First aid is the initial assistance or treatment given to a person who is injured or taken ill. The person who provides this help is known as a first aider.
We want there to be first aiders on hand across Wales whenever and wherever an incident occurs, but we know that's not always the case. So we’ve put together these simple first aid advice guides to show you how to treat some common incidents that require first aid. We also have some specific guidance on first aid for children and infants
An allergic reaction is when the body’s defence system (the immune system) reacts abnormally to a normally harmless 'trigger'. Someone experiencing an allergic reaction might find they suffer from mild itching from a red raised rash, swelling (the hands, feet and face are most commonly affected by this), wheezing or possible abdominal pain/vomiting and/or diarrhoea.
The common allergy triggers in people are:
Pollen
Dust
Nuts
Shellfish
Eggs
Insect stings (usually wasp or bee stings)
Latex
Certain medications
This list is only a few allergens that people can react to, there are many more you may come across.
What to do
Follow the steps below:
Assess the person’s signs and symptoms and ask if they have any allergies.
If you can, remove the trigger if possible, or move the casualty away from whatever is triggering the allergen.
Most of the symptoms of an allergic reaction can be treated by medication. If the person has experienced this sort of a reaction before then they may have their medication on them, which is usually an anti-histamine, and they should take this as soon as possible.
If this is the person’s first reaction or you are concerned about their condition then you should seek medical advice, this can be from your nearest pharmacist, calling NHS Direct, or speaking to a doctor.
Anaphylactic shock is still an allergic reaction, but it is a life threatening severe reaction to an allergen that can affect the whole body. In an anaphylactic reaction, chemicals are released into the body that cause the blood vessels to widen, the air passages in the lungs narrow leading to breathing difficulties and swelling of the tongue and throat obstruct the airway. In cases of anaphylaxis it is vitally important you get emergency help as soon possible.
Causes of anaphylaxis include foods such as peanuts, tree nuts, milk, eggs, shellfish, fish, sesame seeds and kiwi fruit, although many other foods have also been known to trigger anaphylaxis. Some people can react to tiny amounts of food, although this rarely causes a very severe reaction.
Non-food causes include wasp or bee stings, natural latex (rubber), and certain drugs such as penicillin. In some people exercise can trigger a severe reaction – either on its own or in combination with other factors such as food or drugs (for example, aspirin).
What to look out for
Red itchy rash or raised areas of the skin
Read, itchy, watery eyes
Swelling of the hands, feet and/or face
Abdominal pain, vomiting and diarrhoea
Difficulty in breathing; ranging from a tight chest to severe difficulty causing the casualty to wheeze and gasp for air
Pale or flushed skin
Visible swelling of the tongue and throat, puffiness around the eyes
Confusion and agitation
Signs of shock.
What to do
Follow the steps below:
Call 999/112 for an ambulance and state you suspect anaphylaxis.
If the casualty has had a diagnosis of anaphylaxis before then they will most likely have been given an auto-injector pen. This contains a medicine called adrenaline which helps tackle the symptoms of anaphylaxis. You should encourage the casualty to use their own auto-injector themselves. Should they be unable to do this for themselves then you can administer it to them following the instructions found on the auto-injector itself.
Keep the casualty in a comfortable position (sitting up is best to help with breathing) and monitor their breathing and level of response.
Repeated doses of adrenaline from further auto-injectors can be given at five-minute intervals if there is no improvement or the symptoms return.
Asthma
When someone experiences an asthma attack, the muscles of the air passages in the lungs go into spasm. This narrows the airways, which makes breathing difficult. Sometimes things such as an allergy, cold weather, an illness like a cold, cigarette smoke etc. can be enough to trigger an asthma attack. At other times there is no apparent trigger, and asthma sufferers can experience sudden attacks.
People experiencing an asthma attack can experience any of the following signs/symptoms:
Difficulty breathing
Wheezing and/or coughing
Distress and anxiety
Difficulty in speaking, shown through being unable to complete sentences and whispering
Signs of hypoxia such as a grey-blue tinge to the lips, earlobes and nailbeds
Exhaustion, in the case of severe attacks
What to do
Follow the steps below:
Keep the casualty calm, get them sat down in a comfortable position.
Reassure them, and get them to take the usual dose of their “reliever” inhaler and to breathe slowly and deeply.
If they have a spacer available, ask them to use it with their inhaler. The inhaler is more effective with a spacer when being used for young children.
If they have no inhaler call 999 or 112 for emergency help.
A mild attack should ease within a few minutes with the use of their inhaler. If it does not, the casualty may take more doses of their inhaler – they can take 1-2 puffs every 30-60 seconds (up to 10 puffs). If they have a personal plan this should be followed. Seek medical aid if necessary.
If the attack is severe and they are getting worse, becoming exhausted or if this is their first attack call 999 or 112 for emergency help.
Monitor their breathing and level of response until help arrives, if there is a delay of more than 15 minutes, repeat taking 1-2 puffs every 30-60 seconds (up to 10 puffs) and be prepared to start CPR should they become unresponsive.
Bites and stings
An insect sting from a bee or a wasp can be painful but is not usually dangerous. An initial sharp pain is followed by mild swelling, redness and soreness. Certain types or multiple insect stings can produce a serious reaction. A sting in the mouth can be potentially dangerous because swelling can obstruct the airway. It is important to watch for signs of allergic reaction, which can lead to anaphylactic shock, with any insect bite or sting.
What to look for
Pain at the site of the sting
Redness and swelling around the site of the sting
What to do
Follow the steps below:
Reassure the casualty.
If the sting is visible, brush or scrape it off sideways with the edge of a credit card or your finger nail. Do not use tweezers as you may squeeze the sting and inject more poison into the casualty.
Raise the affected part and apply a cold compress for at least 20 minutes to minimise swelling. Advise the casualty to keep the compress in place for at least 10 mins. Tell them to seek medical advice if the pain and swelling persist.
Monitor breathing and level of response and watch for sign so of an allergic reaction such as wheezing and/or reddened, swollen, itchy skin.
Burns and scalds
A burn can be caused by dry heat such as contact with fire, or a hot iron, or exposure to the sun. A scald can be caused by contact with wet heat, like steam or a hot cup of tea. The longer the burning goes on the more severe the injury. Your priority is to cool the burn as quickly as possible.
What to look for
red skin and swelling
pain in the area of the burn
blistering may start to appear
What to do
Follow the steps below:
Start cooling the burn or scald as quickly as possible. Hold it under cool running water for at least 20 minutes or until the pain feels better. If there is no water available, you could use cold milk or canned drinks.
Remove jewellery or clothing, unless stuck to the burn, before the area begins to swell.
When the burn has cooled, cover the area loosely with cling film, lengthways.
Do not wrap the cling film around the burn as the area needs space to swell
If the burn is on a foot or hand you could use a clean plastic bag
Do not use ice, creams or gels. They may cause damage and increase the risk of infection
Do not break any blisters that may appear, as this may cause infection.
Monitor the casualty, if you are concerned seek medical advice. If the burn has happened to a child or an infant you should always seek medical advice, even if the burn is a minor one.
Choking
When someone is choking, their airway is partly or completely blocked, meaning they may be unable to breathe properly. They might be able to clear it by coughing, but if they can't you will need to help them straight away.
What to look for
difficulty breathing, speaking or coughing
a red puffy face
signs of distress, and they may point to their throat or grasp their neck
The advice for helping a choking infant is different. For what to do, click here.
What to do
Follow the stops below:
If you think someone is choking, ask them "Are you choking?" If they can breathe, speak or cough then they might be able to clear their own throat. If they cannot breathe, cough, or make any noise, then they need your help straight away.
Encourage them to cough and remove any obvious obstruction from their mouth.
If coughing fails to work, you need to give five sharp back blows. To do this, help them to lean forwards, supporting their upper body with one hand. With the heel of your other hand give them five sharp back blows between their shoulder blades. After each back blow, check to see if there’s anything in their mouth.
If back blows fail to clear the obstruction, give five abdominal thrusts. To do this, stand behind them and put your arms around their waist. Place one hand in a clenched fist between their belly button and the bottom of their chest. With your other hand, grasp your fist and pull sharply inwards and upwards up to five times. Check their mouth again, each time.
If the blockage has not cleared, call 999 or 112 for emergency help straight away. Repeat five back blows and five abdominal thrusts until help arrives, re-checking their mouth each time.
If they become unresponsive at any point, prepare to start adult CPR or child CPR if dealing with an unresponsive child.
