American Red cross abridged text-book on first aid

Preface

MINERS’ EDITION

The needs of miners, so far as might be, in respect to first-aid instruction were met in an earlier book of this series which was called the “Industrial Edition.’’ This, however, was for other industries as well as for mines. Now, the spread of the first-aid movement in a vast number of mines throughout the country has seemed to demand a special book for miners. Furthermore, experience has shown that instruction in safety and in first aid should go together even more than was thought at first, though in all the Red Cross first-aid manuals the importance of the subject of prevention as a part of first-aid instruction has always been insisted upon. The reception of the former editions of the Red Cross first-aid books was very gratifying to that association and to the authors. It is hoped that a larger experience will make the present edition more useful and practical.

The benefits to be gained from knowledge of first aid to the injured are becoming more apparent year by year as the subject is taught more widely throughout the United States. It may be well here to call attention to the fact that in our country this instruction started in the mines. Nowhere has first aid been learned better and nowhere has the good from knowledge of the subject been greater.

As the experience of the authors has increased they have become more and more convinced of the ease with which first aid to the injured may be learned. All that is necessary is a serious wish to learn and a practical course of instruction. The first must be provided by the student and this is the reason miners have always been so successful in this work. It is hoped that this book may help in respect to the second requirement. It is not

V

VI

PREFACE enough to read the book, however, the student must himself practice first aid on a comrade or on someone else supposed to be injured, and whenever practicable it is very important that this be done under the direction of a competent teacher.

Knowledge of certain facts is necessary to all students of first aid to the injured. So far as these are concerned each book in this series is alike. On the other hand, each industry has a special first aid of its own. Each of the Red Cross manuals differs in respect to the latter. Both the authors of this small text¬ book have published other first-aid books and these have been freely used here as has seemed most advantageous.

Chapter I

WHAT FIRST AID TO THE INJURED IS; GENERAL DIRECTIONS FOR GIVING FIRST AID; SHOCK

What First Aid to the Injured Is

We all know, of course, that a doctor as he has given years to studying the subject is best qualified to take care of ill and injured. On the other hand, accidents and sudden illness often occur where the services of physicians cannot be immediately obtained. The necessary delay may result very disastrously for the ill or injured. A very large experience has shown that any intelligent person can learn what to do in such emergencies. First aid to the injured must be learned, however, like every other subject and no one will know what to do for ill or injured unless he has studied it. But all that is necessary for good re¬ sults is that the student have common sense and devote the small amount of time required for acquiring the special knowl¬ edge and skill.

Knowledge of first aid to the injured is a very valuable and very cheap form of insurance. Possibly we may never need this knowledge, but the wise man or woman would hardly be willing to let any building go without insurance on the chance that it would never burn. How much more important it is for us to

I

WHAT PIRST AID TO THE INJURED IS insure our own selves against the bad results of accidents through knowledge of first aid to the injured.

There is no clashing of interest between the doctor and the first aider. The duties of the former begin when the latter leave off. Knowledge of first aid enables trained persons to put patients into doctors’ hands in the best possible condition for cure. It should also enable them to recognize the severity of an injury or illness so that when necessary they may call a doctor promptly. Treatment, except of very minor cases of in¬ jury or illness and the care of injured and ill in an emergency till a doctor can be procured is not first aid. Such treatment can¬ not be learned from this book, and cannot be too strongly condemned.

Accidents have become far too common and the attention of every student of first aid is earnestly invited to the great bene¬ fits to be gained by studying how to prevent them as part of his or her course in first aid. Prevention is better than cure in in¬ jury as well as in disease and is just as practical. In both, good results in this respect are mainly dependent on the action of in¬ dividuals. Every injury described in this book should suggest how the accident which caused it might have been prevented. Still more if any first aider cares for a real injury he or she should think over the cause for it carefully and so far as within their power take steps to prevent a similar accident in the future.

General Directions for Giving First Aid

If no doctor is present when an accident occurs someone must take charge of things. This duty naturally falls on the first aider. This is what he has studied first aid for and he ’should always stand ready to take the responsibility. In justice to the injured person and to himself he must not allow interference by other people. The only people who should be near an in¬ jured person are those required to help him. He needs all the air he can get and a crowd about him will use air that he should have.

Be observant. Everything depends upon this. See every-

DIRECTIONS FOR GIVING FIRST AID thing and think what each thing means. Then you can hardly go wrong in caring for the patient.

Be calm and don’t be hurried. -Be quiet and cool.

