First Aid to the Injured

FIRST AID TO THE INJURED. First aid refers to measures to be taken immediately after an accident not with any idea of cure but in order to prevent death by prompt action, or in less dangerous cases to prevent further harm being done, and put the victim in the best possible condition for later and more extensive treatment.

General Directions for Giving First Aid.—The American Red Cross gives the following brief summary of first aid instruc tion for cases of emergency : (I) one who understands first aid, or the person in authority, should take charge; (2) keep cool; (3) keep the crowd away ; (4) send for a doctor or ambulance; (5 ) meantime do what you can to help the victim. Unless special attention is needed, proceed to put the patient in a safe and com fortable position, which usually is lying down with head low, although, if the face is flushed, the head should be raised on a pillow. To avoid the possibility of choking never attempt to give water or stimulants to an unconscious person. In all serious cases, be sure to keep the patient lying down. Other important points to remember are : loosen tight clothing; avoid giving whiskey or brandy; but cold water may be given slowly if the patient can swallow; rip or cut clothing away to examine injury. Avoid dis turbing the patient, especially in the case of fracture, when the patient should not be moved before the bone is set, unless abso lutely necessary; keep the patient warm, especially in case of severe shock.

Treatment for Shock.

Shock is present to some degree in all serious injuries, being greatly increased by severe bleeding and pain. Shock may be recognized by pallor of the face, clammy skin, rapid weak pulse and shallow breathing of the patient. After calling a doctor the first essential of treatment is to keep the patient warm with blankets, hot water bottles, hot drinks, etc. (being careful to avoid scalds and burns) . If the patient is con scious, about a cupful of hot strong coffee, hot milk, or hot water, containing a half teaspoonful of aromatic spirits of ammonia, may be used as a stimulant, and repeated in a half hour if necessary, remembering always never to pour liquid down the throat of an unconscious person. Place the patient on the back with the head low and the clothing loosened around the neck, chest and abdomen. In case of the presence of some more severe symptom than shock, such as dangerous bleeding, that should of course receive first attention.

Fractures.

Among the most common severe injuries are frac tures; i.e., broken bones. While a fracture is not always easily recognizable, symptoms are a localized pain, tenderness, limitation of motion or deformity of a part, a grating sound from the broken ends, or an inequality of the bone which sometimes may be felt through the skin. A fracture must be set as soon as possible, of course, but because of the danger of further injury to tissues from the sharp edges of the broken bones, treatment before the doc tor's arrival best consists chiefly in very careful handling of the injured part, and the application of a simple splint to hold the part in position. Splints may be improvised from narrow boards, heavy pasteboard, umbrellas, canes, and the like, but must be padded when applied next to the skin, must not be bound so tightly as to restrict circulation and should be long enough to prevent movement at the nearest joints. In any case of fracture, the patient should not be moved before the broken bone is firmly held in a splint. Although it may be possible and even necessary, if a physician cannot be reached, for the first aider to set the bones, the danger of cutting tissues in exerting sufficient force to bring the ends together is so great that whenever possible it is much better to await a physician's treatment. If in addition to the break there is a wound leading down to the broken bone, or a broken end of bone protruding through the skin, a compound fracture has occurred, and must first be treated as a wound (see "Wounds"). In such cases always treat the patient for shock, and be sure to let nothing touch the abrasion but a surgically clean dressing. In fractures of collar bone, ribs, jaw, nose, etc., band aging obviously must be substituted for splints. If fracture of the skull is possible, the patient should be placed lying down with head slightly raised, and treated for shock until the doctor's arrival. No stimulant should be given unless the patient is very weak, in which case spirits of ammonia may be used.

Dislocations.