CPR
What to do
There is separate guidance on how to perform CPR on an infant or child. For CPR on an adult please follow the steps below:
If you find an adult collapsed or unresponsive, you should first perform a primary survey. Do not open their airway and do not place your face close to theirs to check for breathing.
If this shows that they are unresponsive and not breathing, shout for help. Ask a helper to call 999 or 112 for emergency help while you start CPR. Ask a helper to find and bring a defibrillator, if available.
Ask your helper to put the phone on speaker and hold it out towards you, so they can maintain a 2m distance
If you are on your own, use the hands-free speaker on a phone so you can start CPR while speaking to ambulance control
Do not leave the casualty to look for a defibrillator yourself, the ambulance will bring one.
Before you start CPR, use a towel or piece of clothing and lay it over the mouth and nose of the casualty.
Kneel by the casualty and put the heel of your hand in the middle of their chest.
Put your other hand on top of the first. Interlock your fingers making sure they don't touch the ribs.
Keep your arms straight and lean over the casualty. Press down hard, to a depth of about 5-6cm before releasing the pressure, allowing the chest to come back up (this is called a compression).
You will need to give continuous compressions
The beat of the song 'Staying Alive' can help you keep the right rate
Do not give rescue breaths
Continue to perform CPR until:
emergency help arrives and takes over
the person starts showing signs of life and starts to breathe normally
you are too exhausted to continue - if there is a helper, you can change over every one-to-two minutes with minimal interruptions to chest compressions
This guidance has been adjusted for Covid-19 so may not be what you have previously learned or are used to.
Cuts & Grazes
Cuts and grazes are common injuries that can usually be treated at home. A plaster is generally all that is required, and the wound will heal by itself in a few days.
What to do
Clean the wound by rinsing it under running water or using sterile wipes.
Pat the wound dry using a gauze swab and cover it with a sterile gauze. If you don't have these, use a clean, non-fluffy cloth, like a tea towel.
For a cut, raise and support the injured part above the level of the heart. Avoiding touching the wound.
Clean around the wound with soap and water. Make sure you are wiping away from the wound, using a clean swab for each stroke. Pat dry. Remove the cloth or gauze covering the wound and apply a sterile dressing or a large plaster.
Seek medical help if:
A wound won't stop bleeding.
A foreign object is embedded in the wound - like a splinter of wood or glass.
The wound is from a human or animal bite.
You think the wound might be infected.
You are unsure whether the casualty has been immunised against tetanus.
Diabetic emergencies
Diabetes is a long-term medical condition where the body cannot produce enough insulin. Sometimes those who have diabetes may have a diabetic emergency, where their blood sugar level becomes too high or too low. Both conditions could be serious and may need treatment in hospital.
Insulin is a chemical produced by the pancreas (that lies behind the stomach). It regulates the blood sugar (glucose) levels in the body. When someone has diabetes, their body cannot keep the blood sugar level within the normal range. Their level can be higher or lower than normal blood sugar.
There are two types of diabetes:
Type 1, known as insulin dependent diabetes
Type 2, non-insulin dependent diabetes
Someone with diabetes may have items with them which could lead you to suspect that they have diabetes;
they may be wearing a medical warning bracelet or necklace
they may be carrying glucose gel or glucose tablets
they could have medication, such as an insulin pen, a special pump or tablets and a glucose testing kit
Hyperglycaemia
This is where the blood sugar level is higher than normal. It may be caused by a person with diabetes who has not had the correct dose of medication. They may have eaten too much sugary or starchy food or, they may be unwell with an infection.
What to look for
warm, dry skin
rapid pulse and breathing
fruity, sweet breath
excessive thirst
drowsiness, leading them to become unresponsive if not treated (also known as a diabetic coma)
medical warning jewellery or medication.
What to do
Follow the steps below:
If you suspect hyperglycaemia (high blood sugar), they need urgent treatment. Call 999 or 112 for emergency help and say that you suspect hyperglycaemia. They may be wearing a medical bracelet or medallion, or have a card on them which can alert you to their condition.
While you wait for help to arrive, keep checking their breathing, pulse and whether they respond to you. If they become unresponsive at any point, open their airway, check their breathing and prepare to start CPR.
A dislocated joint happens when bones are partly or completely pulled out of their normal position. Joints can dislocate when a strong force wrenches or pulls the bone into an abnormal position. Please note we also have first aid guidance on first aid for breaks and fractures.
What to look for
complain of a severe, sickening pain
be unable to move the joint
have swelling and bruising around the joint and it may look shorter, bent or deformed.
What to do
Follow the steps below:
Advise the casualty to stay still. Help them to support their dislocated joint in the most comfortable position. Do not try to put the dislocated bone back into its socket, as this may cause further injury.
Stop the joint from moving. If you think they have dislocated their shoulder or elbow, support the injured arm using a sling. To give extra support, tie a broad-fold bandage (wide bandage) around the chest and the sling. If a hand or arm is injured, remove any rings or watches in case of swelling.
If you think they have dislocated their ankle, knee or hip joint, support the injured leg using padding and broad-fold bandages.
Send the casualty to hospital. Call 999 or 112 for emergency help if you can’t take them yourself.
While waiting for help, treat for shock if necessary. Monitor their level of response. Do not raise an injured leg. Only raise the uninjured leg.
Check the circulation beyond any bandages every 10 minutes and loosen if necessary.
Drowning
Drowning is when someone has difficulty breathing because their nose and mouth are submerged in a liquid. When someone's drowning, it may not always look like the distressed call for help that most people expect from watching TV. They may go unnoticed, even if friends or family are nearby.
We've updated our guidance due to the Covid-19 outbreak. Do not perform rescue breaths on the casualty.
What to do
When helping an adult please follow the steps below. There is separate advice for how to help a child who is drowning.
Do not put yourself in danger when trying to rescue a casualty.
When the casualty is rescued from the water, you should first perform a primary survey. If this establishes that they are unresponsive and not breathing, you should ask a helper to call 999 or 112 for emergency help while you start CPR. Ask a helper to find and bring a defibrillator, if available.
if you are on your own, use the hands-free speaker on a phone so you can start CPR while speaking to ambulance control
do not leave the casualty to look for a defibrillator yourself, the ambulance will bring one.
Start performing chest compressions. Kneel by the casualty and put the heel of your hand in the middle of their chest. Put your other hand on top of the first. Interlock your fingers making sure they don't touch the ribs. Keep your arms straight and lean over the casualty. Press down hard, to a depth of about 5-6cm before releasing the pressure, allowing the chest to come back up (this is one compression).
Do this at a rate of 100-120 compressions per minute.
the beat of the song ‘Staying Alive’ can help you keep the right rate
do not give rescue breaths.
Continue to perform CPR until:
emergency help arrives and takes over
the person starts showing signs of life and starts to breathe normally
you are too exhausted to continue (if there is a helper, you can change over every one-to-two minutes, with minimal interruptions to chest compressions)
or a defibrillator is ready to be used (if the helper returns with a defibrillator, ask them to switch it on and follow the voice prompts while you continue with CPR).
Beware, many casualties that drown may bring up stomach contents, so be prepared to roll them onto their side to clear their airway.
If the casualty shows signs of becoming responsive such as coughing, opening eyes, speaking, and starts to breathe normally, put them in the recovery position. You may also need to treat them for hypothermia covering them with warm clothes and blankets. If possible, replace the wet clothes with dry clothes.
Monitor the casualty's level of response and prepare to give CPR again if necessary.
This guidance has been adjusted for Covid-19 so may not be what you have previously learned or are used to.
Fainting
What to do
Ask them to lie down.
Check for other injuries. They may have hurt themselves falling down, so look for head injuries and any other wounds. Treat as appropriate.
Kneel down next to them and raise their legs, supporting their ankles on your shoulders to help blood flow back to the brain.
Make sure that they have plenty of fresh air. Ask other people to move away and if you're inside then ask someone to open a window.
Reassure the casualty and help them to sit up slowly.
If they begin to feel faint again, lie them down.
If they stay unresponsive, open their airway, check their breathing and prepare to treat someone who is unresponsive.
Foreign objects
Objects can find their way into the body either through a wound in the skin or via an orifice such as the eyes or nose. These can range from grit in the eye to a small toy that young children may push into their noses and ears. These injuries can be distressing but do not usually cause serious injury for the casualty.
