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·FIRST AID
IN THE
FACTORY

·Lord Taylor and his colleagues in the Harlow Indus fral Health S rvice have approached industrial first aid in a new way They started by studying what first aiders actually do in factories and other work places They deliberately omitted all that was obsolete and irrelevant in current first aid teaching and have con centrated on the practical detailed care of the accidents and illnesses which occur in industry Suecial attention is devoted to injuries of the hands feet and eyes and wound cleaning and protect on from oil and solvents Modern methods of dealing with shock fractures gassing and chemical splashes are fully considered The care of the unconscious patient and simple methods of transport of the injured are explained and illustrated The statutory duties of the fire aider and the statutory contents of industrial first ald boxes are dealt with Loss of work ng time in industry as a result of the inadequate care of minor injuries and accidents is far greater than the loss from industrial disputes As a resut both industry and government are paying in creasing attention to the need for efficient industr al first aid This book is the first attempt to meet fully the needs of those who learn teach and practice indu trial first aid

·MEDICAL WORLD HANDBOOK
FIRST AID IN THE FACTORY
and on the building site and farm
in the shop, office and warehouse
LORD TAYLOR, BSC, MD, FRCP
Medical Director
Harlon Industrial Hсalth Service
with the assistance of
WN BOOTH MB BS
Senior losing Medical Officer
Harlow Industrial Health Service
BS LAING MB BS DCI
and
O ROSS MB CHID BAO DRCOG
I isiting Medical Officers
Marlon Industrial Health Service
With a foreword by
A AUSTIN EAGGER CBC MB CHB TD
Medical Director
Slough Industrial Health Service
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© Medical World 1960
First published 1960
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·CONTENTS Page 1X FOREWORD ACKNOWLEDGMENTS AND THANKS X 1 11 A NEW LOOK AT AN OLD TOPIC Cinderella s new clothes - First aid in the factory and elsewhere - Present teaching - Examinations - General propositions - Calculated Tusk - The First aider in the Industrial Health Team - Pattern of Organisation - Exponent of Health and Safety - Learning and Teaching - Who should learn Industrial First Aid 2 20 THE FIRST AIDERS TOOLS First aid boxes - The stenlised individual dressing - Cotton wool - Adhesive plaster - Protection from oil - The roller bandage - The tri angular bandage - Tulle gras dressing - Splats - Other statutory requirements - The Harlow supplement - What to leave out - Siting the first aid bor - Stocking up 3 32 PRINCIPLES OF WOUND TREATMENT Definition and description - Major and minor wounds - Bleeding - Applying pressure - Pressure points - The tourniquet - Deep cut of wrist or arm - Importance of blood loss - Infection - Cleaning the wound - Closing and covering the wound 4 40 DETAILS OF WOUND TREATMENT Treating minor wounds - Re-dressing minor wounds - Treating major wounds - Foreign bodies in wounds - Special wounds - Nose bleeding - Ruptured vancose vein - Stings insect bites and blisters - Contusions 5 47 GENERAL EFFECTS OF SERIOUS INJURY Shock defined - Mythology of shock - The shocked patient - What happens in shock - Bleeding as a cause of shock - Capıllary leakage - Vomiting and sucating - Pain - Results of fluid loss - Management of shock - Position - Heat - Fluids - Morphia - Crush injunes - Fainting 6 54 FRACTURES AND HOW TO RECOGNISE THEM Definition - Role of first aider - Types of fracture - Is there a fracture - Fractures of individual bones - Clavicle - Humerus - Radius and ulna Wrist and hand - Hip - Femur - Tibia and fibula - Ankle and foot Ribs - Skull 7 61 CARE OF FRACTURES STRAINS AND SPRAINS Principles of first aid care - Fixing of hip thigh and shin fractures - Moving other fractures - Fixing other individual fractures - Clavicle - Humerus - Radius and ulna - Ankle - Hands and feet - Ribs - Frac tured sine The recovenng fracture - Strains and sprains - Lifting and caring weights - Dislocations ·VI 8 Page BURNS AND SCALDS ELECTRICAL AND HEAT INJURIES 70 Definitions - Area of burn - Depth of burn - Part of body - Age - Varieties of burn - First aid treatment of burns - Trivial burns - Medium burns - Severe burns - Rescuing from a burning building - Danger from fire extinguishers - Electric burns - Treatment - Electric shock -- Symptoms – Treatment - Heat injuries - Cause - Symptoms Prevention - Treatment - Sunstroke 9 78 CHEMICAL INJURIES AND POISONS Chemical burns - Acids - Quick acting acids - Slow acting acids - Treatment of acid splashes - Prevention - Alkalis - Treatment of alkalı splashes – Tar bums - The eye - Chemical skin irritation - Chemical poisons - Notifiable Industrial Diseases 10 83 UNCONSCIOUSNESS GASSING AND ASPHYXIA Ascertaining the cause - Where the cause is obvious - Where the cause is probable - No obvious outside cause - Care of unconscious patients - Some don ts - Internal causes of unconsciousness - Rescuing a gas casualty - Types of respirator - Industrial gases - Irritant gases - Simple asphyxiating gases - Tissue poisoning gases - Narcotising gases - Symp toms of gassing - Treatment of gassing - Dusts and fumes 11 92 ARTIFICIAL RESPIRATION Indications - Methods - Push-Pull - Push and Pull - Rocking - Suck and blow - Minuteman resuscitator - Preparation - The Holger Nielsen method - Movements - First second third and fourth movements - General points - Eve s rocking stretcher method - Oxygen THE EYE IN INDUSTRY 102 Incidence of eye injuries Examining the eye - Removal of foreiin body - Glass in the eye - Dust in the eye - Scratches of front of eye- Foreign bodies within globe of eye - Conjunctivitis - Haemorrhage under conjunctivitis - Welding and the eye - Arc eye or welders flash Chemical splashes in the eye - Treatment of splashes - Lime or cement - Thinners and solvents - Bandaging an eye - Prevention 1. 111 ACHES AND PAINS TRANSPORT RECORDS General rules for dealing with illness - Care of minor aches and pains - Moving an injured person - Preparing a stretcher - Loading a stretcher - Carrying a stretcher - The blanket lift The chair lift - Single handed lifts - The neck drag - Records in industry - The day book - The accident book -The general register 123 14 A MISCELLANY Contents of first and boxes - In the factory - On the building or civil engineering site -- At the dock wharf or quay - On the farm - In food industries and canteens - Special problems of wound treatment - Official views on skin cleansing - Precautions in the use of cetrimide - Protec tion of adhesive dressings from solvents - Protection of adhesive dres sings on building sites - Applying a roller bandage - Bandaging the scalp - Tubular dressings - Bec and wasp venom - Planning a course in industrial first aid - A lecture synopsis - Examinations in industrial first aid - Conduct of examinations - Knowing questions in advance - Type of questions asked - Certificates - Books for further reading ·V11 The Figures - or shin it Page First line of defence the trained first aider 13 2 Second line of defence - the trained industrial nurse 13 3 Third line of d fence - the in dustrial medical department 16 4 Fourth line of defence - the factory doctor 17 S Standard first aid bor 21 6 Official sterilised individual dressing 21 7 Individual plaster dressings 23 8 Brtaking the cover of a roller bandage 25 9 Covering the knot of a roller bandage 25 10 Folding a triangular bandage 27 11 The triangular bandace used as a sling 27 12 The Inangular bandage used as a close hitch 28 13 Improvised slings 29 14 A well-sited first aid bor 20 15 How the body stops bleeding 16 Stopping severe bleeding 35 17 Cleaning a minor wound under a tap 18 Cleaning a minor wound with out running water 38 19 Covening a wound containing a foreign body 42 Concnng a large wound con taining a foreign body 43 Covering a puncture sound of the chest 4 The capillaries in shock 49 The semi prone pos tion $1 Brolen collar bone 35 Broken humerus 53 h Broken radius and ulna १९ Broken wist $ 8 Broken hın 58 9 Brolen thigh SS Brolen thin bones $9 Brolen arlle Broken rihs 59 Page 33 Splinting a brolen hip thigh 61 34 Fixing a broken collar bone 62 35 Fixins a broken humerus 6 36 Fivng a broken radius and ulra 64 37 The wrong way to move a pati ent with an injured back 66 38 The night way to move a pati ent with an injured back 67 39 The wrong and night ways to lift a heavy weight 68 10 The wrong and nicht ways to hold an iron bar 68 41 Applying tulle gras dressing to a minor burn 72 The prone position 844 43 The semi-prone position 85 44 A pencil used as a bag to pre vent tongue biting 86 45 Holger Nielsen method of artt ficial respiration position at start of cycle 94 46 Position of operators hands at start of cele 95 47 First movement in cicle 96 43 Second movement in cicle 97 49 Third movement in cycle 98 O Riley rocking stretcher for Evcs method of artificial respiration 99 St Riley rocking stretcher with patient in position 99 S? Riles rocking stretcher in Oneration 100 53 Giving Origen to a patient on the rocking stretcher 100 54 Exam ning an ene 103 SS Removal of a foreign body from the mic 103 56 Vushroo headed chisel - a dangerous tool 105 Washing out an eie using an irrigating bottle 108 38 Washing out ane using buf fered fhos hate solution from a stora e anrister 108 ·V111 59 60 61 62 Page Bandaging an eye 309 How to read a clinical thermometer 112 Prepanng a stretcher with two blankets - the "fish tail" position 114 Wrapping a patient in two blankets 114 Wrapping a patient in one blanket 114 Loading a stretcher - the three man lift 115 Loading a stretcher - the two man lift or straddle walk 116 Page 66 Carrying a stretcher 117 67a The blanket lift - inserting the rolled blanket under the patient 118 676 Pulling the rolled blanket through under the patient 118 67c Lifting and carrying the blan ket 118 68 The bandy-chair lift 119 69 The real chair lift 120 70 The firemans lift 120 71 The "neck-drag" 121 72 Specimen industrial first aid certificate 132 63 64 65 ·IX FOREWORD In a society which lives by industrial production the health of those who work is a national asset Proper health care in the factory or other work place demands efficient first and The purpose of this book is to set out in a simple and practical way exactly what the industrial first aid worker has to know and do The importance of good first aid has long been realised in Britain by those con cerned with providing industrial health services Two pilot surveys of industry undertaken by the factory inspectorate in Halıfaxi and Stoke on Trentf clearly showed the need for official action They revealed not only an overall lack of people trained in industrial first aid but also the inadequacy and inefficiency of first and facilities in many work places On the recommendation of the Industrial Health Advisory Committee the Minister of Labour has now taken action to stimulate the recruitment and training of factory first aid workers and to bring the contents of first aid bores up to modern standards * The first aid worker has been given the tools He must now be taught when and how to use them Lord Taylor and his colleagues have shown how this can be done Their book will do much to ensure that the necessary standard of training and skill is attained It is therefore a valuable contribution to the national economy Moreover it may well prove useful in countries overseas especially those in the earlier stages of industrial development Factory first aid differs from conventional first aid in many respects not least because the first aid worker in industry often has to accept full responsibility for the initial treatment of a large number of cases of illness and injury While his limitations must be recognised in that he has neither the qualifications nor the training of the medical officer or nurse he is in the front line of the fight against industrial ill health on his efficiency and initiative much of the success of the supporting arms will depend It is estimated that each year in this country there are some forty million indus tral accidents which require treatment The great majority of these are compara tively minor But the importance of prompt and skilled treatment for the most trivial Injury cannot be over emphasised if disability suffering and loss of working time are to be avoided There will always be some diversity of opinion as to details of treatment But if the basic principles which are so clearly defined in this book are understood and practised it will have achieved its object Lord Taylor and his colleagues through their work in the Harlow Industrial Health Service have had practical experience of the standard of first aid which is required particularly in small firms They are to be congratulated on the highly successful way in which they have carried out a by no means casy task for the benefit of all who are engaged in industry A AUSTIN EACCER Slough Industrial Health Service Industrial llett A Survey Hallax HUSO 1958 + Industn 1 Heath A Survey of th Porterv falustry a Szoke-on I HUSO 1949 Awal Report of th Caret in pector of F storie HVSO 199 ·Acknowledgments and Thanks In writing this book we have had much generous assistance But it must be emphasised that the responsibility for the teaching set out here is that of the author and his colleagues alone We wish to record our grateful thanks to the following The Nuffield Provincial Hosp tals Trst whose nutsal stimul von and subsequeat generosity bus made possible the color of the Hs low Indust 11 Health Sery cc The Factory O pariment of the Mastry of Labou pec y those lay and medical factory inspectors nd apporred factory doctors on boscPETIE CC we ha e frequently and Uberally daw t is hard to compute the debt whah all who wok in factories in Brita a one to the devoted labours The St John and St Andrews Ambulance Assoc auons and the Brit Red Cross whose lireless efforts have built up * wonder ID ble enthusiasm for the practice of first ad The industn Ists and workers of Harlow bose keen co-oper tion has shown that health in Industry is a poper object for ibe united efforts of man sement and labour The Council of the Ha low Ind 513) He lth Service and in particula its first Eve chaumen LE or a ot Key GL ssworks Lid MF Vaton of the Hart w Maal Co Mr FT Christms of Scanda d Teleph nes and Cables MCV Col ma of Re ert : Ltd ud M SO Fitch of Newman and Guardia Lid The medcal sung a dlay statt of the Harlow lodusul Halth Service and in p rucular Mr Geoff cy Fisk, FRCS our Liung tr umatkend orthop edic geon and D Leo Bourne of Cossors Our vt ting derm tolo t Mus Pamer Braund SRN Ind NC nd Ms Marian Kennedy SRN Ind NC access e Krior Rurs og silers at the serv ce the nurs.n, colleagues Mis Joan Paype the secretary adminstrator of the stice and M B b ri Dunce nd Mr Joy En who typed the many revis ons of the manuscr pf DRichard Schullins of th Department of Occupat on Health London School of Hygiene D Da d Guluck of the Brush Ved pal Assoc ation, D Robert P per of ICI Paints D vison, Dr CH Hoskyn OBE of the N icoaj Dock Labour Bod Dr JS West of Edmonton, Dr Ausun Eagger CBE of th Sloch I dustrial Health Service and the late Mr Ruscoe Clarke FRCS of th Birstungham Acc d nt Hospit! fo having cruaised the let Se Robert Plait BL PRCP DE K X Green and M A Bates of ICI MI O Peacock, Drector of the Industrial Halth and Safety Centre DK Mellanb CBE of the Rohanisted Experimental Station DIR Bus nne Reader Et mology at the London School of Hygiene M Pet Cooper of king reorge V Hosp tal, God in nz DIT PWH shes of BEA. MG Bry ni hief bem st of Key Glassworks Lid for ad ice on spec fi points Tbe line drawings are the work of Miss Sheila Dunn her skill care and patience have made a unique contribution to industrial first aid teaching she joins us in thanking the workers in the Harlow factories who acted as her models Most of the photographs are by Dr Stuart Carne honorary photographic advisor to the College of General Practitioners he took immense pains to make them show precisely what we wanted Other photographs are by MrL Appleby of Harlow and John Bull Messrs Charles and Read designed the first aid certificate shown in the last chapter and Mr HS Edwards converted its beautiful colours into black and wbite The managements of Revertex Ltd the Harlow Metal Co and Sunvic Controls (nox AEI Instrumentation Ltd) allowed their first aid equipment to be photographed The Riley Rocking Stretcher is made by Messrs Siebe Gorman & Co Ltd Mir Bennett Chief Commissioner of the Canadian Order of St Jobo kiadly supplied us with a copy of Dr Mustards Fundamentals of First Aid VAR Gray MA LLD Executive Editor of the Medical World and his assistant Viss Rebekah Litvin B4 bave given assiduous and valuable help by editorial suggestion and in presenting the material ·Chapter 1 A New Look at an Old Topic For many years first and has been the Cinderella of the health services a poor relation of nursing and ininor surgery While the science of medicine has been advancing at breal neck speed first aid has stood still drably dressed in garments long out of fashion It is high time Cinderella went to her first modern dancing class There is no reason why first aid should be dull and dowdy Approached in the spirit of scientific inquiry it presents a fascinating series of problems for both learner and teacher It is an exercise in social behaviour applied medicine and surgery and teaching method The account glien here of first aid in the factory is not in any sense final First and must advance with the advance of medicine itself and we feci sure that even in the light of existing ctperience what we have to say can be beltered in many ways But if we only unlock the straitjachet of the past we shall have done our job It all started by chance When we set out to create a group industrial h-alth service we found henceded first aiders lle found that we had to supply and stock first aid bores in small factories lie were shocked at some of the things the law compelled us to put in these boxes so as a first step we set out to discover what first aiders in industry really have to do in modern technical jargon we started with a work study or job analysis He soon found too that existing teaching bore little relation to the industrial first aider s actual needs So we had to work out a ncu scheme of teaching directly related to the situations which face the first uider in the factory shop or office on the building site or the farm In every factory or work place first aiders have a real part to play But the emphasis of their work is different from for example first and on the roads ·X Acknowledgments and Thanks In writing this book we have had much generous assistance But it must be empbastsed that the responsibility for the teaching set out here is that of the author and his colleagues alone We wish to record our grateful thanks to the followiag The Nuffi 1d Provincial H sp Lals Trust whos in wal stimol uon and subsequent generosity : made poss blc th creation of the Halow Industri I Health Servce The Factory Department of the Westry of Labour spec ally those lay and medical factory inspectors and appo med factory doctors on whose e pere e we have 1 cquently and liberaly drawn 12 hard to compute the debt which all who work in factories in Bithin one to the devoted labous The St John and St Andrews Ambul ncc Assoc auons and the Bush Red Cross whose turcless efforts h ve built up a wonderful public enthus asni fo the pact ce of first ad The industat Ists and wo kers of Harlow whose koen co-operat on has shown that health in industry s a proper object for the united efforts of m n gement nd bu The Councl of the H slow Industrial Health Serve ind in prticular is first five charmen MPLE Norton of K Y Glaswork Ltd Mr HF Aaron of the Hart w Meal Co MF Cor stmas of St ada d Te phones nd Cables NCV Coleman of Reyerier Ltd and Mr SGFtch of Ne mn and Guard Ltd The medical nu sink and lay staff of the Harlow Industrial Health S cc and in prcular M Geof cy Fisk FRCS our vist traumatic end orthopaed surgeon and Dr Leo Bure of Coscors our visiting dermatolog st Miss Pamel Brand SRN Ind NC and Miss Manan Kennedy SRN Ind NC successiv senior Bur ing s sters of the sety ce their pus.ng colleagu s Mis Jon Paype the sec etary-adaurustrator of the seri ce nd Miss Brbara Dnce and Ms Joy EU , wh typed the many revisions of the ma user pt De Rocha d Shilling of th Dep rtment of Occupat onal Health London Shool of Hye ene D David Gulbck of the Batz b Med cal Assoc at On D Robert Pap r of ICI Paint Divison De CH Hoskyn OBE of the Nauon 1 Dock Labour Board Dr Is We i of Edmonton Dr Austin Essger CBE of the Slough ! du trial Health Servic and the late Mr Rococ Clarke FRCS of the Birmingh m Accid nt Ho p tal to having criticised the text $ Robert Platt BPRCP DE K H Green and Mr A Bames of ICI MJ O Peacock Director of the Industrial Health and sfety Centre Dr K M1 il niby CBE of the Rohamsted Experime Stauon Dr IRB Reader E comolog at th Lond a School of Hyg xe Mc P ter Cooper of King George V Hosptal Godalm a8 DI PW #ghes of BE A and MGB aat hef hem ( of K y G! wo ks Lid for ad ice o spec fic points The line drawings are the work of Miss Sheila Dunn her skill care and patience bave made a unique contribution to industrial first aid teaching she joins us in thanking the workers in the Harlow factories who acted as her models Most of the photographs are by Dr Stuart Carne honorary photographic advisor to the College of General Practitioners he took immense pains to make them show precisely what he wanted Other photographs are by MrL Appleby of Harlow and John Bull Messrs Charles and Read destgacd the first aid certificate shown in the last chapter and Mr HS Edwards converted its beautiful colours into black and wbite The managements of Reverter Ltd the Harlow Metal Co and Sunsic Controls (now AEI Instrumentation Ltd) allowed their first aid equipment to be photographed The Riley Rocking Stretcher is made by Messrs Siebe Gorman & Co Ltd Mr J Bennett Chief Commissioner of the Canadian Order of St Joho kindly supplied us with a copy of Dr Mustard s Fundamentals of First Aid MAR Gray MA LLB Executive Editor of the Medical World and his assistant Miss Rebelah Litvin BA have giren assiduous and valuable help by editorial suggestion and in presenting the materjal ·A New Look at an Old Topic 13 FIG 1 The first line of defence in health care in industry is the trained factor) first aider with the appropriate equipmen! FIG 2 The second line of defence the industrial nurse here seen ai mork in the foreman s office in a small factory The three organisations have also combined to organise a course on occupationa) first and leading to an occupational first aid certificate This course does not modify the clinical teaching of the parent bodies but rather supplements it with some knowledge of industrial safety record keeping legislation and the organisa tion of accident services in major emergencies If such Inow ledge succeeds 10 making industrial first aiders ambassadors of health in the factory it will have been worth acquiring There is the possibility however that factory first aiders may tend to be treated as alternatives to proper Industrial nurses and safety officers This would be a disaster both for the patients and for the first aiders themselves First aiders semi skilled in industrial nursing and safety work would inevitably be doing second class jobs The industrial first aider must be nothing less than first-class this hc can be only if the limits of his job arc clearly defined After we had worked out the form and content of our teaching he were strengthened in our conclusions by the discovery of Fundamentals of First Aid by Dr R A Mustard FRCS(C) of the Toronto General Hospital the official first aid text book of the St John Ambulance organisation in Canada We agree almost entirely with the clinical conclusions of our Canadian colleague and we shall have Occasion to quote some of these conclusions We are by no means convinced of the value of first and competitions in the teaching of industrial first aid Competitions are largely team activities and first aiders in smaller factories have to work on their own and thiok for themselves ·12 A Mex Look at an Old Topic Conventional first aid courses devote much space to the control of serious haemor thage fractures of the long bones and other forms of severe injury Happily, 10 industry serious accidents are comparatively rare when they do occur the first aider must know what to do and how far to go But expert help is usually so quickly available that heroic first aid is seldom needed The day to day picture of first aid in the factory is rather a stream of minor 1Djuries and minor ailments small cuts and burns colds and headaches Many of these the first aider will have to treat himself and they will never be seen by a traided nurse or a doctor In so doing he is stepping beyond conventional first aid he is in fact giving full treatment At first sight this may seem wrong to the doctor or to the trained nurse But pause and think for a moment in the home the mother treats the small cuts and headaches of the family if she did not do so the health services would break down under the strain There are close on a quarter of a million factories in Britain and 200 000 of them employ fewer than 25 workers A nurse or a doctor for each little cut at work is manifestly absurd So in the factory the first aider comes into his own Jo undertaking full treatment of minor injuries and ailments the first aider is shouldering a serious responsibility He must know his job and his limits and when to call for help Given this knowledge and given the tools be needs for the job he is the real first line of defence in the health care of his workmates In our experience all too often he has neither the knowledge nor the tools Here we set out to describe the tools be ought to have and the basic essentials he must know With these he will be able to do properly what he is already forced to do as an upskilled amateur Present Teachung For many years training in first aid has been carried out bravely and earnestly by the St John Ambulance Association the British Red Cross Society and the St Andrews Ambulance Association Certificates have been issued and competitions promoted and the great network of enthusiastic voluntary workers have pursued their activities with an almost religious fervour Though we hope that the scope of their teaching may change in certain respects we do not expect to see the develop ment of any alternative nation wide teaching network Indeed those who have been basically trained by these organisations are good raw material for factory first aiders. But we find that they have to acquire a rather different approach if th-y are to play a proper part in modern industrial medicine Recently these three great organisations have together produced a joint authorised first aid clinical manual This is a major improvement on its predeces sors and for those who wish to learn much more than is taught here it can be recommended There are boxever many thousands of copies of the old and obsolete manuals still preserved in factory first and boxes These should be firmly discarded. In our experience even the new manual does not meet the needs of the industrial first aider In elementary anatomy and physiology in bandaging and splindog be needs to know less and in the treatment of minor injuries and auments and the special hazards of industry he needs to know more that is taught 19 it.

