-Lai Chung; Jonathan Epstein; Louis Gonzales; Rita Ann Herrington; Jeffrey L. Pellegrino; Norda Ratcliff; Adam Singer Modern, organized first aid evolved from military experi- Red Cross (Red Cross) cofounded the National First Aid ences when surgeons taught soldiers how to splint and Science Advisory Board to review and evaluate the scien- bandage battlefield wounds. Two British officers, Peter Shep- tific literature on first aid in preparation for the 2005 herd and Francis Duncan, are said to have been the first to American Heart Association (AHA) and American Red expand the concept to civilians and to develop the first Cross Guidelines for First Aid.1 In preparation for the 2010 curriculum in first aid.4 Organized training in civilian first aid evidence evaluation process, the National First Aid Advi- began in the United States in 1903 when Clara Barton, sory Board was expanded to become the International First president of the Red Cross, formed a committee to establish Aid Science Advisory Board with the addition of repre- instruction in first aid among the nation's industrial workers, sentatives from a number of international first aid organi- where, under dangerous conditions, accidents and deaths zations (see Table). The goal of the board is to reduce were all too frequent.
morbidity and mortality due to emergency events bymaking treatment recommendations based on an analysis The Evidence Evaluation Process
of the scientific evidence that answers the following The International First Aid Science Advisory Board first identified 38 questions in first aid practice that either were not raised in previous evidence evaluations or were in need of In which emergency conditions can morbidity or mortality updating. Two or more board members volunteered to review be reduced by the intervention of a first aid provider? the scientific literature independently and develop an How strong is the scientific evidence that interventions evidence-based review worksheet summarizing the literature performed by a first aid provider are safe, effective, and relevant to each question (see Part 2: "Evidence Evaluation and Management of Potential or Perceived Conflicts of A critical review of the scientific literature by members of Interest"). After each worksheet was presented to, and re- the International First Aid Science Advisory Board is sum- viewed by, the full board, a summary draft of the scientific marized in the 2010 International Consensus on First Aid evidence and a treatment recommendation were crafted. The Science With Treatment Recommendations (ILCOR 2010 evidence-based review for each question was presented and CPR Consensus), from which these guidelines are derived.2 discussed a second time at a subsequent board meeting. All That critical review evaluates the literature and identifies first aid worksheets, co-copyrighted by the American Heart knowledge gaps that might be filled through future scientific Association and the American Red Cross, can be viewed through hyperlinks in the 2010 American Heart Associationand American Red Cross International Consensus on First Aid Science with Treatment Recommendations.2 Each ques- The history of first aid can be traced to the dawn of organized tion, evidence-based review, draft summary of science, and human societies. For example, Native American Sioux med- draft treatment recommendation was presented, discussed, icine men of the Bear Society were noted for treating battle and debated on 2 separate occasions until a consensus was injuries, fixing fractures, controlling bleeding, removing ar- reached. These guidelines are based on the scientific consen- rows, and using a sharp flint to cut around wounds and sus findings reported in the 2010 International Consensus on First Aid Science with Treatment Recommendations.2 The American Heart Association and the American Red Cross request that this document be cited as follows: Markenson D, Ferguson JD, Chameides L, Cassan P, Chung K-L, Epstein J, Gonzales L, Herrington RA, Pellegrino JL, Ratcliff N, Singer A. Part 17: first aid: 2010 American Heart Associationand American Red Cross Guidelines for First Aid. Circulation. 2010;122(suppl 3):S934 –S946.
*Co-chairs and equal first co-authors.
(Circulation. 2010;122[suppl ]:S934 –S946.)
2010 American Heart Association, Inc., and American Red Cross.
Circulation is available at http://circ.ahajournals.org
Markenson et al
Part 17: First Aid
International First Aid Science Advisory Board
sound and based on scientific evidence or, in the absence of such evidence, on expert consensus. Administration offirst aid must not delay activation of the emergency American Academy of Pediatrics medical services (EMS) system or other medical assistance American Burn Association when required. We strongly believe that education in first American College of Emergency Physicians aid should be universal: everyone can learn first aid and American College of Occupational and Environmental Medicine everyone should.