Blurred vision
Pain or discomfort
Redness and watering of the eye
Eyelids may be screwed up in spasm
What to do
Gently clean the area around the splinter with soap and water.
Hold the tweezers close to the end for a better grip. Grasp the splinter as close to the skin as possible.
Draw the splinter out in a straight line in the same angle that it entered the skin making sure it does not break.
Carefully squeeze the wound to encourage a little bleeding and flush out any remaining dirt. Clean the wound and cover it with a plaster.
Fractures
A break or crack in a bone is called a fracture. In the case of an open fracture, the broken bone may pierce the skin surface. But in a closed fracture the skin around the fracture is intact. However, broken bones may be unstable causing internal bleeding and the casualty may develop shock.
What to do
deformity, swelling and bruising around the fracture
pain and/or difficulty moving the area
a limb may look shorter, twisted or bent
a grating noise or feeling from the ends of the broken bones
difficulty or being unable to move the limb normally
a wound where you can see the bone sticking out (known as an open fracture)
signs of shock, particularly with a fracture of a thigh bone, hip or pelvis
If it is an open fracture, cover the wound with a sterile dressing or a clean non-fluffy cloth. Apply pressure around the wound and not over the protruding bone, to control any bleeding. Then secure the dressing with a bandage.
Advise the casualty to keep still while you support the injured part to stop it from moving. Do this by holding the joint above and below the injured area.
Place padding around the injury for extra support.
Once you’ve done this, call 999 or 112 for emergency help. Do not move the casualty until the injured part is secured, unless they are in immediate danger. You can secure an upper limb fracture with a sling and a lower limb fracture with broad fold bandages.
If necessary treat for shock, but do not raise an injured leg. Monitor their breathing and level of response while waiting for help to arrive.
Head Injuries
All head injuries are potentially serious because they may damage the brain. A head injury may cause damage to the brain tissue, a skull fracture or an injury to the spine or neck.
If you're looking for advice on head injuries in children and infants, see our dedicated page.
any loss of responsiveness
scalp wound
dizziness or feeling sick
loss of memory of events before or during the injury
headache
confusion
What to do
All head injuries are potentially serious because they may damage the brain. A head injury may cause damage to the brain tissue, a skull fracture or an injury to the spine or neck.
if you're looking for advice on head injuries in children and infants, see our dedicated page.
If they are responsive, sit the casualty down and hold something cold against the injury to help reduce the swelling, like an ice pack or a frozen bag of vegetables wrapped in a tea towel.
While you do this, try and assess the casualty’s level of response using the AVPU scale:
Alert - Are they alert? Are their eyes open?
Voice - Can they respond to you if you talk to them? Can they answer simple questions?
Pain – Does the casualty respond to pain? If you pinch their ear lobe, do they move or open their eyes?
Unresponsive - Are they unresponsive to all the above? If they are unresponsive or you are worried, call 999 or 112 for emergency help
If they have any wounds, treat them by applying direct pressure to the wound. Secure with a dressing if needed.
Keep monitoring their level of response. If they are alert and responsive and have always been so, their head injury is probably mild. You or another responsible adult should wait with them until they recover.
If they’re not alert or responsive or they appear to be confused, their head injury could be more serious. Call 999 or 112 for emergency help and explain the cause of the injury and give them details of the casualty’s response to the AVPU scale.
If they become unresponsive at any point, open their airway, check their breathing and prepare to treat someone who’s become unresponsive.
If their injury has been caused by a sporting incident, make sure they do not return to the sport until they have been fully assessed by a medical practitioner.
Advise the casualty to seek medical help if the head injury appears to get worse or if any of the following apply:
they are over the age of 65
they had previous brain surgery
they are taking anti-clotting medication
they have been taking drugs or drinking alcohol
there is no one responsible to look after them.
Heart Attack
A heart attack happens when the supply of blood to part of the heart is suddenly blocked, usually by a blood clot. You can make a full recovery following a heart attack, but this may depend on how much of the heart is affected.
have crushing pain in the centre of their chest, that may spread to their jaw, and down one or both arms
be breathless or gasping for breath
be sweating profusely
experience pain similar to indigestion
collapse without warning
complain of dizziness
have pale skin and their lips may have a blue tinge
have a rapid, weak or irregular pulse
have a feeling of impending doom
What to do
Call 999 or 112 for emergency help straight away and tell them you think someone is having a heart attack.
Help move the casualty into a comfortable position. The best position is on the floor, with their knees bent and their head and shoulders supported. You could place cushions behind them or under their knees.
If possible give them one aspirin tablet (300mg) and ask them to chew it slowly. Do not give aspirin to the casualty if they are under 16 or if they are allergic to it.
Find out if the casualty suffers from a condition called angina, and if they do ask the casualty to take their own angina medication, if they have it.
Keep monitoring the casualty’s level of response until emergency help arrives. Should they become unresponsive, be prepared to start CPR.
Hypothermia
The body normally maintains a temperature of around 37oC (98.6oF). When the body temperature dips below 35oC (95oF) it is known as hypothermia. Moderate hypothermia can usually be reversed with treatment, however, severe hypothermia – when the body’s core temperature drops below 30oC (86oF) – is often fatal. The severity of hypothermia is determined on the speed of onset and how low the body temperature drops. In all cases, it's important to always persist with life-saving procedures until help arrives as survival may be possible even after prolonged periods of resuscitation.
Shivering, cold and pale skin
Apathy, disorientation or irrational behaviour
Lethargy or impaired responsiveness
Slow and shallow breathing
Slow and weakening pulse
In extreme cases, the heart may stop
What to do
Take the casualty to shelter as soon as possible.
If possible, remove and replace any wet clothing. Do not give them your clothes. Ensure their head is covered.
Protect the casualty from the ground by lying them on a bed of dry leaves or blankets. Cover them with blankets or newspapers. Wrap them in a foil survival bag if available.
Call 999/112 or send for emergency help.
If the casualty is fully alert, encourage them to drink warm drinks and eat high energy foods such as chocolate.
Monitor their breathing and level of response whilst waiting for help to arrive.
Recovery Position
Once you have carried out your Primary Survey and found the casualty is breathing. You'll need to place the casualty in the recovery position. If you haven’t already done so, make sure that 999 has been called for an ambulance.
We place casualties in the recovery position for two reasons:
To help keep the airway open by preventing the tongue from blocking the airway
It prevents the casualty choking on any fluids
The technique described below can be used in adults and children.
If the casualty is clearly pregnant then you must make sure they are placed in the recovery position on the left hand side.
What to do
If you find someone collapsed, you should first perform a primary survey. If it shows that they are unresponsive but breathing, put them in the recovery position.
Kneel by the casualty and straighten their legs and place the arm closest to you our of the way (don’t worry if the hand doesn’t touch the floor – don’t force it to). If they are wearing glasses, or have any bulky items in their pockets, remove them. Do not search their pockets for small items.
Grasp the other hand and place the back of the hand against the side of the face closest to you. Hold the hand in position by resting your palm against theirs.
With the leg furthest away from you, place your free hand under the hollow of the knee and bend the leg up so that the foot is flat on in the floor.
Using the bent knee, pull the casualty towards you so that they end up lying on their side. Make sure that the bent knee is at a 95 degree angle and tilt the head up with the mouth open to allow any fluid to drain out.
A casualty can remain on their side in the recovery position, whilst you wait for the ambulance, for 30 minutes. When it’s been 30 minutes you will need to roll them into the recovery position on the opposite side.
Seizures
In adults, the most common cause of a seizure, also known as a convulsion or fit, is epilepsy. However, it can be caused by other things, including a head injury, alcohol poisoning, lack of oxygen, after taking certain drugs, or if someone with diabetes has a 'hypo' where their blood glucose is too low.
Epilepsy is a condition that affects the brain and can cause repeated seizures, which are often sudden and dramatic.
People experiencing a seizure can experience any of the following signs/symptoms:
Sudden loss of responsiveness
A rigid body with an arching back
Noisy, difficult breathing
Grey blue tinge on the lips
Start of jerky uncontrolled movements (uncontrolled)
Saliva at the mouth, possibly blood stained if they have bitten their tongue or lip
Loss of bladder or bowel control
What to do
harming themselves during the fit. Ask any bystanders to stand back and clear away any potentially dangerous objects, like hot drinks or sharp objects. Make a note of the time that the seizure started.
Do not restrain the casualty or move them unless they are in immediate danger.
Do not put anything in their mouth.
Protect their head. You could place soft padding underneath it, such as a rolled-up towel. You should also loosen any clothing around their neck.