Dislocations of jaw and of the fingers, except that of the second joint of the thumb, which must be treated by a doctor, may be successfully reduced by the first aider, if care is exercised. In case a finger is dislocated, simply grasp firmly on the hand side, and pull the end straight out away from the hand. The bone will usually slip easily into place. In case of a dislocation of the jaw, the thumbs of the person giving first aid should be well wrapped, placed on the back teeth with fingers grasping the out side of the lower jaw. Pressure exerted first down and then back ward will usually cause the jaw to snap into place, so. that the one giving the treatment should be careful to avoid having his thumbs caught by the snap. A dislocated shoulder should always have a physician's attention within four hours.

Sprains.

Sprains, which are injuries of the joints, causing severe pain and swelling, should be treated immediately and a doc tor called. Absolute rest is necessary. The joint should be elevated and when possible heat or cold applied, heat being preferred in case of severe shock or if the patient is a child or an older person. This treatment should continue for from 24 to 28 hours.

Wounds.

Wounds, including all injuries in which the skin is pierced or broken, always involve the danger of pus germs entering from outside the body. As there is no danger from pus germs in the air or within the body, they must come from the surface of the body or from foreign objects. For this reason a wound which bleeds freely lessens danger by carrying out foreign germs in the wound. The vast majority of wounds wherein bleeding is com paratively slight chiefly require that the surrounding clothing be removed and that nothing be allowed to touch the wound. If a physician is called, a course which should be adopted in the case of every deep wound, nothing further should be done. Exposure to air is much safer than application of anything not surgically clean. It is desirable to make an ordinary wound bleed sufficiently to cleanse itself. Adhesive plaster should never be used to cover directly anything more than a trivial scrape. Nearly all wounds require a dressing, which must be surgically clean and should cover the wound thoroughly. If foreign bodies, such as splinters, re main in the wound, they should be gently pulled out. In removing a splinter from under a nail, put a knife blade against the splinter, holding it on the blade with the thumb nail after scraping the injured nail thin and cutting out a small V-shaped piece in order to reach the splinter. Small splinters may be removed with a needle. All care should be taken to avoid infection, using prefer ably iodine to sterilize. (See "How and When to Use Iodine.") Also it should be remembered that the majority of serious cases of blood poisoning result from quite small cuts or scratches.

Haemorrhages or Severe Bleeding.

In the event of severe bleeding (haemorrhage) the patient should be kept lying down with head low, be kept warm, have plenty of good air to breathe and be supplied with stimulant only if absolutely necessary. The bleeding can usually he stopped by the application of a small pad of gauze and a tight bandage over the wound or by pressure with the thumbs on the main blood vessel between the wound and the heart, the limb being at the same time elevated—if it be a limb which is involved. The points for pressure are just in front of the ear (for bleeding from the temples) ; the inner side of the arm below the arm pit, about where the inner seam of a shirt comes; the inner side of the thigh near the groin; and in the hollow back of the knee. In arterial bleeding a tourniquet should be used. This may be improvised from a handkerchief in which a small stone or other hard object has been wrapped. The tourniquet should at all times be applied between the wound and the heart, with the hard object above the wound, and twisted with a stick until the constriction shuts off the bleeding. Care should be taken always to loosen the tourniquet every 15 minutes in order to avoid death of the part resulting from complete loss of circulation. When the tourniquet is loosened watch closely to see if bleeding has stopped. If so it may remain loosened. Bleeding from veins can usually be checked by applying a compress tightly to the wound, but lacking a surgically clean compress and if severe bleeding is present, pressure must be made with the fingers, at the risk of infecting the wound. Any tight bands preventing the return flow of blood to the heart should be loosened immediately, and if the injury is in a limb it should be elevated. A doctor should always be called. If there is internal haemorrhage the patient should lie down, with his head lower than his body, a doctor should be sent for, and in the meantime ice or a cloth wrung out in very cold water should be applied to the point from which the haemorrhage seems to come. The proper application of bandages requires special study (see BANDAGES AND BANDAGING).

Nose Bleeding.