American College of Surgeons The scope of first aid is not purely scientific; it is American Heart Association influenced by both training and regulatory issues. The defi- American Pediatric Surgical Association nition of scope is therefore variable, and should be defined American Red Cross according to circumstances, need, and regulatoryrequirements.
American Red Cross Advisory Council on First Aid, Aquatics, Safety andPreparedness (ACFASP) American Safety & Health Institute (ASHI) Calling for Help
Austrian Red Cross A first aid provider must be able to recognize when help is Canadian Red Cross needed and how to get it. First aid providers should learn Divers Alert Network how and when to access the EMS system, how to activatethe on-site emergency response plan (ERP), and how to European Reference Center on First Aid Education contact the Poison Control Center (see "Poison Emergen- Egyptian Red Crescent cies" below).
Grenada Red Cross Positioning the Victim
Hong Kong Red Cross As a general rule a victim should not be moved, especially if Hungarian Red Cross you suspect, from the victim's position or the nature of the International Federation of Red Cross and Red Crescent Societies injury, that the victim may have a spinal injury (see "Spine Medic First Aid International Stabilization" below). There are times, however, when the National Association of EMS Educators victim should be moved: National Association of EMS Physicians If the area is unsafe for the rescuer or the victim, move the National Athletic Trainers' Association victim to a safe location if it is safe to do so.
National Safety Council If the victim is face down and is unresponsive, turn the Norwegian Red Cross victim face up.
Occupational Safety and Health Administration If the victim has difficulty breathing because of copious Red Cross Society of China secretions or vomiting, or if you are alone and have to leave Resuscitation Council of Asia an unresponsive victim to get help, place the victim in a St. John Ambulance, UK modified High Arm IN Endangered Spine (HAINES)
recovery position:9,10 Extend one of the victim's arms
above the head and roll the body to the side so the victim's
Previous reports5–8 have noted the paucity of scientific head rests on the extended arm. Bend both legs to stabilize evidence supporting many interventions in prehospital emer- the victim (Class IIb, LOE C).
gency care. In reviewing the medical literature, members of If a victim shows evidence of shock, have the victim lie the International First Aid Science Advisory Board once supine. If there is no evidence of trauma or injury, raise the again found a paucity of evidence to guide first aid interven- feet about 6 to 12 inches (about 30° to 45°) (Class IIb, LOE tions. Very little research is being conducted in first aid, and C). Do not raise the feet if the movement or the position many of the following recommendations are extrapolated causes the victim any pain.
from the experience of healthcare professionals. It is impor-tant to recognize the limitations of the evidence that supports The evidence for a benefit to raising the feet is extrapolated many of these guidelines so that research can be undertaken from leg raising studies on volume expansion; there are no and future guidelines can be based on a larger body of studies on the effect of leg raising as a first aid maneuver for shock. The results of the volume expansion studies arecontradictory with some showing an increase in cardiac Definition of First Aid
output,11–13 while others show no change in cardiac output ormean arterial pressure14–18 with leg raising.
We define first aid as the assessments and interventionsthat can be performed by a bystander (or by the victim)with minimal or no medical equipment. A first aid provider is defined as someone with formal training in first aid, There is insufficient evidence to recommend routine use of emergency care, or medicine who provides first aid. First supplementary oxygen by a first aid provider for victims aid assessments and interventions should be medically complaining of chest discomfort19,20 or shortness of breath21 November 2, 2010
(Class IIb, LOE C). Supplementary oxygen administration epinephrine may be given if symptoms of anaphylaxis may be beneficial as part of first aid for divers with a persist (Class IIb, LOE C).
decompression injury (Class IIb, LOE C22).
The general principles of first aid management of seizuresare to Ensure an open airway.