When any jerky movements have stopped, open their airway and check their breathing.
Monitor their level of response and make a note of how long the seizure lasted.
If they become unresponsive at any time, prepare to call 999 or 112 for emergency help and give CPR.
Call 999 or 112 for emergency help if:
It is the casualty's first seizure
They are having repeated seizures
The cause of the seizure is unknown
The seizure continues for more than five minutes
The casualty is unresponsive for more than 10 minutes
They have an injury on another part of the body
Sepsis
Sepsis is caused by the way the body responds to an infection. The infection can happen anywhere in the body. For example, a chest or urinary infection, or problems in the abdomen like burst ulcers, or even simple skin injuries like cuts and bites. Sepsis is sometimes called septicaemia or blood poisoning. There is different advice for sepsis in children.
It is a life-threatening condition which makes the immune system go into overdrive as it tries to fight the infection. This can reduce the blood supply to vital organs such as the brain, heart, and kidneys, eventually leading to multiple organ failure and possibly death.
If someone is unwell and you think they have one or more symptoms of sepsis, do not wait call 999 or 112 for emergency help straight away.
While you’re waiting for help to arrive, reassure them and keep them comfortable.
Monitor their level of response.
Severe Bleeding
If the bleeding isn’t controlled quickly, they may lose a lot of blood, become unresponsive and possibly develop shock. Shock does not mean emotional shock; it is a life-threatening condition, often caused by loss of blood.
Your priority is to stop the bleeding.
What to do
With open wounds, there’s a risk of infection, so wear protective first aid gloves (if available) to help prevent any infection passing between you both.
Control the bleeding by applying direct pressure to the wound.
Dial 999 or 112 for the emergency services.
Apply an appropriate dressing firmly to control the bleeding and minimise the risk of infection. It should not be so tight that it restricts the casualty’s circulation.
Treat for shock by lying the casualty down with their feet raised. If possible, lay the casualty on a blanket or some other item to insulate them from the cold ground. If the casualty has a head injury, lay them down and slightly raise their head and shoulders.
If blood comes through the dressing, remove the dressing and reapply direct pressure over the wound with a new dressing or pad to control the bleeding.
Secure the dressing with the bandage once the bleeding is controlled, tie the knot over the pad to help maintain pressure.
It may be that the call handler instructs you how to improvise a tourniquet to control life-threatening bleeding if you are not trained or do not have a tourniquet in your first aid kit, using items such as a triangular bandage, belt, or tie.
Monitor the casualty’s breathing and level of response while waiting for the emergency services to arrive.
Shock
Shock, not to be confused with emotional shock, is a life-threatening condition. It happens when the body isn’t getting enough oxygen to the vital organs.
Shock can be caused by anything that reduces the flow of blood, such as:
severe internal or external bleeding
heart problems, such as a heart attack, or heart failure
loss of body fluids, from dehydration, diarrhoea, vomiting, or burns
severe allergic reactions and overwhelming infection (septic shock)
spinal cord injury
pale skin, which may be cold and clammy
sweating
fast pulse - as shock gets worse
fast, shallow breathing
a weak pulse
grey blue skin, especially inside the lips
nausea and possible vomiting - as the brains oxygen supply decreases
restlessness and aggressive behaviour
yawning and gasping for air
the casualty could become unresponsive
What to do
First, treat any cause of shock that you can see or that you have identified from the primary survey, such as severe bleeding.
Lay the casualty down on a blanket. Constantly reassure them.
Raise and support their legs to improve blood supply. If the leg is bleeding and the casualty is comfortable, you can raise both legs, if there is a suspected fracture to the pelvis, hip, or either leg, both legs should stay down.
Dial 999 or 112 for an ambulance.
Loosen tight clothing at the neck, chest, and waist.
Keep the casualty warm and reassure them. Do not let them eat or drink. If the casualty is obviously pregnant lean them to their left side to prevent the baby restricting blood flow back to the heart.
Monitor the casualty’s breathing and level of response until the emergency services arrive. Be prepared to perform CPR.
Sprains and strains
Injuries to the soft structure around the bones and joints are commonly called sprains and strains. They are often associated with sports activities.
What to do
Sprains and strains should be treated initially by following the RICE procedure.
R – Rest the injured part. Help them to sit or lie down and support the injured part in a comfortable position, raised if possible.
I – Apply a cold compress or an Ice pack.
C – Comfortable support.
E – Elevate the injured part if possible. Advise the casualty to get medical advice, if necessary.
Stroke
A stroke can occur when blood supply to the brain is disrupted and starves the brain of oxygen.
Facial weakness - uneven smile, droopy mouth or eye
Arm weakness - can they raise both arms?
Speech problems - can they speak clearly?
What to do
If you suspect someone is having a stroke, use the FAST guide to identify the key signs:
F – stands for facial weakness.
Look at their mouth or eye – they may be droopy, and they can’t smile evenly.
A – arm weakness.
Ask them to raise both of their arms. They may only be able to raise one.
S - speech problems. They are unable to speak clearly or might not be able to understand what you are saying to them.
Ask them a question, such as "What is your name?" Can they respond appropriately?
T – time to call 999/112 for emergency help and tell them you suspect a stroke after using the FAST guide.
While waiting for help to arrive, keep them comfortable, supported and reassure them. Do not give them anything to eat or drink because it may be hard for them to swallow.
Keep monitoring their level of response until help arrives. If they become unresponsive prepare to treat for an unresponsive casualty.
Unresponsive Casualty
When you come across someone who isn't responsive, before you do anything you need to assess is it safe to approach, is the person breathing or bleeding. To do so, use the Primary Survey as your method to assess the person.
Primary Survey (DR ABC)
Follow the steps below:
Danger
Before approaching the casualty, always make sure the area is safe.
Response
Check if the casualty is responsive or unresponsive. As you approach them, introduce yourself and ask them questions to see if you can get a response. Kneel next to their chest and gently shake their shoulders, asking, "What has happened?", "Open your eyes!" Do not place your face close to the casualty’s face when doing this.
If the casualty opens their eyes, or gives another gesture, they are responsive.
If they do not respond to you in any way they are unresponsive and should be treated as quickly as possible.
Airway
Check their airway is open and clear.
Staying at arm’s length of the casualty. Open the airway by placing one hand on the forehead to tilt the head back and use two fingers from the other hand to lift the chin.
Breathing
Check casualty is breathing normally.
You now need to check if the casualty is breathing normally. Do not place your ear above their mouth to look, listen or feel for breathing. Simply look for a rise and fall of the chest instead.
If they are unresponsive and not breathing, you need to call 999/112 for emergency help and start CPR straight away. Ask a helper to find and bring a defibrillator (AED).
If they are responsive and breathing move on to circulation.
Circulation
Check for severe bleeding.
Once you have established they are breathing, look and check for any signs of severe bleeding.
If they are bleeding severely you will need to control and treat the bleeding by applying direct pressure to the wound. Call 999/112 for emergency help.
If they are unresponsive and breathing but with no bleeding, put them in the recovery position and call 999/112 for emergency help.
Using a defibrillator (AED)
Using an AED (COVID-19)
Automated External Defibrillators (AEDs) are used to deliver a shock to a casualty who is in cardiac arrest. You can use an AED on your own or with a helper.
If you have a helper when using the AED then you should wear a face mask as you will be unable to maintain a 2 meter distance between each other when operating the AED.
CPR is different for adults, children, and infants, and our guidance has been updated to reflect changes due to COVID-19 (Coronavirus).
Warm weather advice
The warm weather, whilst being a time to enjoy ourselves, can also present a danger to our health and cause us some problems. As a minimum you should drink plenty of water, wear a hat that shades and apply sunscreen every two hours (SPF 30 with UVB and 4 star UVA protection as a minumum) to protect yourself from sunburn and sun-related conditions.
Below are some warm weather conditions that you can learn how to deal with should you come across them.
Allergic reactions
An allergic reaction is when the body’s defence system (the immune system) reacts abnormally to a normally harmless 'trigger'. Someone experiencing an allergic reaction might find they suffer from mild itching from a red raised rash, swelling (the hands, feet and face are most commonly affected by this), wheezing or possible abdominal pain/vomiting and/or diarrhoea.
The common allergy triggers in people are:
Pollen
Dust
Nuts
Shellfish
Eggs
Insect stings (usually wasp or bee stings)
Latex
Certain medications
This list is only a few allergens that people can react to, there are many more you may come across.