If a doctor is within immediate call it may hardly be necessary for the first aider to do more than to send for the doctor and to keep the crowd away from the injured person. The action taken depends on the injury, however; for example, it would be very foolish to wait a moment for a doctor if there were danger of death from bleeding or in any accident where delay would be dangerous. On the other hand, often it may be better to have a doctor care for the injury from the first. In giving first aid it is quite as necessary to know what not to do as what to do. In any case if the services of a doctor can be had it is always best to employ them, except for slight injuries. Moreover, if any doubt exists in regard to this, it is best to send for a physician or to take the injured person to a doctor as soon as possible. It should be remembered that injuries which are apparently trivial may sometimes, if not treated promptly by a doctor, have serious consequences, and that a physician called in time may prevent conditions which when fully established are beyond the help of medical science.

Tight clothing interferes with both breathing and circulation. The collar should be loosened at once, and also usually the belt, likewise anything else around the body which is tight.

Generally speaking, if something special does not need imme¬ diate attention, the next thing to do is to get the injured person into a safe and comfortable position. The best position, unless there is some reason to the contrary, is on the back with the head low. With a flushed face, the head may be raised on a small pillow or folded coat; with a pale face, it should not be raised at all. If a person is vomiting, he should be placed on his side or his head should be turned to one side, so that the matter vomited will not go into his windpipe and choke him. Unconscious persons cannot swallow and so they should never be given water, stimulants, etc., as these will choke them by entering the wind¬ pipe. Slight cases of illness and injury may sit up, but one must be sure that all seriously injured are kept lying down.

WHAT FIRST AID TO THE INJURED IS

Do not be hurried into moving a person from the place where his accident has occurred and always make sure first that he is not going to be injured further by being moved. It is specially dangerous to move persons with broken bones before proper treatment has been given as the ends of the broken bones are very sharp and cut like a knife.

A hurt person vdll frequently ask for water, which may be given with perfect safety. Cold water is usually more refreshing, but whether cold or hot, it must be given fairly slowly so that the injured person has time to swallow between sips. To neglect giving a stimulant when it is required would be a grav^e error of judgment. The first thought with many people, however, is to procure whisky or brandy for everj* sufferer from illness or injury. These are reallj- as unnecessary’ for every’ case as would be the application of splints to the leg of every* injured man. They’ should never be given in injuries of the head, and it should be remembered that while a small quantity’ of liquor acts as a stimulant, large ones are depressing. If y’ou have it, always use aromatic spirits of ammonia as a stimulant in’preference to any’ alcoholic liquor.

Whatever the injury’ may’ be, it must be seen clearly before any attempt is made to treat it. In order to do this it w'ill generally be necessary to remove some of the clothing. This is likely’ to be very’ painful and possibly dangerous for the injured person, unless he is handled with the greatest gentleness. In remov’ing clothing, rip up the nearest seam in the outer clothing and cut or tear the underclothing. The sound side should be undressed first so that the injured side will be subjected to less movement. In injuries to the foot and ankle it will rarely be possible to remove the boots or shoes without giving severe pain and perhaps doing considerable damage, so they’ should be cut freely when this is necessary.

The first aider must make use of what he finds on the spot. He must explain clearly’ to any’ helpers just what he wants them to do.

When there are several injuries the most severe should be cared for first.

SHOCK

Shock

More or less shock is caused by all injuries and it must be thought of, and treated when necessary.

Description.—Shock is a more or less profound depression of the nervous system. It is sometimes called collapse or prostration.

For the convenience of the student the human body is divided into various systems. One of these and perhaps the most im¬ portant as it regulates the action of all the others is the nervous system. This is a very delicate system which is easily disturbed. Everybody knows what a mental shock is. A person receives bad news, for example, he grows pale, perhaps is unable to move, or even becomes half conscious or totally unconscious and may die. We say he has received a shock. This is exactly what happens as the result of an injury. That is to say, shock always, whatever the cause, is as stated, a more or less severe depression of the nervous system.

Causes.—Usually a severe injury. Some persons are sensitive to shock, however, and so with them more shock will follow a slight injury than is the case with a severe injury in less sensi¬ tive persons.

Prevention.—The prevention of accidents, especially severe accidents. Also do not allow an injured person to see his own injury, as this is apt to increase shock. This is especially true with severe bleeding.