In severe nose bleeding, the patient should be placed in a chair, with his head hanging backward and any tight clothing round his neck loosened, and cold applied to the back of his neck by means of a key, or cloth wrung out in cold water. A roll of paper placed under the upper lip, between it and the gums may help. If bleeding continues, salt and water, one tea spoonful to a cup of water, should be snuffed up the nose. If bleeding still continues call a doctor, plug the nostril with a small piece of cotton or gauze, and pinch the soft part of the nose below the bone. Do not give stimulants.

Burns.

For slight burns, common baking soda, dry or dis solved as a paste, may be applied, or picric acid gauze, wet with water or 2 % solution of picric acid, or plain gauze may be used. Extensive burns on which blisters have formed should be covered, preferably with gauze or a clean soft cloth saturated with baking soda solution, carbolized vaseline, unguentine or, in an emergency, any clean pure oil. Deep burns require prompt attention from a physician. A solution of Epsom salts makes a soothing dressing. If burns come from acids they should be washed off under a water tap as quickly as possible and then washed with lime-water, or baking soda and water or even soap-suds may be employed. For burns from carbolic acid, alcohol should be applied freely. Burns from alkalies should be washed, in'the same way as acid burns, and neutralized by vinegar, lemon juice or hard cider. In all burns use care in removing clothing, cutting away around the burn, but never pulling. Clothing that sticks should be soaked off later with oil. Never place cotton over a burn.

Sunstroke.—If sunstroke has occurred, the face will be hot, flushed and dry. The patient should be cooled as quickly as possible. Cracked ice or cloths wrung out in cold water should be applied, especially to the head, which should be slightly raised— the patient, of course, lying down. When conscious, he may drink cold water freely. If he is rubbed constantly to bring blood to the surface and to avoid shock, he may be wrapped in sheets wrung out in cold water or put in a very cold bath. No stimulants should be used.

Heat Exhaustion.—Heat exhaustion, which must be distin guished from sunstroke, causes the skin to be pale, cold and moist, and should be treated in the same manner as shock (see "Treat ment for Shock") .

Frost-bite or Freezing.—The experience of arctic explorers has demonstrated that rubbing after freezing has taken place is not the treatment. Rubbing with snow. is especially bad. Gently cover the frozen part with the hand or other body surface until it is thawed, or the frozen part may be thawed very gradually in cool air or cold water. If this cannot be done cover with extra clothing until thawed.

Artificial Respiration.—The essential treatment in all forms of suffocation, whether from water, gas, smoke or shock from electrical contact, is artificial respiration. (For explanation and description of this process see ARTIFICIAL RESPIRATION.) Gas Poisoning.—Gas poisoning, commonly resulting from leaking fixtures, or from the fumes of an automobile exhaust (the deadly carbon monoxide gas) causes suffocation, headache, dizzi ness, nausea, vomiting and extreme sleepiness. The pulse is fast and breathing weak and rapid. This poisoning is rapidly fatal. The victim should be quickly carried to fresh but not cold air, as cold will kill a gassed person from shock. If needed, artificial respiration should be given at once. If the patient is conscious, strong coffee should be given liberally, or some other stimulant may be substituted. The patient should be kept warm and not allowed to exercise. A doctor's services must be procured to avoid the danger of pneumonia.

Electric Shock.—In cases of electric shock, the victim must be quickly released from the current by using a dry non-conductor (rubber gloves, several thicknesses of newspaper, dry clothing, a wool cap or felt hat wrapped around the hand, a rope or a dry board may be used). Thus the wire, if on top of the victim, can be quickly flipped off with any board or stick, or an instrument with a wooden handle may be used to cut it. Alternatively, it may be short circuited by dropping a metal bar on it between the victim and source of the current ; or the former may be removed by lifting, care being taken that the rescuer stands on a dry non conducting surface and uses no metal or anything damp or moist in doing so. After the victim is released, artificial respiration and treatment for shock should follow.