·A New Look at an Old Topic 15 5 First aiders are called upon to think for themselves but not to make precise diagnoses of all major conditions They are incompetent to do so and to make the attempt may be dangerous to the patient Their first task is to decide quickly whether a particular illoess or injury is or is not within their power to treat. They will do this all the better if their minds are not befogged with medical inessentials 6 There are a number of time honoured first and treatments often very compla cated whose value is to say the least open to doubt They form no part of the curriculum of modern medicine and 10 our view are best dealt with by purposeful Omission 7 Practical medicine is built on the hypothesis of calculated risk Quite uncon sciously the doctor in bis daily practice is continually making use of the theory of probabilities He decides on the probable diagnosis and acts accordingly If he set out to exclude every improbability he would block the hospital machine and his patient might die in the interim First aid must be taught and conducted on the same basis The first aider must be sure of the correct way of dealing with the common injuries The same way may not be quite right for the rare complicated contingency But it is better to accept this slight risk than so to burden the first aider with complications that he becomes confused when facing the common situation In Fundamentals of First Aid Dr Mustard gives the following example of calculated risk A patient is unconscious from a blow on the head. The essential treatment is to get the patient over into the prone or semi prone position so that the airway 13 kept clear by the tongue falling forward and any vomit or saliva running out instead of back into the lung This simple step may save many lives But one in a thousand of such patients may also have sustained a fractured spine which injury may be made worse by movement into the semi prone position Neverthe less to confuse the teaching by introducing this improbable complexity is more likely to lead to bad treatment of the many than good treatment of the few The First aider in the Industrial Health Team The factory first aider is a front line fighter in the battle for bealth But he cannot do his job without proper support This means he ought to be a part of an organised industrial health service Such a service already exists to a greater or lesser degree in most large firms Here traiced nurses are usually on duty throughout the main working periods with doctors available or on call In medium sized and smaller factones however this is still rare Only about 1 per cent of all factories employing fewer than 250 people have any proper medical services although they contain more than half the factory population Small factories cannot afford the overbeads involved and the volume of work such a factory throws up would not justify a full time nurse The answer is that a gumber of such factories should combine to provide an industrial health service on an arca basis The Muffield Provincial Hospitals Trust has sponsored three such arca bealth services - on the Slough Trading Estate at Harlow New Town and in the Central Middlesex area These services provide patterns for the future broadly similar but differing in detail At Slough the medical staff are abole time at Harlow they are the general practitioners of the town serving on a part ume sessional basis The ·14 A New Look at an Old Topic Competitions may hell be helpful in recruitment and is the training of ambulance workers But there is a risk that they may produce a certain rigidity of mind and procedure which is not in the best interests of the patient On the other hand individual examination of the first aid worker at the end of a teaching course is essential But we deprecate a rigid examination framework If the teacher is to be trusted to teach and conduct an examination he should also be trusted to frame the questions and decide whom to pass or fail. We find that a trenty minute ma voce and practical examination gives a faut picture of the first aider : capacity Two examiners working together are better than one a doctor and a trained industrial nurse make a good combination General Propositions We base our teaching on certain general propositions and assumptions 1 Factory first aid differs from conventional first aid in several important ways a The dumber of atients the first aider can expect to treat much greater A factory first aider may deal with five ten or twenty people in the course of a day By contrast a first aider in the home or on the road may not even have to use his skull once a month á The nature of the work is different There are special risks and dangers which have to be dealt with in special ways Above all there is the stream of minor 10jurses to be coped with The factory first aider has to become a specialist in the proper treatment of minor jury c Dressings and other material needed for proper treatment are or always should be at haod There is therefore Ittle need for improvisation almost all large factories and in an increasing number of medium sized and small factories skilled oursing help of medical help is immediately available or readily called if necessary Except in the more remote places an ambulance can be got in a matter of minutes and a hospital reached within half an hour or so Faced with a situauon beyond his capacity the industrial first aider deed not be alone for long Even in the smallest work place he is not really working in isolation but is one of a team with any condition other than a minor injury or aument be has only to know what to do until the trained nurse doutor os ambulance can be obtained 2 It is not our objective to make the factory first aider into a skilled ambulance worker The ambulance worker us a specialist is his own right in the transport of the severely 10jured 3 As industry changes workers have to develop new stills Technical abstity in physics chemistry or biology is becoming an everyday industrial requirement Increasingly the old fashioned first aider who worked by rote is being replaced by a white coated technician who is quick to criticise faulty reasoning behind any procedure Vague and imprecise talk of germs and antiseptics by the teacher will be quickly detected and exposed 4 The factory first aider ss Bot and never should be a semi skilled doctor or purse The medical teacher has to shake himself free from the way he himself was taught as a student Vapecessary technical terms and theoretical knowledge must be jettisoned Simplicity 15 far more important than fuddled comprehensiveness ·A New Look at an Old Topic 15 S First aiders are called upon to think for themselves but not to make precise diagnoses of all major conditions They are incompetent to do so and to make the attempt may be dangerous to the patient Their first task is to decide quickly whether a particular illness or injury is or is not within their power to treat. They will do this all the better if their miods are not befogged with medical inessentials 6 There are a pumber of time honoured first aid treatments often very compli cated whose value is to say the least open to doubt They form ao part of the curriculum of modern medicine and in our view are best dealt with by purposeful omission 7 Practical medicine is built on the hypothesis of calculated risk Quite uncon sciously the doctor in his daily practice is continually making use of the theory of probabilities He decides on the probable diagnosis and acts accordingly If he set out to exclude every improbability he would block the hospital machine and bis patient might die in the interim First aid must be taught and conducted on the same basis The first aider must be sure of the correct way of dealing with the common injuries The same way may not be quite right for the rare complicated contingency But it is better to accept this slight risk than so to burden the first aider with complications that he becomes confused when facing the common situation In Fundamentals of First Aid Dr Mustard gives the following example of calculated nisk A patient is unconscious from a blow on the head. The essential treatment is to get the patient over into the prone or semi prone position so that the airway is kept clear by the tongue falling forward and any vomit or saliva running out instead of back to the lung This simple step may save many lives But one in a thousand of such patients may also have sustained a fractured spine which injury may be made worse by movement into the semi prone position Neverthe less to confuse the teaching by introducing this improbable complexity is more likely to lead to bad treatment of the many than good treatment of the few The First ander in the Industnal Health Team The factory first aider is a front line fighter in the battle for health But he cannot do bis job without proper support This means be ought to be a part of an organised industrial health service Such a service already exists to a greater or lesser degree in most large firms Here trained nurses are usually on duty throughout the main working periods with doctors available or on call in medium sized and smaller factories however this is still rare Only about i per cent of all factories employing fener than 250 people have any proper medical services although they contain more than half the factory population Small factories cannot afford the overheads lavolved and the volume of work such a factory throws up would not justify a full time Durse The answer is that a number of such factories should combine to provide an industrial health service on an area basis The Nuffield Provincial Hospitals Trust has sponsored three such area bealth services - on the Slough Trading Estate at Harlow New Town and in the Central Middlesex area These services provide patterns for the future broadly similar but differing in detail At Slough the medical staff are whole time at Harlow they are the general practitioners of the town serving on a part time sessional basis The ·A New Look at an Old Topic Competitions may well be helpful in recruitment and in the training of ambulance workers But there is a risk that they may produce a certain rigidity of mind and procedure which is not in the best interests of tbe patient. On the other hand jodividual examination of the first aid worker at the end of a teaching course is essential But we deprecate a rigid examination framework If the teacher is to be trusted to teach and conduct an examination he should also be trusted to frame the questiods and decide whom to pass or fail We find that a twenty minute viva voce and practical examination gives a fair picture of the first aider s capacity Two examiners working together are better than one a doctor and a trained industrial nurse make a good combination General Propositions We base our teaching on certain general propositions and assumptions 1 Factory first aid differs from conventional first aid in several important ways a The number of patients the first aider can expect to treat is much greater A factory first aider may deal with five ten or twenty people in the course of a day By contrast a first aider in the home or on the road may not even have to use his skill once a month. b The nature of the work is different There are special risks and dangers which have to be dealt with a special ways Above all there is the streama of minor injuries to be coped with The factory first aider has to become a specialist in the proper treatment of minor injury © Dressings and other material needed for proper treatment are or always should be at hand There is tberefore little deed for improvisation d In almost all large factories and in an increasing number of medium sized and small factories skilled nursing bolp or medical help is immediately available or readily called if pecessary Except in the more remote places an ambulance car be got is a matter of moutes and a hospital reached withia half an hour or so Faced with a situation beyond bis capacity the industrial first aider deed not be aloce for long Even in the smallest work place he is not really working in isolation but is one of a team Yith any con uon other than a minor injury or ailm-pt he has only to know what to do until the trained nurse doctor or ambulance can be obtained 2 It is got our objective to make the factory first aider into a skilled ambulance worker Thc ambulance worker is a specialist 10 hus onn night in the transport of the severely ajured 3 As industry changes workers bave to develop new skills Technical ability 18 physics chemistry or biology is becoming an everyday industrial requirement Increasingly the old fashioned first ander who worked by rote is being replaced by a white-coated technician who e quick to criticise faulty seasoning behind any procedure Vague and imprecise talk of gems and antiseptics by the teacher will be quickly detected and exposed 4 The factory first asder is not and sever should be a sem skilled doctor or aurse The medical itacher has 10 shake bomself free from the way he himself was taught as a student Uonecessary technical terms agd theoretical knowledge must be jettisoned Simplenty is far more important than fuddled comprehensiveness ·17 A New Look at an Old Topic FIG 4 The fourth line of defence is the factory doctor Here he is holding a consultanon about a health la ard on the factory foor doctors and nurses must be fully mobile Yet it will never be possible for them to be everywhere when they are needed so the industrial first aider on the floor of the shop is essential He will be the first to see almost every industrial casualty He will himself deal with a defined range of minor casualties So his judgment is the first vital link in the chain of efficient industrial medical care The most important single lesson he has to learn is when to pass on a patient or call for help The doctor has to learn this too and the industrial nurse also Everyone of us has his limitations and success in all medical work depends on our capacity to recognise them We must have no obstinacy or false pride The first aider who has to stand on his own in the small factory should at least have a doctor or group of doctors on whom he can call or he must be ready to send on everything beyond his capacity to the casualty department of the local hospital We look forward to the day when first aiders everywhere will be associated with local or area industrial health services or with fully staffed factory medical departments Exponent of Health and Safety Besides playing his part in treatment the factory first aider has another function He should be an exponent of health and safety on the factory floor Nowadays it is almost a platitude to say that all workplaces should be healthy safe and happy as A ell as vigorous and productive Work ought to be enjoyed Professional grumblers and carpers are producers of collective mental ill health Nevertheless critical observation is constantly necessary in the best regulated factory accidents will still ·16 A New Look at an Old Topic Harlow arrangement means that the same group of doctors look after the patients at work and in their homes but the administration of such a service is inevitably more complicated Such group industrial bealth services bring to the workers in smaller factories the same level of industrial medical care as is enjoyed by workers in the very largest firms Each member factory contributes financrally according to the sumber of its employees so that a firm with perhaps only 20 workers can always have available a service which is paid for on behalf of 4 000 or more workers Pattern of Organisation The group pattern of organisation is an adaptation of the physical pattern which exists in any large factory 1 At the hub is an industrial health centre or factory medical department staffed with trained nurses with doctors swiftly available and open during ordinary working bours There are special arrangements for night and week-end cover 2 The larger work places have medical treatment rooms staffed by trained nurses either continually or for regular sessions 3 In the medium sized work places there are first aid posts or rooms with first aid boxes and other equipment Trained nurses visit regularly or as required 4 In the small work places and in individual shops of larger factories there are first aid boxes only with first aiders in charge In any substantial industrial health service whether serving one or many factories . F10 3 The third defence line is a fully equipped surgery in the factory medical department or industrial health centre ·A New Look at an Old Topic 19 Morcover every worker should be conscious of the need for good factory house keeping and for the simple measures which can prevent accidents and promote safety in the workshop Every worker should also be aware of the neces sity for elementary hygiene if factory lavatories and canteens are to be as clean as they ought to be in the interests of health But not everyone can practise industrial first and if they attempted to do so the result would be chaos There must be one first aider responsible for each first aid box for each shift and at least one deputy ready to take over in case of absence or illness it may be that these key first aiders will have had some general training before they learn industrial first aid as taught here But our teaching can stand on its own and the beginner who knows only what is written here will be able to acquit himself well There is one final proviso In some jobs there are special risks for which special local instructions are needed But the general principles and practice of first aid do not vary with locality It is with the general picture of industrial and occupational first aid that we are now concerned ·18 A New Look at an Old Topic happen New machines and processes will always be coming along with new risks and hazards to be overcome It is not our intention here to attempt to teach industrial safety or factory hygiene The St John and Red Cross industrial first aid book has a helpful chapter on industrial safety If he can the industrial first aider should visit the ercellent indus trial health and safety exhibition centre of the Ministry of Labour In industry as elsewhere prevention is obviously better than cure and it is better to have prevented an accident than to have treated one But gratuitous advice from the first aider may be resented The most effective time to offer such advice is immediately after an accident has been satisfactorily treated Leaming and Teachung It is hoped that the picture here presented may be of value both to those who learr and those who teach industrial first and The needs of the one will not always be quite the same as those of the other in particular the theory behind a particular finc of treatment may be essential knowledge for the teacher yet may confuse the taught As far as possible detailed background reasoning and argument, as well as the less common first aid problems and procedures have been set in small print The student can safely omit such sections especially on his first reading It is assumed that the teacher will make his own lecture synopsis Indeed the teacher who fails to do so will hardly be worth his salt Good first and teaching 15 an art which can be learnt only by practice and by trial and error The teacher who talks too much is usually less effective than the teacher who says too little The class must be encouraged to participate but not allowed to get out of hand The exhibitionist must be firmly shut up and the shy ones allowed to have their sas Above all the class must do things for themselves In all teaching repetition is of immense importance The advice of the wise old lay preacher may be recalled First, I tells em what Im going to say Then I says it. Then I tells em what I ve said Throughout there is some deliberate repetition The informed critic must forgive this It is part of the teaching process Besides knowledge the good first aider must acquire certain qualities of behaviour Indeed he can only apply his knon ledge effectively when these qualities have become a part of his approach to every patient. The good first aider must be careful in his observations accurate in his interroga tion honest in his judgment ready to admit mistales and learn from experience clean systematic and gentle in his treatment and quiet unantious and unhurried in bis demeanour He will do sell mor over to re read and ponder thus fast of qualities at the end of his course Who Should Leam Industral First Aid? It is worth considering how many first aiders there sbould be a factories of different sizes and shether or not ciety worker in industry should receive some clementary teaching 19 first aid In our vex everyone in industry should be at least as familiar with elementary first aid as is the fighting soldier in wartime The dress of the city care 97 Horseferty Ros Lindon SW Onen 101 to 5 pm from Aton Fn alon Sur 10 am to pron ·Alen Look ai ch Old Topic 19 vorcover every mo ker should be conscious of the red (o good factory House keeping and for the sample measures ab.ch 27 prevoct 2cxdens and promo e afety in the workshop Every worker should also be aware of the cocos sy for elecoary typepe of factory Lavatoris ard areas are to be as cleaa as they ocze to be the 12 rests of health. Bet cotesergose an practie trdos* 231 first and they attemplied to do so the ruh old be chaos There must be one for andre responsible for each firkan tez fon och syft, aad at least og depey ready to take or case of absence or illn* It ray be that these key first aiders will have had some gal tradisz before they learn indestrul fr 2.d as taught bere Bust Our teaching as kard 01 5ow, and the brange bo krozs caly what is *747 bere will be able to 2-4 horsell Well There as one final proviso la some jobs are 2 e specul risks, fo wbich special local sanctions are reeded. Buitte geral praples and przetxe of first ad do Got vary with localry It is or the gegral fisti e of du 11 acd occupation1 E-and that we are rom conserced ·20 Chapter 2 The First-Aider's Tools The first ander in the factory starts with an advantage over his colleagues else where The law lays down that he must be provided with tools for the job Depend ing on the number of workers in the factory the minimum contents of the first aid box are First aid Bores We shall call the three bor types A Band c(not the official nomenclature) Bor A is for factories with up to 10 workers Bor B is for factories with 11 50 workers Box C is for factories with more than 50 workers Experience at Harlow and elsewhere suggests that the boxes could be improved by certain additions and omissions and officral revision of first aid box contents has recently been completed * Nevertheless most of the basic items are sound in particular the official sterilised individual dressing is still the best emergency dressing as a prelude to removal for treatment elsewhere The classification of box size on the basis of the number of workers at risk is a guide to minimum needs only Some types of work produce very few minor inju ries other types have a beavy minor casualty rate In consequence the latter will use up first aid supplies far quicker than the former Most boxes supplied commercially have fronts which let down to provide a work space for the first aider This is a good arrangement unfortunately the supporting chains are usually far too flimsy Wooden boxes are superior to those made of tın as the metal is more inclined to warp Internally every box should have a space in which bottles can be kept upright This space must be at least 10 inches in height if it is to contain 20 oz bottles W¢ recommend a minimum space of 10 inches by 6 inches by 4 inches for 20 oz bottles and 8t inches by 5 inches by 4 inches for 10 oz bottles Boxes supplied commercially seldom have this space consequently in most small factories dust covered bottles decorate the top of the first aid box The Harlow recommended box is shown in Fig S By law the box must be plainly marked First Aid The Sterilised Individual Dressing The official stenlised individual dressing (Fig 6) is made in three sizes smallfor injured fingers (No 7) medium - for injured hands or feet (No 8) and large Statut ry I trum on ) ry 1 1940) t 1959 N906 M o fo

·21
The First Aiders Tools
FIG S Standard first aid bor in use af Harlow More the let down
front the special space for tall bottles the official indis adual dress
ings pached on the top shell and the items of equipment mentioned
in the text
D
37 dord
D
8PC
ng
a
b
FIG 6 Opcial sterilised individual dressing (a) bosed (b) un
bored and (c) open Mote ile pad wluch must not be touched during
application attached to the roller bandage

·22 The First Aiders Tools for other injured parts (No 9) It is similar to but not identical with the Shell Dressing or First Field Dressing issued to soldiers as an emergency dressing in wartime The dressing consists of a thick absorbent pad with a layer of lint or preferably gauze on the side to be applied to the wound and a roller bandage stitched to the other side The whole forms a small roll which is wrapped in paper and enclosed in a cardboard box The dressing itself inside the paper is sterilised Sometimes the pad is medicated this is unnecessary and undesirable When the paper covering has been torn off the bandage will be found to be rolled in such a way that the pad can be applied to a wound without being touched by the hand and so remains germ free This is an excellent true first aid dressing for any wound which is at all extensive or bleeding much as a preliminary to treatment by a traided nurse doctor or hospital As a dressing for small injuries to keep on while at work it is much too bulky A special version of the sterilised jodividual dressing is the sterilised burn dressing in this the pad is impregnated with picric acid knowledge of the proper treatment of burns is rapidly advancing and it is now clear that the application of picric acid or any other antiseptic or crust forming chemical as a first aid dressing does harm rather than good For burns we advise the use of the non medicated simple sterilised individual dressing rather than the sterilised burn dressing The official minimum supplies of sterilised individual dressings are as follows Box 4 Bor B Bor C Small individual stenlised dressings (No 7) 6 12 24 Medium individual sterilised dressings (No 8) 3 6 12 Large individual sterilised dressings (NO 9) 3 6 12 Small stenlised burn dressings (No 10) a sufficient number Large sterilised burn dressings (No 12) From what has been said above it is clear that a sufficient number of steri Itsed burn dressings is none The 1959 regulations endorse this conclusion Cotton Wool Boxes have to contain a sufficient supply of sterilised absorbent cotton wool in oz packets Cotton wool in substantial quantity is occasionally needed by the first aider for padding a splint or mopping up a lot of blood For such purposes the + oz packets have the great merit of cleanliness and convenience We therefore suggest that each type of first aid box should contain 6 of these packets The dis advantage of the toz packet is that this quantity is far too much for most single jobs for example cleaning a wound in consequence the remainder of a package is left about opened it is then no longer sterile and soon gets physically dirty Small pledgets or pieces of cotton wool are essential for wound cleansing For this purpose a cotton wool strip dispenser as used in barber s saloons is very useful The Harlow model (shown in Fig 3) is made from a screw top jam jar with a inch hole cut in the metal top Clean cotton wool is cut into a inch strip and packed geatly into the jar the end being threaded through the hole in the top Pled gets can then be pulled off as required We advise that every type of first aid box should contain clean cotton wool in a strip dispenser The regular stocking up of the ·The First Aiders Tools 23 dispenser is not a job for the floor of the factory It should be done on a clean table in a clean room by a person with clean hands preferably a trained nurse If a first aider is to attempt to remove foreign bodies from the eye (this question will be discussed in detail later) cotton wool is needed in one other form The individual applicator consists of a wisp of clean cotton wool wound round an orange stick and stored in an envelope This is a permissible alternative to the corner of the none too clean pochet handkerchief which is still in usc in many factories to discourage handkerchief work we include in all types of first aid box 6 such applicators in an envelope each to be used once and thrown away Adhesive Plaster The 1959 regulations require a sufficient supply of adhesive plaster in all boxes Adhesive plaster is used in two forms I The individual small plaster with a gauze dressing attached Many excellent proprietary varieties are available with the gauze plain or medicated We prefer and recommend plain non medicated gauze 2. The reel of plaster from shich strips are cut as required These strips are not normally applied directly to wounds but are used to hold other dressings in place Fia 7 The ino types of individual small plaster with dressing attached to our experience every type of first aid box must contain a large ton of indivi Jual adhesive plaster dressings preferably in three sizes * So useful are these in the treatment of small cuts that if they are not provided the workers will produce them for themselves It is sometimes urged that these dressings should not be suppled because of the risk of filching for home use Provided a responsible first aid worker is in charge of each first aid box this need not anse In any event so valuable and time saving are these dressings that the risk of loss is better accepted The attached gauze dressing may extend from edge to edge of the plaster or it may be central only with a complete surround of adhesive (Fig 7) For most pur poses we prefer the dressing which stretches from edge to edge this permits the escape of skin moisture and so prevents the development of a soggy skin For the same reason we prefer the non water proof to the water proof plaster On a dirty rob the individual small plaster may require frequent changiog Rather than do this it may be better to cover the plaster with a short length of ordinary bandage which can then be changed as often as necessary A reel of sticking plaster is worth its place in the first aid box though it should never be applied directly to a wound without some kind of dressing between it and the injury Its great value is in securing ordinary bandage ends in place The 1959 tg 1st $. cept th ssorted dhes wound dess ogs 12 in Bor A d 36 HB C* compulsory I m ) nuary 1960 ICW ad LD BOB 4 ·24 The First Aiders Tools Protection from Oil In many jobs it is necessary to protect a wound from oil particularly cutting oil Oil is not necessarily germ infected indeed some cutting outs contain an added antiseptic Nevertheless oils must be kept away from wounds to present their affecting the raw tissues for this may lead to the development of skin sensitivity later Oil also delays healing The obvious step would appear to be to cover the wound or the dressing with some oil and water proof barrier The barrier has to be water proof as many lubricating fluids have a watery basis To achieve this rubber finger stalls and gloves water proof plasters and self sealing crepe rubber dressing covers have been tried With one or two possible exceptions these all have the serious dis advantage that they retain perspiration producing a soggy skin around the wound and so delay healing At Harlow at present all first aid cabinets contain one 3 inch roll of self sealing crepe rubber which can be used to make an individual fitting finger stall it is included in deference to the wishes of some factory first aiders and we regard it as obsolescent A water tight occlusive covering should remain on only when the patient is actually at work It should be removed on leaving work in the evening and preferably also at the lunch break and re applied at the start of work in the morning or afternoon Provided it is properly applied and frequently changed the best protection against oil is an ordinary roller bandage applied over some other dressing It will need changing at least three times a day-at the start of work and at the end of the morning and afternoon shifts An oily bandage left in contact with damaged skın overnight predisposes to oil acne and dermatitis The Roller Bandage The proper use of the roller bandage can be taught only by demonstration and practice At present the law specifies twelve roller bandages in Borc only * Experi ence has led us to suggest the following quantity Bor A Bor B Bor C Roller bandages - 1 inch 6 9 12 Roller bandages - 2 inches 6 9 12 The 1 inch bandage is suitable for fingers and hands the 2 inch for limbs In using a roller bandage the first aider should remember the following points 1 Clean the hands before breaking the paper seal 2 Break the paper by grasping in both hands and contra rotating (Fig 8) 3 Always work with the bandage rolled Attempts to apply an unrolled bandage soon result in chaos 4 Keep the coil of unused bandage close to the part being bandaged and pull firm after each turn There is a difference between pulling firm and pulling tightwhich can be taught only by demonstration and learnt by practice S Do not apply too much bandage 6 The correct way of tying a bandage must also be taught by demonstration The bandage end is nicked with scissors split for about a foot and knotted once to the 1959 & ! tons olt bod get om et dwh n cali 11 l of th rolle ad d d al te I sedd & my be k pt in loc thi ở Dnd # krve bo ·25 The First Aiders Tools FIG 8 Breaking the cover of a roller bandage by grasping and contra rotating the hands FiG 9 (inset) Covering the knot and ends of a handage with adhesive plaster to prevent their carclung in miachinery prevent further splitting Bandages round the fingers hand or forearm will usually be tied Bandages round the arm or leg will usually be fixed with a safety pin 7 The split bandage ends should be tied with a reef knot and the ends cut short to prevent their catching in machinery The knot and ends are then best covered with a piece of adhesive plaster (Fig 9) Some advocate fixing the bandage with strapping alone without a knot in our experience this is not safe 8 Unused roller bandage should be fixed with a pin and carefully preserved for future use There are special methods of bandaging the knee and elbow shoulder and ankle scalp ear and eye In our view the first aider in the factory will never have to undertake these complicated manoeuvres He will usually deal with these types of injury by using a sterilised individual dressing and will then refer them for further treatment to a nurse or doctor The idea that bandages must be applied from the extremities of the body working towards the heart is an outdated myth ·26 The First Aiders Tools The Triangular Bandage The 38 inch triangular bandage is 38 inches along each of its two shorter sides It is made by cutung diagonally a square piece of linen or calico The present official requirement is 6 triangular bandages in Box conly The 1959 regulations specify 2 triangular bandages in Box A 4 in Box B and 8 in Boxc The triangular bandage may be used either as a bandage for holding a dressing or a splint in place or as a sling The first aider with a supply of individual sterilised dressings will not need to use it for holding dressings in place To hold splints in place it is folded on itself three times (Fig 10) to produce a stout narrow binder Further details will be considered under fractures Used as a slog the right angle of the triangle should point outwards behind and beyond the elbow and the front layer of the sling should pass over the shoulder on the injured side (Fig 11) To sling the arm at an angle of 45 degrees the triangular bandage folded narrow may be used as a "collar and-cuff sling This is essentially no more than a clove-hitch round the wrist (Fig 12) Slings can be improvised with safety pins a neck tie or simply by using the jacket (Fig 13) Tulle Gras Dressing Factory first aiders often ask for a small soothing dressing which can safely be applied to burns and which will not stick especially since the use of acri flavine emulsion has been discouraged For this purpose we recommend the indivi dual sterilisea tulle gras dressing contained between two slips of transparent paper stored in a small tio Tulle gras is curtain netting impregnated with petroleum jelly At Harlos twelve such dressings are included in Boxes A B and c Splints By law suitable splints with cotton wool or other padding have to be included in Box c Qute rightly these vanish in the 1959 regulations Splints are easy to im provise and often the best splint is the human body itself Nevertheless on occasion a few pieces of wood may be useful The theory of splinting in first aid will be discussed when fractures are considered Other Statutory Requirements Boxes A B and c must each contain a tin of safety pias of assorted sizes as well as a copy of Form 1008 - a single sheet outline of first aid (price 2d or 3s for 50) If the practice recommended here is adopted the following items which suill have to be stocked for statutory reasons will soon lapse into harmless disuse * In bores A B and C - Iodine (2 per cent) in alcoholic solution or Gentian violet (1 per cent) in water Sal volatile solution in dark bottle with dose on label In Boxes B and C - Oily cocaine eye drops (Factory Department Formula No 1) with camel hair brush in the cori In Bor C-Tourniquet The reasons why He regard each of these as obsolete will be given later Eye Dt specify rubber nd se op o dare The 1959 regulat ons on these tem bo We 8 dth unnecessary for all

·The First Aiders Tools
27
ON
FIG 10
Folding a triangular bandage on itself three times to
produce a sfout narrow binder
FIG 11 The triangular bandage used as a sling Note that the right
angle of the triangle points outwards beyond the injured elbow and
that the front layer of the sling passes over the shoulder on the
Injured side

·P De fyker 28 The First Aiders Tools Fa 12 (Lett) How to make a clove hitch (Right) The triangular bandage folded narrow and used as a collar and cul sling The cufi is a close hitch ointment and eye pads are now finding favour in official circles * In our view the first is undesirable and the second unnecessary as an eye can always be covered temporarily with a medium sized sterilised individual dressing "The Harlow Supplement To carry out the treatments recommended here certain other items are needed In compiling this list we have studied carefully what good first aiders are already doing and are expected to do in industry Each item will be discussed later Cetrimide (1 per cent) either two 10 oz bottles or one 20 oz bottle depending on available space in box These hottles should have rub ber or glass bungs not corks Gallipot 2 oz Kidney dish 6 inches Proprietary non inflammable plaster remover 1 4 oz bottle This is also useful for cleaning oil from the skin around wounds Small unbreakable tumbler Eye bath unbreakable Blunt nosed surgical scissors with chajn attached The length of chain helps to prevent the scissors getting lost Splinter forceps Clinical thermometer Bismuth and magnesium trisilicate tablets 50 Aspirin phenacetin and caffeine tablets so Todised throat tablets 50 It should be mentioned here that after use the gallipot kidney dish tumbler and The 1959 eu to d? 4 nd $ ! lied y pads it sopa te at 1 Bo Adc pe 1 ly ppro ed

·The First Aiders Tools
29
cje bath should always be washed thoroughly with soap and hot water and dried
on a clean towel if this is not done infection may be spread from patient to patient
What To Leave Out
Unless there is a firm discipline many other items soon find their way into the
first aid box The result is an inefficient clutter with the essentials for sound work
lost in a jungle of inessentials We therefore strongly urge the omission of all items
not on the prescribed list In particular we regard the following as unnecessary
Lint gauze or dressings other than those specificd above
Proprietary or other antiseptics
Acriftavine solution cream emulsion or proprietary preparations
Mechanicall operated ye bath and bottle
Eye lotions pharmacopoeial or proprietary
Tannuc acid preparations
Ointments pharmacopocial or proprietary
Mixtures for internal consumption
Tablets other than those specified above
Styptics
Lotions for external application
Many of these items have a proper role in industnal medicine Before they are
used however decisions as to diagnosis which are beyond the proper scope of the
FIG 13 The jacket used as an improvised sling