Symptoms.—(This is a word whose meaning should be known to every first aider.’ Symptoms are everything that an injured or ill person shows or feels because of an injury or disease.) Usually appear as soon as an injury is received. Face is pale with an anxious expression; eyelids droop; eyes are dull and the pupils are large. (The pupils are the black circles in the center of the eye.) Skin is cold and covered with a cold sweat. The injured person is more or less stupid and takes no interest in any¬ thing happening near him. May be partly or totally uncon¬ scious or mind may wander. Usually he lies perfectly quiet and will not move unless disturbed. Breathing is feeble and

WHAT FIRST AID TO THE INJURED IS shallow. Pulse is rapid and weak. May not be able to feel it at the wrist. (The first aider should be able to count the pulse at the wrist. Seventy-two per minute is the usual rate in per¬ fect health but this varies considerably. Exercise, for example, increases the rate perhaps many beats per minute.)

Usually shock is recovered from, the improvement being gradual but the shock may grow worse and death finally occur.

It might be thought any one should easily know when a person is suffering from shock. This is the case usually but not invari¬ ably. If you see the accident and its effect you can hardly make a mistake but suppose you do not see the accident then you may have nothing to judge by except the symptoms just given.

Treatment.—Send for doctor at once if possible. Warm and stimulate in every possible way before arrival of doctor.

First, place injured person on back with head low so that plenty of blood will enter brain.

Stimulants should always be given if he is able to swallow. Hot coffee, hot tea or half a teaspoonful of aromatic spirits of ammonia in a half glass of water. Whisky may be only stimu¬ lant procurable. If used, give one large drink only, as more is likely to cause depression. Ammonia or smelling salts to nose, help, when procurable.

Never remove more clothing than necessary from an injured person as this will cause more severe shock, and when possible spread coats or blankets over him.

Place hot-water bottles or hot bricks around him when possible; flannels wrung out in hot water applied to abdomen and chest have the same effect. Rubbing legs and arms toward body, under blankets, quickens circulation of the blood and is useful. Be careful while doing this not to uncover the injured person.

Warning.—While shock is so extremely common in injuries that it should always be kept in mind and treated, it must not be forgotten that something more dangerous even than shock may require attention. The symptoms of severe bleeding are very like shock, and if shock only is treated in such a case and the bleeding is not stopped the patient may bleed to death.

STIMULANTS

More about Stimulants. —Most first-aid stimulants have al¬ ready been mentioned but it will perhaps be well to say a few words more respecting their use.

All stimulants taken internally are best given hot when possible as aside from the particular stimulant used, heat itself is a power¬ ful stimulant whether employed internally or externally. Safe and easily procurable stimulants are tea and coffee, a glass of wine, a dessertspoonful of whisky or brandy with an equal quan¬ tity of water, or a teaspoonful of pure alcohol with three times the quantity of water (not wood alcohol or denatured alcohol, which are poisons).

Alcohol in some form may usually be easily procured and this use of alcohol is, of course, purely a medicinal one which has noth¬ ing to do with the question of the drinking of alcoholic liquors. But many people object to the use of alcohol under any cir¬ cumstances. In large amounts it is depressing and not stimu¬ lating, and for other reasons it is never advisable to carry whisky or brandy for first-aid purposes. Aromatic spirits of ammonia which has none of the disadvantages of alcohol is the best first-aid stimulant. It is best given in half-teaspoonful doses in one-half a glass of hot water.

As unconscious persons cannot swallow, for them we must make use of a stimulant which may be inhaled. The best stimulant under these circumstances is water of ammonia, hartshorn, or smelling salts. This, of course, is held under the nose so its fumes may be breathed in.

Heat employed externally is such a very valuable stimulant that every first-aid student should know how to make use of it. The ordinary hot-water bag is most convenient for this purpose, but glass bottles and jars are good. They should be covered with cloth or paper to prevent them from burning the patient. Hot bricks and stones are also useful. In using heat in this way it must be remembered that, especially with an unconscious person, there is considerable danger of causing severe burns, so one must make sure by testing the bottle, etc., on his arm or face, that it will not burn even if left in contact with the skin for some time. In applying heat by means of the objects mentioned,

WHAT FIRST AID TO THE INJURED IS to get the greatest effect, they should be placed between the legs, at their outer sides and between the body and the arms. A light hot-water bag lying over the heart acts as a special stimulant to it.

Rubbing not only quickens the circulation, but is also stimu¬ lating.

As has been indicated in discussing shock, all the different classes of stimulants are best used together when they can be obtained.