Drowning.—To administer efficient first aid in drowning re quires special knowledge and skill. (For discussion of methods of actual rescuing from the water see LIFE SAVING SERVICE; DROWNING AND LIFE SAVING.) It may suffice to say here that after the body has been secured, artificial respiration, in charge of someone who understands it, should be immediately tried, any water or mud having first been removed from the mouth and a doctor, of course, being sent for. (See ARTIFICIAL RESPIRA TION and DROWNING AND LIFE SAVING.) Unconsciousness.—Unconsciousness may be the result of a large number of causes. Unless special treatment be required for poison, bleeding, sunstroke or suffocation, the procedure is to place the patient prone with head low, and, if the face be pale and the pulse weak, to warm and stimulate him in every way possible. If, however, as sometimes happens, he is red-faced, with a strong pulse, he should be placed prone, head raised, cold water should be sprinkled on the face and chest and no stimulants applied. In any case of fainting, windows should be opened, clothing loosened and smelling salts or ammonia used. Taking the person who feels faint into cold fresh air, or making him double over with his head between his knees for a moment, sometimes will avert a faint.

Convulsions.—If a person is seized with convulsions, do not attempt to hold him, but put him on the ground or floor where he cannot injure himself by thrashing about and place a piece of wood covered with a handkerchief in the mouth to prevent him from biting his tongue.

Apoplexy and Brain Injuries.—In the case of apoplexy and brain injuries send for the doctor at once, giving the patient in the meantime complete rest and quiet, if possible in a darkened room, with the head and shoulders raised on a pillow. Cold cloths may be applied at the same time to the head and hot water bottles to the limbs but no stimulants should be given.

Alcoholic Poisoning or Drunkenness.—Alcoholic poisoning or drunkenness must never be confused with apoplexy. If in doubt as to which condition is present treat for apoplexy and be careful not to cause vomiting. For drunkenness give an emetic, such as mustard and water or quantities of lukewarm water, fol lowed by strong coffee or aromatic spirits of ammonia. Apply hot water bottles and rub the limbs towards the body to increase circulation.

Opium Poisoning.

Poisoning from preparations of opium, of which laudanum and morphine are the most common, should be treated, while awaiting a with an emetic (mustard and water or quantities of lukewarm water) to provoke profuse vomiting. Plenty of strong coffee should be given, and an adult may be slapped with a wet or threatened, to rouse him. Unless weak, he may be walked up and down, but at any signs of weakness he should be made to lie down.

Carbolic Acid Poisoning.

In carbolic acid poisoning, Glauber's or Epsom salts are fair antidotes, or lime water, though less efficient, may be used as a mouth wash and swallowed. Raw eggs, castor oil or sweet oil may be given, and stimulants and warmth should always be included in the treatment. In general, in cases of poisoning, the first step is to send for the doctor, telling him if possible what poison has been taken. Then give an emetic, and antidote, with the doctor's advice. (See table of antidotes, etc., under ANTIDOTES.) Home and Camp Emergencies.—For the numberless small emergencies of home, camp and sports which arise, a few simple bits of first aid knowledge often save discomfort and sometimes avert serious consequences.

Common Cramps. Common cramps of the abdomen, usually due to indigestion or chill, should be treated by gentle rubbing and application of the hot water bottle. For internal relief a soda mint tablet may be given. Cathartics immediately or forced vomiting are not recommended because of the possibility of appendicitis. For nausea and vomiting, drinking lukewarm water freely causes vomiting and washes out the stomach. Following this the patient should lie down in a cool place, hot fomentations should be applied to the abdomen, and a little soda mint may be taken. Cramps in the legs should be treated by rubbing and kneading.

Hiccupping. Hiccup can usually be stopped by holding the breath long enough so that the air in the chest forces the dia phragm down and prevents it from contracting. This may be done by drinking a large glass of water in small sips, without taking a breath. If necessary, vomiting will always cure hiccup by removing the cause of irritation from the stomach.

Convulsions in Children. Convulsions in children always require treatment by a doctor. Until his arrival absolute quiet for the patient is necessary, and cold cloths or an ice cap should be applied to the head, with a mustard pack surrounding the body to bring the blood to the skin. Disturb the child as little as possible.