·30 The First Aiders Tools 11 Fia 14 First aid box well sited in a rolling mill Note the enamel topped table pedal bin and drinking fountain of value for washing out the eye close at hand first aider must be made For example stock eye lotions are sometimes prescribed by industrial first aiders for conjunctivitis yet the symptoms of conjunctivitis may be due to many causes requiring as many different treatments the danger here is manifest Moreover stored eye lotions tend to go stale Siting the First aid Bor Ideally the situation of the first and box should be as follows 1 The box should be fixed to the wall over a small enamel topped table which should be kept clear and clean 2 There should be a strong chair close at hand on which the patient may sit while being treated 3 There should be a sink with running water soap and towel close by for the ·The First Aiders Tools 31 use of both the patient and the first aider A drinking fountain is better than nothing it has special value in that it can be used for washing out the cye after chemical splashes Unfortunately most factory first aid bores will not havc run ning water adjacent and our teaching is based on the assumption that running water is not available 4 Beneath the table there should be a pedal-controlled bucket for the disposal of used dressings It is part of the first aider s jab to see that this is emptied regularly and kept clean 5 The light should be good Sometimes the first aid bor will be located in the main body of the factory or shop (ng 84) sometimes in a special room set aside partially or wholly for the purpose if in the shop itself it is particularly important to try to preserve a small clear working space below this can usually be done if the box is in the stores but it is less easy if it is over a work bench Stocking Up In an organised industrial health service regular inspection and stocking up of first aid boxes is part of the duty of the trained pursing staff The frequency with which this has to be done will depend on the number of casualties to be treated In the Harlow Industrial Health Service factones are divided into those to be visited weekly monthly or three monthly depending on size and casualty rates These visits for inspection and stocking help to build a useful link between first aiders and the trained industrial purses If stocks run low between visits first aiders are res ponsible for letting this be known Complaints about the possibility of pilfering from first aid boxes are usually much louder than the facts justify First and boxes should never be kept locked, first aid which is delayed while a key is searched for is a travesty Normally only a trained first aider should have recourse to the box It follows that there sbould always be at least one trained first aider on every shift Moreover one particular first aider must be responsible for the box and its stocks His name and that of his deputy should be on the outside of it Where a first aid box is supplementary to a factory first aid room or medical department it is may be used only when the room or department is shut In such a case it is helpful if instructions to patients peeding treatment are also displayed on the box ·32 Chapter 3 Principles of Wound Treatment We define a wound as any break in the skin with or without injury to the deeper tissues Thus the term wound covers every type of skig break from the trivial scratch to the severe crush injury The skin is the body tissue most liable to injury and it is estimated that in Britain every day there are half a million skin injuries of sufficient size to need at least a first aid dressing of these one in every ten needs attention at a factory surgery or industrial health centre It follows that wounds are by far the commonest reason for first aid Experienced first and workers will have treated many different types of wound Even beginners must have seen cuts of various kinds It is a useful class exercise for each member to describe a wound he has seen and how it was caused Here are some typical industrial wounds 1 A straight cut from a chisel or sheet metal. This is an incised wound 2 A tearing wound with tagged edges where flesh is caught in a machine This is a lacerated wound 3 A crushing wound with the flesh around bruised and injured from a hammer blow or injury from a spanner or rollers This is a contused wound 4 A deep stab from stepping on a pail This is a puncture wound Incidentally a severe puncture sound may bleed very little or even not at all 5 A scraping wound or graze where the skin surface torn by a file or sand paper for example This is an abrasion Major and Minor Hounds The most uportant division for all first aiders to learn especially industrial first aiders is 1 Minor or simple wounds - the ordinary every day small skin cuts of home or work place which can properly be treated by the first aider 2 Vajor sounds - Cverything more severe than the minor wound in these the first aider gives true first aid treatment only pending the arrival of or referral to a trained nurse or a doctor This division of wounds emphasises the most important single decision which the industrial first aider has to make Can I properly treat this wound myself? Or ought I to apply first aid only and send for or refer to a trained nurse or doctor? * The first aider must never feel reluctant about passing on the patient to more ·33 Principles of Wound Treatment skilled hands - Just as the nurse passes the patient on to the general practitioner and the general practitioner passes on to the specialist The good first aider thinks only of the patient's welfare so is always ready to scck further help The bad first aider tries to be an amateur doctor to the danger of the patient and at some legal ns. to his employer and himself In the case of obviously severe wounds there is no difficulty in making a decision nor is there any with the half inch long shallou grare on the hand Between these two there are many types of wound where the first aider in industry will have to make a judgment. There are three things to be considered 1 The positon of the wound Any wound around the eye or involving the skin of the face is serious Any wound other than a small shallow cut of the finger hand or wrist is to be treated as serious even a small scar on a finger may reduce the skill and affect the liveli hood of a manual worker Any wound of the abdomen is serious 2 The type of wound Any wound with ragged edges or with the flesh around it bruised is serious because the damaged tissue is more liable to infection Any deep wound or stab or puncture wound is serious because infection carried in by the wounding object is more likely to gain a foothold and because there may be unseen damage to deeper tissues Any gaping wound the edges of which do not easily come together is serious because the exposed raw area is more likely to get infected and the scar will be wide and disabling 3 Complıcanons of the wound Any wound from which the blood pumps out in jerks is serious because this means an attery has been cut Any wound from which the blood gushes out in a steady stream is serious because this means a vein has been cut Any wound more than an eighth-of an inch deep may involve damage to muscles tendons nerves or other structures This risk is greatest in the wrist hand and fingers The first aider cannot tell if these structures have been injured Therefore any cut more than an eighth of an inch deep especially in the wrist hand or fingers is serious Bleeding Bieeding (haemorrhage) is part of the natural response to injury So it need not cause alarm in the first aider or the patient Bleeding 15 nature s means of wound cleansing because it wasbes dirt out from the bottom of the wound Too much bleeding is a danger simply because beyond a certain point the body cannot swiftly make up for blood loss But bleeding from most wounds will stop spontaneously without any treatment at all (Fig 15 a and b) The body has two very effective methods of stopping bleeding 1 The clotting of blood as a result of its coming in contact with cut and injured tissues 2 The pulling back and shrinkiog of the cut ends of blood vessels so that the holes from which the blood is coming get smaller and may close entirely Bleeding from minor wounds will occur during the cleansing of the wound it belps to make the cleansing more thorough As soon as the wound is covered and ·Principles of Bound Treatment F b Fio 15 The body's way of stopping bleeding (a) At the moment of wounding blood pours out from the cur blood vessels (b) Pithin a few minutes the blood has otted to form a tough jelly and the cut ends of the blood vessels have pulled back and shrunk (Fluid blood is shokh as dots clotted blood as cross hatching the arrows show the site of the bound) the edges drawn together by the dressing clotting of the blood will take place and the bleeding will stop Bleeding from major wounds will also usually stop on its own when a dressing is applied The first aider can do three things to help the body to stop such bleeding 1 Rest Make the patient lie down quelly and keep the wounded part stud This lowers the blood pressure and slows the pulse so that the volume of blood flowing through the sojured part is lessened 2 Raising the injured part If the injured part is raised above the level of the rest of the body the amount of blood reaching it will be less for sussple hydraulic reasons A wounded arm or les may be raised on pillows but the stomach or chest cannot be effectively raised 3 Pressure on the place which is bleeding This is the most important and most effective way of controllog bleeding It can be stated that if enough pressure is applied haemorrhage can always be controlled Applying Pressure 1 Place a clean pad over the wound and bandage at firmly in place If blood quickly comes through the first pad put another pad on top and bandage bis firmly in place if blood comes through the second pad apply a third pad it blood sull comes through press firmly with the bands on the third pad and hold 19 position unul a doctor can take over (Fig 16a and boverleaf) 2 As already stressed the official Factones Act sterilised individual dressing ss Ideal for the control of bleeding since it has a burls in pad attached to a bandage and the wbole dressig is sterilised 3 1 an official first aid dressing is not available a rolled up bandage may be used as a pod or a cleap folded handkerchief if necessary a clean handkerchief may also be used as a bandage ·35 Principles of 11 mnd Treatment! a b Fig 16 (a) Applying a pad and bandage (the official sterilised individual dressing) 10 stop haemorrhage (b) if after three pads have been applied the blood shall comes through the last pad must be pressed upon firmly unnl medical or nursing help arrives Every first aider especially in industry must have personally practised applying a pad and bandage to control bleeding so that he can do it effectively when faced with his first major wound Pressure Points Most first alders are taught that there are certain points between the heart and the site of bleeding where by pressing hard against an underlying bone the arterial flow can be stopped Most doctors have never made use of these pressure points Here is a summary with which we fully agree of what is said in the Canadian St John First Aid book about pressure points Extensive experience with battle casualties and civilian accidents has failed to reveal an instance of life saved by pressure point technique With the very rare massive haemorrhage which might in theory be stopped by pressure point control it is almost inconceivable that a first aider will reach the scene of the accident and find the correct pressure point in the few seconds before death results Even with such a haemorrhage and certainly with any bleeding less catastrophic effective control is much more likely to be accomplished by simple direct pressure on the wound Indeed valuable time may be wasted trying to locate the elusive pressure point while the patients life blood continues to drain away unchecked by simple pressure on the wound In fact it is extraordinarily difficult especially in fat people to compress the femoral artery in the groin and almost impossible to deal with the subclavian anery in the neck We recommend the abandonment of pressure point teaching in industrial first and We do not expect any industrial first aider to risk the patient s life by hunting ·3.1 Principles of Wound Treatment a b FIG 15 The body s way of stopping bleeding (a) At the moment of wound ng blood pours out from the cut blood vessels (b) TÝithin a few minutes the blood has clotted to form a rough jelly and the cul ends of the blood vessels have pulled back and shrunk (Fluid blood is shown as dots clotted blood as cross harching the arrows show the site of the wound) the edges drawn together by the dressing clotting of the blood will take place and the bleeding will stop Bleeding from major wounds will also usually stop on its own when a dressing 18 applied The first aider can do three things to help the body to stop such bleeding 1 Rest Make the patient lie dowo quietly and keep the wounded part still This lowers the blood pressure and slows the pulse so that the volume of blood flowing through the injured part 15 lessened 2 Raising the injured part If the injured part is raised above the level of the rest of the body the amount of blood reaching it will be less for simple hydraulic reasons A wounded arm or leg may be raised on pillows but the stomach or chest cannot be effectively raised 3 Pressure on the place which is bleeding This is the most important and most effective way of controlling bleeding It can be stated that if enough pressure is applied haemorrhage can always be controlled Applying Pressure 1 Place a clean pad over the wound and bandage it firmly in place of blood quickly comes through the first pad put another pad on top and bandage this firmly in place If blood comes through the second pad apply a third pad If blood still comes through press firmly with the bands on the third pad and hold in position unul a doctor can take over (Fig 162 and boverleaf) 2 As already stressed the official Factories Act sterilised individual dressing is ideal for the control of bleeding since it has a built in pad attached to a bandage and the whole dressing is sterilised 3 If an official first aid dressing is not available a rolled up bandage may be used as a pad or a clean folded handkerchief If necessary a clean handkerchief may also be used as a bandage ·35 Principles of Wound Treatment a b F10 16 (a) Applying a pod and bandage (the official stenlised individual dressing) 10 stop haemorrhage (0) 1 after three pads have been applied the blood sull comes through the last pad must be pressed upon firmly until medical or nursing help arrives Every first aider especially in industry must have personally practised applying a pad and bandage to control bleeding so that be can do it effectively when faced with his first major wound Pressure Points Most first aiders are taught that there are certain points between the heart and the site of bleeding where by pressing hard against an underlying bone the arterial flow can be stopped Most doctors have never made use of these pressure points Here is a summary with which we fully agree of what is said in the Canadian St John First Aid book about pressure points Extensive experience with battle casualties and civilian accidents has failed to reveal an instance of life saved by pressure point technique With the very rare massive haemorrhage which might in theory be stopped by pressure point control it is almost inconceivable that a first aider will reach the scene of the accident and find the correct pressure point in the few seconds before death results Even with such a haemorrhage and certainly with any bleeding less catastrophic effective control is much more likely to be accomplished by simple direct pressure on the wound Indeed valuable time may be wasted trying to locate the elusive pressure point while the patients life blood continues to drain away unchecked by simple pressure on the wound In fact it is extraordinarily difficult especially in fat people to compress the femoral artery in the groun and almost impossible to deal with the subclavian artery in the neck We recommend the abandonment of pressure point teaching in industrial first aid We do not expect any industrial first aider to risk the patient s life by hunting ·36 Principles of Wound Treatment for a pressure point instead of applying direct pressure to the place which is actually bleeding The Tourniquet Factory first aid boxes must contain a rubber or pressure bandage for use as a tourniquet It should never be used as it is not a first aid measure It is often ineffective and frequently harmful if properly applied it can cause death of a limb If improperly applied it can increase bleeding by obstructing the veins but not the arteries Finally it is never necessary as bleeding can always be stopped by the safe simple method of direct pressure Deep Cut of Wrist or Arm Such a cut, particularly at the wrist may produce spirting or pumping haemor rhage of one of the larger arteries is cut If this happens treatment follows exactly the lines set out above 1 Make the patient lie down 2 Hold up the arm so as to raise the injured part above the level of the rest of the body 3 Place a clean pad over the wound and bind it very firmly in place Apply Another pad and bandage 4 Send for a trained nurse or doctor or transport the patient to the industrial health centre or hospital If possible the patient should be lying down with the arm and wrist raised on a pillow or folded blapket Importance of Blood Loss About one-eleventh of the weight of the body is blood There are about 12 pints of blood in the average adult A little blood can make a big mess to demonstrate this upset a 2 ounce bottle of red ink and see how much bandage and cotton wool it will colour A normal adult can lose a pint of blood without ill effect many people give this much blood twice a year to the blood transfusion service Most bleeding is not serious and the first aider need never be frightened by it On the other hand the loss of a large amount of blood produces a very dangerous state As the bleeding goes on it leads to pallor and weakness then unconscious ness and finally death If life is to be saved after the bleeding has been controlled by firm pressure it 15 vital at the earliest possible moment to replace the blood which has been lost by means of a blood transfusion A patient who is believed to have lost a large amount of blood must be moved as swiftly as possible to a hospital where a blood transfusion can be started at once If transfusion can be started within half an hour life will probably be saved delay of over an hour may prove fatal By making arrangements quickly and calmly the first aider is acting in a life saving role It will help the doctor at the hospital to estimate the amount of blood which has been lost and hence the amount of blood the patient needs of the blood lost can be mopped or scooped up and the blood and stained dressings cotton wool and clothing put in an enamel basin and sent with the patient to hospital But do not waste time on this if it means delay in getting him there ·Prmoples of Ilotend 7 realment 37 Cover the patient with two blankets or a coat Apart from lifting out of danger or on to a stretcher Iccp movement to a minimum Infection Infection means the entry of harmful germs into a wound so that they start to grow and multiply Every year about 20 000 industrial workers receive compensation for Infected injuries and each loses on an average three weeks of working time This takes no account of minor degrees of infection involving less than three days off work Clearly the prevention of infection in first aid is just as important as the control of bleeding When germs were first discovered doctors sought chemical substances which would kill them Such chemical substances are called antiseptics Unfortunately most antiseptics not only kill germs they also damage human tissues In addition they may sometimes produce skin rashes For these reasons their use as a means of trying to kill germs in wounds has been largely given up Old ideas die hard until recently first aid boxes still had to include iodine or gentian violet * and many first aiders still like to use acriflavine or one of the many proprietary anti septics To paraphrase the Canadian St John manual lodine and other fissue damaging antisepucs have no place in first aid and should not under any circumstances be poured into or on a wound Germs get carried into a wound by whatever causes the wound -a nail hammer chisel cutting tool drill or kmfe Even if the injuring instrument is germ free for example a very hot tool germs may be picked up as it passes through the patients boot or shoe clothing and skin These germs are got rid of by the process of cleaning the wound and as already mentioned by bleeding After the original injury germs may still get in by droplet spray infection from people talking sneezing or coughing near the wound or from the skin of careless first aiders doctors or nurses These germs are kept out by surgically clean tech nique and by closing and covering the wound Cleaning the Wound A major wound needs thorough cleaning by a trained nurse or doctor An extensive major wound may need opening and cleaning thoroughly by a surgeon with the patient or at least the wounded part anaesthetised Delay in getting a major wound properly cleaned increases the likelihood of the germs gaining a foothold in the tissues The first aiders job is to cover the major wound with a sterile pad as quickly as possible A minor wound is best cleaned by washing thoroughly with clean water under a running tap (Fig 17) If there is any visible dirt present around the minor wound it may be washed away with soap and water Better even than soap is the officially recognised detergent cetrimide ( Cetavlon ) this has an antiseptic action as well but does not injure the tissues lod na Id Ppe under the Fcto Ft dB es Orde (1959) Whh tme nto forcen Touary 1960 Although not recomme ded for first a ders ud a re ! th y luencin spec l types medelt $ !! yny cum tanc tm ·38 Š FIG 17 (left) A minor wound is best cleaned by washing thoroughly with clean water under a running tap F1G 18 (right) In most small and medium sized factories running waler is not available at first aid points The standard method recom mended of cleaning a minor wound is to use cotton wool swabs dipped in ceinmide (i per cent) A full description of the technique is given in the text In many factories running water is not available at the first aid point Here cleaning of the wound and surrounding skin is best done with cotton wool dipped in cetrimide (Fig 18) The cetrimide is poured into a small galleypot A piece of cotton wool about two inches long is pulled from a cotton wool container and dipped into the cetrimide The wound us thoroughly cleaned The process is repeated twice with fresh pieces of cotton wool each time The skin around the wound is then cleaned in a similar way care being taken to work outwards from tbe wound and to avoid touching the wound with the cotton wool used for skin cleaning Finally first the wound then the surrounding skin are thoroughly dried with fresh dry pieces of cotton wool so as to remove all the cetrimide for soap and water) This is necessary for tho reasons first cetrimide or soap left in contact with raw tissue may lead to sensitivity with the possibility of a skin rash later on second unless the skin is dried strapping will not stick to it After use each piece of cotton wool should be thrown into an appropriate receptacle Closing and Covering the Wound Any wound which is left gaping is more hable to become infected Even if not infected a gaping wound will heal much more slowly and will leave behind a wide and perhaps disabling scar This is why the first aider must regard any gaping ·Principles of Bound Treatment 39 wound as a major wound to be covered with a clean or sterile dressing and passed on at once to a trained nurse or doctor Many gaping wounds will require stitching (suturing) to bring the edges together for which most doctors nowadays use a local anaesthetic Io covering a minor wound the first aider must take all reasonable steps to keep germs away from the cleaned wound and the dressing Ideally the first aider should wash his hands thoroughly before he starts cleanifig or dressing but in a factory this may be impossible He must be careful not to cough sneeze or talk over the wound Even more important is to keep his own skın germs away from the wound or anything which is going to touch the wound surface This means no touching of the wound with the fingers and no touching of the surface of the dressing which will be placed next to the wound Every first aider must practise this simplified no touch method of dressing wounds until he does it quite automatically The wound which has been properly cleaned closed and covered will heal in the shortest possible time almost without pain and with the smallest possible scar In surgery this is spoken of as healing by first intention It is the object of good first aid good industrial medicine and good casualty surgery to enable every wound to heal by first intention ·38 Fio 17 (left) A minor kound is best cleaned by washing thoroughly Muh clean water under 2 rurtning tap F16 18 (right) in most small and medium sted factories running koler is not available at first and points The standard method recom mended of cleaning a minor wound is to use cotton wool swabs dipped in cerrimide (i per cenn a full descripnon of the technique 15 g/Ker is the rest In many factories running water is not avaslable at the first and point Here cleasing of the wound and surrounding skin is best donc with cotton *ool dipped i cetrimde (Fig 18) The cetrimide us poured into a small galleypo! A piece of cotton wool about to inches loog is pulled from a cotton wool container and dipped into the cetrimide The wound is thoroughly cleaned The process 25 repealed thice usb fresh pieces of cotton wool each time The skin around the sound is then cleaned in a similar way care being taken to work outwards from the wound and to avoid touching the sound with the cotton wool used for skin cleaning Finally first tbe sound then the surrounding skin are thoroughly dried #7th (resh dry pieces of couon Hool so as to remove all tbe cetrumide (or soap and water) This is necessary for (xo reasons first, cetrsmide or soap left in contact with raw tissue man lead to sensitivity with the possibilny of a skin rash later on second unless the skin is dried strappiag will not stick to it. After use each piece of cotton wool should be thrown into an appropriate receptacle Closing ond Covering the found Aay wound which is left gaping us more lable to become infected Even if not infected a gaping wound will heal much more slowly and will leave behind a wide and perhaps disabling scar This is why the first aider must regard aay gaping ·Details oj }ound Treatment frequently changed is to be preferred to an occlusive dressing since the skin bencath stays in better condition and healing is therefore quicker But workers in food factories should have all bandages and dressings covered with an occlusivc finger stall or cot to prevent any possible contamination of the product Re-dressing Minor Wounds A minor wound should be re-dressed as seldom as possible If there is no pain it is only necessary to change the outer dressing when it is soiled the dressing imme diately over the wound should be left in position of possible for 48 hours Exactly the same care must be used in changing a dressing as when the dressing is first applied. If the patient complains of pain or discomfort in a minor wound on the day after injury or thereafter the first aider must refer the patient at once to a trained nurse or doctor as infection is hikely to have occurred Treating Major Wounds Again treating the major wound is a matter of applying procedures already described Here the first aider gives true first aid pending the arrival of or referral to a trained nurse or doctor The first aider will make no attempt to clean a major wound His job is I To prevent any further risk of infection by covering the raw surface of the wound with a sterile or clean dressing as quickly as possible 2 To control haemorrhage by making the patient lie down quietly raising the injured part and binding the pad or dressing over the wound firmly in place The ideal pad and bandage is the official individual sterilised first aid dressing If the bleeding rapidly soaks through one or more pads should be applied and firmly bound in place over the first one Once a major wound has been covered the sooner expert help is obtained the better for the patient Foreign Bodies in Wounds A large foreign body such as a piece of metal or glass if sticking out of the wound should be removed gently provided this can be done without putting the fingers into the wound If the foreign body does not come out easily it should be left alone Small foreign bodies are best not touched but a note that they have been seen should be sent on with the patient In a severe injury there may on rare occasions be a piece of bone projecting through the wound or the skin this should be left alone and not touched If a large foreign body cannot be removed or if there is projecting bone rolled bandages with the paper removed may be placed on each side of the projecting object the wound object and rolled bandages are then covered with a large individual first aid dressing this should be bandaged in place firmly but not tightly (Fig 19) Most first aiders are taught to build up a ring or box of dressing around Hounds of this type so that the covering dressing does not press on the wound But rolled bandages are just as good and to put them in place takes very little time Any elaborate building up while the wound is left uncovered increases the ·40 Chapter 4 Details of Wound Treatment The principles governing the treatment of wounds must now be extended to cover wounds of special types and in special places But first the standard treatment of minor and major wounds must be recapitulated so that the necessary variations to meet special conditions may be seen in proper relation to standard procedure Treating Minor Wounds In treating a minor wound the prevention of infection is more important than the control of bleeding With proper treatment to prevent infection bleeding will stop on Its own The stages of treatment are 1 Clean the wound with cetrimide in a galley pot and cotton wool or wash it under running water if available 2 Dry the wound and surrounding carefully with cotton wool 3 Cover the wound with an appropriate sized piece of prepared strapping with a central dressing This must be so applied as to draw the edges of the wound together Remember not to cough sneeze or talk over the wound Do not touch anything which will be in direct contact with it If the wound is on a part which is continually in movement or is liable to get soiled with dirt or oil the strapping should be covered with a neatly applied roller bandage Even a short end of bandage is a danger to a machine operator So after the bandage has been split and tied and the ends cut short these ends should be covered with one or two turns of strapping Neatness is essential and the first aider should practise this under supervision At the beginning and end of each working day or better still cach four hour work ing period a fresh outer bandage should be applied It is dangerous to leave soiled and oil stained bandages over a ray Hound for any length of time for example overnight this is one cause of skin sensitivity and dermatitis Tube gauze dressings though excellent in skilled hands are not recommended for the first aid worker A bandage gives partial protection only against oul The alternative is a completely occlusive cover of rubber or something similar over the dressing A rubber of plastic finger-cot may be used or specially constructed finger-cot made from crimped Stericrepe No occlusive dressing should be allowed to stay on for more than a few hours or the skin beneath it will become boggy On balance a protective bandage ·43 Details of pound Treatment TO Fig 20 Protecting and handaging a larger wound with a projecting foreign body The pads of sno individual sterilised dressings are made use of to reliese pressure on the projecting foreign body germs may be carried deep into the tissues where they cannot be reached by ordinary cleaning There is no point in cleaning the wound and the skin around unless the skin is dirty as the site of the injury cannot be reached All that is needed is to apply a small dressing the patient should then be referred as soon as possible to a trained nurse or doctor Animal or human bite The mouth is full of germs so bites are usually badly infected Moreover they are often also lacerated or puncture wounds Every bite however small should be treated as a major wound as set out above Wound of the chest A crush sound of the chest may damage the lungs The patient may cough up blood and find it hard to breathe He may breathe easier if propped up in the serni sitting position but what is most important is to find the position of greatest comfort for the patient A puncture wound of the chest is a rare occurrence Sometimes the puncture may actually reach into the chest cavity With such a wound air is sucked in at each breath It should be covered at once with a large dressing which must be fixed on firmly to keep out the air (Fig 21) Any patient with a chest wound should be moved to hospital as quickly as possible Il ound of the abdomen Because of the risk that an abdominal wound may have ·Details of Wound Treatment w FG 19 Protechng and bandaging a wound wuh a projeching foreign body Note the two rolled bandages held in place by the parent or an assistant and so arranged as to present the dressing pad pressing hard on the foreign body when the bandage is fired chances of infection An alternative method of bandaging over a foreign body without pressiog on it is to use individual sterilised dresscogs on either side of the wound as shown in Fig 20 this method is specially useful where the wound 18 large Special Wounds Small crush graue or laceration Any crush graze or laceration other than a very small one is to be treated as a major wound and referred to a trained purse or doctor First aiders often ask to be allowed to use acriflavine or some otber oily dressing for small crusbes grazes and lacerations since it prevents sticking when the dressing is changed But acridavne das the disadvantages of iodide and other cherca! antiseptics and oily preparations delay healing In any event frequent changing of the dressing should not be needed unless the injury has become infected The proper treatment for a really small crush graze or laceration is thorough cleaning with cerimude as described above followed by a dry dressing protected by a bandage to keep it clean Anythiog larger should be covered with a stchlised first aid dressing and referred to a trained nurse or doctor Puncture wound This may be caused by a sail through the boot a drill which slips a glass splinter & wire brusb, or any other this pointed object. All such souods are to be treated as serious because gems particularly ietanus ·Details of Wound Treatment 45 The treatment follows exactly the general principles for all serious bleeding 1 Rest The patient should lie down 2 Raise the wounded part The foot should be raised and when the wound has been dressed the leg should be supported with cushions or pillows 3 Direct pressure on the biceding part A sterile pad should be applied and firmly bandaged in place This should stop the bleeding almost at oncc One or more pads should be bound on top of the first if necessary It is very dangerous to apply a tourniquet to a leg with a bleeding varicose vein as it may increase the haemorrhage Stings, Insect bites and Blisters Bee and wasp stings may occur in factories and canteens as elsewhere They are a special risk in jam factories The bee leaves both its sting and poison bag behind If the sting is grasped with a pair of forceps in order to pull it out the contents of the poison bag may be pumped into the patient The sting is best liſted or scraped off the skin with one blade of a pair of forceps or with a pin The patient should then suck the wound and spit out The only other local treatments of any value are the application of a proprietary antihistamine ointment (eg Anthisan ) sold in a collapsible metal tube failing this a cold compress or an ice-pack may help These are described in the next section The statement that the bee s venom* is acid is quite untrue and treatment with mild alkalı based on this assumption is useless If the sting is in the mouth skulled nursing or medical help is required at once While help is coming the patient should be given a piece of ice to suck The wasp leaves no sting behind so the patient should suck the wound and spit out forthwith Further local treatment is eractly the same as for a bee sting - that is to say antihistamine ointment a cold compress or an ice pack Like bee venom wasp venom is a complicated mixture of organic compounds The old story that it is alkaline is without foundation so vinegar and lemon juice are valueless as methods of treatment As with a bee sting of the wasp sting is in the mouth skilled help should be sought at once and ice given to suck With any sting the patient may start to swell up either around the injury or generally or show signs of shock If this happens skilled nursing or medical help is needed immediately Spider and snake bites may occur in industrial workers Those at risk are dockers and banana ripeaing store operatives The creatures are imported in the banana bunches usually from Brazıl They are not found in West Indian bananas though a 3 inch non biting spider is sometimes seen The Brazilian banana spider is huge with a 2 inch body and a leg span of 6 or more inches It is not a true tarantula Its bite will draw blood but is usually not serious nevertheless anyone bitten should be sent to a hospital or doctor The snake most often seen is the Brazılıan tree snake but even this is very rare Bee compl catod mt re of Onic compounds One is op ton . 1ow mol 1 #ght proten other is phosph Ip se damages th body ells so ih t they 1 berale a fitation and swell ng Ince the le of nant ut ne € om s th h SD hh causes the local bsta ce :תפותו 0 n ·44 Details of Wound Treatment punctured the stomach or bowels it is very important that the patient should be given nothing to eat or drink He should be moved to hospital without delay Nose Bleeding Epistaxis or nose bleeding may follow a blow on the nose nose picking or a bad cold such nose bleeding will usually stop quickly Or it may follow a severe head injury which means usually that the skull is fractured Often nose bleeding is spontaneous and has no obvious external cause this type is more likely to last for some time and perhaps be serious It is not part of first aid to attempt to diagnose the cause of spontaneous nose bleeding If there is other serious injury its treat ment must take precedence over nose bleeding First and treatment in the absence of major injury is as follows 1 Sit the patient up with the head thrown back 2 Make him breathe through his mouth and bold his nostrils closed for five minutes Thereafter he must be warned not to sniff 3 Apply cold water to the bridge of the nose by means of a bandkerchief or cotton wool soaked in it If the bleeding continues or recurs the patient should be seen by a doctor The first aider should never attempt to plug the nose Ruptured Varicose Vein A varicose vein is an enlarged leg vein just under the skin in which the blood is circulating inefficiently Varicose veins are common in both sexes in those over 40 A small leg wound which penetrates a varicose vein will bleed profusely Here first aid can be life saving FiG 21 A large pad and bandage applied over a pune ture wound of the chest to help to keep out the air which tends to be sucked in et cach breath A folded triangular bardage tied round the chest is used to keep the pad firmly in place ·Details of 1 ound Treatment 45 The treatment follows cxactly the general principles for all serious bleeding 1 Rest The patient should lie down 2 Raise the wounded part The foot should be raised and when the wound has been dressed the leg should be supported with cushions or pillows 3 Direct pressure on the bleeding part A sterile pad should be applied and firmly bandaged in place This should stop the bleeding almost at once One or more pads should be bound on top of the first if necessary It is very dangerous to apply a tourniquet to a leg with a bleeding varicose vein as it may increase the haemorrhage Stings, Insect bites and Blisters Bee and wasp stings may occur in factories and canteens as elsewhere They are a special risk in jam factories The bee leaves both its sting and poison bag behind If the sting is grasped with a pair of forceps in order to pull it out the contents of the poison bag may be pumped into the patient The sting is best iifted or scraped off the skin with one blade of a pair of forceps or with a pin The patient should then suck the wound and Spit out The only other local treatments of any value are the application of a proprietary antihistamine ointment (eg Anthisan ) sold in a collapsible metal tube failing this a cold compress or an ice pack may help These are described in the next section The statement that the bee s venom* is acid is quite untrue and treatment with muld alkalı based on this assumption is useless If the sting is in the mouth skilled nursing or medical help is required at once While help is coming the patient should be given a piece of ice to suck The wasp leaves no sting behind so the patient should suck the wound and spit out forthwith Further local treatment is exactly the same as for a bee sting-that is to say antihistamine ointment a cold compress or an ice pack Like bee venom wasp venom is a complicated mixture of organic compounds The old story that it 1$ alkaline is without foundation so vinegar and lemon juice are valueless as methods of treatment As with a bee sting of the wasp sting is in the mouth skilled help should be sought at once and ice given to ck With any sting the patient may start to swell up either around the injury or generally or show signs of shock If this happens skilled nursing or medical help is needed immediately Spider and snake bites may occur in industrial workers Those at risk are dockers and banana ripening store operatives The creatures are imported in the banana bunches usually from Brazil They are not found in West Indian bananas though a 3 inch non biting spider is sometimes seen The Brazilian banana spider is huge with a 2 inch body and a leg span of 6 or more inches It is not a true tarantula Its bite will draw blood but is usually not serious nevertheless anyone bitten should be sent to a hospital or doctor The snake most often seen is the Brazilian tree snake but even this is very rare 3. compl cated mic of Ognje ompound Ptoxn I w molecul IS pho phol p se ths damages the body cells so ih they I berate a sub t ncc Hence the le of an int histam ne One 1 Bee venom we ght Porn him ne o imt Anoth wh ch causes the I Int t on and well g 0 ·46 Details of Wound Treatment The treatment is as for other snake bites Wash the bite thoroughly to remove any venom which the snake may bave spat out into the skin Suck the wound hard and spit out Tie a bandage (or the bandage part of a sterilised individual dressing) tightly round the limb between the bite and the body This will not stop the blood flow but will cut down the flow of lymph (body tissue fluid) back to the body of as in the lymph that the venom mainly travels The bandage should be loosened for half a minute every quarter of an hour Send for skilled help at once or send the patient immediately to hospital The snake should be killed and sent in a box with the patient for identification Patients sometimes arrive at work with painful swellings due to mosquito or other bites These are not first aid problems and need nursing or medical examina tion aod care Blisters other than blood blisters are not emergencies (hough they may be very incapacitating The first aider sbould not puncture blisters as the chances of carrying 10 10fection are high The blister and surrounding skin should be cleaned gently with cetrimide and covered with a dry dressing under this the blister may burst spon tapeously and safely If a blister is painful or obviously infected it sbould be seen by a trained nurse or doctor Contestons A contusion or bruise is bleeding under the skin with the skin surface unbroken First aiders will be able to think of many examples the bruised bottom following a slıp a fall downstairs or a skating accident the black eye the thuck ear the egg like bruise on the scalp the bruise on the front of the shin the bruise under the nail following a pinch from a door or a weight dropped on a toe the bruse over the nos Faced with a bruise the main duty of the first aider is to make sure that no bones are broken and there is no other serious injury If slight movement causes severe paio serious injury must be assumed Because the germs capot get through the intact skin no dressing is needed over a bruise Pain may be relieved by a cold compress re-cooled as often as necessary or by an ice pack A cold compress is made by dipping a clean folded bandkerchief or a folded triangular bandage in water this is placed on the bruise without wring søg out it may then be covered with cotton wool and a firm bandage An ice pack may be made by wrapping ice-cubes in a thick tone) and crushing them with a mallet No attempt should ever be made by a first aider to empty a bruise by puncturing it The idea that it is necessary to bring out a bruise is an old wives tale ·47 Chapter 5 General Effects of Serious Injury Every severely injured patient soon becomes very ill This illness is known as shock Without proper treatment shock is often fatal With proper treatment applied quickly enough the patient almost always recovers Proper treatment of shock can be summed up in the words blood transfusion Every half hour that blood transfusion is delayed decreases the patient s chances of recovery The first aider s duty is plain It is to speed the removal of the severely injured patient to a properly equipped hospital doing only what is necessary meanwhile to prevent the shock getting worse If the severely injured patient is in hospital within half an hour the first aider will have played a major part in saving life Mythology of Shock Since shock following wounds was first recognised in the 1914 18 war medical ideas about its causes and treatment have repeatedly changed These changes have inevitably been reflected in first and teaching the consequence has been muddle and confusion Now the facts are becoming clear and from the first aider s point of view they can be stated quite simply But first the muddle must be cleared away Some first and teachers actually describe six kinds of shock primary secondary haemorrhagic traumatic toxic and nervous 1 Primary shock is fainting and the condition popularly spoken of as shock follow ing an unpleasant experience or a nasty shake-up We shall descnbe it later 2 Secondary shock or established shock is true wound shock with which we are concerned here 3 Haemorrhagic shock is anober name for true wound shock emphasising the importance of bleeding in its cause 4 Traumatic shock is yet another name for true wound shock The word traumatic is the adjective of “ trauma which simply means injury 5 Toxic shock is a rare condition coming on four or more hours after severe injury and therefore almost never seen by the industrial first aider 6 Nene shock or Aervous shock is a meaningless term since there are nervous factors in every case of shock These nervous factors range from purely psycholog cal anxiety to the excruciating pain following a blow in the solar plexus or on the testicle From this point on we shall use the word shock only for true wound shock that is for Nos 2 3 and 4 in the above list The muddle over the definition of shock is matched by the confusion and con troversy over treatment Here we shall follow what we hope is a reasonable middle course based largely on the valuable researches carried out at the Birmingham ·46 Details of 1 ound Treatment The treatment is as for other snake bites Wash the bite thoroughly to remove any venom ubicb the snake may bave spat out into the skin Suck the wound hard and spit out Tie a bandage (or the bandage part of a sterilised individua) dressing) ughtly round the limb between the bite and the body This will not stop the blood How but will cut down the flow of lymph (body tissue fluid) back to the body it is in the lymph that the senom mainly travels The bandage should be loosened for half a mipute every quarter of an hour Send for skilled belp at once or send the patreat immediately to hospital The stake should be killed and sent in a box with the patient for identification Panents sometimes arrive at work with painful swellings due to mosquito or other bites These are not first aid problems and need nursing or medical examina ton and care Blisters other than blood blasters are not emergencies though they may be very jocapacitating. The first aider should not puncture blisters as the chances of carrying 10 infection are high The blister and surrounding skin should be cleaned gently with cetrimide and covered with a dry dressing under this the blister may burst spon Ladeously and safely If a blister is painful or obviously infected at should be seen by a tramed nurse or doctor Contusions A contusion or bruise is bleeding under the skin with the skin surface unbroken First aiders will be able to think of many examples the bruised bottom following a stup a fall downstairs or a skating accident the black eye the thick car the egg uke bruise on the scalp the bruise on the front of the shin the bruise under the nail following a pinch from a door or a weight dropped on a toe the bruise over the ribs Faced with a bruise ibe main duty of the first aider is to make sure that no bones are brokeo and there is no other serious injury If slight movement causes severe pain serious injury must be assumed Because the germs cannot get through the intact skin no dressing is needed over a bruise Pain may be relieved by a cold compress re-cooled as often as necessary or by an ice pack. A cold compress is made by dipping a clean folded handkerchief or a folded triangular bandage in water this is placed on the bruise without wring ing out it may then be covered with cotton wool and a firm bandage An ice pack may be made by wrappiog ice-cubes in a thick lonel and crushing them with a mallet No attempt should ever be made by a first aider to empty a bruise by puncturing it. The idea that st is necessary to bring out a bruise is an old wives tale ·General Lffects of Serious injury 49 Blocdms as a Cause of Shock Actual blood loss is now regarded as by far the most important factor in pro ducing shock after severe injury External blood loss can be seen and as already mentioned the blood should be mopped up and collected and sent with the patient to hospital to help the surgeon to judge how much has been lost Internal blood loss usually takes the form of bleeding from an ulcer in the stomach or bowel the blood may be vomited up or passed in a motion Although this is not produced by injury the condition of shock does not diſler in any way at all from that produced by etternal bleeding Blood loss into the tissues themselves can be equally important as a cause of shock If a large bone is broken there will usually be a great deal of bleeding into the tissues around the broken ends even though nothing shows from outside This internal bruising can be detected by measuring the amount of swelling of a limb A broken shin bone (or tibia) will cause an internal bleeding of about a pint of blood not really enough on its own to produce shock But a broken thigh bone (or femur) will cause two and a half to three pints of hidden internal bleeding with quite considerable shock as a result Capillary Leakage When tissues are injured they produce certain chemical substances which pass into the blood These substances affect the capillanes in the immediate vicinity of the injury and also generally throughout the body Their distant effect can be shown in the follow ing way If the veins from the injured part are temporarily blocked the degree of shock 1s reduced and when the block is released the shock gets worse The capillanes affected are first caused to dilate This means that some part of the blood of the body stagnates here out of effective use Next the walls of the capillaries begin to Icak so that the fluid part of the blood can seep away (Fig 22) The result is a further reduction in the amount of available blood This seeping away of the fluid part of the blood is specially important in extensive bums The capillanes in the burnt area itself become very leaky indeed and huge quantities of fluid can be lost from the burnt surface One result of this is that the blood which remains becomes thicker and stickier In severe bums local Auid loss is of paramount importance in producing shock a NORMAL CAPILLARIES b DILATED CAPILLARIES с DILATED LEAKING CAPILLARIES im fiG 22 (a) Normal capillaries The dots in the blood are the red blood-cells (b) In shock the affected capillaries first dilate so that blood stagnates in them thus reducing the amount of blood in circulation (c) They then start to leak so that the flud part of the blood can seep onay The red blood cells are 100 large to escape through the leaks as a result the loss of fluid increases their con ceniranon so that the blood becomes thicker and stickier ·48 General Elects of Serious injury Accident Hospital In so doing we hope not to upset too deeply either the con servatives or radicals The Shocked Patient The picture of the patient with sbock looks like this 1 The facsal expression is anxious and worsed looking or stating in a vacant way 2 The skin colour is pale - white ashen grey or slightly blue 3 The skin feels cold yet in spite of this it may be soaked in sweat 4 The patient is sometimes restless fidgety and even talkative but may be dall and sometimes even unconscious $ The breathing is rapid and shallow sometimes sighing 6 The polse is usually rapid and feeble though occasionally normal 7 The patient usually complains little of pain but may complain greatly of thirst 8 There may be external signs of the cause of shock such as injury or bloody vomit The first aider cannot measure the blood pressure If he could he would usually find st low or even very low Similarly he would find the body temperature to be subnormal though he must not waste time trying to take it We can sum up the picture of the shocked patient thus anxious pale cold sweating restless shallow breathing rapid pulse usually little pain much thirst Hut remember that a shocked patient does not always show all of these things a! the same time in medicine there are exceptions to even the best word pictures Thus a patient with shock due to a heart attack or a bad fracture may be in great para That Happens in Shock Shock is due to loss of body Nud This happens in four different ways 1 Bleeding This may be (a) external from the outer surface of the body (b) internal from the per surfaces of the body into the stomach or gut for example from a bleeding stomach ulcer or (c) into the soft tissues of the body say around the broken ends of a bone 2 Seeping away of plasma from the capillaries Plasma is the furd part of ibe blood (that is blood minus red cells) The capillaries are the small tubes which join the arteries to the veios They are the finest blood vessels of all and they have the bidnest walls Those which start to leak in shock are () at the site of oury especially if the jury is a crush or a burn and (6) in the rest of the body probably mainly in tbe muscles and the gut 3 Vomiting 4 Sweating Each of these ways of losiog body ftud must be looked at a rather more detai But here we must notice that the fluid in each case comes either directly or indirectly from the blood Moreover the more rapid the blood loss the smaller ss the amount needed to produce shock By contrast a much greater blood loss can be borge without symptoms of shock provided it occurs suficiently slowly ·General Class of Serious injur 49 Bleeding as a Cause of Shock Actual blood loss is now regarded as by far the most important factor in pro ducing shock after severe injury External blood loss can be seen and as already mentioned the blood should be mopped up and collected and sent with the patient to hospital to help the surgeon to judge how much has been lost Internal blood loss usually takes the form of bleeding from an ulcer in the stomach or bowel the blood may be vomited up or passed in a motion Although this is not produced by injury the condition of shock does not differ in any way at all from that produced by external bleeding Blood loss into the tissues themselves can be equally important as a cause of shock If a large bone is broken there will usually be a great deal of bleeding into the tissues around the brolen ends even though nothing shows from outside This internal bruising can be detected by measuring the amount of swelling of a limb A broken shin bone (or tibia) will cause an internal bleeding of about a pint of blood not really enough on its own to produce shock But a broken thigh bone (or femur) will cause two and a half to three pints of hidden internal bleeding with quite considerable shock as a result Capillary Leakage When tissues are injured they produce certain chemical substances which pass into the blood 'These substances affect the capillaries in the immediate vicinity of the injury and also generally throughout the body Their distant effect can be shown in the follow ing way If the veins from the injured part are temporarily blocked the degree of shock is reduced and when the block is released the shock gets worse The capillares affected are first caused to dilate This means that some part of the blood of the body stagnates here out of effective use Next the walls of the capillaries begin to leak so that the fluid part of the blood can seep away (Fig 22) The result is a further reduction in the amount of available blood This seeping away of the fluid part of the blood is specially important in extensive burns The capıllanes in the burnt area itself become very leaky indeed and huge quantities of fluid can be lost from the burnt surface One result of this is that the blood which remains becomes thicker and stickier In severe burns local fluid loss is of paramount importance in producing shock b a NORMAL CAPILLARIES DILATED CAPILLARIES с DILATED LEAKING CAPILLARIES FIG 22 (a) Normal capillaries The dots in the blood are the red blood cells (b) in shock the affected capillaries first dılare so that blood stagnates in them thus reducing the amount of blood in circulation (c) They then start to leak so that the fluid part of the hlood can seep an ay The red blood cells are too large to escape through the leaks as a result the loss of fluid increases their con centration so that the blood becomes thicker and stickier ·48 General Effects of Serious injury Accident Hospital in so doing we hope not to upset too deeply either the con servatives or radicals The Shocked Patient The picture of the patent with shock looks like this 1 The facial expression is anxious and worried looking or stasing sa a vacant way 2 The skin colour is pale - white ashen grey or slightly blue 3 The skia feels cold yet in spite of this it may be soaked in sweat 4 The patient is sometimes restless fidgety and even talkative but may be dull and sometimes even unconscious $ The breathing is rapid and shallow sometimes sighing 6 The pulse is usually rapid and feeble though occasionally normal 7 The patient usually complains Istile of pain but may complain greatly of thurst & There may be external signs of the cause of shock such as injury or bloody vorut The first aider cannot measure the blood pressure if he could he would usually find it low or even very low Simlarly he would find the body temperature to be subnormal though he must not waste time trying to take it We can sum up the picture of the shocked patient thus anxious pale cold sweating restless shallow breathing rapid pulse usually fastle pain much thirst But remember that a shocked patient does not always sbow all of these things at the same time in medicine there are exceptions to even the best word pictures Thus a patient with shock due to a heart attack or a bad fracture may be in great pain What Happens in Shock Shock is due to loss of body flad This happens in four different ways 1 Bleeding this may be (a) external from the outer surface of the body (b) internal from the inner surfaces of the body into the stomach or get for example from a bleeding stomach ulcer or (c) into the soft tissues of the body say around the broken ends of a bone 2 Secping away of plasma from the capillaries Plasma is the fluid part of the blood (that is blood minus red cells) The capillaries are the small tubes which join the arteries to the veros They are the finest blood vessels of all and they have the thonest walls Those which start to leak in shock are (a) at the site of injury especially if the injury is a crush or a buon and (b) in the rest of the body probably mainly in the muscles and the gut 3 Vomitog 4 Sneating Each of these ways of losing body fud must be looked at a rather more detail But here we must notice that the fiuid in each case comes cither directly or sodirectly from the blood Moreover the more rapid the blood loss the smaller is the amount needed to produce shock By contrast a much greater blood loss can be bome without symptoms of shock provided it occurs sufficiently slowly ·General Effects of Serions Injury 51 4 Any tight clothing round the neck chest and waist should be loosened but no clothes should be removed 5 If the weather is cold the patient should be covered with an overcoat or a blandet In warm wcather no covering is needed 6 The first aider should be quietly cheerful and confident and have a friendly smile There should be no anxious over activity or forced jollity The answer to the question What first aid treatment is administered by the ear? words of comfort Remember that the shocked patient has a very acute sense of hearing so do not discuss his condition unless well out of earshot We now have to consider four rather mare controversial aspects of the manage ment of shock position heat fuids and morphia IS Position In theory it is a good thing to raise the legs and lower the head of the shocked patient so as to increase the blood flow to the brain In practice unless the patient is already on a stretcher first aid attempts are likely to do more harm than good If the patient is on a stretcher the foot end may be raised nine inches provided it can be done without risking a spill Otherwise leave well alone Do not put anything under the shocked patients head to raise it to do so is simply to reduce the blood flow to the brain The exceptions to this rule are severe injuries to the chest or stomach when pillows or folded blankets under the head and shoulders will give added comfort and safety If the patient is vomiting or is semi-conscious or unconscious and the injuries permit he should be gently rolled into the semi prone position (Fig 23) once again there should be nothing placed under the head to raise it Heat For many years warmth has been regarded as the standard treatment of shock and first aiders have been taught to do their duty with hot water bottles and even electric cradles But the reason why the patient feels cold is that the blood vessels in the skin have all closed down as part of a deliberate move to force what little blood is available to the brain and other vital organs Lack of blood in the skin does no harm f external heat is applied so that the skin is made to glow blood FIG 23 The sem prone position Note that the body 15 supported by the upper arm and knee and that the face is turned three quarters towards the fround in this position the tongue falls' forward and vomit and saliva can run out of the mouth instead of being suched into the lungs ·50 General Effects of Serious Injury Apart from severe burns capillan icatage is a major factor in producing shock when ever there i substantial damage or destriction of lving tissue Such injury is usually due to crashing from falls collapsing buildings pioning under vehicles also limbs crushed n rolless or torn off by machinery Vomiting and Sweating Vomiting and sucating to to occur as reactions to intense anxiety of severe pain Both tend to make shock a little worse than it otherwise would be but by themselves they seldom mnvolve enough fluid loss 10 cause serious harm The shealing on a cold skin which the shocked person so often shows may not be dve either to anxiety or to pain The skya has become cold as a means of cutting dous heat loss from the body and sweat which would normally evaporate unnoticed remains on the skin as clammy beads of perspsration Pain Painfil serve stimuls play a small part only mainly at the start of shock the nerves from the injured part are blocked the degree of shock is reduced But despite th: it is doubtful of pain on its own van produce real shock Thus minor risuries can be excruciatingly painful for example a tom oli nail such minor imjurier may cause fall of blood pressure and faiating but do not cause real shock Results of Flusd Loss Once it is realssed that the fundamental cause of shock xs lack of blood 11 circu lation the other changes are easily understood Most of them are attempts by the Test of the body to bake up for this lack of blood The heart works faster to get what blood there is around the lungs do the same to get all the oxygen they can 10 the reduced amount of blood the skin blood vessels contract to cut down loss of heat from the body But if internal bleeding or the seeping away of bods fluid continues the compensatiog machinery tan do no more The pulse gets ncaker the breathing alternates between brg sighing and little shallow movements consciousness is clouded and then lost and the patent finally dies because too httle blood as teaching the brain From the above discussion it should be clear that shock is certain to follow all severe crushes tissue tearing sjuries burns major bleeding from wounds or from the stomach and breaks of the lasger bones The mere occurrence of one of these injuries or conditions is enough to lead to the decision that the patient is sufferiog from shock Management of Shock Because the cały hile saving treatment of sbock is blood transfusion we prefer to speak of the work of the first aider as management rather than treatment Here are the lines he should follow 1 As soon as really enous injury is apparent an ambulance should be called 1115 iben best to telephone the bospital so as to warn the casualty departmeat that a severely injured and shocked patient is on his way 2 The patient should be moved only si absolutely accessary and then only enough to get him out of danger and made comfortable The priociple to be fol lowed is utmost gestleness Methods of mo nag the shocked or unconscious patient will be discussed later } Any wounds shovid be covered and any external bleeding checked ·Gencral Liccis of Scrious injury S3 "crush syndrome The same kind of kidney damage may follow severc burns Crush injuries of this type often occur in air raids and mining and train disasters In industry a limb may be trapped between rollers or part of the body may be crushed by a falling beam or masonry or the collapse of a trench in civil engineering operations The patient should be released as swiftly as possible if breathing has stopped artificial respiration should be commenced at once The general care of the crush injury follows precisely the same lines as for shock The current first aid text books sull teach that large quantities of fluid should be given by mouth to the patient with a severe crush injury. The theory behind this treatment is that the fluids dilute the poisons and flush out the kidneys There is no real evidence that giving fluids indiscriminately to patients with crush injuries helps them in any way Indeed it may do harm by putting pressure on the kidneys when they are least able to cope At such a time the amount of Nuid in the body needs careful scientific control which is possible only in hospital So in crush injuries as with shock from other causes the rule for first aiders must be no fluids by mouth To the best of rules however there have to be occasional exceptions When there is bound to be great delay in getting a shocked patient to hospital either because of distance or because the patient is trapped and when there is no abdo minal injury it is inhuman and unnecessary to refuse the shocked patient a drink if it is asked for But water only should be given and in half-cupfuls only at a time A big drink taken suddenly may produce nausea and vomiting Fainting At first sight a person who has fainted looks shocked There is extreme pallor with beads of cold sweat on the forehead It may be impossible to feel the pulse Breathing may be shallow and sighing But in a few moments recovery starts and consciousness begins to return The person who faints is usually young and healthy The cause may be mental such as the sight of blood fear of an injection or sudden bad news - or physical such as extreme pain or standing for a long time to attention The mechanism is not unlike that which causes shock Nerve impulses from the brain allow the capillaries in the muscles and gut to dilate and blood stagnates in these capillaries - temporarily out of circulation as it were Lack of blood supply to the brain produces first giddiness pallor and yawning then unconscious ness As a rule the circumstances in which fainting occurs make the diagnosis obvious The only treatment needed is to loosen any tight clothing around the neck if consciousness does not return within two minutes the patient should be rolled into the semi prone position (Fig 23) and expert help sent for as there may be some more serious cause for the unconsciousness The patient who feels he is about to faint can usually prevent this by pulling his stomach buttock and leg muscles tight and holding them tight a minute or so th WT t hstem fom the Med IR rch Co прo t on the met of wond hock Post Sc ch on the co trol of the olm of flud the body has de las the actue ·$2 General Effects of Serions Injury will be drawn away from the vital places where it is needed and the patient will be worse off rather than better Following this reasoning it was discovered that shocked patients who were not warmed did as well as or even better than those who were warmed Moreover if hot water bottles or electric cradles are used there is the additionat danger of skin burns during the period when consciousness and sensitivity to pain are diminished In the Birmingham Accident Hospital the resuscitation room to which all shocked patients are brought is at ordinary room temperature and the patient bas only a sheet to cover him We have no doubt that the right first aid management of shock is to dispense entirely with artificial sources of heat Even covering the patreat is a matter only of physical comfort in cold weather The traditional hat water bottles can safely be disposed of at jumble sales Fluids The sbocked patient is often intensely thirsty this is nature s response to blood and fluid loss Part of the traditional treatment for shock is giving hot sweet tea this is now realised to be a dangerous practice As has already been emphassed the first principle in the management of shock is to get the patient to hospital as swiftly as possible On arrival there the surgeon may well decide that besides transfusion inmediate operation is essential But the dangers of anaesthetising someone who has just been drinking hot sweet tea or indeed any fluids are considerable for this reason alone the surgeon may have to hold huis hand while three or four vital hours slip away with stomach injuries there is the added danger that any fund drunk will leak out of the stomach or gut into the abdominal cavity It follows that the only safe tule is no fluids of any kind by mouth to the shocked panent The same absolute prohibition applies to giving chocolate or boiled sweets to suck If however the patient complains of thirst he may be allowed to riase his mouth with water and spit it out Morphia The actual giving of morphia is no concern of the factory first aider But he may sometimes have to call the doctor so that morphia may be given Morphia is not a treatment for shock but a means of relieving pain It is needed only if pain is continuous and severe - as for example when a timb is trapped in machinery Obviously it will not be necessary if the patient is unconscious Because it may take a doctor an hour or more to reach the site of a disaster in a coal mine first anders in coal mines are given special powers under the law to administer morphia For this they have to be specially trained Full details are given in the St John publtcation First Aid in Coal Mines For similar reasons industrial nurses working in the docks are now allowed to administer morphia Crash Injuries Severe crushes with much destruction of muscle tissue involve an added risk besides sbock Debrs and poisons from the crushed muscle released into the blood may damage or even destroy the kidneys The resulting condition is called the