1. What is First Aid to the Injured?

2. Suppose you have to care for an injured person. What would you do first.

3. When should you send for a doctor, or take the injured person to a doctor?

4. What about tight clothing?

5. When would you move an injured person?

6. What are the dangers of moving an injured person?

7. What do you know about giving injured persons water; stimu¬ lants?

8. Should clothing always be removed?

9. When would you remove some of the clothing and how would you do this?

10. When does shock occur?

11. What is shock? Cause of shock? Prevention? Symptoms? Treatment? What is a symptom?

12. Suppose you see a person whom you think is severely shocked, what would you look for in order to determine nothing more severe than shock had occurred?

13. Explain the use and abuse of stimulants.

Have one of the class pretend to be injured, or secure some one else to act as “subject.” Members of the class should be required to show just what they would do for any case of injury. They should also be required to loosen and to remove clothing, the place of the injury having been stated. They should place the injured person in the proper position. The pupil of the eye should be demonstrated and each member of the class should be required to take the pulse.

Show on the subject exactly what should be done in shock.

Chapter II

The first aider must learn to use his hands as well as his head. To know how to bandage well is necessary for him. Practice makes perfect in this as well as in other respects and the first-aid student should learn how to bandage as early as practical in his course of instruction and thereafter take every opportunity to perfect himself by constant practice.

Kinds of Bandages

1. The Triangular Bandage.

2. The Roller Bandage.

3. The Four-tailed Bandage.

I. Triangular Bandage. —The triangular bandage is perhaps best suited for general first-aid work, as it can be easily made, is not difficult to apply as a temporary dressing and is not likely to be put on so tightly that it will cause injury by stopping the circulation of the blood.

Some first-aid classes may desire to learn the use of this band¬ age alone. If so the description of the other kinds of bandages and their use may be omitted. For the reasons stated later, however, it is believed, generally speaking, skill in the applica¬ tion of the other bandages is desirable for the first aider.

The triangular bandage is commonly made from unbleached cotton cloth, though any strong cloth will answer. Bed sheets, pillow cases, napkins and- handkerchiefs may all be used to make it.

It is desirable that the piece of cloth for the bandage be not less than 34 to 38 inches square. It is folded diagonally and is cut across in the fold; of course this will give two triangular

ROLLER BANDAGE

II bandages. While made triangular bandages may be readily bought, the only advantage they possess is that most of them have pictures showing methods of application stamped upon them.

The triangular bandage may be applied in two ways: Unfolded.

Folded.

Unfolded means that the bandage is used in the form of the whole triangle.

To fold, the point of the triangle is brought to the middle of the opposite side, and then the bandage is folded lengthwise to the width desired. When folded so as to make a narrow strip the bandage is called a cravat.

2. Roller Bandage. —The roller bandage is invaluable for the surgeon but this is not the case with the first aider. The latter must, however, know how to make use of any appliance at hand, and he is very likely in an accident to find it much more convenient to obtain the roller bandage so it is well that he should know the principles of its application.

Roller bandages are usually made of muslin, cotton cloth, flannel, gauze or cheese cloth, and they may be improvised by tearing strips from a sheet and rolling them up. By far the best material is gauze or cheese cloth. This is elastic and fits itself wtII to the part to be bandaged so that bandages made of it are easy to apply and do not have the disadvantages of inelastic bandages of muslin, which in unskilled hands are very apt either to be pulled so tight on one edge that they cut off the cir¬ culation or to be so loose that they will not stay in place.

While roller bandages may usually be readily bought, it is well to know how they should be rolled. One end of the bandage should be turned over for a distance of about 6 inches, this lap should be folded on itself and this process should be repeated till a small hard roll is formed. Then place the bandage on the thigh (the foot should be on a stool or chair so that the thigh is nearly at right angles to the body) with roll of bandage near the body, length of bandage at bottom of roll and bandage extending down the thigh. Roll, beginning with the fingers of right hand running down to the wrist, and repeat till bandage is completely rolled. The left hand is used to hold the bandage tight and even. The bandage when completed should be in a hard roll with even edges. It may be fastened with a couple of pins.

Roller bandages are preferably used in the following sizes:

For the finger, f of an inch wide and i yard long.

For the arm and head, 2^ inches wide and 4 to 6 yards long.

For the leg and thigh, 3 inches wide and 6 to 8 yards long.

For the chest and abdomen, 4 to 5 inches wide and 8 to 12 yards long.

The bandage 2| inches wide and 4 to 6 yards long is the most generally used.

