Basic First Aid Skills

As a first aider, you cannot deliver appropriate first to an injured player or athlete, if you have not done some basic assessment of the athlete's situation. The previous unit exposed you to your responsibility as a first aider. This unit presents the important on-the-field assessments required by a first aider and the skills needed to do such assessments. These assessments are done on the field, court, floor or ground where the injury occurred. This is called on-the-field assessment, and provides information on the nature of the injury which will help the first aider to know the type of first aid the injured player might need.

1. Injury Assessment

This is the assessment of all situations surrounding the injured athlete and his injury at the point where the injury occurred. It is usually called on-the-field injury assessment.

There are two sub divisions of on-the-field assessment:

(1) Primary Assessment

(2) Secondary Assessment.

 

1. Primary Assessment

This assessment focuses on the priorities of first aid. Do you remember them?  Life–threatening conditions.

The primary assessment is done to know if there is life threatening conditions (Mention few of the life-threatening conditions). They include airway blockage, no breathing, no circulation, severe bleeding and shock. If it is established that an athlete has any of these conditions, it should be treated immediately or be transported to an emergency care center as soon as possible.

What is done in this primary assessment are what Flegel, (2008) called emergency action steps, which are: Assess the scene and athlete; Alert, and Attend to the ABCs. These three important steps are recommended to be performed very quickly, if possible in less than a minute.

Step 1 – Assess the scene and athlete

In assessing the scene, the first thing to consider is protection or safety of the injured player. You do this by  

1. Instructing all other players and bystanders to leave the injured athlete alone.

2. Ensuring that you and the injured player are in a safe environment. If the cause of the injury is from the environment of play, you may consider moving the athlete away to safety.

3. Calming the injured athlete and preventing him or her from rolling around or jumping up and down.

These actions can complicate the injury or cause further injuries.

• Considering whether the position of the athlete or equipment he or she is wearing will allow primary assessment and first aid for life-threatening situations.

• To assess the athlete, you must be involved in the sports you are covering. You must know when injury occurred, what caused it and how it occurred; what body part is involved and how it is involved. As you approach the scene of the injury, you keep reviewing the injured athlete's medical history to know what may be the problem. When you get there, determine whether the athlete is responsive or not. As mentioned previously, gently tap the athletes shoulder and shout “Are you Ok”, (add his or her name)? Then, listen and observe.

Step II – Alert

If the athlete does not respond, quickly alert or call for the pre-arranged medical team.

Then activate step 3.

Step III – Attend to the ABCs

The ABCs are airway, breathing and circulation. This step is very important because without taking it within minutes, the athlete might die.

The objectives of this step are:

(1) To determine if the athlete needs cardio-pulmonary resuscitation (CPR).

(2) To check if any other life-threatening condition such as severe bleeding exists. If no immediate life-threatening condition is identified, you end the primary assessment and go into the secondary assessment, which involves physical assessment of the athlete.

If you observe that the injured athlete is responsive, what will you do?  

Suggests that you can follow these steps to attend to the ABCs:

1. Identify yourself and ask the athletes permission to help.

2. Make sure that the athlete is fully responsive and is breathing normally

3. Look for and control any severe bleeding with direct pressure;

4. Look for normal skin colour and body temperature.

5. While waiting for medical assistance, continue attending to the ABCs by ensuring open airways and normal breathing.

6. Continue to maintain normal breathing, body temperature and monitor skin colour.

There may also be a situation where the athlete in not responsive.

In such situation, do the following:

1. Call for medical assistance

2. Attend to ABCs. If the athlete is lying face down, roll him over so that you can check if breathing is normal or not. Use the head/chin tilt method to open the blocked air-way. The method requires you to:

(1) Place your fingertips just below the athletes chin, and your other hand on the athletes forehead.

(2) Gently lift the chin up with your fingertips while you are gently tilting the forehead back or tipping the forehead.

(3) Then, determine if the athlete is breathing by looking, listening and feeling for breathing for at least 5 seconds and not more than 10 seconds. If the athlete is not breathing well or has a breathing failure, initiate rescuer breathing called, mouth–to–mouth resuscitation.

2. Mouth–To–Mouth Resuscitation.

Have you ever seen someone finding it very difficult to breathe? Did you imagine how you could have been of help? This section will help you to know what you can do to help in such situation. Mouth–to–mouth resuscitation is a method of inflating an injured person’s lungs with air from your lungs. It is done by blowing the air from your lungs into the athlete’s mouth.

Follow this suggested procedure to administer mouth–to–mouth resuscitation. The procedure follows the procedures for determining breathing or no- breathing. It is as follows:

1. With your mouth form an airtight seal with the mouth of the athlete. A barrier mask can be used prevent blood – borne infections. So, use it if available.