·Fraxtures and lion to Recognise Them
55
20
FiG 24 Broken collar bone or clavicle
Note that the broken ends of the bone
overlap slightly that the back of the
head is turned and alied towards the
injured side that the arm is held against
the side of the chest and the forearm
supported by the other hand
FIG 25 Broken humerus As with the
broken collar bone the arm is held to
the side and the forearm supported by
the other hand The broken bone ends
overlap slightly so that compared with
the good side the upper arm
shortened
IS
a
b
FIG 26 Broken radius and ulna (a) Complete break of both
bones (b) Parral break of the radius without separation of the
broken bone ends the so-called green stick fracture

·5+ Chapter 6 Fractures And How To Recognise Them A fracture is a broken or cracked bone Fractures are common in street and riding accidents in industrial accidents they are comparatively rare in our experience the bones most often broken in industry are the small bones of the hands and feet usually as a result of objects falling The value of specially strengthened protective boots as a means of preventag fractures especially for workers in heavier industry and the building trades cannot be too strongly stressed Conversely boots or shoes with rubber or canvas uppers are a real source of danger to the worker Role of First aider la industry because skilled help can almost always be quickly obtained the first aider s role in fracture treatment is confined to true first aid The transport of a pauent with a fracture of the thigh for example is a task for the skilled and experi enced ambulance worker who ss handlog such cases every week Usually the factory first aider s role is to look after such a patient until the expert arrives But with a suspected fracture of the arm band or foot the factory first aider may well have to get the patient ready for transport as a sitting case to the hospital or indus trial health centre The seriously injured patient will often have one or more fractures Here treat ment of the patients general condition must have priority care of the fracture will be limited to making the part as comfortable as possible With the panent who has sustained a moderate and local injury the first aider must always remember the possibility of a fracture In such cases he should send for help or refer the patient to the factory medical department health centre or hospital If there is any reason at all to suspect a fracture he must take special steps to make sure that it gets no worse Transport of severe fracture, is excellently taught in the official first aid manuals The ambulance worker must know all this and so must a first and worker in a coal mine The factory first aider needs to know only certain basic principles and how to apply them if the need arises But what is koown must be known properly Types of Fracture Alany varieties of fracture are described For the industrial first aider only two are important - closed or simple and open or compound Most fractures are closed Open fractures are so rare that many first aiders will never see one

·35
I turts and low tu iruntur I lut
11 24 Iuben rollar line or claviete
Note that the man enfor the Inne
well up alighily that the lack of ile
ratio turned and milind towards the
infuris se il nithe arm to held against
the air of the chiru ant the forearm
eur postedly the other hand
25 Broken humerus me with the
Iroken collar bone the arm I held to
the slide and the forearm supportedly
the other hand The broken onrends
overlap allghily so that compared with
the fooil ilde the upper arm Ir
shortened
а a
b
I# Broken ratus anil ulna fa) Complete Irak ol hath
timer ffarital Itead of the radius without separation of the
tulenli ar into the n (allet green sich frarlute

·S6 Fractures and How to RrLomise Them An open or compound fracture is one where there is an outside wound as well as a fracture and a communication between the skin and air and the broken bone compound fractures the bone cannot be seen in the wound The best the first arder can tell a compound fracture if there is a broken bone-end sticking out from a wound or through the skin or if broken bone is vssible in a wound But in most compound fractures the bone cannot be seen in the wound The best the first aider can do is to say there is a wound outside and a broken bone inside whether they communicate is a matter for the surgeon The safe rule is to treat the wound as a wound - that ss to say cover 1 as quickly as possible with a large adividual sterilised dressing in order to keep out any further safection Once this is done the patients general condition and the fracture itself can be attended to it is particularly important to handle any such injury extremely gently One rough movement may link together an outside wound and an inside fracture and so convert a closed into an open fracture Is There a Fracture ? For the first aider there are only two certain signs of a fracture 1 If the patient is conscious he often says that he heard or felt a bone snap 2 The Ismb or injured part is often bent in a way which could happen only if the bone was broken This is called the deformity can usually be detected without removing the clothes Deformity is best appreciated by comparing the injured and uninjured limbs Everything else must be suspicion only With many fractures including many those of the fingers and toes wrist and ankle pals is the only indication of trouble and diagnosis is impossible without an x ray The only safe course is for every injury with pain oves or near a bone to be seen by a tramed nurse or doctor Fractures of Individual Bones Here we are concerned with bones other than the spine which will be considered later Certain bones are particularly liable get broken Often the deformity or change in shape produced ss so characteristic that by simply looking at the injured part it is possible to tell that there is a fracture Here pictures speak louder than words Each illustration should be studied carefully as the text is read in particu far attention should be pard to the way the displacement of the broken bones produces changes in the outside shape of the part of the body affected Collar bone or clavicle (Fug 24) The cause is usually a fall on the outstretched hand The arm is held tight against the side of the chest and any movement gives pain over the collar bone Upper arm bone or humerus (Fig 25) Again the arm is held tight against the side of the chest but this time pain on movement is over the broken humerus Forearm bones the radius and adno (Fig 26) The snjured forearm is supported with the other hand There will be pain at the ·Fractures and How to Recognise Them 57 a. b. FIG 27 Broken urist (a) From the back the wrist merely looks swollen (b) The break is really of the forearm bones just above the Mrist Note that the dinner fork deformity is seen only in side Men For simplicit's onl one bone the ulna is shown site of the break The amount of deformity depends on the extent of the breaking A young person may crack one of the forearm bones only part of the way through this is called a green stick fracture If one bone alone is broken the other will act as a splint Forearm bones at the wrist (Fig 27) The common cause is a fall on the wrist particularly in an elderly woman The fracture is called Colless fracture and the deformity seen from the side is like a dinner fork Small bones of the wrist and hand The usual causes are jerks falls and blows Chauffeurs fracture may follow a back fire while using a starting handle though now rare with cars it still occurs with diesel engines Thigh bone or femur at the hip (Fig 28) The femur is the largest bone in the body and breaks always produce considerable shock In old people the femur is fragile and a simple fall will snap the neck of the femur close to the hip joint The deformity is quite characteristic The leg is ·58 Fractures and How to Recognise Them held rolled outwards so that the toes point away from the other foot Sometimes 15 can be seen that the injured leg is shorter Shaft of the thigh bone (Fig 29) Because it is so strong the shaft of the femur will be broken only by great violence а. > b FIC 29 Broken shaft of the thigh bore or femser More thar the bone ends overlap 50 that the leg is shortened but the foor i nor rurned ow! AS a broken hup FG 28 (a) Broken thigh bone or femur at the hip Though usually spoken of as a broken hp" the injury u really o break of the narrow neck of the femur The main shafi of the femus es pulled up by the powerful thigh muscles so that the injured leg is made shorter than the other (6) Ponnon of feet with a broken hep The tou of she injured side point oussards instead of forwards

·59
24
olebb
FIG 31 Broken ankle The break is
really of the sun bones just aboie and
at the side of the ankle The suelling
is usually so great that the break can
be detected onl br x ray cramınation
1
pen
Hellele
1 b
FIO 32 Broken nb Diagrammatic sec
tonal view Large arrows show direction
of forces producing injuries small
arrows position of injuries Break pro
duced (a) by direct force (b) by com
pression of chest
FIG 30 Broken shin bones The large
shin bone the tibia les just under the
skin so that the break may be felt by
running the finger down the bone A
break of the small shin bone the fibula
cannot be detected in this way It both
bones are broken the ends overlap
so that the legis shortened

·60 Fractures and How to Recognise Them such as a fall from a height or a bad traffic smash up Pain and tenderness will be extreme the leg will be held quite still there may be shortening Shin bones the abia and fibula (Fig 30) The large shin bone the tibia is just under the skin so a break can be felt quite casily by running a finger along it As a rule the thin little fibula is broken as well The common causes are football injuries road accidents and falls Shin bones at the ankle (F18 31) It is usually impossible for the first aider to distinguish a badly strained ankle from a broken one The cause is usually a twist or a fall often a slight one Somctimes the whole foot is pushed backwards on the leg. the characteristic deformity of Potts s fracture in which besides the broken bones the ankle is dislocated Small bones of the ankle and foot Fractures should be borne in mind whenever a weight is dropped on the foot or toe Ribs (Fig 32) Rib fractures are common They may be caused by sudden compression of the chest or by falls for example on the corner of a workbench There is usually no deformity but sharp pain on breathing or coughing Skull With head injuries the general condition of the patient matters much more than the local damage Falls blows and road accidents are the usual causes Often the patient will be drowsy or unconscious Blood from the nose or ear following a blow on the head suggests a broken skull A bad bruise on the scalp may feel like a fracture of the skull there is a raised circular swelling with an apparent dip or hole in the centre Usually there is no break but this is a matter for a trained nurse or a doctor to decide ·61 Chapter 7 Care of Fractures, Strains and Sprains The principle of first and care of any fracture is to steady the broken bone-cods so that the patient can move or be moved without added pain or further injury 1 The injured part shoul be steadied and supported to prevent movement of the broken bone-ends With long bones this means that the joints at each end of the broken bone must be held still 2 If the limb is in a very unnatural position it should be moved with great care and without force into as natural a position as possible if it is not in a very un natural position it should not be moved 3 If the patient is to move or to be moved without further expert help the injured part should be fixed in a comfortable natural position Fuing is done with triangular bandages opened out or folded plenty of cotton wool padding and with the body the other limb or a piece of wood used as a splint FIG 33 Splinting a broken hip thigh or shin For simplicity the first aider doing the bandaging is not shown The arrow indicates the position of the suspected break An assistant exerts a steady pull on the foot without bending or turning 11 while she bad leg is sed to the good leg with folded trangular bandages Plenty of collon kool is placed round the injured limb before the two bandages are applied just above and below the fracture ·62 Care of Fractures Strains and Sprains 4 Do not try to remove the patient s clothes this may do further damage by moving the broken bone ends In some of the pictures certain clothes are shown removed only for the sake of clarity Fixing of Hıp, Thigh and Shin Fractures Patients with fractures of the hip thigh and shin will normally be transported to hospital by ambulance as quickly as possible Any splinting needed will there fore usually be done by the expert ambulance men If for any reason the factory first aider does have to splint a fractured hip thigh or shin the safest way is to tie the two limbs together with four to six folded triangular bandages Should an assistant be available he may at the same time exert a steady pull on the foot without bending or turning it in any way This pull is to overcome or at least reduce the muscle spasm around the fracture which is the main cause of the pain (Fig 33) Plenty of cotton wool should be placed round the injured limb before the two a |Ь FIG 34 Fırıng a broken collar bone (a) A pad of collon wool is placed in the arm pit and the upper arm bound to the side of the chest by two folded triangular bandages (b) The forearm is supported in a sling at an angle of 45 degrees and a large cotton wool pad placed between the sling and the injured shoulder Alter matn els a clove hitch (FIG 12) may be used or by those who have learnt its use the special St John sling ·63 Care of Fractures Strains and Sprains bandages are applied on cuther side of the fracture Never bandage directly over a fracture On no account should any attempt be made to remove the clothes it is reason able however to roll up the trouser or pull down the stocking to see if a frac tured shio bone has penetrated the skin Once the limb is properly immobilised the patient may be lifted carefully an to a stretcher Mormg Other Fractures Patients with severe head injuries will go straight to hospital under expert care they will usually be unconscious and the fractured skull as such needs no first aid Details will be given later when the unconscious patient is considered Unless they are shocked patients with fractures or suspected fractures of the arm and forearm Wrist and ankle hand and foot collar bone and ribs can be moved to the factory medical department health centre or hospital by car as sitting patients for such patients then first and fixing may be necessary Fixing of Other Indiydual Fractures Collar bone (Fig 34) Put a cotton wool pad in the arm pit Bind the upper arm to the side of the chest with two triangular bandages Support the forcarm in a sling at an angle of 45 degrees Place a large cotton wool pad under the sling end which passes over the injured collar bone Humerus (Fig 35) Use the side of the chest as a splint Place a large cotton wool pad between the arm and the chest Bind the arm to the side of the chest with two triangular ban dages Support the forearm in a sling at a night angle Radius and Ulna (Fig 36) Pad with cotton wool a splint long enough to extend from the elbow to the junction of the fingers and hand Fix the splint to the forearm and hand along the palm surface with a bandage at either end Place cotton wool pads on each side of the fracture and bandage over these This treatment also applies to fractures of the radius and ulna at the wrist or other doubtful wrist 10juries Ankle Pad all round with cotton wool and bandage firmly No weight should be borne on the injured ankle Hands and feet Fractures of the small bones of the hand and foot fingers and toes require no first aid splinting The injured hand should be rested in a sling No weight should be borne on the injured foot

·64
FIG 35 Fixing a broken humerus (Left) The side of the chest is
useid as a splint A large pad of cotton wool is placed between the
arm and the chest and cotton wool placed round the arm above
and below the break The arm is bound to the chest with two
folded triangular bandages (Right) The forearm is supported in a
sling at a right angle
FIG 36 Furing a broken radius and wind
A simple splint padded with cotton wool
extends from the elbow to the knuckles
along the palm surface of the forearm and
hand Note the corton wool pads under
the bandages on each side of the fracture
The forearm is carried in a right angle
sling (not shown)
AB