Toothache. If toothache begins at a time when it is impossible to reach a dentist immediately, clean out the cavity if accessible and place a small piece of cotton, dipped in oil of cloves, in the cavity, with a toothpick or needle, If treatment must be through the gum, use absorbent cotton soaked in spirits of camphor as an emergency measure.

Earache. For emergency and temporary treatment of earache, hot cloths or hot water bottles, or fumes from hot alcohol poured on a cloth and held outside the ear may be of help. A few drops of hot sweet oil not hot enough to burn, dropped in the ear, the ear then being plugged with cotton, may give temporary relief but the earache should be treated as soon as possible by a physician.

Sties. Pain from a sty may be diminished by holding to the eye a cloth wet with water as hot as can be borne.

Prickly Heat. Prickly heat is often relieved by a good talcum powder, but if severe it should be bathed with a mixture of one part alcohol to three of water, and afterwards dusted with talcum.

Lime-water with two drops of carbolic acid to the ounce is an excellent application for prickly heat. These applications should always be used after bathing.

Hives (U.rticaria or ash ).. In severe cases of hives a doctor would be called. Ordinarily an emetic should be taken followed by a purgative such as Rochelle or Epsom salts. To re lieve itching, a warm bath containing a handful of washing soda may be given, or bathing the parts with a strong solution of bi carbonate of soda and water, or rubbing with spirits of camphor, may give relief.

Mosquito Bites.

Mosquito bites are best treated with ammonia, or lime-water containing two drops of carbolic acid. The applica tion of cool, wet dressings may ielp.

Ivy .or Dade Poisoning. Severe ivy or oak poisoning should be treated by a doctor, but the -application of a simple wash of 3% boracic acid solution, with carbolized vaseline as an ointment affords relief, the treatment being repeated daily. Epsom salts solution is also recommended.

Blisters. Blisters on the bands or feet are best treated by wash ing the part thoroughly in hot water, pricking the blister through the skin at the side with a clean needle and gently pressing out the fluid.

Snake Bites. Snake bites are comparatively rare injuries but may be rapidly fataL In the United States, the rattlesnake and moccasin are most to be feared. The treatment consists in imme diately circling the wounded part with a tightly tied string, hand kerchief, or bandage, between the bite and the body, if the bite is on a limb, thus preventing absorption of the poison by cutting off the return of blood to the body. Soak the wound in hot water and squeeze or suck it as it is absolutely essential to extract as much of the poison as possible. There is little danger in sucking wounds made .by the poisonous snakes in the United States, unless there is a cut or infection in the mouth. Then cauterize or burn the wound, using ammonia or permanganate of potassium freely, in strong solution. Dose freely with strong stimulants such as aromatic spirits of ammonia. Do not fail to loosen the tight bandage after one hour, loosening it a little at a time, and observing the effect of the poison thus let into the blood-stream on the patient. Tighten again and repeat the loosening process. If the poison should cause severe depression, care should be taken to keep the wound tightly tied up regardless of the danger of the part dying from lack of circulation.

Dog and Cat Bites. Treatment for dog and cat bites is the same as for snake bite, except that the bandage may be removed as soon as the wound is cauterized. A doctor should be consulted and every effort made to discover whether or not the animal was rabid; if so every measure for the prevention of hydrophobia must of course be taken.

Insect Bites. In general, for the bites of insects and spiders, ammonia should be applied and care taken to ensure that the sting does not remain in the wound.