While it is not, of course, absolutely necessary to use the band¬ age best adapted in size for the part to which it is to be applied, it is very difficult to bandage satisfactorily a small part with a wide bandage. Any bandage when rolled may be easily cut through with a sharp knife and thus a bandage of the required size may always be obtained.

The roller bandage is applied by holding the roll in the right hand, the loose end being in the left, and laying the outer side of the end on the place where it is desired to start the bandage.

The simplest method of application is the Circular, but this can be used only when the part to be bandaged is of nearly the same circumference throughout. This is the case with the forearm above the wrist, and with the fingers. In first-aid work, however, the roller bandage is usually applied to hold splints or dressings in place which much extends the field of the cir¬ cular method of application as, especially with splints, an even circumference is likely to be presented. The circular method is also more often ayailable with gauze bandages, for on account of their elasticity they adapt themselves to slight pulling much better than do bandages made of stiffer cloth. The circular method of application consists simply of a series of circular turns from below upward, each turn overlapping the upper third of the one below.

Where the part is larger at one end than the other, at the start a few turns should be made round and round one over the other,

THE ROLLER BANDAGE

1. The Ciicular

2. The Reverse

3. The Figure-8

THE FOUR-TAILED BANDAGE

Be«t Use a Piece of Cloth Six or Eight Inches Wide and Three Feet Long Two to Four Inches should be left in Center.

4. B 2 tndage for Forehead

6. Bandage for Back of Head

7. Bandage for Nose

8. B^tndage for Jaw. (This

is excellent Bandage for Fracture of the Jaw)

Plate I.—Bandages.

then begin to move up the limb, using the circular method as long as a turn overlaps the preceding one about one-third. It will be found as soon as the limb increases much in size that if the bandage lies flat, uncoveted spaces will be left. To prevent these spaces the Reverse must be employed. The Reverse is generally considered to be the most difficult point to learn in the application of any bandage.

To make the Reverse, place the thumb of the left hand on the lower edge of the bandage to hold it in place, slacken the bandage between the hands (about 3 inches) and turn the roller one-half over toward you. Pass the roller under the limb keeping the lower edge of the bandage parallel with that of the turn below, reverse again at the proper point and so on. The reverses should be made so they lie in the center of the limb or to its outer side and all reverses should be in one line up the limb.

The jigure-of-?) bandage is found specially useful about joints. It consists of a series of loops each overlapping the one below by about two-thirds the width of the bandage. The middle part is over the bend of the joint while the loops lie one below the other above it.

The spica bandage is a modification of the figure-of-8 bandage, having one loop much larger than the other.

A very valuable exercise in the application of the roller bandage is afforded in bandaging the leg from the foot to include the hip. This gives an opportunity to practise all the methods of applica¬ tion which have been described.

For those unskilled in bandaging, lengths may be cut from a roller bandage and these may be tied or pinned in place in the same way that the folded triangular bandage is used. Some special bandages made in this way from the roller are described in the proper place.

3. Four-tailed Bandage. —This is especially useful for frac¬ tures of the lower jaw and injuries of the head. Preferably a piece of cloth 5 to 8 inches wide and from 2 to 3 feet long should be used. It should be doubled on itself and torn from each end until a piece about 4 inches long is left undivided in the middle.

HOW TO FASTEN BANDAGES * 15

The 4-inch roller can be used to make this bandage for the lower jaw; it is rather too narrow for the head. The four-tailed band¬ age is made from it exactly as described above.

How to Fasten Bandages

Triangular and four-tailed bandages are usually completed by tying the ends together securely though they may be pinned, and frequently with triangular bandages flaps are held in place by pinning. The free end of'the roller bandage is usually turned over and pinned in place. Other pins are frequently used to hold the different layers of the roller bandage from slipping. A convenient method sometimes employed in securing a roller bandage is to rip the bandage down the center, then to tie a knot to prevent further ripping and carrying the ends around the limb in opposite directions, tie.

Knots should be placed where they do not cause discomfort and where they may be easily reached. If you know the reef knot use it, if not, three knots are quite as secure. Safety pins are better than ordinary pins as they hold better and scratching is prevented.

Precautions

Whatever the bandage used, care must be taken that it is not put on too tightly. It must not be so tight that it constricts at any point, for this will cut off the blood supply, and if the bandage is left in place for some time even so severe an injury as mortification or actual death of the part below may be caused. Pain, swelling and blueness or coldness of limb below the band¬ age show that the bandage is too tight and should be loosened or removed.