·65 Care of Fractures Strains and Sprains Ribs Fractures of the nbs require no first aid splinting If pain is extreme this may be cased by propping up with several pillows Whenever bandages or slings are used for fixing fractures these must be secured firmly enough but not too tight. Too tight a bandage will cause the part below it to start to swell Fractured Spine The spine may be broken in the neck or the back A broken neck may follow diving into a pond which is too shallow More commonly nowadays it follows the sudden stop when a car motor-cycle plane or train crashes The head jerks forward or back wards and snaps the neck in much the same way as in judicial hanging A broken back may follow a fall from a height such as scaffolding it may bap pen regardless of whether the head or feet buttocks or back strikes the ground first The back may also be broken by direct violence --for example when a heavy weight falls across the back The damage to the bone is comparatively unimportant What matters is damage or the risk of damage to the spinal cord inside the bone Any damage to the spinal cord is absolutely permanent There can be no recovery from the paralysis (loss of movement of muscles) and loss of sensation below the level of the damage Because movement of the broken spine may itself produce damage to the spinal cord the first aider should do absolutely nothing unless he has to The first aider will suspect or recognise a broken spine by the following (1) the story of the accident (2) pain at the place of injury (3) the patient feels afraid to move and may be unable to move if he tries If it is absolutely necessary to move the patient or adjust his position it must be donc very gently and slowly The greatest care must be taken not to bend up the back or neck or twist the spine How not to do it is shown in Fig 37 For anything more than the slightest movement head and foot traction should be used preferably with four people helping (F18 38) But it must be emphasised that this is a job for expert first aiders who have practised the manoeuvre carefully If lifting is absolutely necessary then the opportunity should be taken to put the patient on to a flat hard stretcher without pillows or on to a door But the proper course is always to wait for the expert ambulance men unless there is an overwhelming reason for not doing so If the patient with a broken back is found lying on his face he may with advan tage be transported on his face With a broken neck the patient should be moved on his back with his head supported between two rolled blankets sand bags or bricks wrapped in cotton wool The Recovenng Fracture The modern orthopaedic surgeon usually wants to get most of his fracture cases back to work as soon as possible sometimes even within a day or so of the injury Early suitable work is the finest possible way of keeping a patient generally fit

·64
FIG 35 Fixing a broken humerus (Left) The side of the chest is
used as a splini A large pad of cotton wool is placed between the
arm and the chest and cotton wool placed round the arm above
and below the break The arm is bound to the chest with ino
folded triangular bandages (Right) The forearm is supported in a
sling at a nght angle
FIO 36 Fexing a broken radius and ulna
A simple splini padded with cotton wool
extends from the elbow to the knuckles
along the palm surface of the forearm and
hand Note the cotton wool pads under
the bandages on each side of the fracture
The forearm is carried in a right angle
sling (not shown)
IC