The incidence of acute asthma is increasing, especially in Prevent injury.
urban populations.23 Many victims with asthma take a pre-scribed bronchodilator medication and can self-administer Do not restrain the victim during a seizure. Do not try to it.24–26 First aid providers are not expected to make a open the victim's mouth or try to place any object between diagnosis of asthma, but they may assist the victim in using the victim's teeth or in the mouth. Restraining the victim the victim's prescribed bronchodilator medication (Class IIa, may cause musculoskeletal or soft-tissue injury. Placing an LOE B) under the following conditions: object in the victim's mouth may cause dental damage or The victim states that he or she is having an asthma attack aspiration (Class IIa, LOE C). It is not unusual for the or symptoms associated with a previously diagnosed victim to be unresponsive or confused for a short time after breathing disorder, and the victim has the prescribed medications or inhaler in his or her possession.
The victim identifies the medication and is unable to administer it without assistance.24 Because it is very difficult, even for the healthcare profes-sional, to differentiate chest discomfort of cardiac origin from First aid providers should become familiar with inhalers so other chest discomfort, the first aid provider should assume that they can assist a victim with an acute asthma attack in that chest discomfort is cardiac until proven otherwise.
using the inhaler.
Cardiac chest discomfort is often described as "crushing" or"pressing" and is often accompanied by shortness of breath or perspiration. But cardiac chest discomfort may not have these Allergies are relatively common, but only a small proportion classical characteristics, especially in women. Call EMS of people with allergies develop anaphylactic reactions. An immediately for anyone with chest discomfort. Do not delay anaphylactic reaction is a progressive series of signs and and do not try to transport the patient to a healthcare facility symptoms characterized by swelling, breathing difficulty, an itching rash, and eventually shock, which, if left While waiting for EMS to arrive, the first aid provider may untreated, may lead to death. Some of these signs and encourage the victim to chew 1 adult (not enteric coated) or symptoms can also be present in other conditions, and first 2 low-dose "baby" aspirin if the patient has no allergy to aid rescuers should not be expected to make a diagnosis of aspirin or other contraindication to aspirin, such as evidence of a stroke or recent bleeding (Class IIa, LOE A).44–46 Older patients who suffer from anaphylactic reactions know their signs and symptoms and many carry a lifesavingepinephrine auto-injector. With proper training, parents can be taught to correctly use an auto-injector to administerepinephrine to their allergic children.31 All too often, how- ever, neither the victim nor family members know how to Control of bleeding is a basic skill of first aid and one of the correctly use an auto-injector.32–34 First aid providers should few actions with which a first aid provider can critically be familiar with the epinephrine auto-injector so that they can influence outcome.
help a victim with an anaphylactic reaction to self-administerit. First aid providers should also know how to administer the auto-injector if the victim is unable to do so, provided that the Bleeding is best controlled by applying pressure until bleed- medication has been prescribed by a physician and state law ing stops47–53 or EMS rescuers arrive (Class I, LOE A). The permits it (Class IIb, LOE B).
amount of pressure applied and the time the pressure is held In retrospective studies35–37 18% to 35% of patients are the most important factors affecting successful control of having signs of anaphylaxis required a second dose of bleeding. The pressure must be firm, and it must be main- epinephrine if symptoms persisted or progressed after the tained for a long time. Methods of applying pressure include first dose. Because of the difficulty in making a diagnosisof anaphylaxis27–30,38,39 and the potential harm from epi- Manual pressure on gauze or other cloth placed over the nephrine if the diagnosis is incorrect,40 – 43 first aid provid- bleeding source. If bleeding continues, do not remove the ers are advised to seek medical assistance if symptoms gauze; add more gauze on top and apply more pressure.