What to do
Follow the steps below:
Step 1
Assess the person’s signs and symptoms and ask if they have any allergies.
Step 2
If you can, remove the trigger if possible, or move the casualty away from whatever is triggering the allergen.
Step 3
Most of the symptoms of an allergic reaction can be treated by medication. If the person has experienced this sort of a reaction before then they may have their medication on them, which is usually an anti-histamine, and they should take this as soon as possible.
Step 4
If this is the person’s first reaction or you are concerned about their condition then you should seek medical advice, this can be from your nearest pharmacist, calling NHS Direct, or speaking to a doctor.
Anaphylactic shock is still an allergic reaction, but it is a life threatening severe reaction to an allergen that can affect the whole body. In an anaphylactic reaction, chemicals are released into the body that cause the blood vessels to widen, the air passages in the lungs narrow leading to breathing difficulties and swelling of the tongue and throat obstruct the airway. In cases of anaphylaxis it is vitally important you get emergency help as soon possible.
Causes of anaphylaxis include foods such as peanuts, tree nuts, milk, eggs, shellfish, fish, sesame seeds and kiwi fruit, although many other foods have also been known to trigger anaphylaxis. Some people can react to tiny amounts of food, although this rarely causes a very severe reaction.
Non-food causes include wasp or bee stings, natural latex (rubber), and certain drugs such as penicillin. In some people exercise can trigger a severe reaction – either on its own or in combination with other factors such as food or drugs (for example, aspirin).
What to look out for
Red itchy rash or raised areas of the skin
Read, itchy, watery eyes
Swelling of the hands, feet and/or face
Abdominal pain, vomiting and diarrhoea
Difficulty in breathing; ranging from a tight chest to severe difficulty causing the casualty to wheeze and gasp for air
Pale or flushed skin
Visible swelling of the tongue and throat, puffiness around the eyes
Confusion and agitation
Signs of shock.
What to do
Follow the steps below:
Step 1
Call 999/112 for an ambulance and state you suspect anaphylaxis.
Step 2
If the casualty has had a diagnosis of anaphylaxis before then they will most likely have been given an auto-injector pen. This contains a medicine called adrenaline which helps tackle the symptoms of anaphylaxis. You should encourage the casualty to use their own auto-injector themselves. Should they be unable to do this for themselves then you can administer it to them following the instructions found on the auto-injector itself.
Step 3
Keep the casualty in a comfortable position (sitting up is best to help with breathing) and monitor their breathing and level of response.
Repeated doses of adrenaline from further auto-injectors can be given at five-minute intervals if there is no improvement or the symptoms return.
Asthma
When someone experiences an asthma attack, the muscles of the air passages in the lungs go into spasm. This narrows the airways, which makes breathing difficult. Sometimes things such as an allergy, cold weather, an illness like a cold, cigarette smoke etc. can be enough to trigger an asthma attack. At other times there is no apparent trigger, and asthma sufferers can experience sudden attacks.
People experiencing an asthma attack can experience any of the following signs/symptoms:
Difficulty breathing
Wheezing and/or coughing
Distress and anxiety
Difficulty in speaking, shown through being unable to complete sentences and whispering
Signs of hypoxia such as a grey-blue tinge to the lips, earlobes and nailbeds
Exhaustion, in the case of severe attacks
What to do
Follow the steps below:
Step 1
Keep the casualty calm, get them sat down in a comfortable position.
Step 2
Reassure them, and get them to take the usual dose of their “reliever” inhaler and to breathe slowly and deeply.
If they have a spacer available, ask them to use it with their inhaler. The inhaler is more effective with a spacer when being used for young children.
If they have no inhaler call 999 or 112 for emergency help.
Step 3
A mild attack should ease within a few minutes with the use of their inhaler. If it does not, the casualty may take more doses of their inhaler – they can take 1-2 puffs every 30-60 seconds (up to 10 puffs). If they have a personal plan this should be followed. Seek medical aid if necessary.
Step 4
If the attack is severe and they are getting worse, becoming exhausted or if this is their first attack call 999 or 112 for emergency help.
Step 5
Monitor their breathing and level of response until help arrives, if there is a delay of more than 15 minutes, repeat taking 1-2 puffs every 30-60 seconds (up to 10 puffs) and be prepared to start CPR should they become unresponsive.
Bites and stings
An insect sting from a bee or a wasp can be painful but is not usually dangerous. An initial sharp pain is followed by mild swelling, redness and soreness. Certain types or multiple insect stings can produce a serious reaction. A sting in the mouth can be potentially dangerous because swelling can obstruct the airway. It is important to watch for signs of allergic reaction, which can lead to anaphylactic shock, with any insect bite or sting.
What to look for
Pain at the site of the sting
Redness and swelling around the site of the sting
What to do
Follow the steps below:
Step 1
Reassure the casualty.
Step 2
If the sting is visible, brush or scrape it off sideways with the edge of a credit card or your finger nail. Do not use tweezers as you may squeeze the sting and inject more poison into the casualty.
Step 3
Raise the affected part and apply a cold compress for at least 20 minutes to minimise swelling. Advise the casualty to keep the compress in place for at least 10 mins. Tell them to seek medical advice if the pain and swelling persist.
Step 4
Monitor breathing and level of response and watch for sign so of an allergic reaction such as wheezing and/or reddened, swollen, itchy skin.
Burns and scalds
A burn can be caused by dry heat such as contact with fire, or a hot iron, or exposure to the sun. A scald can be caused by contact with wet heat, like steam or a hot cup of tea. The longer the burning goes on the more severe the injury. Your priority is to cool the burn as quickly as possible.
What to look for
red skin and swelling
pain in the area of the burn
blistering may start to appear
What to do
Follow the steps below:
Step 1
Start cooling the burn or scald as quickly as possible. Hold it under cool running water for at least 20 minutes or until the pain feels better. If there is no water available, you could use cold milk or canned drinks.
Step 2
Remove jewellery or clothing, unless stuck to the burn, before the area begins to swell.
Step 3
When the burn has cooled, cover the area loosely with cling film, lengthways.
Do not wrap the cling film around the burn as the area needs space to swell
If the burn is on a foot or hand you could use a clean plastic bag
Do not use ice, creams or gels. They may cause damage and increase the risk of infection
Do not break any blisters that may appear, as this may cause infection.
Step 4
Monitor the casualty, if you are concerned seek medical advice. If the burn has happened to a child or an infant you should always seek medical advice, even if the burn is a minor one.
Choking
When someone is choking, their airway is partly or completely blocked, meaning they may be unable to breathe properly. They might be able to clear it by coughing, but if they can't you will need to help them straight away.
What to look for
difficulty breathing, speaking or coughing
a red puffy face
signs of distress, and they may point to their throat or grasp their neck
The advice for helping a choking infant is different. For what to do, click here.
What to do
Follow the stops below:
Step 1
If you think someone is choking, ask them "Are you choking?" If they can breathe, speak or cough then they might be able to clear their own throat. If they cannot breathe, cough, or make any noise, then they need your help straight away.
Step 2
Encourage them to cough and remove any obvious obstruction from their mouth.
Step 3
If coughing fails to work, you need to give five sharp back blows. To do this, help them to lean forwards, supporting their upper body with one hand. With the heel of your other hand give them five sharp back blows between their shoulder blades. After each back blow, check to see if there’s anything in their mouth.
Step 4
If back blows fail to clear the obstruction, give five abdominal thrusts. To do this, stand behind them and put your arms around their waist. Place one hand in a clenched fist between their belly button and the bottom of their chest. With your other hand, grasp your fist and pull sharply inwards and upwards up to five times. Check their mouth again, each time.
Step 5
If the blockage has not cleared, call 999 or 112 for emergency help straight away. Repeat five back blows and five abdominal thrusts until help arrives, re-checking their mouth each time.
If they become unresponsive at any point, prepare to start adult CPR or child CPR if dealing with an unresponsive child.
CPR
What to do
There is separate guidance on how to perform CPR on an infant or child. For CPR on an adult please follow the steps below:
Step 1
If you find an adult collapsed or unresponsive, you should first perform a primary survey. Do not open their airway and do not place your face close to theirs to check for breathing.
If this shows that they are unresponsive and not breathing, shout for help. Ask a helper to call 999 or 112 for emergency help while you start CPR. Ask a helper to find and bring a defibrillator, if available.