·67 Care of Fractaires Siraris and Sprains 1 FIG 38 The night way to move a patient with an injured back The patient s spine must be hept absolutely straight and head and foot traction applied at the same time the first man places one hand under the patients neck and the other under his chin he heeps up a steady pull on the neck with the head bent back The second puts lus hands around the patient's heels All four men must move ven slowly and carefully and in complete unison 11 is best however not to move the patient al all bul to wait for the expert ambulance men Strains and Sprains A strain is an injury to a muscle or tendon A sprain is an injury to a joint With both strains and sprains the first aider s prime duty is to make sure that other and more serious injury is not being passed by undetected Often the decision will be beyond him indeed even the most experienced expert may need an x ray to make sure It follows that if there is the least doubt the patient should be referred to a trained nurse or doctor Sirains The story of a strain is usually characteristic Sharp pain in a muscle or tendon follows a sudden effort The affected part is held stiff The muscles most commonly strained are those of the back A severe strain may involve the complete rupture of a muscle or tendon The pain is more severe there may be great swelling and the affected part cannot be moved Such cases will probably need surgical treatment A simple strain need not be rested active movement from the start hastens recovery To relieve pain a cold compress may be applied Treatment with an infra red lamp is also helpful though such treatment is outside the scope of first aid it is ·Care of Fractures Strains and Sprains DANGER FORBIDDEN FIG 37 How not to more a patient with an injured back It is called jack krufing If the spine is injured it is certain to cause damage to the spinal cord Such patients often need encouragement to make the necessary effort Here the first aider on the shop floor can play a valuable part He can also offer certain practical advice A plaster splint should not be covered with a rubber glove the retained sweat softens the plaster For similar reasons it is important not to rub a plaster or to get suds or water op it The patient with crutches or in plaster must be encouraged to move around from time to time and not remain sitting in one place The rubbers on the ends of crutches must be in good repair ·69 Care of Fractures Strains und Sprains often available in the factory medical department or industrial health centre Many industrial strains particularly those of the back can and should be pre vented Modern mechanical handling methods can get rid of much back breaking toil When manual labour cannot be avoided its proper technique should be learnt the motive power should come from the hip and thigh muscles with bending at the hips and knees rather than from the back muscles with bending at the spine (Fig 39) There is too a right and a wrong way to carry heavy objects (Fig 40) • Sprains Sprains are produced by the same kinds of injury which produce fractures Indeed both are often present and it is only possible to make sure no bones are broken by taking an x ray picture In a sprain the ligaments and other soft parts around the joint arc cither stretched or actually torn The story is usually of either a twist or a wrench There is pain at the point of injury and the joint is held stiff Swelling may be considerable Among the commonest sprains are the footballers sprained knee and the sprained external ligaments of the ankle Like strains sprains are best not rested but moved actively from the start A cold compress will relieve pain Cotton wool and a firm bandage will give comfort this is the best first and treatment If the pain 15 not too bad the boot should be left on as it makes a good splint the laces however should be loosened if the pain is very severe the cause is usually pressure from the swelling the boot must then be removed Once the boot is taken off it will be hard if not impossible to get it back on again Dislocations A dislocation is the displacement of one or more bones at a joint Dislocations are much less common than either fractures or sprains There is loss of movement in the dislocated joint and the joint looks peculiar The pain is often described as sickening Often the patient can tell what has happened with some joints it may have happened before The joint most commonly dislocated is the shoulder usually following a fall on the outstretched band next the jaw usually following a big yawn next the ankle usually with a fracture as well Thumb and finger joints are sometimes dislocated especially at football It needs great violence to dislocate either the elbow or the knee The first aid treatment is to support the part beyond the dislocation in the post tion of greatest comfort and to get expert help The first aider must never himself try to put back a dislocation as by doing so he may cause a fracture Ancelle t p mphlet ufas and Ce si : pice Is As recently been publ hed by HY Stal onery ome for the Multy of Labour und Nional Service ·68 Care of Fractures Strains and Sprains a be FIC 39 Lifting a heavy weight (a) The wrong way is 10 use the muscles of the back under great strain these muscles may tear o a weak spinal disc may slip The feet are together the knees are straight and the back is bent (b) The righr war is to use the great muscles of the hips and thighs The feet are apart the knees are bent and the back is straight ☺ b FIG 40 Holding an iron bar (a) The i rong wou with the arms al an angle to the chest and both hands on the same side of the bar places unnecessary strain on the comparatively weak shoulder joints and on the fingers the bar can easily slip and injure the feel (b) The night way involves a minimum of physical effort and reduces the chances of the bar shipping ·Care of Fractures Straits and Sprains 69 often available in the factory medical department or industrial health centre Many industrial strains particularly those of the back can and should be pre vented Modern mechanical handling methods can get rid of much back breaking toil When manual labour cannot be avoided its proper technique should be learnt the motive power should come from the hip and thigh muscles with bending at the hips and knees rather than from the back muscles with bending at the spine (Fig 39) There is too a right and a wrong way to carry heavy objects (Fig 40) * Sprains Sprains are produced by the same kinds of injury which produce fractures Indeed both are often present and it is only possible to make sure no bones are broken by taking an x ray picture In a sprain the ligaments and other soft parts around the joint are either stretched or actually torr The story usually of either a twist or a wrench There is pain at the point of injury and the joint is held stiff Swelling may be considerable Among the commonest sprains are the footballer s sprained knee and the sprained external ligaments of the ankle Like strains sprains are best not rested but moved actively from the start A cold compress will relieve pain Cotton wool and a firm bandage will give comfort this is the best first aid treatment not too bad the boot shauld be left on as it makes a good splint the laces however should be loosened if the pain is very severe the cause is usually pressure from the swelling the boot must then be removed Once the boot is taken off it will be hard if not impossible to get it back on again If the pain is Dislocations A dislocation is the displacement of one or more bones at a joint Dislocations are much less common than either fractures or sprains There is loss of movement in the dislocated joint and the joint looks peculiar The pain is often described as sickening Often the patient can tell what has happened With some joints it may have happened before The joint most commonly dislocated is the shoulder usually following a fall on the outstretched hand next the jaw usually following a big yawn next the ankle usually with a fracture as well Thumb and finger joints are sometimes dislocated especially at football It needs great violence to dislocate either the elbow or the kpee The first and treatment is to support the part beyond the dislocation in the posi tion of greatest comfort and to get expert help The first aider must never himself try to put back a dislocation as by doing so he may cause a fracture Ane cell mphlt Lift ? Office f the M nu try of Labou а са глу рce 1 1 ecently been pol hd by HM St tion ry ·70 Chapter 8 Burns and Scalds, Electrical and Heat Injuries A burn is tissue damage produced by dry heat a scald is damage by wet heat Tissue damage produced by the direct action of a strong chemical is referred to as a chemical burn The seriousness of any burn depends on four factors area depth part of body affected and the age of the patient Area of Burn The skin area involved in a burn is more important than the depth Even a super ficial burn involving more than 5 per cent of the body surface is serious if more than 15 per cent of the surface is involved the condition is extremely dangerous and the patient may die of shock unless blood transfusion is started within an hour or so In all large burns there is severe shock due to the great quantities of fluid lost both from the raw surface and into the damaged tissues as shown by the swelling of the burnt part Naturally the larger the burnt area the greater the shock Burning sterilises the tissues but the damage and the exposure of a large raw area greatly increase the chances of subsequent infection The greater the area the greater the infection risk Good first aid will help to keep the burn clean and infection free bad first aid may itself introduce infection Depth of Burn For practical purposes two depths of burn have to be recognised Superficial burns Only the outer layers of the skin are affected The burnt area goes red and blisters may or may not form Pain is considerable but the burn usually heals rapidly as a rule there is little scarring Large superficial burns produce considerable shock Deep burns All the layers of the skin are damaged and the fat and muscle beneath the skin and even the bone may be involved The burnt area is yellowy white or actually charred If the skin is completely destroyed there will be less pain than in superficial burns because the sensitive nerve endings in the skin will also have been destroyed Deep burns often become infected They heal very slowly and scarring is often serious I est m tieth tent of th bu 1 wJI be fod h Ipf I Th body v fac ene tly od ffi tly cu ly fo fi d purp ptage as each im 9 per cent head and n k 9 pe cele 18 18 pe cent front of tr b ck of trunk 18 per cet tb rulot to the flow & did s upc k 18 P ent ·Burns and Scalds Electrical and Heat Injuries Part of Body Burns of the face and hands are more serious than burns of corresponding size elsen here because quite small scarring may upset both function and appearance Age of Patient Children and old people react badly to severe burns Moreover they are particu larly liable to extensive burns Vanetes of Bum Dry heat burn may be caused by contact with hot metal-for example a soldering iron or an unprotected hot water bottle The burn is sharply localised and may be superficial or deep Fire burn may follow a blow back from a boiler or involvement in flaming petrol or other solvent or a burning building the clothes usually catch fire Such a burn often covers a large area parts of it may be superficial and other parts deep Charred clothing may be stuck to the burn The patient is usually very shocked Sunburn may follow exposure to natural or artificial sunlight It is very super ficial but there is often considerable reddening and blistering Friction burn is a rare type of burn It is caused through catching hold of a rapidly moving rope - for example a haulage rope in a mine Electrical and chemical burns will be considered in detail later Her burns or scalds may be caused by steam hot water hot oils fats (for example cooking fat) hot solvents or tar They are usually superficial but are often extensive and therefore serious They are common among young children especially when a child tries to get a kettle or saucepan off a stove Atomic flash burn is caused by the flash of intense heat from an exploding atomic bomb The heat generated is so great that although only instantaneous it can cause superficial burns on the exposed skin of people two miles away Complete protection is given by anything which shades the skin from the white hot flash-for example clothing buildings or trees Flash burns are serious only if the area of skin is large First Aid Treatment of Burns In treating a burn or scald the objectives are to prevent shock avoid infection and relieve pain The first aider must not allow anything bacteriologically dirty to be put on the burn-for example grease or ointment from some dirty old por which has been standing on an open shelf for months or years He must not touch the burn with his hands and should speak as little as possible until the burn has been covered with a clean or sterile dressing For treatment purposes burns are divided into trivial medium and serious The first aider can safely treat the trivial burn himself but any medium burn that is to say one larger than a farthing or an average cigarette burn ought to receive expert treatment from a trained nurse or a doctor so that the chances of infection may be kept to a minimum The serious burn involving more than a few square inches of skin will be sent direct to hospital ·72 Burns and Scalds Electrical and Heat Injuries FIG 41 Applying tulle gras dressing 10 a minor burn The dressing Is held in place at one corner with forceps while the ship of grease proof paper is pulled off with the free hand Trivial Burns Trivial burns should be carefully cleaned with cetrimide or soap and water and cotton wool in the same way that minor wounds are dealt with After cleaning the bum and surrounding skin should be dried with clean cotton wool and covered with 20 individual sterilised tulle gras dressing The dressing is contained between two slips of transparent paper One slip is pulled off and the dressing still attached to the other slip is applied The second slip is then quite easily removed leaving the sterilised tulle gras in place In applying the tulle gras the first aider must take care not to touch the dressing except at the corners or edges jo separating it from the slip of paper forceps will be helpful (Fig 41) If the tulle gras is too farge it should be cut to the right size before the slips of paper are removed The tulle gras is ·73 Burns and Scald's Electrical and Heat Injuries covered with a small individual sterilised dressing an individual plaster or clean cotton wool and a roller bandage If there is a blister it should not be pricked and the first aider should not try to remove dead skin Medium Burns Since thorough cleansing of the burnt area will be undertaken by the doctor or nurse the first aider s duty 15 simply to cover the burn with one or more individual sterilised dressings and to get the patient to the expert as quickly as possiblc There is no point in putting tulle gras on any burn which is to be efficiently cleaned within an hour or so any oil or grease applied by the first aider simply makes the cleaning more difficult Serious Burns attempt must be made to clean the burn or to remove the clothes or to pull away any charred clothing which has stuck to the burn the burning will itself have sterilised the whole area The burnt area must be quickly covered with one or more large sterilised individual dressings If the area burnt is too extensive even for this a clean towel or sheet may be used as a covering At hospital cleaning will be undertaken with full surgical precautions in an operating theatre Rapid replacement of body fluid lost is the hfe saving treatment in such cases so rapid transport to hospital is Literally vital As a rule attempts to carry out blood transfusion or even intravenous saline infusion outside hospital do more harm than good by delaying full scale controlled fluid replacement They are now resorted to only when the patient is trapped and cannot be quickly released or where the journey to hospital will probably take a long time The general treatment of shock as set out earlier must be followed If the patient is thirsty he may wash out his mouth and spit out Only if there is likely to be considerable delay in getting the patient to hospital may water drunk 10 small sips only be permitted larger quantities of fluid taken suddenly may cause vomiting With small burns hot sueet tea is harmless and comforting and may be given Rescung from a Burning Building The following rules should be observed in rescuing a patient from a burning building 1 The rescuer should cover his nose and mouth with a cloth soaked in cold water This helps to keep the hot over dried air out of the lungs 2 He should cra xl on his hands and knees Because hot air and smoke rise the coolest and purest air is to be found nearest the floor 3 He should feel any door he comes to before opening it If it is very hot it should be opened with great caution so that he is not caught in a blast of bot aus and fame which may come out 4 The patient will probably be best moved by tying his hands together and hitch ing his arms over the rescuers neck The rescuer can then crawl along pulling the patient s body beneath his own body Further details of the neck drag 25 this method of transport is called will be given later ·74 Burns and Scalds Electrical and Heat Injuries Danger from Fire Extinguishers Many fire extinguishers work on the principle of releasing a non inflammable gas much beavier than an Two of these gases are carbon tetrachloride (used in the Pyrene extinguisher) which us 5 3 times heavier than air and metbył bromide which is 33 times heavier than art and unlike carbon tetrachloride has ao smell Both cherucals are effective fire extinguishers but both may be poisonous ?f inhaled Carbon tetrachloride is the less dangerous of the two but at high temperatures may be converted into dangerous phosgene gas If fire extinguishers have been used the gases produced will be concentrated at floor level and crawling on the hands and knees will no longer be the safest approach for the rescuer Electric Bums Electricity may cause burns electric shock or both Burns occur ar be points of entry of an electric current that is the points of contact with a live conductor A common cause is worn electric cable of a portable hand tool such as a soldering iron or drill especially if there is madequate earthag A much more severe bura with extensive charring of the tissues will follow contact with a high tension supply Indeed the heat and destruction from a high tension contact are so great that the path of conduction is broken and the worker runs away with his clothes on fire A mild electric current may produce a pattern on the skin like the branches of a free or the meshes of wire netting This is probably because the electricity flows along the trickles of sweat on the skin A moderate current will produce a dry shrivelled burn with great pain - much more than from a heat burn of the same size There is little or no reddening around the burn and the burnt tissue takes the form of a cone with the point inwards extending down from the skin into the deeper structures Quite a small burn may involve tendons and other important structures and this may not be apparent for three or four days Sometimes as well as the burn at the point of entry of an electric current there may be a similar burn at the point of exit For example where the entry burn is on the hand there may be an exit burn on the foos Treatment Even the smallest electric burn should be covered with a clean dry dressing and referred to a nurse or doctor The devitalisation of the tissue around the bum will delay heahag and increase the risk of infection The best treatment may often prove to be a small skin graft usually applied in the out parient department Electnc Shock Electric shock is the general bodily reaction to the passage of an electric current It may vary from slight tngling to sudden unconsciousness looking just like death But the first aider must never presume death in electric shock for the breathing may stop and the pulse vanish yet life can still be restored Direct current is said to be less dangerous than alternating current for the following reason Direct current produces a single violent muscular contraction which tends to throw the patient away from the source of the shock Indeed the resulting fall 15 as likely to cause injury as the shock itself By contrast alternating current produces continuous muscle spasm which may cause the affected muscles of the arm and hand to grip involuntarily the ·75 Burns and Scalds Electrical and lical Injuries source of clectnc supply So a continuous prolonged shock is more likely For this reason an electrician who is unwise enough to test a source of alternating current by touch will do so with the back of his hand! Voltages under 150 250 are rarely fatal and occasionally 800 volts have been survived The lowest fatal voltage ever recorded was 38 A great deal depends on the contact between the source of electricity and the skin and between the skin and the ground I the skin clothes or shoes are wet or moist the shock is correspondingly greater and its effects correspondingly worse A metal floor will also increase conductivity A person who rs fatigued stands shock worse than one who is fresh With very high voltages the current usually does not penetrate the body deeply because the electrical pressure is so great that the tissues and conductors are destroyed Ordinary domestic ac current alternates at 50 cycles per second Such a current can just be felt if it is of one milliamp By contrast a DC current has to reach 5 milliamps before it is perceptible One hundred milliamps AC is the usual minimum fatal current but as low a figure as 20 milliamps ac has caused death The length of duration of exposure to a current is very important with exposures of over 5 seconds the danger of serious injury is great The skin has a very high electrical resistance about 3 000 ohms of dry and healthy Once this resistance is overcome the current follows the internal water courses of the body A current passing from leg to log does less harm than one passing from arm to leg since the latter will pass over and often damage the electrical mechanism of the heart A current passing from head to leg as in judicial execution will travel via the fluid around the brain and spinal cord damaging vital electric control centres on its way Most electric shocks occur among works and maintenance engineers A third of all fatal electrical accidents are due to portable electrical apparatus and hand tools A severe electric shock may occur during electric welding where a sweaty worker is lying in contact with a metal sheet which may become live A fatal shock may be caused by a jib crane fouling an overhead cable or a metal strip may touch the live overhead wires feeding an electric gantry Symptoms These may vary from muscle spasm and pain to unconsciousness and even deep coma The muscle spasm may be momentary with a single direct current shock or continuous from alternating current Pain in the affected muscles may be intense Inasmuch as the patient cannot overcome the spasm of the muscles by an effort of will the muscles are effectively paralysed as long as the shock continues If it is strong enough the electric current may paralyse the breathing muscles or put the breathing control centre in the brain out of action It cannot be too strongly emphasised that such a paralysis is usually transitory At the same time the electric current may partially paralyse the heart muscle As a result the heart beats rapidly but feebly in a state of flutter in this state although the blood is still circulating the pulse cannot be detected It follows that absence of both pulse and respiration in a patient unconscious from electric shock are not signs of death Prolonged artificial respiration may yet save life Treatment Speed and coolness are essential and may be life saving The first move is to dis connect the patient from the source of the electricity 1 Switch off the current ? If this is impossible pull or push the patient away from the source of the ·747 Burns and Scalds El ctrical and Hear Injuries Danger from Fire Extinguishers Many fire extinguishers work on the principle of releasing a non inflammable gas much heavier than air Two of these gases are carbon tetrachloride (used in the Pyrene extinguisher) which is 53 times heavier than air and methyl bromde which is 33 times heavier than air and unlike carbon tetrachloride has no smell Bath chemicals are effective fire extinguishers but both may be poisonous if obated Carbon tetracbloride is the less dangerous of the two but at high temperatures may be converted into dangerous phosgene gas If fire extingunshers have been used the gases produced will be concentrated at floor level and crawling on the hands and knees will no longer be the safest approach for the rescuer Electric Burns Electricity may cause burns electric shock or both Burns occur at the points of entry of an electric current that is the points of contact with a live conductor A common cause is worn electric cable of a portable hand tool such as a soldering uron or dall especially if there is inadequate earthing A much more severe burn with extensive charring of the tissues will follow contact with a high tension supply Indeed the heat and destruction from a high tension contact are so great that the pash of conduction ss broken and the worker runs away with his clothes on fire A mild electric current may produce a pattern on the skin like the branches of a tree or the meshes of wire netting This is probably because the electricity flows along the trickles of sweat on the skin A moderate current will produce a dry shrivelled burn with great pain-much more than from a beat burn of the same size There is little or no reddening around the burn and the burnt tissue takes the form of a cone with the point inwards extending down from the skin into the deeper structures Quite a small burn may involve tendons and other important structures and this may not be apparent for three or four days Sometimes as well as the burn at the point of entry of an electric current there may be a similar burn at the point of exit For example where the entry burn is on the hand there may be an exit burn on the foot Tredlersent Even the smallest electric burn should be covered with a clean dry dressing and referred to a nurse or doctor The devitalisation of the tissue around the burn will delay healing and increase the risk of infection The best treatment may often prove to be a small skin graft usually applied in the out patient department Electric Shock Electrt shock is the general bodily reaction to the passage of an electric current It may vary from slight tingling to sudden unconsciousness looking just izke death But the first aider must never presume death in electric shock for the breathing may stop and the pulse vanish yet he can still be restored Direct current is said to be less dangerous than alternating current for the following Teason Direct current produces a single violent muscular contraction which tends to throw the patient away from the source of the shock Indeed the resulting fall us as likely to cause injury as the shock itself By contrast alternaung surrent produces continuous muscle spasra which may cause the affected muscles of the arm and hand to grip involuntarily the ·Burns and Scalds Electrical and llcar Injuries 77 is lost as saral, or if the surrounding air is so full of water vapour that the sweat cannot evaporate the body cuts down on further sweating and the internal tem perature starts to rise If this is allowed to continue rue heat stroke develops Symptoms Heat exhaustion The skin is clammy and the patient irritable he complains of SCYTTC Cramps in the limbs Early heat stroke The skin is hot and dry and the irritability and cramps are much more severe Second stage of heat stroke The patient may be found unconscious breathing hard and sometimes twitching a little The skin is dry red and burning hot Prevention Among those specially liable to heat exhaustion and heat stroke are stokers especially marine stokers the ICS steel workers and miners So workers at furnaces and in foundries glass works and other very hot places should be provided with special salt drinks ad lib which may be flavoured with orange or lemon and glucose The workers concerned soon learn for themselves how much salt drink they require to meet their differing individual needs Working in air tight rubber protective clothing may produce heat exhaustion and beat stroke especially if the weather is warm The layer of air between the skin and the protective clothing soon becomes saturated with sweat so that an artificial humid atmosphere is produced If such clothing is essential for heavy work its outside should be soaked in cold water The evaporation of this water will cool down the worker inside la very hot conditions as much as half to one pint of sweat may be lost per hour and this must be made good by fluid intake Treatment The patient should be removed from the heat stripped to the waist and bathed or sprinkled with cold water He should then be fanned with towels to encourage the evaporation of the water wbich will cool the patient still further These cooling processes must be stopped when the patients temperature has fallen fo 100 degrees Fahrenheit. If the patient is conscious or as soon as he becomes conscious he should be given copious draughts of cold water with a saltspoonful of common salt per tumbler and orange or lemon to improve the taste On recovery the patient should rest quietly for a time the length of the rest depending on the severity of the attack All cases of heat exbaustion or heat stroke should be seen by a doctor or nurse before returning to work Sunstroke This is usually a combination of heat exhaustion and ordinary fainting It is parucularly liable to occur in those who are suddenly exposed to the heat in un suitable clothing Its treatment is the same as for heat exhaustion ·76 Burns and Scalds Electrical and Heat Injuries electricity while taking great care not to make clectrical contact with cither the ground or the patient (a) Stand or kneel on a dry non-conductor such as a dry rug mackintosh or rubber mat (b) Pull or push the patient anay from the source of the electricity again using a dry non conductor Considerable force may be needed to get the patient free If the patient has to be grasped use special lieavy rubber gloves or dry sacking a dry coat or several thicknesses of dry paper Domestic rubber gloves give no protec tion against high voltages If a crooked stick is available this may be used but not an umbrella since it has metal ribs (c) Avoid contact with any part of the patient which may be moist for example the arm pits or crutch or the face which may be wet with spittle 3 With very high voltages - for example at clectricity stations or in overhead wires - the patient will usually have been thrown clear If not the danger to a rescuer while the current is still on is very great and all possible precautions must be taken Every effort should therefore be made to get the electricity workers to switch off the current before rescue is attempted Once the patient has been rescued from contact with the electric source of breathing has ceased or is very feeble artificial respiration should be started at once using the methods described later At the same time the standard treatment for shock in an unconscious patient should be applied but this definitely takes second place to artificial respiration Since artificial respiration may have to continue for an hour or more a rocking stretcher is of the greatest value In about half of all electrocution cases with cessation of breathing there is rc covery with artificial respiration nine out of ten patients who start breathing again do so within half an hour of artificial respiration being started There is no record of recovery after electrocution where artificial respiration has had to continue for more than an hour But carry on' Yours may be the first case Delay in starting artificial respiration can prove disastrous If it is started at once 70 per cent of the patients recover If there is more than three minutes delay only 20 per cent recover The lesson here is obvious First aid workers should get to know the position of the electrical switches in the part of the factory for which they are responsible Heat Injuries True heat stroke is a rare and somewhat dangerous condition which occurs when the overheated patient has neglected treatment and continued for some time in a very hot environment The first and much more common effect of too much heat is heat exhaustion This is also known as miners or stokers cramp Cause The essential cause is loss of too much body water and body salt as a result of too little replacement to make good what has been lost by sweating Sweating is part of the natural mechanism of cooling the body It is not the production of sweat but its evaporation from the body surface which uses up body heat and so lowers the body temperature If the body is getting too little water and salt to replace what ·Chemical In}unies and Poisons 79 Mitric acid is a fuming liquid acting even more quickly than hydrochloric acid It is used in the chemical explosives and pottery industries It produces a yellow brown skin burn Nitro in drochloric acid is a mixture used for cleaning glass ware Sulphuric acid is used in metal pickling copper cleaning and in the electric battery and chemical Industries It is similar in action to nitric acid Slon-acting Acids With slow acting acids there is no immediate pain so that the patient may not know that he has been in contact with the acid for a period of half an hour to four hours By then the acid will have penetrated deep into the tissues Hidrofluoric acid a powerful and dangerous acid is used for cleaning and etching glass removing faults from pottery and so on The affected skin becomes dead white Inhalation of its fumes may produce ulcers inside the nose Hidrobromic and is a similar but rather less powerful acid and is used in the photo graphic industry Carbolic acid and the phenols cresols and lysols all act similarly Long contact may lead to burns or even absorption through the intact skin The exposed skin is dead white and puckered Oxalic acid used in printing dyeing leather and straw hat making is the slowest acting of the four It affects particularly the fingers and may damage or destroy the nails Similar damage around the nails may be produced by selenious acid used in rectifier manufacture and for photo-electric cells Treatment of Acid Splashes Again it must be emphasised that with either type of acid speed is vially important | Wash off the acid immediately with a large volume of water from a tap shower or bath Go on washing until the neutralising antidote is available 2 If water is not available the acid should be dabbed off the skin with cotton wool a clean rag or a handkerchief Any wiping movement must be avoided for this tends to spread the acid 3 If an antidote is immediately available in large quantity it should be used instead of water but it must be used freely and copiously If there is only a small supply it should be applied as soon as the affected part has been completely fio del and douched with water The antidote here recommended is buffered phosphuc solution which has the valuable property of neutralising both acids and alkalis. If this is not available a solution of bicarbonate of soda ( tablespoonfuls to o pint of water) may be used The effectiveness of buffered phosphate solution may be demonstrated to a cas tu using bromo thymol blue indicator A rack of test tubes and some dilute said : Jalas will be needed Bromo thymol blue turns yellow with acid ad deep blue whale in the presence of the class enough buffered phosphate s lution is added to either the acid or the alkali an apple green colour is produced, indicating deutralisauce a swing over in the opposite direction For successful demonstrator : Lerou experimenting is needed with the amount and strength of aad 293 7'11' 12.11 21 to the indicator Otherwise the test tube may not helt enou bufered frog ng lurre full neutralisation 4 If the clothes are contaminated with acd they should be removed in Bhed pho phate Jut on muy bobt ned from : des or KH PO 1.2 HPO 10 free upes la - 1 Lt mun dedici form la 5 tlled w ·78 Chapter 9 Chemical Injuries and Poisons Injuries and buras due to chemicals are far more common in industry than in domestic life Chemical substances may harm the human body in three ways by directly burning the skin or eyes by irritating the skin so that dermatitis is pro duced and by entering the body and causing rapid or slow poisoning Almost all chemical substances can cause trouble if misused if used with vader standing and proper care however they can be handled with complete safety in this type of work in particular prevention is better than cure and in planning prevention management and workers must co operate fully This applies u th equal force to measures for early and prompt treatment Chemucal Burns Chemical burns may be caused by acids or alkalis In either case speedy treatment is vital The acid or alkalt must be washed off at once or at least greatly diluted by flooding the affected part with large volumes of water Thus if no special antidotes are available a chemical splash in the eye should be treated by holding the eye open under a running cold tap or by plunging the upper part of the face into a bucket of cold water and blinking hard Similarly an acıd or alkah splash on the skin should immediately be held under a running tap To lay people the word antidote has an almost magical significance Hence there is always the danger that with chemical burns precious minutes may be lost hunt lag for an antidote when speedy treatment with water will do far more good The best antidote of all is plenty of water applied quickly Only after this has been done should time be given to finding and applying the correct chemical antidote unless of course a large volume of antidote is immediately at hand Acids Acids may be quick acting or slow acting The chief nisks come from filling transporting and emptying carboys and from accidental spilling and splashing Those without technical training for example cleaners in laboratories run special risks and should be carefully instructed in the necessary precautions Quick acting Acids With quick acting acids the patient feels irritation and burning almost at once Hydrochlonc acid is used a pickling vats metal wire drawing the manufacture of other acids etc It produces a dark brown blister which later turns black ·81 Chemical Injuries and Poisons Tar Burns Burns caused by tar should be covered with a dry dressing and the patient referred to a trained nurse or doctor Solidified tar is itself a good dressing so no attempt should be made to remove it Chemical Injancs to the Eye Eye injuries are dealt with initially in much the same way as chemical injuries to the skın using water and buffered phosphate solution They will be considered in detail later Chemical Skin Irritation Dermatitis or inflammation of the skin is of great importance in industry Almost any chemical substance can produce dermatitis in a person whose skin is sensitive yet others can handle the same substances with complete impunity An extreme example is dermatitis produced by water in some washerwomen A strongly alka line soap may also produce dermatitis Some substances are particularly liable to cause trouble for example acids and alkalis solvents and degreasers detergents oils and fars glues synthetic resins plasticisers and accelerators metallic irritants such as mercury and arsenic nickel and cyanide and sugar flour and certain woods At the same time it must be remembered that many skin complaints are not caused by occupation or chemical irritation of the skin These non industrial skin complaints are equally liable to lead to absence from work if neglected They do not of course entitle the sufferer to industrial injury benefit The first aider should never attempt to deal with a case of industrial dermatitis or indeed any other skin condition His job is to encourage treatment by an expert at the earliest possible stage Delay makes treatment far more difficult and exposes others to the same risk Here again prevention is a matter for the factory management and the doctor and it must be individually planned wherever there is a real risk It involves the proper planning of the job the personal cleanliness of the worker and the use of a carefully selected barrier cream or other physical protection Hence the proper hygiene of wash places and lavatories and the changing and cleaning of protective clothing are of great importance The first aider may have special duties here He may also help by directing the attention of the factory authorities to any possible hazard or risk Remember that the most important single way of preventing indus trial dermatitis is personal cleanliness Industrial dermatitis is not a notifiable industrial disease in the legal sense (see below) But the sufferer is entitled to cash benefit at the industrial injury rate Chemical Poisons Chemical substances may enter the body through the skin the lungs or through the stomach and digestive system The subject of industrial poisoning is a vast one most of it being outside the range of the first aid worker He must however know how to deal with such emergencies as may arise and be aware of the existence of certain possibilities ·80 Chemical Injuries and Poisons possible {f not immediately possible tbe affected area of clothing should be flooded with water or antidote If so doubt swill everywhere 5 Slow acting acids should be dealt with as abase but special treatment by a trained nurse or doctor will be needed to neutralise any acid which has penetrated into the tissues For example calcium gluconate may have to be injected under a hydrofluoric acid burn 6 It follows that every suspected case of a slow acting acid burn should be seen by a trained nurse or doctor as soon as possible after initial first aid treatment with quick acting acids the same applies if after ital treatment the skin shows any change or the patient feels an; adverse effects or if the quantity of acid involved was at all considerable Prevention The prevention of chemical buens is a matter for the management as a whole often in onsultation with the factory medical officer This will include the pro vision of first and facilities at all danger points These will be described later when cye injuries are dealt with The factory medical officer must make sure that the workers and first-aiders directly concerned know how to use these facıhtres Alkalis Generally speaking alkalı burns are more serious than acıd burns because the alkalis tend to penetrate quickly into the tissues and to go on acting even after thorough washing and neutralisation Thus alkalis closely resemble the more dangerous slow acting acids An alkalı burn is therefore usually worse than 16 appears at first Once the alkalı has penetrated the skin appears pallid and sodden and later a deep slow healing ulcer may develop The main alkabs used in industry are caustic soda caustic potash ammonia bleaching powder lime and cemeat They are used in a wide variety of chemical processes includes the making of soap paper dyes and detergents as well as for cleaning wool barrels and enamel and in the building industry Treatment of Alkol Splashes First aid treatment is exactly the same as for acids with the first emphasis on speedy complete washing with a large volume of water this may be followed by buffered phosphate solution If the solution is avaslable is a large quantity 16 may be used instead of water from the start Some first aid books suggest that if no buffered phosphate solution is at band dilute vinegar (two tablespoonfuls to a pint of water) or citric acid tablets dissolved in water may be used but these are unlikely to be available in a factory in any event they add little to the benefit of the water douche With lime bleaching powder or cement sold particles should be removed from the skia before the part is flooded with water as water makes them stick Removal is best done with a piece of cotton wool or a soft brush All alkal injuries should be seen by a tramed nurse or doctor at the earliest possible moment The provision of first and facilities at danger points is even more important with alkalis thao with acids ·83 Chapter 10 Unconsciousness, Gassing and Asphyxia The first aider who is faced with a patient who has been found or has become unconscious is not called on to make a diagnosis He must however make an immediate assessment of what has happened Ascertaining the Cause There are three kinds of situation - (1) where the cause is obvious (2) where it is probable and (3) where the first aider can see no obvious cause it is vitally import ant to make this assessment since the first step in first aid is to remove the unconscious person from danger and this can be done only after a broad decision about the probable cause has been made Where the Cause is Obvious Some circumstances in which the patient is found show fairly clearly what has happened - for example where unconsciousness is due to partial drowning electric shock head injuries or attempted suicide The patient who has attempted suicide may be found hanging or with his bead in a gas oven and a pillow under the head or in bed with an open bottle of tablets beside him in these circumstances the first aider must not try to be an amateur detective His job is to waste no time and save life if he can Where the Cause is probable In a situation where the cause of unconsciousness is probable we are concerned almost entirely with accidental gassing wh ther domestic or industrial Domestic gassing may occur in a bathroom owing to a defective geyser or in a bedroom owing to a gas fire blou ing out when the patient is asleep Gassing 10 industry may have many different causes The first aider should know of the existence of risks in any particular processes in his factory Some common industrial processes always have a certain risk Thus flues and boilers may develop defects causing gas or exhaust to blow back into the stoke hole this may result in asphyxia or unconsciousness Similarly workers in deep hol s and mines are subject to special risks No Obvious Outside Cause As a rule the first aider will not be able to make an accurate diagnosis in cases ·82 Chemical Injuries and Poisons The direct action of chemicals on the skin has been dealt with above But certain chemicals for example chrome and nickel may produce ulcers in the skin or in the membrane lining the nose Such ulcers are known as trade holes Fortunately these are now extremely rare Certain other chemicals can penetrate the skin with out damaging it in consequence they have to be handled with great care and circumspection in these cases safeguards are laid down by law Gases fumes and dusts are important hazards in certain industries They will be dealt with in detail later Many dusts though unpleasant are not poisonous But dusts containing particles of silica of a certain size are liable over the years to produce severe lung damage These risks are now well appreciated and preventive measures are general Nevertheless laxity on the part of those involved may break the preventive chain here the first aider can help both by example and precept Chemicals entering via the mouth stomach and digestive system are of compara tively small importance in industry Very rarely are there surrides and accidents More important dirty hands may contaminate food This emphasises the impor tance of washing the hands before food is eaten and where chemical processes are involved of pot eating on the factory floor Notifiable Industrial Diseases As a result of the Factories Acts and the work of the factory inspectors the well known industrial poisons have been very largely brought under control These poisons mainly cause symptoms of very slou onset and are therefore seldom seen by the industrial first aider Fourteen different industrial diseases and conditions are notifiable by doctors and employers to the factory inspectorate of the Ministry of Labour These are lead Poisoning by phosphorus manganese arsenic Anthrax Compressed air illness (Carsson dis ase) Tosic jaundice mercury carbon bisulphide aniline benzene Toxic anaemia Chemical skin cancer Ulceration due to chromium If a first aider suspects erther a process or an illness he should let hrs factory manage ment know at once The matter can then be investigated and the Ministry of Labour appointed factory doctor informed if there is a prima facie case for doing so Under the Industrial Injuries Act a much longer frst of diseases is included A sufferer from any of these or from an industrial injury is entitled to cash sickness benefit at the special industrial Injury rate The patient himself has to make the necessary claim by filling in Part III B of the ordinary First Medical Certificate issued by the patients own general practitioner This certificate is then sent by the patient to the local Ministry of Pensions and National Insurance office An addi tional fourteen chemical substances besides those which cause noufiable diseases and a number of processes are covered Full particulars are given in a free Ministry of Pensions and National Insurance leaflet Prescribed Industrial Diseases (N 1 2) ·83 Chapter 10 Unconsciousness, Gassing and Asphyxia The first aider who is faced with a patient who has been found or has become unconscious is not called on to make a diagnosis He must however make an immediate assessment of what has happened Ascertaroing the Cause There are three kinds of situation - (1) where the cause is obvious (2) where it is probable and (3) where the first aider can see no obvious cause it is vitally import ant to make this assessment since the first step in first aid is to remove the unconscious person from danger and this can be done only after a broad decision about the probable cause has been made Where the cause is Obulous Some circumstances in which the patient is found show fairly clearly what has happened - for example where unconsciousness is due to partial drowning electric shock head injuries or attempted suicide The patient who has attempted su cide may be found hanging or with his head in a gas-oven and a pillow under the head or in bed with an open bottle of tablets beside him in these circumstances the first aider must not try to be an amateur detective His job is to waste no time and save life if he can Ik here the Cause is probable In a situation where the cause of unconsciousness is probable we are concerned almost entirely with accidental gassing wh ther domestic or industrial Domestic kassing may occur in a bathroom owing to a defective geyser or in a bedroom owing to a gas fire blowing out when the patient is asleep Gassing in industry may have many different causes The first aider should know of the existence of risks in any particular processes in his factory Some common industrial processes always have a certain risk Thus flues and boilers may develop defects causing gas or exhaust to blow back into the stoke hole this may tesult in asphyxia or unconsciousness Similarly workers in deep hol s and mines are subject to special risks NObvious Outside Cause As a rule the first aider will not be able to make an accurate diagnosis in cases ·84 Unconsciousness Gassing and Asphyxia where there is ao obvious external cause though he may have his suspicions It will help bim to remember that there are six common causes which cover most cases of this type fainting fits, strokes diabetes alcohol and hysteria These are referred to below Care of Unconscious Patients Oace the patient has been removed from external danger there are certain general lines of care whatever the cause of unconsciousness which must always be followed 1 Remove the unconscious person from danger If he is not in danger do not attempt to move him 2 Roll the patient over into the prone or semi prone position An unconscious patient may suffocate if left lying on his back The tongue falls back into the throat and may block the entry to the windpipe so also may badly fitting false teeth In addstion salsva or vomited material may be breathed into the lungs with very serious results Often the unconscious patient is seen to be choking struggling for breath and turning blue This may be due almost entirely to obstruction of the air passages as a consequence of lying on the back Many lives have been lost because patients have not been turned over into the prone or semi prone position Prone means face downwards and the elbows bent so that the forearms and hands are under the forchead (Fig 42) Semi prone means that the patients body is on its side his face turned towards the ground To stop the body rolling right over both arms should be bent naturally at the elbows and the upper leg bent slightly at the hip and knee so that it falls forward over the lower leg and acts as a supporting strut (Fig 43) If there is retching or vomiting the semi prone position is to be preferred as the mouth and nose are more easily kept clear Before rolling the patient over make sure that no obvious fractures are present If they are roll the patient over but support the fractured part Rolling should be done firmly but gently moving the whole body into what looks like a natural and easy position FIG 42 The prone position Note the forehead resting on the forearms and hands and the face furnet ven slighil 10 one si le ·85 Unconsciousness Gassing and Asphyria FOC FIG 43 The semi prone posinon Because the patient is uncon cious the collar and trousers have been loosened 3 Remove any false teeth It is important to do this gently so as not to damage either the patient or the teeth The teeth should be wrapped in the patients own handkerchief and put in his pocket If the jaw is tightly closed do not try to force it open 4 Raise the point of the chin with the hand so that the neck is bent slightly back This helps to open up the air passage at the back of the mouth Try it on yourself by dropping your chin on to your chest and then lifting it well up the difference in case of breathing is immediately felt. 5 Loosen any tight clothing especially round the neck or waist 6 If the patient has to be moved he should be lifted carefully on to a stretcher still in the prone or semi prone position and carried in this way Details will be given later Some Don's (1) Do not force fluid (wbisky brandy or anything else) into an unconscious patients mouth He cannot swallow and will probably inhale it and may get pneu monia (11) Don t slap or throw water over him (111) Don & try to transport him sitting up He must be moved lying down in the prone or semi prone position Attempts to sit up an unconscious person for example in the back of a car have proved fatal Internal Causes of Unconsciousness Mention has already been made of raternal causes of unconsciousness Here the general principles for the care of the unconscious patient set out above apply with full force Fainting has been discussed earlier The sufferer is usually a young person and the situation is often suggestive The unconscioustiess is always of short duration Fils are alarming but are usually quickly over They are almost always due to the condition of epilepsy and the patient will often have had previous attacks Happily as a result of the new drugs used to control them epileptic fits are much rarer than they used to be but they may occur if the patient forgets to take his tablets or to bring them with him to work As a rule at the start of the fit the person utters a cry and then falls over The ·86 Unconsciousness Gassing and Asphyxia limbs stuffen and then start to jerk The patient may froth at the mouth bite the tongue pass urine or pass a motion All the time he is quite unconscious and when the volent phase is over he falls into what appears to be a deep sleep This usually lasts only a short time He may hurt himself in falling Never restrain the patient violently This simply makes the fit worse The secret of good first aid is to prevent the patient harming himself Pillows coats and other soft objects placed around him are safer and more effective than human strength Never force the jaws apart in order to prevent tongue biting it is possible to knock out teeth and fracture the jax If the mouth is open it is reasonable and safe to put in a gas This is no more than a wedge to keep the jaws apart One such wedge is a pece of firewood with a clean handkerch ef wrapped round it Another is a stout pencil not less than 5 inches long (Fig 44) Never tell an epileptic patient what his fit is like as he may be quite unnecessarily distressed Unconsciousness during the fit is one natural blessing of the dis ase Strokes are caused by a bursting artery or a blood-clot in the brain Though a stroke is sometimes fatal many patients recover Good first and care as already described above may save life The patient is usually elderly He may feel giddy and may or may not pass out completely As a result of the injury to the brain he usually loses the ability to move one side of the body wholly or in part This involves most obviously the arm FIC 44 A stout pencil used as a gag 10 preveni fongue buung in an epileptic fit Note that the eve balls are rotated upwards so that the pupils are almost out of sighi ·Unconsciousness Gassily and Asphyxia 87 or leg At the same time the other side of the face is also paralysed in an uncon scious patient who has had a stroke the paralysed cheek may be seen flapping in and out each time the patient breathes The fact that the patient has had a stroke is suggested by his age - he is usually in his 50s or 60s the colour of his skin which is usually blue loud harsh breathing called stertorous breathing the flapping cheek and dribbling from the corner of the mouth Treatment is generally as set out above Of course the first aider must snd for skilled help without delay Diabetes People may conceal the fact that they are diabetics from their work mates and from the factory management sometimes with disastrous results It is in their own interest that their condition should be known about at any rate to the management or the factorv medical department No one need be ashamed of suf fering from diabetes since the discovery of insulin the world has been full of diabetics leading useful and happy lives often doing first class jobs The most usual cause of trouble in a diabetic is over action of a normal dose of insulin as a result of physical fatigue excessive work or worry or missing a meal The patient may become giddy confused and even apparently mentally disordered The treatment is to give sugar at once preferably in the form of a sweet drink Skilled help should be sent for Alcohol It must never be assumed that an unconscious patient who smells of alcohol is therefore drunk People who feel giddy often take a drink before passing out Tragedies can occur when an unconscious patient smelling of alcohol is handed over to the police The proper course for the first aider is to send for expert nursing or medical help Hysteria The first aider should never assume that an unconscious patient is hysterical Indeed hysteria hardly ever causes complete unconsciousness Occasionally however a patient usually a young girl but sometimes an older woman or a man will become typically hysterical The situation is usually one of danger or anxiety such as a man made or natural disaster Hysterical bad beba viour like screaming or violent weeping may lead to panic in such circumstances and in such circumstances only firm physical measures are justified to prevent panic from breaking out More occasionally still hysterical behaviour can follow serious injury to or disease of the brain In these cases it appears to be caused by lack of oxygen to the brain tissue This is another reason why hysteria other than the hysteria of panic should be treated with gentle but firm kindness rather than the traditional slap Rescuing a Gas Casualty As gas casualties are of considerable industrial importance first aiders in factories where there are substantial hazards should be fully trained and practised in rescue work The following are the general principles to be observed 1 Before entering a gas filled room or house open or if necessary smash doors and windows so as to get a through or cross draught This will blow gas or fumes away The first aider must be careful not to add himself to the casualty list Courage 1$ no substitute for using one s head ·88 Unconsciousness Gassing and Asphyxia 2 Remember that a damp cloth or towel tied round the face gives no protection against gas 3 If two or more people are present one should stay outside in case the rescuer himself needs rescuing A lıfe line tred round the rescuers waist should always be used It is simply a rope strong enough to pull a man along the ground 4 If the rescue worker has to make a dash into a gas laden atmosphere he should take slowly six really deep breaths then hold his breath and dash in He will be able to hold his breath for three quarters of a minute to one minute at the most 5 In gas-filled places the light is often poor Some gases for example carbon monoxide and methane are inflammable The first aider engaged in rescuing a gas casualty should never use a naked flame 6 Respirators should not be used by the inexperienced or untrained first aider Rescues which require their use also call for an experienced rescue worker The proper use of respirators requires a good deal of practice The first aider who puts one on for the first time in a real action situation may easily panic Types of Respirator Details about the use of the different types of respirator are set out in the instructions issued by the makers of each type and in the St John Ambulance Association occupational first and handbook Filter Respirator The filter respirator is essentially the ordinary civilian or service gas mask The canister and filter must be in good order Protection is only against certain special gases Industrial filter type gas masks have coloured canisters for different gases - for example blue for ammonia and black for bromine chlorine and hydrogen sulphide A respirator of this type gives no protection at all against carbon monoxide or coal gas Flexible hose Respirator Attached to the face prece is a long flexible tube the intake end of which must be fixed in good fresh air The tube may be up to 120 feet long and care must be taken to avoid its kinking There should always be a second man to make sure that the tube is clear all the way Such tubes are commonly supplied for cleaning out tanks-for example Inchlorethylene de greasing tanks When in use a lifeline should be employed as well Oxygen cylinder Respirator The oxygen-cylinder type of respirator is made for an open or a closed circuit With an open circuit the air breathed out from the lungs escapes with a closed circuit il passes through a cylinder which absorbs the Co The air can then be used again It fol lows that with a closed circuit re breathing machine of this type the available oxygen fasts much longer Respirator with Compressed air Cylinder The respirator with a compressed air cylinder is of the open circuit type and there is no re breathing With a typical cylinder (1 200 litre) the rescue worker can do 25 minutes hard work or 75 minutes light work The mask of a respirator mas cover the whole face or the nose and mouth or the mouth only with a mouth only mask a nose clip is required as well with a pose and mouth or a mouth only mask goggles may be needed to protect the eyes ·Unconsciousness Gassing and Asphyxia 89 Indostnal Gases There are four types of gas encountered in industry iritant gases asphyxiating or smothering gases tissue poi oning gases and narcotising gases 1 i Imitant Gases Irritant gases are immediately detected by their effects particularly on the nose and eyes The smell is powerful and the eyes start to water As a rule those exposed fly for their lives Hence these gases are less dangerous than those which are non irritant The common irritant gases met with in industry are as follows Sulphur diouide (50) is used in the manufacture of sulphuric acid and in fumigation and refngeration it also occurs in ordinary smoke Ammonia (NII) is employed in refrigeration and ice making and a number of other industrial processes Chlorine (CI) is used in bleaching paper making etc Phosgene (COCI) mainly of importance as a war gas is produced during the manu facture of some aniline dyes It is also produced when trichlorethylene is inhaled through a lighted cigarette hence the instruction that those using trichlorethylene should not smoke at work Simple Asphyxiating Gases The air we breathe consists of about four fifths nitrogen and one fifth oxygen The nitrogen is inert the oxygen is absorbed by the blood and carried throughout the body to enable the tissues to live without oxygen the tissues die Asphyxiating gases work simply by replacing the oxygen in the air It follows that they must be present in very large quantities to get rid of enough oxygen to do harm Most of them have no smell this makes them the more dangerous The following are the common asphyxiating or smothering gases met with in industry Nitrogen (N) is important for practical purposes only in wells mines and other deep holes where all the oxygen has been used up Absence of oxygen is shown when a safety lamp flame lowered into the hole goes out In mines nitrogen with some carbon dioxide 15 spoken of as black damp or choke damp Methane (CHI) is the gas most commonly met with in mines where it is called fire damp because it explodes of ignited Carbon dioxide (CO) is produced by the living tissues of the body as a waste product and breathed out by the lungs Large quantities are produced in brewing aerating and fermenting It may also be met with in mines tunnels cellars and boilers In mines as mentioned above it is a constituent of black damp Tissue poisoning Gases Small quantities of tissue poisoning gases exert a disproportionate poisonous effect They are absorbed quickly into the blood from the lungs (or even from the mouth) and equally quickly they poison the living tissues by preventing their intake of otygen The common gases under this beading are set out overleaf B1 ck amp #bo t *7 pec nt op n d 13 percet a bond ox d ·90 Unconsciousness Gassing and Asphyxia Carbon monoxide (CO) is perhaps the most important industrial gas poison A consti tuent of coal gas it is also produced when coke coal or petrol is burnt in consequence a blocked flue which causes the products of combustion to leak out into a workplace may produce carbon monoxide poisoning The same result may be brought about by a petrol engine working in a closed space Carbon monoxide may also be met with 19 tunnels and at gas works and in coal mines where it is called after damp because it follows explosions Ordinary coal gas contains 5 per cent carbon monoxide exhaust from a petrol engine 7 per cent carbon monoxide and producer gas 25 per cent Hydrogen sulphide or sulphuretted hydrogen (HS) is cvolved in gluc making and tan ning and may occur in mines In small concentrations it is violently irritating and has a foul smell in large concentrations a man inhaling it may drop down dead Because of its foul smell it is called stink damp Hydrogen cyanide (HCM) is so poisonous that it is usually employed only in the open air Sometimes however it is used for fumigation of premises or dirty fabrics It has a smell of butter almonds and is almost instantly fatal Wherever it is used the makers pre caution card should be exhibited and antidotes should be immediately available Cyanides (liquids not gases) are equally poisonous of taken by mouth Although they are widely used in industry for case hardening and electro plating casualties from therr employment appear to be almost unknown Narcotising Gases Narcotising gases produce anaesthesia or unconsciousness when inhaled by acting directly on the brain They are in fact the anaesthetics so widely used in medicine Any anaesthetic if pushed too far will ultimately prove fatal Some industrial solvents are anaesthetics - for example ether and chloroform The most common anaesthetic used in industry is inchlorethylene employed in du greasing Workers with trichlorethylene tanks must be especially instructed in the precautions needed to avoid gassing The makers placard should be exhibited and read Another even more dangerous substance is carbon tetrachloride used as a solvent a dry cleaner and a fire extinguisher The vapour may cause sudden unconsciousness or 10 small quantities stomach upset and abdominal pain if rendered unconscious by carbon tetrachloride the patient should not be placed on the floor of the room where the accident has occurred as the vapour is five times heavier than air and therefore accumulates on the floor Symptoms of Gassing The symptoms produced by gassing depend on the nature of the gas the amount inhaled and the length of exposure With the irritant gases coughing and watering of the eyes and nose are immediately apparent with the tissue poisoning or narco tising gases the patient quickly becomes unconscious but may retain a good colour With the simple asphyxiating gases there are usually two stages 1 Partial asphyxia The patient feels dizzy and weak and may stagger and col lapse There may be difficulty in breathing with panting and gasping Occasionally there are convulsions especially as the patient breathes out 2 Full asphyxia The patient is unconscious and blue especially at the tips of the body - the nose ears lips and fingers Breathing is first intermittent and then absent. The pulse is first weak and then absent The absent pulse does not neces sarily mean however that the heart has stopped ·Unconsciousness Gassing and Asphyria 91 Treatment of Gassing The treatment of gassing may be briefly summarised removal from danger artificial respiration of breathing has ceased administration of oxygen treatment of shock and general care of the unconscious patient as set out above Dusts and Fumes Many industrial dusts are harmless even if unpleasant Some produce mild symptoms A few are truly dangerous One of the slowly dangerous dusts is that from cotton fibre in textile mills This produces a mild form of bronchitis called byssinosis Exposure over many years may produce more serious results The most dangerous dusts are those containing silica in the form of silicon dioxide * This acts on the lungs to produce a hardening of the tissues which over the years is first disabling and may ultimately prove fatal The condition is called Silicosis Common sources of silica are hard anthracite coals flint chippings and certain grinding processes Asbestos is another dangerous source it is inert in its final form but may cause trouble during manufacture When melted certain metals give off fumes which may be dangerous to health Hence the need for efficient extraction apparatus in foundries Dust and fume suppression and control is a matter for the management but the first aider can assist by example and precept in seeing that the workers concerned take the necessary precautions even though these may be irksome This applies particularly to the use of filter containing masks on dangerous processes Dexs only wh th te mo thn Smllp of lod whe e th tles e betwee 10 m to de pe cub c foot f ·92 Chapter 11 Artificial Respiration Artificial respiration or artificial breathing is required when breathing has stopped but ife is not extinct Patients who need artificial respiration are always uncon scious but most unconscious patients have not stopped breathing so do not need artificial respiration The most usual causes of cessation of breathrog are electric shock drowning carbon monoxide poisoning and pressure outside the chest from falls of earth or masonry and very rarely from a dense crowd of people In such cases the time between the cessation of breathing and the stopping of the heart beat is short The purpose of artificial respiration is to give the heart and other tissues the oxygen they need to remove the unwanted carbon dioxide from the body and to encourage the lungs to start work again Clearly speed is vital Artificial respiration must be started on the spot unless the panent has to be moved out of obvious danger such as contaminated air Methods of Artificial Respiration Many ways of carrying out artificial respirauon have been devised They may be considered under five main headings Pusb Methods In push methods the operator pushes on the outside of the chest to force air out relying on the natural recoil of the ribs to suck air in The classical push method is that of Schafer which was invariably taught to first anders uaul a few years ago It has the advantage of simplicity but it produces onl a small movement of the lungs and cannot be used if the ribs have been fractured Pull Methods In pull" methods the operator moves the arms so as to stretch and expand the chest thus causing an intake of air The best known pull" method is that of Silvester although in this there is a smali element of pushing as well *Pash apd pull ” Methods Both the above methods are combined in push and put methods The push and pull" method devised by Lieut Col Holger Nielsen of the Danish Army is now tausht to first aiders the world Over It is almost certainly the most effective of the simple manual methods and is the method chosen for fulí description here Is first aid st is Always best to have a clear and simple plan of action So in trajning to carry out artificial respiration it is better to know one method properly than to have confused ideas of several Descriptions of the other manual methods are therefore omitted "Rocking " Methods in Tocking methods the principle is to use the diaphragm (the partition between ·Årtificial Respiration 93 the chest and the abdomen) and the contents of the abdomen as a piston first to compress and then to inflate the lungs This is more efficient than any of the manual methods but it requires special apparatus It is possible to improvise 4 rocking stretcher but this is not without danger in a fully cquipped industrial medical department or industrial health service a proper rocking stretcher should be available Such-and Blow" Methods The lungs may be espanded and contracted in a natural way by applying first a positive pressure then a negative pressure either outside the walls of the chest or directly down the wind pipe An outside pressure can be applied onts with an elaborate mechanical apparatus the iron lung It will never be available in first aid It is however of great value in hospital when the patients breathing muscles have been temporarily paralysed by a disease such as poliomyelitis Direct inflation and deflation of the lungs by air or oxygen is achieved by alternately blowing and sucking through the nose and mouth and the air passages Provided there is a cleat air way such a method is completely effective It is used by all modern anacs thetists during operations when chest and other muscles have been temporanly paralysed by special drugs For first aiders there are two possible suck and blow methods Mouth to mouth was the method used by Elisha . It has recently been revived by Dr Peter Safar in America Unfortunately it is very hard to teach to first aiders indeed the only practical teaching method is to use an expensive human dummy! The operator has to blow hard into the mouth of the patient making sure that the patients chin is well up the mouth open the tongue out of the way the nostrils closed and above all that there is a good fit of lips to lips The method is undoubtedly very effective but for the present its teaching is impracticable Stephenson s Minuteman Resuscilatort produces positive and negative pressure through a face mask using no elaborate pumps or moving machinery The power comes from the pressure of oxygen in an ordinary oxygen cylinder Its full use is described in the manu facturers booklet properly employed it is the most efficient means of artificial respira tion available to the first aider We advocate its installation in industry wherever there is a substantial risk of electric shock or asphyxia from other causes Where a Stephenson Minuteman is available first aiders must receive special training in its use Only two methods of artificial respiration will be described in detail -- the Holger Nielson Method and the Rocking Stretcher Method If the first aider is able to carry out these efficiently he can do all that is generally requred of him Preparation for Artificial Respiration Before starting artificial respiration the following steps should be taken as quickly as possible 1 Roll the patient into the pronc position 2 Put the finger inside the mouth and sweep it around to remove any obstruc uion-for example sea or pond weed or false teeth 3. Make sure that the tongue is hanging in its normal forward position 4 Loosen the collar 5 Remove any lumps in the clothing from the front of the chest - for example a tin in a pocket Such an object may damage the ribs when artificial respiration is started 6 If the patient has been submerged or has been vomiting the first aider should stand astride the patient clasp the hands underneath his stomach and raise him 2 KRI 34 + Made in @ by BINO ygen Gt es Ltd Great West Road Be word M ddles ·94 Artificial Respiration quickly a short distance from the ground Repeat twice This helps to empty the air passages Do not waste any time in removing wet clothing The steps referred to above should not take more than a minute or so Artificial respiration should then be started immediately Meanwhile an assistant should send for a doctor and an ambulance and make arrangements for a rocking stretcher or a Stephenson Minuteman Resuscitator if these are available Artificial respiration should be continued rhythmically without stopping unul natural breathing starts again or until the doctor pronounces the patient to be dead Remember that patients have sometimes been revived after as long as an hour or more When the patient begins to breathe on his own the timing must be adjusted to fit in with his breathing From then on the patient sets the rbythm and the first aider has to help the patients own chest movements Once he is breathing properly he should be well covered and left lying quietly in the prone position until removed by ambulance to hospital The Holger Nielsen Method The Holger Nielsen method is also known as the back pressure arm lift method a good descriptive title Posilion The patient must be placed in the prone position with the elbows bent and projecting out sideways and the hands crossed under the head The head will be turned slightly on one side so that the check rests on the hands The nose and mouth must be clear of any obstruction The operator kneels on one knee at the head of the patient and facing him The knee is placed in the angle between the patients head and his forearm The opposite foot is placed near the patient s other elbow (Fig 45) Alternatively the FIG 45 Holger Nielsen method of artificial respiration position of operator and patient at the start of the cycle Note the patients head turned slightly to one side with the cheek resting on the hands the operator s knee is in the angle between the patient's head and forearm the operator's arms are straight inclined at an angle to the patient's back ·Artificial Respiration 95 FIG 46 Holger Nielsen inethod position of the operators hands on the pati ents back Note that the tips of the thumbs are just touch ing and the wrists on a level with the panent's armpus Operator may kneel on both knees one on either side of the head If the one knee position is used he will find it an advantage to change the knee from time to time The operator places his hands on the flat of the patients back The tips of the thumbs should be just touching with the fingers pointing downwards and outwards and the wrists on a level with the armpits (Fig 46) In making the movements the operators arms should be kept straight and the body weight used to produce the effects All the movements should be made steadily slowly and rhythmically the operator counting out loud slowly as he proceeds Movements The sequence of movements is best looked at first in tabular form Movement Time Count First movement Compression of patients chest 2 seconds One two Second movement Slide hands to patients elbows 1 second Three Third movement Raise patient s elbows 2 seconds Four five Fourth movement Lower elbows and slide hands to patients back 1 second * Six ·96 Arnficial Respıranon Compression of the patients chest produces breathing out or expiration Raising the parents elbows produces breathing in or inspiration The effect of the cycle of movements on the patient is as folloss Breathing out 2 seconds Relaxation I second Breathing in 2 seconds Relaxation i second The full cycle takes six seconds giving a rate of artficial breathing of ten to the minute The movements will now be described in detail First Movement The aim of the first movement is to force air out of the patients chest that is to produce artificial expiration The operator rocks slowly forward until his arms are vertical and the weight of the upper part of his body is pressing steadily down on to the patients chest through bis hands He counts slowly out loud One two (Fig 47) It is important to exert the pressure on the patient s chest by the rocking move ment and the weight of the body and not by bending the elbows and pushing Second Movement The pressure on the chest wall is relaxed and operator rocks slowly backwards sliding his hands up the patients arms to just below his elbows He counts oui loud Three (Fig 48) Third Movement The aim of the third movement is to stretch the chest so as to draw in air thus 110 47 Holger Nielsen met ud first movement compression of the chest produring oynficial expranon breathing ous) The operator has rocked forward so that the arms are vertical the elbows being kept straighi The weight of the operators body 13 prossing steadily down on the chest ·Artificial Respiration 97 producing artificial inspiration The elbows and arms are drawn up off the floor towards the operator He counts out loud Four five (F18 49) In making this movement it is important not to drag the patient s body forward towards the operator this tends to bend up the neck and block the air way Fourth Movement The patients arms are dropped gently to the ground and the operators hands are slid down the arms and back to their starting position on the chest. The operator counts out loud Six (Fıs 45) one for General Points How hard should the operator press on the chest? This must vary with the build and size of the subject. For a large male pressures of 30 lb may be exerted for a small female 12 lb and proportionately less for a child To estimate these pressures try pressing on a bathroom spring weighing machine A strong man must be careful not to do damage by pressing too hard on a small subject When breathing starts the arm raising and lowering only should be carried out, keeping carefully in time with the breathing Count two three inspiration when the arms are raised and four five Si for expiration when the arms are lowered If there are chest injuries the first movement of pressing on the chest should be omitted and arm raising and lowering only should be carried out. If there are arm injuries the arms should be laid by the sides The chest pressure movement should be carried out but in place of the arm and elbow raising the points of the shoulders should be lifted from underneath If there are chest injuries and arm injuries shoulder raising only should be carried out Eves Rocking stretcher Method As mentioned above the principle of the Eves rocking stretcher is to use the FIG 48 Holger Nielsen method second movement The operator has rocked backwards sliding his hands and arms (still straight) along the patient's arms to the elbows The release of pressure on the chest has already started the process of inspiration (breaking in) ·96 Artificial Respiration Compression of the patients chest produces breathing out or expiration Raising the patients elbows produces breathing in or inspiration The effect of the cycle of movements on the patient is as follows Breathing out 2 seconds Relaxation 1 second Breathing in 2 seconds Relaxation 1 second The full cycle takes six seconds giving a rate of artificial breathing of ten to the minute The movements will now be described in detail irst Movement The aim of the first movement is to force air out of the patients chest that is to produce artificial expiration The operator rocks slowly forward until his arms are vertical and the weight of the upper part of his body is pressing steadily down on to the patients chest through his hands He counts slowly out loud One two (Fig 47) It is important to evert the pressure on the patients chest by the rockras move ment and the weight of the body and not by bending the elbows and pushing Second Movement The pressure on the chest wall is relaxed and operator rocks slowly backwards sliding his hands up the patient s arms to just below his elbows He counts out loud - Three (Fig 48) Tlırd Movement The aim of the third movement is to stretch the chest so as to draw in air thus FO 47 Holger Nielsen method first movement compression of the chest producing arnfcial expiranon (breathing out). The operator has rocked forward so that the arms are vertical the elbows being kept straight The Height of the operators body is pressing steadily down on the chest ·Artificial Respiration 99 ro 50 (left) Riley rocking stretcher for Eves rocking stretcher method of arnficial respiration Fig 31 (right) Riley rock ing stretcher method of stropping patient Note the adjustable harness and foot rest The hands are under the patient with the fingers our straight well out of the way of the moving ports ·98 4thficial Respiration FIG 49 Holger Nielsen method third movement The operator has raised the patient's elbows and arms and drawn them slightly towards hum But he has not raised the parents head from his hands or the hands from the ground Throughout the cycle note The was the operators head moies back and forth above the patient diaphragm and the abdominal contents as a piston The patent is fixed to stretcher which can al on an axis exactly like a see saw When the patients head is up the abdominal contents fall down towards the feet and tbereby suck air into the lungs and vice versa in the United States and in this country children with poliomyelitis affecting the breathing muscles may be pursed contouously on rochiog beds using precisely tbe same principle An improvised Eves method is possible using an ordinary stretcher over a trestle The patient must be ved to the stretcher by the wrists and ankles but even so there is considerable risk of an accident. It is far more satisfactory to use a specially copstructed rocking stretcher (Fig 50) The Riley model' folds flat and is quite rigid and firm when erected In setung up the stretcher beware of praching the fingers Simple straps and barness bold be patient firmly and safely in position A mercury indicator is embodied in one handle to shon when the head should be raised or lowered As soon as all the mercury has rub through a hole 19 tbe indicator the position of the stretcher is reversed Thus the indicator rorks on the bour glass principle The rocking stretcher should be brought to the scene of operations without delay and crected The patient will be quickly lifted from the floor on to the stretches the head rest and foot rest adjusted and the patient strapped on in tbe prone position (Fig SI) Unul the moment the patient is placed on the stretcher artificial respiration by the Holger Nielsen method will have been so progress. The fixrag of the patient to the stretcher should take under half a minute Made br Siebe Gormsa & Co Lid Day Road Chessington Surrey