persist, rather than routinely administering a second dose If it is not possible to provide continuous manual pressure, of epinephrine. In unusual circumstances, when advanced wrap an elastic bandage firmly over gauze to hold it in medical assistance is not available, a second dose of place with pressure.54–57 Markenson et al
Part 17: First Aid
Although tourniquets have been shown to control bleedingeffectively on the battlefield58–60 and during surgery and have been used by paramedics in a civilian setting without com- Cool thermal burns with cold (15° to 25°C) tap water as soon plications,61 there are no studies on controlling bleeding with as possible and continue cooling at least until pain is relieved first aid provider use of a tourniquet. Potential dangers of (Class I, LOE B).86–93 Cooling reduces pain, edema, and prolonged tourniquet application include temporary62 or per- depth of injury. It speeds healing and may reduce the need for manent63 injury to the underlying nerves and muscles,64 and excision and grafting of deep burns. Don't apply ice directly systemic complications resulting from limb ischemia,65 in- to a burn; it can produce tissue ischemia (Class III, LOE B).
cluding acidemia, hyperkalemia, arrhythmias, shock, and Prolonged cold exposure to small burns, and even brief death. Complications are related to tourniquet pressure66 and exposure if the burn is large, can cause further local tissue duration of occlusion,67 but there is insufficient evidence to injury93–95 and hypothermia.
determine a minimal critical time beyond which irreversiblecomplications may occur. Because of the potential adverse effects of tourniquets and difficulty in their proper applica- Loosely cover burn blisters with a sterile dressing but leave tion, use of a tourniquet to control bleeding of the extremities blisters intact because this improves healing and reduces pain is indicated only if direct pressure is not effective or possible (Class IIa, LOE B).96–99 (Class IIb, LOE B). Specifically designed tourniquets appearto be better than ones that are improvised,60,68–71 but tourni- quets should only be used with proper training (Class IIa, The severity of electric injuries can vary widely, from an LOE B). If a tourniquet is used, make sure that you note the unpleasant tingling sensation caused by low-intensity cur- time it was applied and communicate that time to EMS rent to thermal burns, cardiopulmonary arrest, and death.
Thermal burns may result from burning clothing that is incontact with the skin or from electric current traversing a Pressure Points and Elevation
portion of the body. When current traverses the body, Elevation and use of pressure points are not recommended to thermal burns may be present at the entry and exit points control bleeding (Class III, LOE C). This new recommenda- and along its internal pathway. Cardiopulmonary arrest is tion is made because there is evidence that other ways of the primary cause of immediate death from electrocu- controlling bleeding are more effective. The hemostatic effect tion.100 Cardiac arrhythmias, including ventricular fibrilla- of elevation has not been studied. No effect on distal pulses tion, ventricular asystole, and ventricular tachycardia that was found in volunteers when pressure points were used.72 progresses to ventricular fibrillation, may result from Most important, these unproven procedures may compromise exposure to low- or high-voltage current.101 Respiratory the proven intervention of direct pressure, so they could be arrest may result from electric injury to the respiratory center in the brain or from tetanic contractions or paralysisof respiratory muscles.
Do not place yourself in danger by touching an electro- Among the large number of commercially available hemo- cuted victim while the power is on (Class III, LOE C).
static agents, some have been shown to be effective.73–76 Turn off the power at its source; at home the switch is However, their routine use in first aid cannot be recom- usually near the fuse box. In case of high-voltage electro- mended at this time because of significant variation in cutions caused by fallen power lines, immediately notify effectiveness by different agents and their potential for the appropriate authorities (eg, 911 or fire department). All adverse effects, including tissue destruction with induction of materials conduct electricity if the voltage is high enough, a proembolic state and potential thermal injury (Class IIb, so do not enter the area around the victim or try to remove wires or other materials with any object, including awooden one, until the power has been turned off by Wounds and Abrasions
Superficial wounds and abrasions should be thoroughly Once the power is off, assess the victim, who may need irrigated with a large volume of warm or room temperature CPR, defibrillation, and treatment for shock and thermal potable water with or without soap77–82 until there is no burns. All victims of electric shock require medical assess- foreign matter in the wound (Class I, LOE A). Cold water ment because the extent of injury may not be apparent.