Ask your helper to put the phone on speaker and hold it out towards you, so they can maintain a 2m distance
If you are on your own, use the hands-free speaker on a phone so you can start CPR while speaking to ambulance control
Do not leave the casualty to look for a defibrillator yourself, the ambulance will bring one.
Step 2
Before you start CPR, use a towel or piece of clothing and lay it over the mouth and nose of the casualty.
Kneel by the casualty and put the heel of your hand in the middle of their chest.
Put your other hand on top of the first. Interlock your fingers making sure they don't touch the ribs.
Keep your arms straight and lean over the casualty. Press down hard, to a depth of about 5-6cm before releasing the pressure, allowing the chest to come back up (this is called a compression).
You will need to give continuous compressions
The beat of the song 'Staying Alive' can help you keep the right rate
Do not give rescue breaths
Step 3
Continue to perform CPR until:
emergency help arrives and takes over
the person starts showing signs of life and starts to breathe normally
you are too exhausted to continue - if there is a helper, you can change over every one-to-two minutes with minimal interruptions to chest compressions
This guidance has been adjusted for Covid-19 so may not be what you have previously learned or are used to.
Cuts & Grazes
Cuts and grazes are common injuries that can usually be treated at home. A plaster is generally all that is required, and the wound will heal by itself in a few days.
What to do
Step 1
Clean the wound by rinsing it under running water or using sterile wipes.
Step 2
Pat the wound dry using a gauze swab and cover it with a sterile gauze. If you don't have these, use a clean, non-fluffy cloth, like a tea towel.
Step 3
For a cut, raise and support the injured part above the level of the heart. Avoiding touching the wound.
Step 4
Clean around the wound with soap and water. Make sure you are wiping away from the wound, using a clean swab for each stroke. Pat dry. Remove the cloth or gauze covering the wound and apply a sterile dressing or a large plaster.
Step 5
Seek medical help if:
A wound won't stop bleeding.
A foreign object is embedded in the wound - like a splinter of wood or glass.
The wound is from a human or animal bite.
You think the wound might be infected.
You are unsure whether the casualty has been immunised against tetanus.
Diabetic emergencies
Diabetes is a long-term medical condition where the body cannot produce enough insulin. Sometimes those who have diabetes may have a diabetic emergency, where their blood sugar level becomes too high or too low. Both conditions could be serious and may need treatment in hospital.
Insulin is a chemical produced by the pancreas (that lies behind the stomach). It regulates the blood sugar (glucose) levels in the body. When someone has diabetes, their body cannot keep the blood sugar level within the normal range. Their level can be higher or lower than normal blood sugar.
There are two types of diabetes:
Type 1, known as insulin dependent diabetes
Type 2, non-insulin dependent diabetes
Someone with diabetes may have items with them which could lead you to suspect that they have diabetes;
they may be wearing a medical warning bracelet or necklace
they may be carrying glucose gel or glucose tablets
they could have medication, such as an insulin pen, a special pump or tablets and a glucose testing kit
Hyperglycaemia
This is where the blood sugar level is higher than normal. It may be caused by a person with diabetes who has not had the correct dose of medication. They may have eaten too much sugary or starchy food or, they may be unwell with an infection.
What to look for
warm, dry skin
rapid pulse and breathing
fruity, sweet breath
excessive thirst
drowsiness, leading them to become unresponsive if not treated (also known as a diabetic coma)
medical warning jewellery or medication.
What to do
Follow the steps below:
Step 1
If you suspect hyperglycaemia (high blood sugar), they need urgent treatment. Call 999 or 112 for emergency help and say that you suspect hyperglycaemia. They may be wearing a medical bracelet or medallion, or have a card on them which can alert you to their condition.
Step 2
While you wait for help to arrive, keep checking their breathing, pulse and whether they respond to you. If they become unresponsive at any point, open their airway, check their breathing and prepare to start CPR.
A dislocated joint happens when bones are partly or completely pulled out of their normal position. Joints can dislocate when a strong force wrenches or pulls the bone into an abnormal position. Please note we also have first aid guidance on first aid for breaks and fractures.
What to look for
complain of a severe, sickening pain
be unable to move the joint
have swelling and bruising around the joint and it may look shorter, bent or deformed.
What to do
Follow the steps below:
Step 1
Advise the casualty to stay still. Help them to support their dislocated joint in the most comfortable position. Do not try to put the dislocated bone back into its socket, as this may cause further injury.
Step 2
Stop the joint from moving. If you think they have dislocated their shoulder or elbow, support the injured arm using a sling. To give extra support, tie a broad-fold bandage (wide bandage) around the chest and the sling. If a hand or arm is injured, remove any rings or watches in case of swelling.
If you think they have dislocated their ankle, knee or hip joint, support the injured leg using padding and broad-fold bandages.
Step 3
Send the casualty to hospital. Call 999 or 112 for emergency help if you can’t take them yourself.
Step 4
While waiting for help, treat for shock if necessary. Monitor their level of response. Do not raise an injured leg. Only raise the uninjured leg.
Step 5
Check the circulation beyond any bandages every 10 minutes and loosen if necessary.
Drowning
Drowning is when someone has difficulty breathing because their nose and mouth are submerged in a liquid. When someone's drowning, it may not always look like the distressed call for help that most people expect from watching TV. They may go unnoticed, even if friends or family are nearby.
We've updated our guidance due to the Covid-19 outbreak. Do not perform rescue breaths on the casualty.
What to do
When helping an adult please follow the steps below. There is separate advice for how to help a child who is drowning.
Step 1
Do not put yourself in danger when trying to rescue a casualty.
Step 2
When the casualty is rescued from the water, you should first perform a primary survey. If this establishes that they are unresponsive and not breathing, you should ask a helper to call 999 or 112 for emergency help while you start CPR. Ask a helper to find and bring a defibrillator, if available.
if you are on your own, use the hands-free speaker on a phone so you can start CPR while speaking to ambulance control
do not leave the casualty to look for a defibrillator yourself, the ambulance will bring one.
Step 3
Start performing chest compressions. Kneel by the casualty and put the heel of your hand in the middle of their chest. Put your other hand on top of the first. Interlock your fingers making sure they don't touch the ribs. Keep your arms straight and lean over the casualty. Press down hard, to a depth of about 5-6cm before releasing the pressure, allowing the chest to come back up (this is one compression).
Do this at a rate of 100-120 compressions per minute.
the beat of the song ‘Staying Alive’ can help you keep the right rate
do not give rescue breaths.
Step 4
Continue to perform CPR until:
emergency help arrives and takes over
the person starts showing signs of life and starts to breathe normally
you are too exhausted to continue (if there is a helper, you can change over every one-to-two minutes, with minimal interruptions to chest compressions)
or a defibrillator is ready to be used (if the helper returns with a defibrillator, ask them to switch it on and follow the voice prompts while you continue with CPR).
Step 5
Beware, many casualties that drown may bring up stomach contents, so be prepared to roll them onto their side to clear their airway.
Step 6
If the casualty shows signs of becoming responsive such as coughing, opening eyes, speaking, and starts to breathe normally, put them in the recovery position. You may also need to treat them for hypothermia covering them with warm clothes and blankets. If possible, replace the wet clothes with dry clothes.
Step 7
Monitor the casualty's level of response and prepare to give CPR again if necessary.
This guidance has been adjusted for Covid-19 so may not be what you have previously learned or are used to.
Fainting
What to do
Step 1
Ask them to lie down.
Step 2
Check for other injuries. They may have hurt themselves falling down, so look for head injuries and any other wounds. Treat as appropriate.
Step 3
Kneel down next to them and raise their legs, supporting their ankles on your shoulders to help blood flow back to the brain.
Step 4
Make sure that they have plenty of fresh air. Ask other people to move away and if you're inside then ask someone to open a window.
Step 5
Reassure the casualty and help them to sit up slowly.
If they begin to feel faint again, lie them down.
If they stay unresponsive, open their airway, check their breathing and prepare to treat someone who is unresponsive.
Foreign objects
Objects can find their way into the body either through a wound in the skin or via an orifice such as the eyes or nose. These can range from grit in the eye to a small toy that young children may push into their noses and ears. These injuries can be distressing but do not usually cause serious injury for the casualty.
Blurred vision
Pain or discomfort
Redness and watering of the eye
Eyelids may be screwed up in spasm
What to do
Step 1
Gently clean the area around the splinter with soap and water.
Step 2
Hold the tweezers close to the end for a better grip. Grasp the splinter as close to the skin as possible.