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·100 Artificial Respiraſjon Arr FIG 52 Riles rocking strercher in operation The operoror is in such a position that he can obsene the mercun indicator Kar FG 51 Gung origen to a patient receiving artificial rerorohon on a Riten rocking stretcher 4 small or een resusciration appara tus is in kse the mask hene strapped to the patients face ·Artificial Respiration 101 As soon as the pauent is firmly fixed in position the tipping motion is started Thereafter one person can easily operate the stretcher for an hour or more without fatigue The stretcher should be operated at the same rhythm as for artificial respiration by the Holger Nielsen method that is to say there should be about ten complete up and down movements per minute (rig 52) Care should be taken that the patients hands are under his body with the fingers out straight and well within the confines of the stretcher otherwise they may be nipped in the trestle support Because of a similar risk the operator should keep his hands to the end of the stretcher It is a good exercise for first aiders to experience the rocking stretcher in tne position of the patient Oxygen If poss ble orygen should be obtained and administered to the patient during artificial respiration whether this is carn d out by the Holger Nielsen or the rocking stretcher method (Fig 53) Oxygen resuscitation apparatus consists of a cylinder containing compressed orygon a main valve (often spanner operated) a control valve a pressure gauge a corrugated rubber or stiff plastic tube and a face mask Certain models embody a flow meter and a flexible rubber breathing bag in some the flow of oxygen to the mask is governed by the movements of the breathing bag and hence by the movements of the lungs In others the flow to the face mask is regulated by the control valve As the details for operating each type of machine vary first aiders must study and master the manufacturers instructions before use In applying any type of face mask to a patient it is important that the chin should be raised up from the neck as much as possible so as to maintain a good air way The mask can be applied and the chin raised with one hand with the little finger under the chin The details of the method are best learnt by demonstration and practice ·102 Chapter 12 The Eye in Industry More than one in ten of all accidents in sodustry involve the eye by far the com monest of these is a foreign body in the eye In a typical metal working factory there were about 250 foreigt bodies in the eye in the course of a year for every 1 000 workers employed It is therefore obvious that eye injury constitutes a most important part of the first aider s work Most industrial eye casualties never reach hospital but are dealt with by first aiders industrial nurses industrial medical officers or general practitioners Never theless one third of all patients going to an eye hospital come from industry Half of these casualties are caused through working with an emery wheel When a foreigo body comes away from the surface of the wheel it travels comparatively slowly and so does not penetrate too deeply into the eye it is usually composed of metalhe dust abrasive and bonding material and is non magnetic Most of the other industrial eye casualties arriving at hospital come from turning milling spinning boring hammering and chipping Examing the Eye Any first aider who may be called upon to deal with a colleague s eye should know how to examine it This is best taught in a first aid class by cach examining the eye of a fellow student in turn 1 The patient should be seated with a good light shining on his face and eye The first ander should stand behind the patient and support the head against his own body 2 The patients head should be tipped well back and the eye then held open with two fiagers (Fig 54) It will make it much easier to examine the bad eye if the patient is asked to keep both eyes open The patient should be made to look slowly and in turn at each of the four points of the compass so that the whole of the exposed eye may be carefully inspected There should be no hurry It is particularly impor tant to inspect the front of the cornea (the transparent curved surface covering the pupil and tris) 3 If nothing can be seen the lower lid should be pulled away from the globe while at the same time the patient looks upwards This enables a foreign body under the lower lid to be seen it is possible to turn up the upper lid in such a way that sts uoder surface can be seen but as this manoeuvre needs considerable experience it it is to be sattsfactorily performed it is best not done by first aiders ·The LSC Industry 103 FIG 54 (left) Fxamining an eve The first aider stands behind the patient supporting the head against hus own bod: The patients head is tipped well back and the eve held open with no fingers of the left hand Fio 55 (nght) Removal of a foreign body with a collon nool applicator Note that the eve is held open with the left hand while the applicator is held in the right hand A foreign body may be seen on the front of the cornea on the white of the eye or on the red inside lid It may be black or glistening and may be fixed or moving Removal of Foreign Body A foreign body which moves will probably come out of the eye very easily Nature s method is to flush the eye with tears from the tear gland Flushing can be produced by getting the patient to blow his nose strongly and blinking several times On no account must the eye be rubbed Should this fail the eye should be washed out with an eye bath using ordinary Water The bath is completely filled and the eye lowered until in contact with it The bath is then raised and the patient must blink under water this is easier if both eyes are blinked at once If this fails to remove the foreign body then it is almost certainly stuck to the surface of the cornea Remember to wash and dry the cye bath after use before putting it away The first aider who feels confident and has been properly instructed may make one attempt and one only to remove a foreign body which fails to come away with washing But if expert medical or nursing help is readily available it is better to pass the patient on for skilled attention The attempt at removal should be made with clean cotton wool on an applicator (Fig 55) In the Harlow first aid box sıx of these are provided in an envelope When onc bas been used it should be thrown away immediately The eye should be held open and a single sweep with the cotton wool should be made over the foreign body If it is loose it will be seen attached to the tip of the cotton wool The first aider should never use 2 matchstick or the corner of a handkerchief ·104 The Eye in Industry Neither will be sufficiently clean to be safe A camel hair brush is also unsatis factory because it is too soft moreover if not sterilised after use it will carry germs from eye to eye Unless the first aider is completely certain that a foreign body has been removed the patient should be referred to a nurse or doctor at once If the patient complains of any pain at all after removal th s also is an indication for referral In any case to make sure that the foreign body has gone the eye should be carefully inspected under a good light A foreign body so well embedded in the surface of the cornea that it does not project may at first cause no pain There may be a latent period before the onset of pain of up to twelve hours or occasionally even longer Any patient who complars of pain and thinks that the foreign body entered at some earlier time should there fore be referred straight away to a nurse or doctor If a foreign body has been in the eye for some time it may leave behind a small red ring of rust A nurse or doctor will remove this quite easily the following day after the foreign body has been dealt with It cannot be removed by a first aider It is essential that the first aider should run no risks in dealing with eye injuries If there is the slightest doubt the patient should be sent to a nurse or doctor at once This applies with special force at night when there may be natural reluctance to call a doctor on duty Always cover the eye with a medium sized dressing or eye pad before referral A doctor or sister can make use of a local anaesthetic on the eye so that both examination and treatment can be slowly and thoroughly carried out Olly cocaine eye drops used to be part of the official equipment in certain first aid boxes and they may still linger on in boxes which have not been restocked They should never be used by the first aider as in certain cases they are not without danger and make subsequent treatment far more difficult The official 1960 first aid box regulations specify that all bores must contain an approved eye ointment in a collapsible metal tube this is a 6 10 per cent sulphacetamide ointment It is not easy to apply ointment efficiently to the eye if the nozzle of the tube touches the eye it may transmit infection from eye to eye moreover in certain types of case application of an eye ointment may make subsequent treatment more difficult and indeed may do harm On balance we think the inclusion of this eye ointment is unwise and we recommend that it should never be used by the first aider Small hand magnets are sometimes used by first aiders in practice these are virtually useless as almost all easily removed foreign bodies are non magnetic Glass in the Eye It may be very difficult to see glass in the eye Moreover a piece of glass is ltable to cut the surface of the eye sometimes severely The first aider must on no account wash out the eye for fear of the washing fluid getting into the globe through the cut Nor must any drops ointment or liquid paraffin be put into the eye by the first aider liquid paraffin makes the glass slippery and its removal by an expert is much more difficult In fact the first ander should not attempt to remove glass from the eye The eye should be covered with a medium sized individual sterilised dressing and the patient sent for expert treatment as quickly as possible ·The Eye in Industry 10S Dust in the Eye Dust may blow in through the open doorways of a factory or be blown up follow 10g the use of a compressed 31r hose for clearing debris The eye should be washed out, using water and an eye bath If the irritation is not speedily relieved the patient should be sent to a nurse or doctor in case there is a scratch of the cornca Scratches of Front of Eye The cornea or the conjunctiva (the membrane covering the white of the eye and the inside of the eye lids) may be scratched by a brush of the hand or some other object The patient often thinks there is a foreign body in the eye but on eramına tion the first aider will usually be unable to see anything abnormal though there may be a good deal of watering Such cases should always be referred to the nurse or doctor for treatment as these scratches may otherwise become infected leading to the painful and much more dangerous condition of corneal ulcer FIG 56 Mushroom headed chisel with a badlı worn head Foreign Bodies within Globe of Eye A foreign body which penetrates the globe of the eye will not be visible when the eye is etamined though a small cut in the cornea or the white of the eye may be seen Such an accident usually follows hammering or chippiog with a mushroom headed chisel (Fig 56) particularly where the head of the chisel is badly worn A part of the head flies off at high speed and penetrates completely Any eye accident following the use of such a chisel must be assumed to be serious and should be sent for immediate treatment The eye should be covered with a medium sized individual sterilised dressing and the patient should be transported by car for preference lying down movement must be kept to a minimum for fear of starting bleeding Within the eyeball In such a case it is dangerous to wash out the eye if it is not swiftly diagnosed and treated the patient may lose the use of an eye Conjunctivitis Conjunctivitis is the state of inflammation of the membrane covering the front of the eye and the inner sides of the eyelids The patient feels a pricking or irritation in the eye and the eye itself appears red The condition may be caused by germs or dust but in industry there is often a foreign body present the entry of which has not been noticed by the patient For this reason it is best to refer every case of conjunctivitis to a trained sister or doctor for investigation In Industry conjunc tivitis may also be caused by chemical fumes llaemorrhage under Conjunctiva It is appropriate here to mention the haemorrhages which sometimes occur under the conjunctiva The whole of one side of the white of the eye is red giving a some ·106 The Eye in Industry what alarming appearance but the patieat feels nothing abnormal Usualy a subconjunctival haemorrhage is not at all serious but nevertheless it is a wise pre caution to refer all such cases to a doctor Welding and the Eye Exposure of the unprotected eye to gas or electnc welding or cutting is the com monest cause of conjunctivitis in industry There are three common types of welding Spot melding the operator ought to hear goggles or have the eyes protected with a mica or other transparent shield The only risk to the eye is from sparks Eye injuries from spot welding should be referred for espert treatment as tiny pieces of metal are usually stuck to the burnt conjunctiva Gas welding Orygen (4000 degrees Fahrenhert) and acetyline (6 000 degrees Fahrenheit) are the common flames used Electric arc welding The temperatures here are similar to those with gas welding The welding rod is one electrode and this melts to fill the space between the metals to be welded Welding or cutting places should be well ventilated as certain harmful gases are present they should also be screened to prevent exposure to the strong ultra violet rays which are produced particularly with gas and electric welding Arceye or elder s Flash Welder s flash follows exposure of the unprotected eye to gas or electric welding or cutting The operator must use dark goggles or a dark shield and most operators are fully aware of this. The main risk is to his helper mate or learner or to a careless passer by Momentary exposure is enough and trouble can be caused up to 200 feet anas especially if exposure is prolonged The condition resembles snow blindness The eye is red watery and uncomfortable and the patient will usually remember momentary exposure to a welding flash four to eight hours previously When there is no such recollection it may be impossible for the first aider to distinguish this condition from a foreign body For safety all cases of arceye should be referred for treatment. The first aid treatment is to wash out the eye with water or a simple solution, but a special arc eye lotion and other special preparations are more effective * These preparations however are best applied by a trained ourse Dark glasses give some relief Exposure of the unprotected eye to infra red rays from fumaces molten glass or white hot metal can over many years, damage both the lens and the cornea The result is opacity of the lens or cataract Modern methods of protection bave vir tually completely eliminated this particular condition Chemical Splashes in the Eje I dealing with cherucal splashes first and is of the utmost importance since it cap if done promptly and efficiently save sight As with chemical burns of the skin la somme f cones 1 spl sy lotion bd anth are powded n the weht f-shop the elders being structed to rush out ther eyes at the end of each work ·The Eye in Industry 107 alkalis are more dangerous even than acids Unless the alkali is removed at once it combines with the tissues of the cye and goes on acting on the tissues long after the eye bas been thoroughly washed out A neglected alkali burn of the eye will in consequence continue to increase in size and depth despite washing with antidote and this may cause loss of vision The common alkalıs liable to get splashed into the eye are caustic sod3 ammonia (espectally from refrigerator plants) lime and cement Other liquids used in industry which may get into the eye are the industrial acids mentioned earlier thinners solvents and de greasers Although these should all be flushed out as quickly as possible they are less likely than alkalts to cause permanent damage Treatment Unless antidote is immediately available the head should be held under a tap or plunged into a bucket of clean water the victim should then blink vigorously A drinking fountain gives quite a good eye irrigating jet The patent may have difficulty in opening the eye because of spasm He should be told to try to bold both eyes open If the first aider is trying to irrigate the eye with water or antidote the patient should sit or lie with the head tilted right back and an assistant should hold the eye open if no assistant is available the first aider may use the first and second fingers of the left hand The jet of water or antı dote should not be directed right on to the front of the eye instead the patient should be told to look outwards and the jet directed on to the inner angle of the eye (Fig 57) Every industrial first aider should have experience of irrigating an eye at the giving and receiving end there are few more useful class exercises Wherever there is a high risk of alkalı or acid splashes buffered phosphate should be supplied with an irrigating bottle or storage canıster (Fig 58) As explained carlier this solution will neutralise either acid or alka), It may also be used quite safely for splashes with other industrial chemicals but it has no advantage over water or salt solution (saline) * Irrigation should be continued with short rest pauses for the patient for five to ten minutes. The patient should then be transferred as swiftly as possible to expert nursing or medical care for inspection and further irrigation if necessary After alkalı splashes this irrigation may have to continue for up to an hour Lime or Cement The principle of treatment for time or Cement is just the same as for other splashes Flood the eye with water salt solution or buffered phosphate immediately and go on fooding for at least five minutes Speed is vital Often the only source of water on a building site is a stand pipe The eye should be held open under the stand pipe tap even if it means soaking the patient s clothes A wetting is a small Some doctors pre! to provide a 5 per cent solution of ammo m chionde a the first ads atmet tal spl the eye on blanc we prefe the buffed phosphate soluto It less in de lly effects c Sg Ast both all lus dac da ·108 The Eye in Industry a Fio 57 (left) Washing out an eje following chemical splash The irriganng bottle is held in the left hand and the eye Is held open OUTILRED PHOSPHATE SOU ON AC OS & ALKALIES Fia 58 (night) Wash ing out an eye follow ing a chemucal splash using buffered phos phate from a storage canister The five gal Ion glass canister is mounted on a wall brachet As soon as the bulldog clip on the rubber tube is loosen ed a jer of solution Aushes our 'Note the Mire hook on the neck of the canister for holding the rubber Tube when not in use and the wire across the bottom of the bung to prevent It coming out The patient is lying har on the floor with huis head on a piece of newspaper the eye is held open and the ſet of antidote is directed into the inner angle of the eye

·The Lie in Industry
109
price to pay for the prevention of permanent damage to the cyc Eyelid spasm
may be considerabic the first aider must overcome this by pulling the eyelids apart
under the tap
All such cases should be seen as soon as possible after emergency first aid treat
ment by a trained nurse or doctor
Thinners and Solients
Arain the prisciple and method of treatment for thinners and solvents are
exartly the same Thinners and solvents are less dangerous to the eye than acids and
allalis. Even though the thinners or solvents may not mit well with water the
mechanical action of the flooding will quickly remove the imitant.
Bandaning an Eye
Whenever an eye condition has to be sent for further treatment to a nurse a
doctor or hospital the eye should be covered with a bandage This can be easily
aod swiftly done with a medium sized individual sterilised dressing (Fig 59) It is
important to pass the bandage over and under the ear on the affected side
Under the 1960 first aid box regulations bores must contain sterilised eye pads
10 sealed packets These do not differ substantially from the medium sized individual
Sterilised dressings and either may be used to cover an eye in exactly the same way
FIG 59 Medium si ed indova
dual sterilised dressing used as
an eye bandage Note that the
bandage passes above and below
the ear on the injured side The
method of applying the official
stenlosed ne pad is precisely
the same

·110 The Eye in Industry Prevention If goggles or protective face shields were more widely worn in industry eye injuries whether from chemical splashes or foreign bodies would be far fewer There may be a traditional reluctance in certain factories to wear goggles or where the need is only occasional they may be forgotten Sometimes unsuitable goggles mist up and prevent the proper performance of the job a face shield which is not closely applied round the eyes may be the answer It is unrealistic to expect workers to wear goggles when the risk to the eyes is slight But when the risk is great not to protect the eyes is to endanger one s capacity to make a living Here are some practical points about the relative dangers of different processes and materials Grinding wheels should always be eye guarded either by transparent plastic shields fitted to the mountings or by the wearing of goggles Some metals fracture more easily than others and therefore shoot off dangerous particles when worked examples are aluminium and magnesium alloys and bronze Mild steel flies more than cast iron A continuous cutting lathe is less dangerous than one with an intermittent cut because continuous swarf does not usually fly Fettling and milling with an interrupted cutter are both potentially dangerous Flying particles of wire can be very dangerous but when trimmed some types of wire fly more than others Another wire danger arises when particles fly off wire brushes used for cleaning structural steel The first arder has a real part to play in encouraging the use of eye protectors whenever there is substantial danger He must himself set a good example and can belp his work mates by making sure that they appreciate the risks they are running by not protecting their eyes on the more dangerous jobs ·111 Chapter 13 Aches and Pains Transport Records In dealing with illness as opposed to injury the industrial first aider is in much the same position as the sensible mother of a family in the home He must sternly resist the temptation to try to become a semi skilled doctor His job is to make not diagnoses but rather some simple practical decisions 1 Is the condition a minor one which will get better quickly at work? 2 Is the patient sufficiently ill to be sent to the factory surgery or industrial health centre or of these are not available to his home? 3 Is the patient so all that skilled help must be sent for at once? The major emergencies of factory life have already been dealt with and the first aider who knows his job should be able to recognise shock (even when caused by internal trouble such as stomach bleeding or a heart attack and not by an accident) strokes and epilepsy and semi consciousness in a diabetic There are however many other types of serious illness which can just as often start at work as anywhere else The capacity to recognise serious illness with cer tainty comes with experience The only reliable working rule is If in doubt always play safe and send for help or refer to a trained doctor or nurse The seriously ill patient should be kept lying down until expert help arrives In reaching his decision the first aider will find it helpful to ask himself the following questions Is the patient able or unable to do his job? Does he look 111? Is his colour different from what it usually is? Does he stand or sit as though in pain? Is he sweating? Is his breathing laboured or rapid? Does he complain of pain on breathing? Is be feeling sick? Has he actually vomited or had diarrhoea? Is any pain he may complain of unusual for him? Only when the first aider is satisfied that the condition is indeed trivial is he justified in proceeding further on his own Care of Minor Aches and Pains The Harlow first aid box contains four items for use in appropriate cases of aches and pains a clinical thermometer bismuth or magnesium trisilicate tablets aspirin phenacetin and caffeine tablets and 10dised throat tablets Thermometer Every first aider should know how to take a patients temperature and read a clinical thermometer It has been a surprise to discover how many first aiders cannot carry out these simple manoeuvres Here an ounce of demonstration is worth a pound of precept ·112 Aches and Pans Transport Records שוויוונו 95 + 100 5 110 FIG 60 Reading a clinical thermometer The thermometer which may have a spherical or oblong mercury container is held in the right hand and slowly rotated until the mercury in the stem is seen magni fied When the thermometer is in the correct position the two parallel lines just below 95 act as a guide to finding the mercury The thermometer should be held in the right hand and slowly rotated (Fig 60) At a certain point it will be seen that its contents are magnified and the column of mercury which it contains shows up quite clearly An arrow or other special mark indicates the normal figure of 98 4 degrees Fahrenheit The mercury column should be well below this If it is above up to or even near the normal mark the thermometer should be shaken vigorously until the mercury is well down in the lower nineties The thermometer is then placed in the patient s mouth under the tongue and the mouth must be kept shut It must remain in place for at least two full minutes this applies to the so called half minute thermometer as well as to the two minute one The mark to which the mercury has risen indicates the patients temperature Before the thermometer is replaced in its case it should be carefully wasbed under a cold tap dried with a piece of clean cotton wool strip and shaken down If wasbed under a hot tap the mercury may expand so much that it breaks the thermometer The first aider may legitimately take the temperature of any patient who feels 111 If the temperature is above normal the patient must be referred to a trained nurse or doctor But a normal or subnormal temperature does not necessarily mean that there is nothing the matter if the patient looks or seems in any way ill in him self referral is essentral Bismuth or magnesium frisilicate tablets (dose 1 2 tablets) may be safely and ·Aches and Pams Transport Records 113 beneficially given to the patient with a hang over or to the regular gastric suf ferer who is under medical treatment but is caught without his powder They should not be given to anyone who appears to be all Unless the tablets give speedy relief the patient should be referred Severe stomach pain should never be treated by the first aider Aspirin phenacetin and caffeine tablets (dose 1 2 tablets) relieve the mild head aches of ordinary life and may help women workers who have pain at the penods It is wise for period pain to be dealt with only by women first aiders A severe headache or a headache accompanied by any other symptoms should always be referred to a trained nurse or doctor lodised throat tablets give some relief to winter coughs and colds (A tablet may be sucked once an hour up to four tablets in all) In such cases the temperature should always be taken if the patient looks at all 111 Sore throats are best referred as also are coughs or colds accompanied by pain in the chest Taking the pulse is more difficult than taking a temperature and it is outside the proper scope of the first aider Moving an Injured Person As a general rule any severely injured or ill person should be moved as little as possible until expenenced ambulance workers nurses or a doctor are available The transport of the injured is a specialised branch of first aid calling for con siderable practical training and experience Such training and experience is possessed by ambulance workers and is rightly emphasised in the St John courses The industrial first aider may occasionally have to move someone out of a position of immediate and continuing danger and in emergency may have to undertake a longer carry to an ambulance or first aid post to meet these emergencies some practical experience on the lines set out below is essential for the demonstrations of work here described a stretcher two blankets and a strong scarf are the only equipment needed It is difficult but not impossible to move an injured person safely without a Stretcher it is easier both to load and to carry a stretcher with four bearers than with two It is easier to move a patient without a stretcher with two bearers than with one But in emergency one person can move another provided that the proper techniques have been learnt Preparing a Stretcher If two blankets are available they should be arranged on the stretcher in what is known as the fish tail position (Fig 61) The patients feet and legs are covered with the fish tail and the body and head wrapped in the lower blanket tucking in firmly with the longer side (Fig 62) If only one blanket is available it should be arranged on the stretcher dia gonally The patient is then folded into the blanket with the longer angle being turned over on top and tucked in (Fig 63) Loading a Streicher Ideally there should be four loaders one of whom must give orders so that all act together Three men lift the patient the fourth pushes the stretcher with ·Aches and Pains Transport Records blanket or blankets under the lifted patient so that he can be gently lowered in the right position on the stretcher The three man isft is an art to be perfected by practice Its object is to hift the patent while keeprag the head body and legs in a straight line All three men must be on the same side of the patient They all kneel on one knee in each FG 61 (Left) Preparing a stretcher for a patient ksing the blankets - the fish tanl method Nose there is more of the first blanket on the one side of the stretcher than on the other and that there will be four thicknesses of blanket under the patient's body but only one thickness under his head FIG 62 (Right) The fish tail method with the patent in pomon The feet are fucked up in the fish farl and the body and lead wrapped in the lower Planter using the longer side for the final fuck an A Fra 63 Urug a single blanket or a sireicher to its best ad antale The blanket s placed diagonally with more on one side than the other The forger section will be used for the final fuck in ·115 Achies and Pains Transport Records FIG 64 The three man lift This is the ideal method of lifting an injured man and loading a stretcher Note that all three bearers are on the same side of the ponent that the parents head body and legs are kept in a straight line that the bearers knees nearest the patient's head form a shell on which to rest the panent while the stretcher is placed in position and that the bearer at the head end supports the head in the crook of his elbow This method may also be used for carrying over a distance case the knee nearer the patients feet Their other knees - the knees nearer the patients head - form a shelf on which the patient can be rested Hands and arms are gently but firmly insinuated right under the patient The first man has to raise the head and shoulders The second man who should be the strongest has to raise the chest and abdomen The third man bas to raise the legs with one arm under the thighs and the other under the calves he must take care not to let the feet sag and the knees bend (Fig 64) When all are ready the leader gives the command to lift and the patient is raised and rested on the lifters bent knees 50 that the stretcher can be shipped into position Again the leader must give the command to lower so that all three move as one The three man lift may also be used for carrying a patient a short distance It is then spoken of as the human stretcher If only three loaders are available they will use the three man lift and carry the patient to the stretcher ·116 Aches and Pains I ransport Records Fic 65 The mo man haft or straddle walk Both bearers stand astride the panens facing his head The first passes his arms under the patient's shoulders the second pauses one arm under the buttocks and the other under the calves The man in the rear gnes commands If there are only loaders available both should stand astride the parent facng his head The first passes his arms under the patients shoulders the second passes one arm under the buttocks and the other under the calves (Fig 65) When both are in position the man is the rear gives the command to lift With short steps they then walk over the stretcher and lower the patient on to : This procedure is koown as the straddle walk It is sometimes becessary to load an unconscious passent on to a stretcher The rules are these lift in the proae position carry in the semi prone position Attempts to lift in the sem prone position ate dangerous as the unconscious patiebt may roll out of the hfters arms Carriage in the prone position is difficult because of the position of the patient s arms also the ais way may be obstructed The transport of the patient with a broken back or neck bas already been dealt with under the care of fractures in Chapter 7 Carrying a Stretcher Carrying a stretcher is more difficult than it looks Practical experience is needed both as a bearer and 25 a patent It is surprisingly easy for be unskilled to tipa patient off a stretcher There has been much discussion as to whether it is better to carry a patient bead first or {cct first We support the conventional St John method of carrying feet first, though there are exceptions to this for example when kling into an ambulance The stroagest map of men should be at tbe head This ss because the upper half of the body is beavier than the lower half The command to kft move ·117 Aches and Pains Transport Records forward and stop should be given by one of the men at the rear end of the stretcher Care must be taken to leep the stretcher level and the bearers must walk out of the traditional marching step otherwise the stretcher will soon start to swing The smoothest carry is achieved by all four bearers adopting the rhythm inner foot-outer foot inner foot-outer foot etc (Fig 66) The Blanket Lift Four men can carry a severely injured man making use of a single blanket The blanket must first be inserted under the injured man This is done by rolling up the blanket longways and placing the roll beside the patient Three people pull the patient towards them and a fourth inserts the roll under the patient (Fig 67a) The patient is lowered on to the roll then pulled or pushed up the other way (Fig 676) this enables the roll to be pulled through The patient is then lowered on to the blanket. At the outset the blanket should be so placed that when the patient is in position a small roll can be made along each side of the patient For lifting one man takes hold of a half of each of these small rolls and the blanket is lifted and moved like a stretcher (Fig 670) Note particularly the position of the bearers hands The hands in the middle of each roll must be close together Otherwise it is impossible to maintain the tension on the blanket needed to keep it fiat An efficient blanket lift is impossible with fewer than four bearers Flo 66 Four men carrying a stretcher of that the strongest men should be at the rear end of the stretcher nearest the patient's head one of these men should gne commands The thithm of walking should be inner foot - outer foot instead of left-right ·116 Aches and Pains Transport Records FG 6$ The two man hit or straddle wolh Both bearers stand astride the panent facing his head The first posses his arms under the parent's shoulders the second passes one arm under the buttocks and the other under the calves The man in the rear gives commands If there are only two loaders available both should stand astride the patent facing his head The first passes his arms under the patients shoulders the second passes ope arm under the buttoks and the other under the calves (Fig 65) When both are in position the man in the sear gives the command to lift With short steps they then walk over the stretcher and lower the patient on to it This procedure is knowo as the straddle walk It is sometimes necessary to load an unconscious patient on to a stret. her The rules are toese lift in the prone position carry in the semi prone position Attempts to hft in the semi prone position are dangerous as the unconscious patient may roll out of the lifters arms Carnago sn the prope position is difficult because of the position of the patient sans also the air way may be obstructed The transport of the patient with a broken back or neck has already been dealt with under the care of fractures in Chapier 7 Carrying a Stretcher Carrying a stretcher is more difficult than it looks Pracucal experience is needed both as a bearer and as a patient It is surprisingly easy for the upskilled to tip a patient of a stretcher There has been much discussion as to whether it is better to carry a patient head first feet first. We support the conventional St John method of carrying feet first, though there are exceptions to this for example whes lifting into an ambulance The strongest man or mico should be at the head This is because the uppet half of the body is heavier than the lower hall The command to lift move ·119 dches and Paints Iransport Records FIO 68 The hands-chair loft The patient must be able to use his arms to grip round the neck of his carriers The Chair Lift If a patient can stand or sit but cannot walk two men can move him by means of a chuir lift The familiar bandy-chair (Fig 68) needs no equipment but the patent must be able to use his arms to grip round the necks of his carriers Much better is a real chair This is carried by two men facing each other each man grasps the back of the chair and a front les close to the point where it joins the seat (Fig 69) Care has to be taken not to tip the patient forwards The real chair lift makes it comparatively easy to carry a patient up or down stairs Single handed Lifts If a patient can just stand and has the use of his arms the familiar pick a back 1$ useful for the pick a-back the rescuer must use both his hands and cannot therefore climb a ladder The firemans lift leaves a hand free and so males ladder-climbing possible It demands considerable strength on the part of the rescuer and a good balance it cannot therefore be used if the patient is very heavy unless the rescuer is pro portionately strong The patient must be helped to stand upright facing the rescuer The rescuer