appears to be as effective as warm water, but it is not ascomfortable. If running water is unavailable, use any source of clean water. Wounds heal better with less infection if they There is approximately a 2% risk of injury to the cervical are covered with an antibiotic ointment or cream and a clean spine after blunt trauma that is serious enough to require occlusive dressing (Class IIa, LOE A).83–85 Apply antibiotic spinal imaging in an emergency department,102,103 and this ointment or cream only if the wound is an abrasion or a risk is tripled in patients with craniofacial injury.104 Most superficial injury and only if the victim has no known victims with spinal injuries are males between the ages of allergies to the antibiotic.
10 and 30 years. Motor vehicles cause approximately half November 2, 2010
of all spinal injuries; many of the remainder are caused by thin towel, between the cold container and the skin (Class IIb, falls (especially from a height or diving), sports, and LOE C126,128).
It is not clear whether a compression bandage is helpful for If the cervical spine is injured, the spinal cord may be a joint injury. Heat application to a contusion or injured joint unprotected, and further injury (secondary spinal cord is not as good a first aid measure as cold application.115 injury) could result from stresses to the cord that occurwhen the victim is manipulated or moved. This could result in permanent neurological damage including quad- Assume that any injury to an extremity includes a bone riplegia.106,107 Only one controlled but underpowered study fracture. Cover open wounds with a dressing. Do not move with some methodological problems108 has examined this or try to straighten an injured extremity (Class III, LOE C).
question. In the study, the group of injured victims with There is no evidence that straightening an angulated spinal immobilization by emergency medical technicians suspected long bone fracture shortens healing time or using equipment failed to show any neurological benefit reduces pain prior to permanent fixation. Expert opinion compared with a group of injured victims without spinal suggests that splinting may reduce pain130 and prevent further injury. So, if you are far from definitive health care, Because of the dire consequences if secondary injury stabilize the extremity with a splint in the position found does occur, maintain spinal motion restriction by manually (Class IIa, LOE C). If a splint is used, it should be padded stabilizing the head so that the motion of head, neck, and to cushion the injury. If an injured extremity is blue or spine is minimized (Class IIb, LOE C). First aid providers extremely pale, activate EMS immediately because this should not use immobilization devices because their ben- could be a medical emergency. A victim with an injured efit in first aid has not been proven and they may be lower extremity should not bear weight until advised to do harmful (Class III, LOE C). Immobilization devices may so by a medical professional.
be needed in special circumstances when immediate extri-cation (eg, rescue of drowning victim) is required, but first Human and Animal Bites
aid providers should not use these devices unless they have Irrigate human and animal bites with copious amounts of been properly trained in their use.
water (Class I, LOE B). This irrigation has been shown to First aid rescuers cannot conclusively identify a victim prevent rabies from animal bites131,132 and bacterial with a spinal injury, but they should suspect spinal injury if an injured victim has any of the following risk factors(these have been modified slightly from the 2005 Ameri- can Heart Association and American Red Cross First Aid Do not apply suction as first aid for snakebites (Class III, LOE C). Suction does remove some venom, but the amountis very small.134 Suction has no clinical benefit135 and it may aggravate the injury.136–138 Driver, passenger, or pedestrian, in a motor vehicle, mo- Applying a pressure immobilization bandage with a pres- torized cycle, or bicycle crash sure between 40 and 70 mm Hg in the upper extremity and Fall from a greater than standing height between 55 and 70 mm Hg in the lower extremity around the Tingling in the extremities entire length of the bitten extremity is a reasonable way to Pain or tenderness in the neck or back slow the dissemination of venom by slowing lymph flow Sensory deficit or muscle weakness involving the torso or (Class IIa, LOE C139,140). For practical purposes pressure is upper extremities sufficient if the bandage is comfortably tight and snug but Not fully alert or is intoxicated allows a finger to be slipped under it. Initially it was theorized Other painful injuries, especially of the head and neck that slowing lymphatic flow by external pressure would only Children 2 years of age or older with evidence of head or benefit victims bitten by snakes producing neurotoxic venom,140 but the effectiveness of pressure immobilizationhas also been demonstrated for bites by non-neurotoxic American snakes in an animal model.141 This treatmentrequires further study to prove its efficacy in humans. The Sprains and Strains