Step 3
Draw the splinter out in a straight line in the same angle that it entered the skin making sure it does not break.
Step 4
Carefully squeeze the wound to encourage a little bleeding and flush out any remaining dirt. Clean the wound and cover it with a plaster.
Fractures
A break or crack in a bone is called a fracture. In the case of an open fracture, the broken bone may pierce the skin surface. But in a closed fracture the skin around the fracture is intact. However, broken bones may be unstable causing internal bleeding and the casualty may develop shock.
What to do
deformity, swelling and bruising around the fracture
pain and/or difficulty moving the area
a limb may look shorter, twisted or bent
a grating noise or feeling from the ends of the broken bones
difficulty or being unable to move the limb normally
a wound where you can see the bone sticking out (known as an open fracture)
signs of shock, particularly with a fracture of a thigh bone, hip or pelvis
Step 1
If it is an open fracture, cover the wound with a sterile dressing or a clean non-fluffy cloth. Apply pressure around the wound and not over the protruding bone, to control any bleeding. Then secure the dressing with a bandage.
Step 2
Advise the casualty to keep still while you support the injured part to stop it from moving. Do this by holding the joint above and below the injured area.
Step 3
Place padding around the injury for extra support.
Step 4
Once you’ve done this, call 999 or 112 for emergency help. Do not move the casualty until the injured part is secured, unless they are in immediate danger. You can secure an upper limb fracture with a sling and a lower limb fracture with broad fold bandages.
Step 5
If necessary treat for shock, but do not raise an injured leg. Monitor their breathing and level of response while waiting for help to arrive.
Head Injuries
All head injuries are potentially serious because they may damage the brain. A head injury may cause damage to the brain tissue, a skull fracture or an injury to the spine or neck.
If you're looking for advice on head injuries in children and infants, see our dedicated page.
any loss of responsiveness
scalp wound
dizziness or feeling sick
loss of memory of events before or during the injury
headache
confusion
What to do
All head injuries are potentially serious because they may damage the brain. A head injury may cause damage to the brain tissue, a skull fracture or an injury to the spine or neck.
if you're looking for advice on head injuries in children and infants, see our dedicated page.
Step 1
If they are responsive, sit the casualty down and hold something cold against the injury to help reduce the swelling, like an ice pack or a frozen bag of vegetables wrapped in a tea towel.
Step 2
While you do this, try and assess the casualty’s level of response using the AVPU scale:
Alert - Are they alert? Are their eyes open?
Voice - Can they respond to you if you talk to them? Can they answer simple questions?
Pain – Does the casualty respond to pain? If you pinch their ear lobe, do they move or open their eyes?
Unresponsive - Are they unresponsive to all the above? If they are unresponsive or you are worried, call 999 or 112 for emergency help
Step 3
If they have any wounds, treat them by applying direct pressure to the wound. Secure with a dressing if needed.
Step 4
Keep monitoring their level of response. If they are alert and responsive and have always been so, their head injury is probably mild. You or another responsible adult should wait with them until they recover.
If they’re not alert or responsive or they appear to be confused, their head injury could be more serious. Call 999 or 112 for emergency help and explain the cause of the injury and give them details of the casualty’s response to the AVPU scale.
If they become unresponsive at any point, open their airway, check their breathing and prepare to treat someone who’s become unresponsive.
Step 5
If their injury has been caused by a sporting incident, make sure they do not return to the sport until they have been fully assessed by a medical practitioner.
Step 6
Advise the casualty to seek medical help if the head injury appears to get worse or if any of the following apply:
they are over the age of 65
they had previous brain surgery
they are taking anti-clotting medication
they have been taking drugs or drinking alcohol
there is no one responsible to look after them.
Heart Attack
A heart attack happens when the supply of blood to part of the heart is suddenly blocked, usually by a blood clot. You can make a full recovery following a heart attack, but this may depend on how much of the heart is affected.
have crushing pain in the centre of their chest, that may spread to their jaw, and down one or both arms
be breathless or gasping for breath
be sweating profusely
experience pain similar to indigestion
collapse without warning
complain of dizziness
have pale skin and their lips may have a blue tinge
have a rapid, weak or irregular pulse
have a feeling of impending doom
What to do
Step 1
Call 999 or 112 for emergency help straight away and tell them you think someone is having a heart attack.
Step 2
Help move the casualty into a comfortable position. The best position is on the floor, with their knees bent and their head and shoulders supported. You could place cushions behind them or under their knees.
Step 3
If possible give them one aspirin tablet (300mg) and ask them to chew it slowly. Do not give aspirin to the casualty if they are under 16 or if they are allergic to it.
Step 4
Find out if the casualty suffers from a condition called angina, and if they do ask the casualty to take their own angina medication, if they have it.
Step 5
Keep monitoring the casualty’s level of response until emergency help arrives. Should they become unresponsive, be prepared to start CPR.
Hypothermia
The body normally maintains a temperature of around 37oC (98.6oF). When the body temperature dips below 35oC (95oF) it is known as hypothermia. Moderate hypothermia can usually be reversed with treatment, however, severe hypothermia – when the body’s core temperature drops below 30oC (86oF) – is often fatal. The severity of hypothermia is determined on the speed of onset and how low the body temperature drops. In all cases, it's important to always persist with life-saving procedures until help arrives as survival may be possible even after prolonged periods of resuscitation.
Shivering, cold and pale skin
Apathy, disorientation or irrational behaviour
Lethargy or impaired responsiveness
Slow and shallow breathing
Slow and weakening pulse
In extreme cases, the heart may stop
What to do
Step 1
Take the casualty to shelter as soon as possible.
Step 2
If possible, remove and replace any wet clothing. Do not give them your clothes. Ensure their head is covered.
Step 3
Protect the casualty from the ground by lying them on a bed of dry leaves or blankets. Cover them with blankets or newspapers. Wrap them in a foil survival bag if available.
Step 4
Call 999/112 or send for emergency help.
Step 5
If the casualty is fully alert, encourage them to drink warm drinks and eat high energy foods such as chocolate.
Step 6
Monitor their breathing and level of response whilst waiting for help to arrive.
Recovery Position
Once you have carried out your Primary Survey and found the casualty is breathing. You'll need to place the casualty in the recovery position. If you haven’t already done so, make sure that 999 has been called for an ambulance.
We place casualties in the recovery position for two reasons:
To help keep the airway open by preventing the tongue from blocking the airway
It prevents the casualty choking on any fluids
The technique described below can be used in adults and children.
If the casualty is clearly pregnant then you must make sure they are placed in the recovery position on the left hand side.
What to do
Step 1
If you find someone collapsed, you should first perform a primary survey. If it shows that they are unresponsive but breathing, put them in the recovery position.
Step 2
Kneel by the casualty and straighten their legs and place the arm closest to you our of the way (don’t worry if the hand doesn’t touch the floor – don’t force it to). If they are wearing glasses, or have any bulky items in their pockets, remove them. Do not search their pockets for small items.
Step 3
Grasp the other hand and place the back of the hand against the side of the face closest to you. Hold the hand in position by resting your palm against theirs.
Step 4
With the leg furthest away from you, place your free hand under the hollow of the knee and bend the leg up so that the foot is flat on in the floor.
Step 5
Using the bent knee, pull the casualty towards you so that they end up lying on their side. Make sure that the bent knee is at a 95 degree angle and tilt the head up with the mouth open to allow any fluid to drain out.
Step 6
A casualty can remain on their side in the recovery position, whilst you wait for the ambulance, for 30 minutes. When it’s been 30 minutes you will need to roll them into the recovery position on the opposite side.
Seizures
In adults, the most common cause of a seizure, also known as a convulsion or fit, is epilepsy. However, it can be caused by other things, including a head injury, alcohol poisoning, lack of oxygen, after taking certain drugs, or if someone with diabetes has a 'hypo' where their blood glucose is too low.
Epilepsy is a condition that affects the brain and can cause repeated seizures, which are often sudden and dramatic.
People experiencing a seizure can experience any of the following signs/symptoms:
Sudden loss of responsiveness
A rigid body with an arching back
Noisy, difficult breathing
Grey blue tinge on the lips
Start of jerky uncontrolled movements (uncontrolled)
Saliva at the mouth, possibly blood stained if they have bitten their tongue or lip
Loss of bladder or bowel control
What to do
Step 1
harming themselves during the fit. Ask any bystanders to stand back and clear away any potentially dangerous objects, like hot drinks or sharp objects. Make a note of the time that the seizure started.