2. Deliver two slow, full rescue breaths to the athlete; one in one second, with your eyes on the player’s chest.

3. Continue until normal breathing is restored.

4. Check for heart beat using the pulse. Place two fingers (thumb not included) on the side of the neck and feel for rhythmic pulsation. If there is no pulse, start external chest compressions or cardiac massage.

3. Cardiac Massage

The following procedures are followed in external chest compression called cardiac massage:

1. Place the heel of one of your hand on the center of the athlete’s chest between the nipples;

2. Place the other hand on the first hand.

Note: The fingers of the two hands can either be straight or fastened together, but should not be kept off the chest of the injured athlete.

3. Position your body so that your shoulders are directly over hands on the athlete’s chest.

4. Extend and lock your elbows

5. With the help of your upper body weight, push forcefully, straight down on the chest of the athlete. Push down 4 – 5cm and release.

Give 30 chest compressions at the speed of 100 per minute and allow the chest to recoil.

4. Cardio-Pulmonary Resuscitation (CPR)

When a person’s heart stop beating and there is a breathing failure; the two methods – mouth–to–mouth resuscitation and external chest compressions – are combined. This is called cardio-pulmonary recitation, (CPR). In this method, you give 30 chest compressions followed by two rescue breathing. After the 30 chest compressions, open the athlete’s airway and give two rescue breaths. Continue with CPR until medical assistance arrives.

Your school invited you to be part an athletic health care team that will provide medical coverage during an interscholastic sports competition. In the team, your experience in human kinetics made you to stand out as the only person with experience in first aid. How can other members of the team help you to carry out your duties as a first aider during emergency? What injuries can result in bleeding?

When you observe bleeding, how should you handle the athlete?

2. Bleeding

Bleeding can be external or internal. External bleeding can be as a result of open wound such as abrasion, incisions, lacerations, punctures or avulsion which are conditions or injuries you have learnt about. Do you remember them? Please, handle every case of external bleeding as you would handle a person with blood-borne infection. Always use disposable latex gloves to prevent blood-borne diseases.

There are three ways to control bleeding and they are:

• Direct pressure: place a sterile gauze pad on the wound and directly apply pressure with your hands over the gauze.

• Elevation: Elevate or raise the injured part against gravity to increase venous return. This method works well with pressure.

• The Pressure Point: This method is employed when the first two methods did not stop the bleeding (hemorrhaging). It involves the location of the pressure points in the body and press them against the borne.

The most common pressure points are:

(i) The brachial artery in the upper limb, (arm)

(ii) The femoral artery in the lower limb, (superior thigh). These points are located and compressed against the humerus and femur respectively. When internal bleeding in observed within the skull, chest or abdomen, it may be difficult to determine what may have gone wrong. So, the athlete should immediately be moved to the hospital for proper diagnoses. The ambulance may be called in or you ask another member of the health care team to help you. Use your seat if there is no stretchers close

3. Secondary Assessment

When the life-threatening conditions in the primary assessment have been handled and the athlete kept in a stable condition, the secondary assessment will be conducted to assess the existing injuries closely. This involves recognizing physiological signs of injury, which include the following vital signs: heat rate, temperature, blood pressure, rate of breathing, colour of skin, movement, eye pupil, the presence of pain and unconsciousness. All these constitute physical assessment. It determines what caused the injury. Do you remember injury mechanisms? It also determines where the injury hurts and any unusual sign and symptoms.

Heart rate is one of the most common vital signs to be assessed by you. It is the number of times the heart beats per minute. Follow these guides to determine heart rate. It is commonly estimated using the pulse. The most common is the radial pulse. Remember to always put on your latex glove.

1. Radial Pulse

1.  Place your index and middle fingertips just below the athletes thumb at the wrist.

2.  Slide your fingertips down until you feel a bony bump.

3.  Move your fingers just to the inside of the thumb, toward the middle of the wrist.

4.  Apply slight pressure to feel the athlete’s pulse.

5. COUNT the number of thumps in 10 seconds and multiply.

6. To get heart rate.

2. Carotid Pulse

The carotid pulse can also be taken to estimate the athlete’s heart rate. The carotid is located under the jaw, or the Adam’s apple at the neck of the athlete. The pressure you apply with your fingers is mild when compared to the radial pulse. Protection of the life of an injured player places great responsibility on the first aid provider. When the heart of the player is involved, it is the heart of the matter, and this must be handled before any other situation. Mastery of the skills in the assessment of the athlete’s situation, and administration of CPR or its components are important in taking care of the athlete.