challenge is to find a way to teach the application of the Soft-tissue injuries include joint sprains and muscle contu- correct snugness of the bandage because inadequate pressure sions. Cold application decreases hemorrhage, edema, pain, is ineffective and too much pressure may cause local tissue and disability,115–120 and it is reasonable to apply cold to a damage. It has also been demonstrated that, once learned, soft-tissue injury. Cooling is best accomplished with a plastic retention of the skill of proper pressure and immobilization bag or damp cloth filled with a mixture of ice and water; the application is poor.142,143 mixture is better than ice alone.121–123 Refreezable gel packsdo not cool as effectively as an ice-water mixture.124,125 To prevent cold injury, limit each application of cold to periods This section is new to the First Aid Guidelines. First aid ⱕ20 minutes.126–128 If that length of time is uncomfortable, for jellyfish stings consists of two important actions: limit application to 10 minutes.129 Place a barrier, such as a preventing further nematocyst discharge and pain relief.
Markenson et al
Part 17: First Aid
To inactivate venom load and prevent further envenoma- clude placing the victim near a heat source and placing tion, jellyfish stings should be liberally washed with containers of warm, but not hot, water in contact with the vinegar (4% to 6% acetic acid solution) as soon as possible for at least 30 seconds (Class IIa, LOE B). The inactivationof venom has been demonstrated for Olindias sambaquien- sis144 and for Physalia physalis (Portuguese man-of- Frostbite usually affects an exposed part of the body such as war).145 If vinegar is not available, a baking soda slurry the extremities and nose. In case of frostbite, remove wet may be used instead.145 clothing and dry and cover the victim to prevent hypothermia.
For the treatment of pain, after the nematocysts are Transport the victim to an advanced medical facility as removed or deactivated, jellyfish stings should be treated with rapidly as possible. Do not try to rewarm the frostbite if there hot-water immersion when possible (Class IIa, LOE B). The is any chance that it might refreeze161,162 or if you are close to victim should be instructed to take a hot shower or immerse a medical facility (Class III, LOE C).
the affected part in hot water (temperature as hot as tolerated, Minor or superficial frostbite (frostnip) can be treated with or 45°C if there is the capability to regulate temperature), as simple, rapid rewarming using skin-to-skin contact such as a soon as possible, for at least 20 minutes or for as long as pain persists.146–149 If hot water is not available, dry hot packs or, Severe or deep frostbite should be rewarmed within 24 as a second choice, dry cold packs may be helpful in hours of injury and this is best accomplished by immersing decreasing pain but these are not as effective as hot water the frostbitten part in warm (37° to 40°C or approximately (Class IIb, LOE B146,150,151). Topical application of aluminum body temperature) water for 20 to 30 minutes (Class IIb, LOE sulfate or meat tenderizer, commercially available aerosol C161–170). Chemical warmers should not be placed directly on products, fresh water wash, and papain, an enzyme derived frostbitten tissue because they can reach temperatures that from papaya used as a local medicine, are even less effective can cause burns (Class III, LOE C171). Following rewarming, in relieving pain (Class IIb, LOE B147,152).
efforts should be made to protect frostbitten parts from Pressure immobilization bandages are not recommended refreezing and to quickly evacuate the patient for further care.
for the treatment of jellyfish stings because animal stud- The effectiveness of ibuprofen or other nonsteroidal antiin- ies153,154 show that pressure with an immobilization bandage flammatory drugs (NSAIDs) in frostbite has not been well causes further release of venom, even from already fired established in human studies.170,172–175 nematocysts (Class III, LOE C).