Eye Injuries. In any injury of the eyeball, cover both eyes with absorbent cotton or soft cloths, soaked in cool water, so as to keep the eyelids still, and bandage them into place with head bandages, being careful not to bind tightly enough to cause pressure on the eyeballs. They should then be kept constantly cooled with water till a doctor can be procured. Splinters in the eye should be pulled out if possible. A little olive- or castor-oil in the eye may help. If foreign bodies, such as cinders, sand or dust get in, never rub the eye, but first close it to allow tears to accumulate which may wash the object into view so that it may be removed with a bit of clean cloth or cotton. Failing in this, pull the upper lid over the lower two or three times, close the nostril on the opposite side with the finger and blow the nose hard. If the offending object is still in the eye, examine first the lower lid by pressing down and then the upper lid. To do this last, seat the patient in a chair, head bent backward, and standing behind him place the finger or a match on the upper lid, fin. from its edge. Turn the upper lid back and if the foreign body can be seen brush it off with a bit of clean cotton. Particular care must be taken to avoid any rough treatment and in case of any difficulty the eye should be bandaged as above instructed, and a doctor called.

How and When to Use Iodine.—Iodine is the only disin fectant suitable for general use which is of sufficient strength to be efficacious. Painting iodine on wounds is unquestionably of value in preventing infection, but only if applied within two hours after the accident. It will probably not reach the tissues in a very deep wound, however, and will not prevent pus infection if the tissues are extensively crushed. The best iodine solution is Lugol's, a weak solution of iodine crystals with iodide of potassium in water. Tincture of iodine (a 7% solution) is, itself, too strong and must be diluted with one part alcohol to one of tincture. Tinc ture of iodine in accordance with the British Pharmacopeia (a 21% solution), does not require dilution. The method of applying is to paint it on freely with a camel's hair brush or cotton wool on a stick. Do not pour iodine into a wound or cut, and never use it on or near the eyes. Use a rubber plug in the bottle.

Carrying Sick or Injured Persons.—Before attempting to carry a sick or injured person, loosen any tight clothing and see that the patient is warm. In case a stretcher is needed it may be improvised by the use of a pair of poles and two suit coats. The sleeves are first turned inside out and the coats placed on the ground, with the lower edges touching each other, the poles are then passed through the sleeves on each side, the coats buttoned and the buttoned side turned down. A stretcher may also be improvised from a large blanket or rug, in which the poles have been rolled from the outer edge inwards until firmly held, leaving about loin. between the two poles, the whole being then turned over. In case narrow blankets are used the edges should be bound to the poles with twine.

Household Medicine Cabinet.

For the household medicine cabinet, the Red Cross recommends the following standard sup plies, which are best kept in a white enamelled box, provided with lock and key:— Aromatic spirits of ammonia, 20z. Antiseptic gauze, a small package.

(rubber stopper).

Absorbent cotton, 1lb.

Olive oil,

2 drams. Roller bandages, gauze, 6-3 large Epsom salts, 4oz. (or 6 Seidlitz and 3 small.

powders) .

Collodion, I small bottle with Lime-water, 2oz. brush.

Mustard, powdered,

20z. First aid outfits, Red Cross, 2.

Syrup of ginger, 2oz.

Tooth plasters, i box.

Syrup of ipecac,

20z. Corn plasters, i box.

Witch hazel, 4oz.

Glass and spoon, i each or medi Bismuth subnitrate tablets, 5 grain cine glass.

(too tablets in bottle) .

Scissors, i pair.

Carbolized vaseline or petrolatum, Pins, ordinary and safety.

I tube.

Iodine, one-half tincture with Oil of cloves, I dram bottle one-half alcohol, 2oz. in bottle, (labelled "poison") . rubber stopper.

Soda mint tablets, too tablets in

Iodine swabs, 6.

bottle.

Bottle, 2oz., I.

Talcum powder, i tin.

Camel's hair brush, 1.

A convenient first aid kit obtained from the Red Cross or easily made at home consists of a white enamelled tin box with a tight fitting cover, containing: 2 triangular bandages. ioz. aromatic spirits of ammonia 2 roller bandages. (rubber stopper) .

2

packages of dressing. 2 or 3 safety pins.

I small roll of absorbent cotton.

Small scissors.

loz. of iodine (rubber stopper in First aid text-book, with list of bottle) . contents pasted on inside cover of box.

See

American Red Cross Abridged Text-book on First Aid (3rd general edition) . See also RED CROSS. (M. J. S.)