First aid must be administered immediately to:

• Restore breathing and heart-beat.
• Control bleeding.
• Remove poisons.
• Prevent further injury to the patient (for example, by removing them from a room containing carbon monoxide or smoke).

A rapid emergency evaluation of the patient should be carried out immediately at the scene of the injury to determine the type and extent of the trauma. Because every second may be critical, only essential pieces of the patient’s clothing should be removed.

In the case of an injured limb, remove clothing from the uninjured limb first, and then carefully remove clothing from the injured limb. If necessary, cut the clothes to expose the injured area.

Keep bystanders from crowding around the patient.

The patient’s pulse should be checked. If it cannot be felt at the wrist, it should be checked at the carotid artery on the side of the neck (see Fig. 2). If there is no pulse, heart compression and artificial respiration must be started (see Basic Life Support, page 6). The patient should be treated for shock if the pulse is weak and rapid, or if the skin is pale, cold, and possibly moist, with an increased rate of shallow and irregular breathing. Remember that shock can be life-threatening, and its prevention is one of the main objectives of first aid. The patient should be kept in the position that provides the most relief from their injuries. Usually, this is a lying-down position, as it improves blood circulation to the head.

Observe the patient’s breathing and check for any bleeding. If the patient is not breathing, mouth-to-mouth or mouth-to-nose artificial respiration must be given (see pages 8–9).

Severe bleeding must be controlled.

During this time, if the patient is conscious, they should be reassured and informed that all possible help is being provided. The rescuer should ask about the location of any pain.

The patient should be kept lying down and moved only when absolutely necessary. The general appearance of the patient should be observed, including any signs and symptoms that may indicate a specific injury or illness.

The patient should not be moved if injuries to the neck or spine are suspected. Fractures should be immobilized (splinted) before moving the patient. No attempt should be made to set a fracture.

Wounds and most burns should be covered to prevent infection. The treatment of specific injuries will be discussed in more detail in the rest of this chapter and in the next chapter.

Once life-saving measures have been started or deemed unnecessary, the patient should be examined more thoroughly for other injuries.

The patient should be covered to prevent loss of body heat.
If necessary, protect the patient from heat as well, remembering that in tropical conditions, an exposed steel deck on which the patient may be lying can become extremely hot.

The patient should not be given alcohol in any form.

Never underestimate or treat the following as minor injuries:

• Unconsciousness
• Suspected internal bleeding
• Stab or puncture wounds
• Wounds near joints
• Possible fractures
• Eye injuries

Note. Never consider anyone to be dead until you and others agree that:

• No pulse can be felt, and no sounds are heard when the examiner’s ear is placed on the chest.
• Breathing has stopped.
• The eyes are glazed and sunken.
• There is progressive cooling of the body (this may not apply if the surrounding air temperature is close to normal body temperature).