Heat-induced symptoms, often precipitated by vigorous ex- Traumatic dental injuries are common. The first aid for an ercise, may include heat cramps, heat exhaustion, and heat avulsed tooth is as follows: Heat cramps are painful involuntary muscle spasms that Clean bleeding wound(s) with saline solution or tap water.
most often affect the calves, arms, abdominal muscles, and Stop bleeding by applying pressure with gauze or cotton.
back. First aid includes rest, cooling off, and drinking an Handle the tooth by the crown, not the root (ie, do not electrolyte-carbohydrate mixture, such as juice, milk, or a handle the part that was beneath the gum).
Place the tooth in milk, or clean water if milk is not commercial electrolyte-carbohydrate drink.176–185 Stretching, icing, and massaging the painful muscles may be helpful.
Contact the patient's dentist or take the tooth and victim to Exercise should not be resumed until all symptoms have an emergency care center as quickly as possible (Class IIa, Heat exhaustion is caused by a combination of exercise- induced heat and fluid and electrolyte loss as sweat. Signs andsymptoms may start suddenly and include: nausea, dizziness, muscle cramps, feeling faint, headache, fatigue, and heavysweating. Heat exhaustion is a serious condition because it can rapidly advance to the next stage, heat stroke, which can be fatal. Heat exhaustion must be vigorously treated by Hypothermia is caused by exposure to cold. The urgency of having the victim lie down in a cool place, taking off as many treatment depends on the length of exposure and the victim's clothes as possible, cooling the victim with a cool water body temperature. Begin rewarming a victim of hypothermia spray, and encouraging the victim to drink cool fluids, immediately by moving the victim to a warm environment, preferably containing carbohydrates and electrolytes.
removing wet clothing, and wrapping all exposed body Heat stroke includes all the symptoms of heat exhaustion surfaces with anything at hand, such as blankets, clothing, plus signs of central nervous system involvement, including and newspapers. If the hypothermia victim is far from dizziness, syncope, confusion, or seizures. The most impor- definitive health care, begin active rewarming (Class IIa, tant action by a first aid provider for a victim of heat stroke LOE B159,160) although the effectiveness of active rewarming is to begin immediate cooling, preferably by immersing the has not been evaluated. Active rewarming should not delay victim up to the chin in cold water.186–189 It is also important definitive care. Potential methods of active rewarming in- to activate the EMS system. Heat stroke requires emergency November 2, 2010
treatment with intravenous fluids. Do not try to force the victim to drink liquids.
Brush powdered chemicals off the skin with a gloved hand orpiece of cloth. Remove all contaminated clothing from the victim, making sure you do not contaminate yourself in the Drowning is a major cause of unintentional death. Methods of process. In case of exposure to an acid or alkali on the skin196–202 preventing drowning include isolation fencing around swim- or eye,203–208 immediately irrigate the affected area with copious ming pools (gates should be self-closing and self-latching),190 amounts of water (Class I, LOE B).
wearing personal flotation devices (life jackets) while in,around, or on water, never swimming alone, and avoidingswimming or operating motorized watercraft while intoxi- Toxic Eye Injury
cated. Outcome following drowning depends on the duration Rinse eyes exposed to toxic substances immediately with a of the submersion, the water temperature, and how promptly copious amount of water (Class I, LOE C203,209,210), unless a CPR is started.191,192 Occasional case reports have docu- specific antidote is available.203,210,211 mented intact neurological survival in children followingprolonged submersion in icy waters.193,194 Remove the victim rapidly and safely from the water, but do not place yourself in danger. If you have special training, Treatment With Milk or Water
you can start rescue breathing while the victim is still in the Do not administer anything by mouth for any poison water195 providing that it does not delay removing the victim ingestion unless advised to do so by a poison control center from the water. There is no evidence that water acts as an or emergency medical personnel because it may be harmful obstructive foreign body, so do not waste time trying to (Class III, LOE C). There is insufficient evidence that remove it with abdominal or chest thrusts. Start CPR and, if dilution of the ingested poison with water or milk is of any you are alone, continue with about 5 cycles (about 2 minutes) benefit as a first aid measure. Animal studies212–216 have of chest compressions and ventilations before activating shown that dilution or neutralization of a caustic agent EMS. If 2 rescuers are present, send 1 rescuer to activateEMS immediately.