Do not restrain the casualty or move them unless they are in immediate danger.
Do not put anything in their mouth.
Step 2
Protect their head. You could place soft padding underneath it, such as a rolled-up towel. You should also loosen any clothing around their neck.
Step 3
When any jerky movements have stopped, open their airway and check their breathing.
Monitor their level of response and make a note of how long the seizure lasted.
If they become unresponsive at any time, prepare to call 999 or 112 for emergency help and give CPR.
Step 5
Call 999 or 112 for emergency help if:
It is the casualty's first seizure
They are having repeated seizures
The cause of the seizure is unknown
The seizure continues for more than five minutes
The casualty is unresponsive for more than 10 minutes
They have an injury on another part of the body
Sepsis
Sepsis is caused by the way the body responds to an infection. The infection can happen anywhere in the body. For example, a chest or urinary infection, or problems in the abdomen like burst ulcers, or even simple skin injuries like cuts and bites. Sepsis is sometimes called septicaemia or blood poisoning. There is different advice for sepsis in children.
It is a life-threatening condition which makes the immune system go into overdrive as it tries to fight the infection. This can reduce the blood supply to vital organs such as the brain, heart, and kidneys, eventually leading to multiple organ failure and possibly death.
If someone is unwell and you think they have one or more symptoms of sepsis, do not wait call 999 or 112 for emergency help straight away.
Step 2
While you’re waiting for help to arrive, reassure them and keep them comfortable.
Step 3
Monitor their level of response.
Severe Bleeding
If the bleeding isn’t controlled quickly, they may lose a lot of blood, become unresponsive and possibly develop shock. Shock does not mean emotional shock; it is a life-threatening condition, often caused by loss of blood.
Your priority is to stop the bleeding.
What to do
Step 1
With open wounds, there’s a risk of infection, so wear protective first aid gloves (if available) to help prevent any infection passing between you both.
Step 2
Control the bleeding by applying direct pressure to the wound.
Step 3
Dial 999 or 112 for the emergency services.
Step 4
Apply an appropriate dressing firmly to control the bleeding and minimise the risk of infection. It should not be so tight that it restricts the casualty’s circulation.
Step 5
Treat for shock by lying the casualty down with their feet raised. If possible, lay the casualty on a blanket or some other item to insulate them from the cold ground. If the casualty has a head injury, lay them down and slightly raise their head and shoulders.
Step 6
If blood comes through the dressing, remove the dressing and reapply direct pressure over the wound with a new dressing or pad to control the bleeding.
Step 7
Secure the dressing with the bandage once the bleeding is controlled, tie the knot over the pad to help maintain pressure.
Step 8
It may be that the call handler instructs you how to improvise a tourniquet to control life-threatening bleeding if you are not trained or do not have a tourniquet in your first aid kit, using items such as a triangular bandage, belt, or tie.
Step 9
Monitor the casualty’s breathing and level of response while waiting for the emergency services to arrive.
Shock
Shock, not to be confused with emotional shock, is a life-threatening condition. It happens when the body isn’t getting enough oxygen to the vital organs.
Shock can be caused by anything that reduces the flow of blood, such as:
severe internal or external bleeding
heart problems, such as a heart attack, or heart failure
loss of body fluids, from dehydration, diarrhoea, vomiting, or burns
severe allergic reactions and overwhelming infection (septic shock)
spinal cord injury
pale skin, which may be cold and clammy
sweating
fast pulse - as shock gets worse
fast, shallow breathing
a weak pulse
grey blue skin, especially inside the lips
nausea and possible vomiting - as the brains oxygen supply decreases
restlessness and aggressive behaviour
yawning and gasping for air
the casualty could become unresponsive
What to do
Step 1
First, treat any cause of shock that you can see or that you have identified from the primary survey, such as severe bleeding.
Step 2
Lay the casualty down on a blanket. Constantly reassure them.
Step 3
Raise and support their legs to improve blood supply. If the leg is bleeding and the casualty is comfortable, you can raise both legs, if there is a suspected fracture to the pelvis, hip, or either leg, both legs should stay down.
Step 4
Dial 999 or 112 for an ambulance.
Step 5
Loosen tight clothing at the neck, chest, and waist.
Step 6
Keep the casualty warm and reassure them. Do not let them eat or drink. If the casualty is obviously pregnant lean them to their left side to prevent the baby restricting blood flow back to the heart.
Step 7
Monitor the casualty’s breathing and level of response until the emergency services arrive. Be prepared to perform CPR.
Sprains and strains
Injuries to the soft structure around the bones and joints are commonly called sprains and strains. They are often associated with sports activities.
What to do
Sprains and strains should be treated initially by following the RICE procedure.
Step 1
R – Rest the injured part. Help them to sit or lie down and support the injured part in a comfortable position, raised if possible.
Step 2
I – Apply a cold compress or an Ice pack.
Step 3
C – Comfortable support.
Step 4
E – Elevate the injured part if possible. Advise the casualty to get medical advice, if necessary.
Stroke
A stroke can occur when blood supply to the brain is disrupted and starves the brain of oxygen.
Facial weakness - uneven smile, droopy mouth or eye
Arm weakness - can they raise both arms?
Speech problems - can they speak clearly?
What to do
Step 1
If you suspect someone is having a stroke, use the FAST guide to identify the key signs:
F – stands for facial weakness.
Look at their mouth or eye – they may be droopy, and they can’t smile evenly.
A – arm weakness.
Ask them to raise both of their arms. They may only be able to raise one.
S - speech problems. They are unable to speak clearly or might not be able to understand what you are saying to them.
Ask them a question, such as "What is your name?" Can they respond appropriately?
T – time to call 999/112 for emergency help and tell them you suspect a stroke after using the FAST guide.
Step 2
While waiting for help to arrive, keep them comfortable, supported and reassure them. Do not give them anything to eat or drink because it may be hard for them to swallow.
Step 3
Keep monitoring their level of response until help arrives. If they become unresponsive prepare to treat for an unresponsive casualty.
Unresponsive Casualty
When you come across someone who isn't responsive, before you do anything you need to assess is it safe to approach, is the person breathing or bleeding. To do so, use the Primary Survey as your method to assess the person.
Primary Survey (DR ABC)
Follow the steps below:
Danger
Before approaching the casualty, always make sure the area is safe.
Response
Check if the casualty is responsive or unresponsive. As you approach them, introduce yourself and ask them questions to see if you can get a response. Kneel next to their chest and gently shake their shoulders, asking, "What has happened?", "Open your eyes!" Do not place your face close to the casualty’s face when doing this.
If the casualty opens their eyes, or gives another gesture, they are responsive.
If they do not respond to you in any way they are unresponsive and should be treated as quickly as possible.
Airway
Check their airway is open and clear.
Staying at arm’s length of the casualty. Open the airway by placing one hand on the forehead to tilt the head back and use two fingers from the other hand to lift the chin.
Breathing
Check casualty is breathing normally.
You now need to check if the casualty is breathing normally. Do not place your ear above their mouth to look, listen or feel for breathing. Simply look for a rise and fall of the chest instead.
If they are unresponsive and not breathing, you need to call 999/112 for emergency help and start CPR straight away. Ask a helper to find and bring a defibrillator (AED).
If they are responsive and breathing move on to circulation.
Circulation
Check for severe bleeding.
Once you have established they are breathing, look and check for any signs of severe bleeding.
If they are bleeding severely you will need to control and treat the bleeding by applying direct pressure to the wound. Call 999/112 for emergency help.
If they are unresponsive and breathing but with no bleeding, put them in the recovery position and call 999/112 for emergency help.
Using a defibrillator (AED)
Using an AED (COVID-19)
Automated External Defibrillators (AEDs) are used to deliver a shock to a casualty who is in cardiac arrest. You can use an AED on your own or with a helper.
If you have a helper when using the AED then you should wear a face mask as you will be unable to maintain a 2 meter distance between each other when operating the AED.
CPR is different for adults, children, and infants, and our guidance has been updated to reflect changes due to COVID-19 (Coronavirus).
Warm weather advice
The warm weather, whilst being a time to enjoy ourselves, can also present a danger to our health and cause us some problems. As a minimum you should drink plenty of water, wear a hat that shades and apply sunscreen every two hours (SPF 30 with UVB and 4 star UVA protection as a minumum) to protect yourself from sunburn and sun-related conditions.
Below are some warm weather conditions that you can learn how to deal with should you come across them.
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