with water or milk reduces tissue injury, but no humanstudies have shown a clinical benefit. Possible adverseeffects of water or milk administration include emesis and If the patient exhibits any signs or symptoms of a life-threatening condition, (eg, sleepiness, seizures, difficulty breathing, vomiting) after exposure to a poison, activate the Do not administer activated charcoal to a victim who has EMS immediately.
ingested a poisonous substance unless you are advised to doso by poison control center or emergency medical personnel Poison Control Centers
(Class IIb, LOE C). There is no evidence that activated There are many poisonous substances in the home and charcoal is effective as a component of first aid. It may be worksite. It is important to understand the toxic nature of the safe to administer,217,218 but it has not been shown to be chemical substances in the environment and the proper beneficial, and there are reports of it causing harm.219–221 In protective equipment and emergency procedures in case of addition the majority of children will not take the recom- toxic exposure. The Poison Help hotline of the American Association of Poison Control Centers (800-222-1222) is anexcellent resource in the United States for information abouttreating ingestion of, or exposure to, a potential poison.
Further information is available at www.aapcc.org. Similar Do not administer syrup of ipecac for ingestions of toxins resources may be available internationally, and their contact (Class III, LOE B). Several studies223–225 found that there is information (eg, 112 in Europe) should be standard in no clinically relevant advantage to administering syrup of international first aid training. When phoning a poison control ipecac; its administration is not associated with decreased center or other emergency medical services, know the nature healthcare utilization.226 Untoward effects of ipecac admin- and time of exposure and the name of the product or toxic istration include intractable emesis and delayed care in an advanced medical facility.227,228 Markenson et al
Part 17: First Aid
Guidelines Part 17: First Aid: Writing Group Disclosures
NYMC–Interim Chair; EMA–Chief Brody School of Medicine, East *Serving as an expert witness in two ongoing lawsuits involving EMS related cases. Billing for this service has not yet occurred and will likely represent less than $10,000 per 12 months.
This payment is expected to come directly to me Emeritus Director Pediatric Cardiology, Connecticut Children's Medical Center, Clinical Professor, University of Connecticut French Red Cross, National Medical Advisor and Coordinator of the European Reference Centre for first aid education Coordinator of the Scientific Commission of First Aid for the French Interior Ministry Hong Kong Hospital Authority Hospital Chief Executive NorthEast Emergency Medical *Volunteer: American Red Services, Inc.– Regional EMS Cross Advisory Council Council: Provide EMS System on First Aid, Aquatics, Oversight. Also provide education Safety and Preparedness (First aid and CPR/AED) as an AHA (ACFASP) Vice-Chair Training Center. Executive Director; Isis Maternity: Pre-Natal and Post Partum edu.- Provide CPR and First Aid Training via AHA Curriculum.
City of Austin - Office of the Medical Director: EMS System Medical Director Staff–Performance Management & Research *Beginning July 1, 2009, I will serve as a paid consultant to the AHA ECC Product Development Group as a Senior Science Editor.
This assignment will include providing Science review of AHA First Aid Products Minute Clinic–Family Nurse Kent State University–Assistant Dir †Wilderness First Aid Faculty Professional Dev. Center consultant for StayWell Bloomington Hospital Prompt Stony Brook University-Physician This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be "significant" if (a) the personreceives $10 000 or more during any 12-month period, or 5% or more of the person's gross income; or (b) the person owns 5% or more of the voting stock or shareof the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be "modest" if it is less than "significant" under thepreceding definition.
November 2, 2010
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KEY WORDS: emergency 䡲 injury

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