·118
a
FIG 67a To get the blanket
under the pament three
bearers pull the parent
Ionards them while a fourth
inserts the rolled blanler
under the patient
FIG 676 The
palien! 15
lowered on to the roll the
bearers move over to the
other side of the patient
and again pull hum fonards
them the fourth bearer pulls
out the rolled blankc!
FIO 670 The blanket on
erther side of the patient is
rolled and one bearer takes
hold of each half roll Con
siderable tension is needed
to keep the blanket flat

·121 Aches and Pains Transport Records Fig 71 The neck-drag The paneni's wrists are led together and looped os er ihe rescult s neck under the shoulders and pulled along head and shoulders first in a semi sifting position On no account must a patient be dragged by the feet as the risk of injury to the head is then great. Records in Industry The law requires certain records of industrial accidents to be kept but for the most part minor accidents are excluded The first aider in charge of a first and box or post is however wise to keep a complete record of all that he does Such a record may be kept in an ordinary exercise book appropriately ruled up it is called a Day Book The Day Book should gve the date and the name of the patient the nature of the jojury or condition the cause of this can be stated the treatment given and the disposal (back to work to factory nurse or doctor or to own doctor or hospital as the case may be) Simple abbreviations will soon be denised Writing must be kept to a minimum or it will soon be neglected The Day Book should be kept is the first aid bor The Accident Book is a special cream coloured ruled up book issued by the Ministry of Pensions and National Insurance with space for over 1 000 entries It is the statutory duty of the emploser to provide this book but the duty of filling it in rests with the employee or his agent It is the basis for claims for industrial injury benefit * if the 10jury involves time off work It is also a notification of the accident to the employer he then has the duty to investigate its circumstances It is necessary to record in this book only injuries or industrial illnesses wbuch are likely to lead to time off work But because it must often be difficult to foretell which injuries are serious and which are not some employers allow their first aid Entry in the Accident Book does not however at the loc 1 offre of the Mu try of PRO bsol e the mployce f m lode ng i çlam wth anto I In nince - ·120 Aches and Paris Transport Records FIC 69 (Left) The real chair luft This is of special value in going up and down stairs Care must be cohen rot 10 nl the patient forward F10 70 (Right) The firenions {a) Rescuer grasp's potsents nghe wrist with left hand rescuers night shoulder into patrene's stomach rigiit arm berkeen passent's legt night hand grasps patient's might leg (b) Werght of patient raken on rescuers righi shoulder patseni's righi arm pulled well over rescuers left shoulder panent's right wrist grasped by rescuers right hand leaving his left hand free grasps the patients right wrist with his left hand the bends down until his head is just under the patients right hand This brings the rescuers right shoulder level with the lower part of the passents abdomen He then puts his right arm between (or round) the patients legs and grasps the les for legs) firmly The werght of the patient is then taken on his night shoulder As he rises to stand upright the patient is pulled across both shoulders The patients right wristys then transferred to the rescuess right hand thus leaving his left hand frec (ng 70.3 and 706) A little pracuce will soon demonstrate the value and the limitations of the fireman s lift. Beck drag The Neck Drag The single handed movement and rescue of an unconscious or badly injured patient is effected by the The only equipment needed is a strong scarf belt or ne The patients wrists are ued together The rescuer kneels astride the patient with his knees in the patient s armpits The rescuer loops the patients bands over his own neck (Fig 71) As he crawts forward he pulls the patient forward on his own neck and shoulders This method of rescue is used by soldiers when under fire If a patient has to be pulled a short distance only he may instead be grasped ·123 Chapter 14 A Miscellany In this last part of our picture of first aid in the factory we shall draw together a number of points which have escaped mention earlier Some of these points have been raised by doctors engaged in teaching factory first aiders Other have been brought out by first aiders themselves Others again have come from workers and employers in the building and civil engineering industries First aid in industry outside the factory in the shop or transport depot on the farm or the building site does not differ in any essential way from the teaching set out here but minor points need explanation or amplification Because this a true miscellany of replies to prac tical problems the Socratic method of question and answer has been adopted Contents of First aid Boxes It hat should a factory first aid box contain Under the First aid Botes in Factories Order 1959 (Statutory Instrument 1959 No 906) operating from January 1 1960 factory first aid boxes must contain the items set out in the upper half of Table 1 The lower half of the table gives the supplementary contents which we have found essential for efficient factory first aid The table calls for a number of comments For every item the quantity officially specified is a minimum only 2 In our experience the number of small individual dressings specified for each type of box is on the high side These dressings are used only for major injuries to fingers which are comparatively rare These small dressing cartons are apt to fall out of first aid boxes whenever they are opened for this reason the bulk of the supply is best kept in a drawer adjacent to the first aid box The same applies to the number of medium and large individual dressings specified for Boxes B and C Again most of them are best stored in a handy drawer 3 The recommended supply of assorted adhesive Hound dressings is in our experi ence too small These are by far the most frequently used dressings in industrial first aid Under a supplementary order made by the Chief Factory Inspector these dressings have to be put up in individual sealed packets This adds to their cost but in typical factory conditions it is an advantage in the Chief Inspectors original order (Form 694 1949) the dressing itself in the centre of the plaster was specified as unmedicated А variant of this order (Form 694 revised 1949) allows the dressing to be impregnated with a variety of medicaments in our view the unmedicated dressing is to be preferred users should insist on the omission of useless possibly dangerous antiseptics 4 No size is specified for the roll of adhesive plaster It will be used only to fix ban dage ends to prevent their catching in machinery for this purpose we recommend inch unmedicated plaster ·122 Aches and Pains Transport Records workers to use the Accident Book as a Day Book for which it is well sui ed The consumption of accident books is then greatly increased But the mployee s rights are safeguarded and the employer is guaranteed a fu}piuture of what is happening at each first aid post The General Register for Factories is a special blue ruled up book issued by the Ministry of Labour It is the statutory duty of the occupier of the factory (the employer) to see that it is filled up Normally it is not dealt with by the first aider but he should be aware of what ought to go into it so that he can report such matters at once Part III of this Register is for Accidents and Dangerous Occurrences This has to be filled in for any accident involving more than 3 days disablement from earning full wages at normal work or for any fatal accident For these cases the employer also has to fill in Form 43 and send it to HM District Iaspec tor of Factories A record also has to be kept and Form 43 filled in for certain special types of accident whether or not anyone 15 injured These include crane accidents explo ssons and the burstiog af any revolving object Nonfiable industrial diseases also have to be recorded and reported ·A Miscellany 125 3 No number is specified for the ounce packets of colton wool Such packets are needed only for dcaling with fractures or mopping up large quantities of blood These occasions will be comparatively rare but for each fracture or severe injury a substantial amount of cotton wool will be required We therefore suggest six packets to cach box they may be stored with advantage outside the box in a drawer 6 The approved eye ointment specified by the Chief Factory Inspector (Form 693 1949) is a 610 per cent sulphacetamide sodium sterilised ointment in a water muscible base The amount specified is 60 grains in a collapsible tube with a nozzle and cap In our opinion it should not be used by first aiders 7 A rubber bandage is beyond the capacity of the first aider to apply properly it should not, and indeed need oot be included. Any bandage or an individual stenlised dressing may be used as a pressure bandage so no special one need be supplied 8 Every first aid box must be plainly marked First Aid and should also carry the name of the first aid worker in charge of it 9. There must be at least one first and box for each 150 employees in a factory Thus If there are 170 employees onc Box C and one Box B will be needed If however a properly equipped ambulance room is available the factory inspector can give cxemption from this requirement 10 Roller bandages used to be a statutory requirement in the larger factory first aid boxes but are now omitted from the official list in our experience they are essential as the best means of protecting adhesive wound dressings from oil or other dirt They are therelore retained in our supplement 11 The formula of the tablets recommended in our supplement is as follows (a) There are three alternative antacid tablets 1 Tab Magnesium Trısılıcate Co (National Formulary) contains Mag Trısıl gr 4 Alum Hydrox gr 2 01 Menth Pop min 1/20 Or 11 Bismuth and Magnesia Tablets contain Bismuth Carb gr Sodium Bicarb gr Mag Carb Pond gr 3 Excipient ad gr 7 Peppermint oil flavouring Or 1 Tab Mag Carb Co(NF and BPC) contains Mag Carb Pond gr 3 Calc Carb ST 3 Sod Bicarb gr 2 Light kaolin ST Ginger and peppermint oil flavouring (b) Tab "APC Tab Acd Acetylsalicyl CO (NF and BPC) contains Acetylsalicylic Acid 31 Phenacetin Caffeine ST (C) "Todised throat tablet contains Liqlod Mit min 1/10 Phenol gr 1/24 Menthol gr 1/48 Methyl Salicyl min 1/100 Excipient ad gr 10 اها لما د ·124 A Miscellan) TABLE 1 Contents of l'actory Forst aid Boxes Box d (fat factor es wth up to 10 craployees) Small ng dus in medicated ster 1 sed dressings for fa sets (No 7) 6 Ved umed ndi dual usmed atcd tet 1 sed dress ngs for h nds and fe : (No 8) 3 Bor B {lo {actor es with 11 30 employees) Bor C (or 18-20ties wth more than 50 employee) 4 6 12 3 6 12 Large nd du 1 un med cated ses 1 sed drenge for other injured parts (No 9) A sorted adh sive wound dress ngs Triangul bandages of unbleached c 1:00 Jest 16x 36 X 31 in 4 36 2 4 8 Adhesive plaster Absorbent stert sed cotton wool not racket Appro ed eye animent Indivduat st nt sede pad s pa ate scat d packets Rubber or pressure hansdage * sufficient supply a suffic ent supply * $uffcnt supply 2 & 1 Safety AS no numher specified Vinstry of Labour L aflet on Fts Ad (Form 1008) 1 The supplement which we recommend to carry out efficient factory first aid s as follows 1 ) 6 6 6 1 t 6 9 12 Cotton wool dispease contaca Ag cotton wool sinp lad v dual co too wool appl stors for eye foreign bod es an envelope Sell seal ng c pe rubbe nch rou Rolle bandages In Roller bandage 2n Jad v dual slet it d tuli gras dessings ni un Cetr made per cent 5 10 or o ou bottl (derend ng on space ay table in box) Gallipot white enamel Z OL K dney dish what namel 6 10 6 9 1 1 10 07 Doz 20 or 1 1 1 1 i * 1 1 1 1 1 1 hon inflammabe pl et remove one 4 d bottle Eye-bath unbreakable Sinan unbreakable tumbler Blunt Roscurg cal ses with chain tached Splunter fosteps Cun cal thermom ter Tablets Magnes un sase or othe anaerd Asp in patenta etin and eat ine lod sed the oat tad ets 1 + $0 50 SU 50 SO SU SC SD so ·A Miscellans 127 large wounds may occur to stop haemorrhage from a typical large hound three large Hound dressings are a minimum requirement On a farm major fractures are more com mon than in a factory To deal with these the recommended supply of cotton wool and trangular bandages 15 inadequate We would advise the prudent farmer to equip his bores or containers according to our lists (with the supplements) set out in Table I By so doing he will perform fully what the law requires of him and at the same time make possible efficient first aid for his workers Are there any special rules about first and for workers in the food industries and m canteens Yes Under the Food Hygiene Regulations 1955 (Statutory Instrument 1955 No 1906) workers in the food industries have to keep all cuts and abrasions on exposed parts (that is the hands arms and face) covered with a suitable waterproof dressing This provision is met if the assorted adhesive wound dressings in the first aid box are of the waterproof variety The first and worker in such industries will be wise in addition to cover any dres sing on the fingers with a waterproof plastic finger stall secured by tapes around the wrist This precaution keeps to a minimum the risk of an adhesive dressing coming loose and getting into food in the course of its manufacture or preparation The Food Hygiene Regulations also specify that the first aid stocks provided in food industries must include suitable and sufficient bandages and antiseptic Neither of these are now included in the official factory first aid boxes They are however included in the supplement which we recommend Thus our boxes will fully cover the statutory requirements in the food industries The Regulations also require a notice to be fixed in each lavatory asking every one to wash their hands after using the lavatory Wound Treatment Why is no skin cleansing agent included in the official factory first aid box? It appears that officially first aid is still looked upon as a preliminary further expert treatment This is sound enough for anything more than minor injury But the great bulk of industrial first aid is concerned with minor injury and most small cuts in industry as in the home are never seen by a nurse or a doctor It is however officially accepted that an adhesive wound dressing will not stick to oily skin Accordingly it is suggested that the oil around the wound should be wiped off with cotton wool before an adhesive plaster is applied in our experience this is far less satisfactory than using cetrimide Are there any disadvantages arising out of the use of cetrimide? In our experience a 1 per cent solution of cetrimide is the ideal wound and skin cleaaser provided three points are remembered 1 Always wipe off all the cetrimide from the wound and skin with clean cotton wool after it has been used This is essential to get the plaster to stick and to avoid the development of sensitivity to cetrimide ·126 A Miscellany What should a first aid box on a building or civil engineering Site contain? Under the “ Bulding Operations (First aid Boxes) Order 1959 (Statutory Instrument 1959 No 2080) there are only two types of box specified 1 Where the number of employees is between 11 and 25 the contents art atactly the same as the official list for Box A in Table ! 2 Where the number of employecs exceeds 25 the contents are exactly the same as the official list for Box Cm Table 1 In both boxes we strongly recommend the inclusion of our supplementary items If there are 10 or lewer employees on a building site no first aid box is required by law Yet the wise employer will sista! Box A with our supplementary items What should a first aid bor for a dock wharlor quay contain? Under the Docks (First aid Boxes) Order 1959 (Statutory Instrument 1959 No 2083) there are three types of bax specified Their contents are destacal with the official fists for Boxes A 8 and C given in Table I The size of box in relation to numbers of workers is the same but the sumber is the number of persons working at any one time at the work place As elsewhere se adesse the inclusion of our supplementary items What should a first aid box on a farm contar? The regulations for farms were drafted two years before the new regulations for factories and other work places in consequence they are not in line with the new factory provisions The provisions under the Agriculture (First aid) Regulations 1957" (Statutory Instrument 1957 No 940) are set out in Table 33 The following comments must be made on the table 1 It will be seen that the contents of the Container Z is identical with that of Box Y although it 11 supposed to meet the needs of up to three times as many workers 2 JI more than 30 workers are employed at one place an additional container z has to be supplied fos every 30 workers but so ersploser seed supply more than 3 containers in any ope farm unit Any number lest than 30 18 10 count ay 30 3 This order is badly drafted in parts it is virtually incomprehensiblc Moreover it! out of touch with tht itaines of first aid on the farm We can see no difference betscen a "finger" wound dressing and a small wound dressing. No * large" wound dressings are included Yet the farm is just the place where TABLE !! Statotory first ald requirements for farms Bor X (for 1 or fener 39 Y (tor 410 worker Cooler 2 (fot 30 work 3 6 6 3 2 3 3 Suprised wounds Finger Su Morfiura 17azvior and in Waterproof adhere wound drettet it * 2 R 2 6 6 ww 6 1 1 2 1 Ahobeat cordon wool or packer Frux learstisured by Must Ayxture 3 ·Miscellany 129 vidual sterilised dressing and the patient sent for further treatment from a nurse or doctor If the wound is on the top of the head the bandage attached to the individual sterilised dressing should pass below and be tied under the chin if the wound is on the back or front of the head the bandage attached to the dressing should pass round the head from the forehead to the junction of the head and neck at the back After one or more individual sterilised dressings have been applied to a scalp Hound it will sometimes be helpful to cover the whole head This is best done with a triangular bandage It is put on etactly as a woman puts on a head scarf The long side of the triangle is held along the back of the head The top point is drawn. over the top of the head to the froat The two side points are drawn round the sides of the head and tied in front over the top point Should tubular dressings be used by first aiders? In skilled hands these dressings are of great value But in unskilled hands they may be dangerous So their use is best restricted to trained industrial nurses It was stated carlier that bee venom is not acid and wasp venom is not alkaline is this really so? We were wrong A doctor friend writes this I expressed the sting bags of a bee and a wasp and I find that the former acts on litmus as an acid and the latter is an alkalı It is true however that the poisonous effects of these stogs are not due to their being acid or alkaline but to the complicated organic compounds which they contain Hence treatment with neutralising agents is useless For a full account of the composition of wasp and bee venoms the medical reader is referred to Dr TI Marshall s article in The Practitioner June 1957 Vol 178 page 712 Planning a Course How many lecture demonstrations are needed to teach industrial first aid and what should they cover? Provided that the lecturer is concise and avoids irrelevance and discursiveness the course as set out here can be covered comfortably in six lecture demonstra tions each lasting 60-75 minutes A fully stocked first aid box and a blackboard must be available for each lecture demonstration It is an advantage not to try to cover the course in less than six weeks This gives class members who are inevitably busy people an opportunity to read over and think about what they have learnt The teacher should prepare his own detailed lecture notes before each class and revise them each time a lecture is repeated The quality of his teaching will be directly proportional to the trouble he takes beforehand The outline synopsis which we use is as follows Lecture 1 The nature of industrial first aid the first-aiders tools How industrial first aid resembles and differs from ordinary first aid The first aid box and wbere to put it individual sterilised dressings cotton wool adhesive plaster protection from 01 the roller bandage the triangular bandage other items what to leave out ·128 A Miscellany 2 Do not mix cetrimide with soap as this renders it inactive 3 Choose the correct bung for the cetrimide bottle Corks are liable to become contaminated with germs particularly the pus producing germ Pseudomonas pyocyanea Cetrimide will destroy this germ in a test tube but will not do so in the presence of organic matter for example cork So corks must never be used in cetrimide bottles We have tried rubber bungs but after some months of contact with cetrimide they become soft and slimy We have found a plastic screw cap the best answer To counter the risk of contamination with Pseudomonas pyocyanea it is some times recommended that 01 per cent chlorhexidine should be added to the I per cent cetrimide solution Over a four year trial period cetrimide alone has in the hands of our first aiders at Harlow given uniformly satisfactory results We think that the addition of chlorhexidine is unnecessary for first aid purposes What is the best way to protect an adhesive dressing from the action of solvents such as thinners ? We have tried rubber and crêpe rubber finger stalls Both are useless as they dissolve within a few minutes The only protection of any value is a roller bandage carefully applied and frequently changed But even with this a new adhesive dres sing will probably be needed every time the bandage is changed The only complete answer is to keep the wound and its covering away from the solvent On a farm or a building site an adhesive dressing over a small wound on the hand needs special protection What do you recommend? By far the best protection is a roller bandage properly applied and changed when necessary How can a roller bandage be applied to protect an adhesive dressing over a wound on the palm of the hand? The bandage should be wound round the whole band alternatively above and below the thumb Get a trained nurse to give you a demonstration Then practise on a friend until you can do it as well as she does! In applying a roller bandage to any part of the body remember the points made earlier in the section on the first aiders tools It is often an advantage to leave the first su inches of a bandage sticking out loose this can be held tight as a anchor to prevent the bandage slipping as it is applied The end of the bandage can be tied to thus loose piece to finish off when the application is complete In the building trade wounds of the scalp are common How can you apply an adhesive plaster or a roller bandage to the sralp Adhesive plaster will not stick to the scalp unless the victim happens to be bald There is a method of applying a roller bandage to the scalp but it is very difficult and beyond the capacity of almost all doctors most first aiders and many nurses Small scalp wounds heal well with no dressing at all Clean the wound with cetrimide dry off the cetrimide with cotton wool and leave exposed to the air 18 however the wound is large ragged or gaping it should be covered with an indı ·131 A Miscellany examined orally and must also do certain simple practical tests The industrial first aider will do most of his work and make most decisions on his own, so his individual capacity without the support of colleagues must be assessed We have found it best to have two cxaminers - say a nursing sister and a doctor They should ask alternate questions but both should scorc all answers We mark cach answer from 0-5 A fully stocked first aid box should be at hand and open One of the examiners should allow himself to be used as a subject In a fifteen minute oral examination it is usually possible to get through cight to ten questions Is it right to let first aiders know the kind of questions they may be asked at examination? This problem arises in every type of examination The short answer is that regardless of whether it is right or wrong resourceful candidates are bound to find out the questions asked previously from those who have taken the examination before So for most examinations the questions previously asked are now pub lished for candidates to study knowing the type of question likely to be asked has one real advantage It takes away some of the anxiety with which the candidate approaches the examination and enables him to do more justice to himself Moreover the study of a well selected group of questions is an excellent method of revision What type of questions may be asked? Questions should be practical rather than theoretical and related as far as possible to the kind of situations which the first aider will meet at work It is important to achieve a good scatter so that ignorance in any particular field does not go un detected Accordingly the following specimen questions are arranged under eight subject headings At least one question should be asked on each of these subjects Wounds 1 I have a two inch long cut on my forearm which is bleeding rather badly Select from the first aid box the dressing to apply and show me how you would apply it 2 Quite quickly blood comes through the dressing you have just applied What would you do to the wound the arm and to the patient generally? 3 I have a small cut on my finger How would you decide whether to deal with it yourself or to send it on to someone else? If you decided to deal with it yourself how would you clean and dress it? 4 The patient has to return to an oily job How would you protect the wound and the dressing you have applied? 5 A man wearing rubber soled shoes has trod on a nail projecting from a plank What would you do? 6 A middle aged woman wheeling a tea trolley has slipped and cut her leg on a steel bar The cut although small is pouning out blood What has happened? How would you treat her? 7 Blood is squirting out from a cut on the wrist How would you deal with this? 8 How would you treat a blister on say the heel? Severe injury 9 A patient has collapsed in the lavatory He is just conscious pale and sweating His skin feels cold What is this condition called? What has probably caused it? How could you look after him?

·130 A Miscellany Lecture 2 Principles and details of wound treatment Major and minor wounds bleeding infection general treatment foreign bodies grazes and crushes wounds of the chest and abdomen nose bleeding ruptured varicose veio contusions blisters insect bites and stings Lecture 3 The effects of serious injun fractures strains and sprains Shock what the shocked patient looks like what happens in shock results of fluid loss management of shock crush injuries fainting General consideration of fractures bones commonly broken and how to recognise them first aid care of fractures general and particular strains and sprains dislocations Lecture 4 Burns and scalds physical and chemical injuries Minor and senous burns different kinds of burn objects of first aid treatment of trivial medium and sonous butns rescue from a burning building fire extaguishers Electric burns electric shock types symptoms and treatment Heat injuries types care and prevention Chemical injuries acids quick and slow acting alkalis chemical skin irritation chemical poisons Notifiable industrial diseases Lecture 5 Unconsciousness gassing and asphyxia artificial respiration Unconsciousness where the cause is obvious where the cause is probable with no obvious cause care of the unconscious patient some don is internal causes of unconsciousness fainting fits strokes diabetes alcohol hysteria Rescue of a gas casualty industrial gases intants smothering gases tissue poisons narcotising gases treatment of a gas casualty dust and fumes Artificial respiration when it is needed speed preliminates the Holger Neilsen method Eves rocking stretcher Stephensons Minuteman oxygen the airway Lecture 6 The eye aches and pains records transport Importance of eye injunes examining an eye removal of a foreign body glass scratches dust foreign body within the globe of the esc welding and the eye chemical splashes bandaging an eje prevention of cye injur Aches and pains reading a thermometer tablets Records the day book the accident book the register Moving an injured person preparing a stretcher the three man lift carrying a stret cher the blanket lift the chair lift single handed lifts the neck drag. Examinations in First Aid How should examinations in industrial first and be conducted? The purpose of such an examination must always be kept in mind it is to see the candidate is capable of doing first aid work safely and efficiently if he can do the job he should pass If not it is in the interest of all that he should fail We find that the great majority of candidates who have conscientiously attended a course based on the teachiog set out here will in fact pass A few will pass but will be found to have inadequate knowledge of one subject they should be told this and re examined in this subject later A few will find the work beyond them In our experience group examinations are useless Each candidate must be ·A Afiscellan) 133 10 You are called to a man with a severe crush injury of the hand Describe his geacral condition How would you look after him? Hc 3313 he feels thirsty Would you gave him anything to drink? Why or shy not? Fractures 11 What is meant by the word fracture? How can you tell if a patient has got a fracture? Suppose I had got a fracture of my forearm how would you deal with it? 12 What does a patient with a fractured hip look like? And a fractured wrist? And what does a patient with a fractured rib complain of? 13 Show me how you would use a triangular bandage as a sling? Burns and chemical injuries 14 I have a small burn on my finger from a soldering iron Show me how you would treat il. 15 How would you deal with a petrol burn involving say six square inches on the arm? 16 How would you set about rescuing someone from a burning building? 17 I am pounog some acid from a carboy and some spills over my arm and hand and on to my trousers How nould you deal with the situation? Suppose it had been caustic soda What would you do then? 18 How would you deal with a chemical splash in the cyc? 19 How would you deal with cement or lime in the eye? 20 Tell me the names of some substances which are used in industry and may cause dermatitis What would you do if a worker came to you with a complaint of skin imtation? The upconscious patient 21 You are called to an elderly man who is lying on his back unconscious and breathing heanly What would sou suspect was the matter with him? What would you do? 22 What would you do for a patient who is having an epileptic fit? 23 What are the semi prone and the prone positions? When do you make use of these positions? 24 An unconscious patient smells of alcohol What conclusion would you draw? 25 A fellow worker whom you know to have diabetes comes up to you and tells you rather aggressively that he is feeling muzzy and can see double What would you do for him? Why? 26 How would you set about rescuing someone who has been overcome by coal gas? Electric sbock 27 How would you deal with a case of electric shock? 28 Is there anything peculiar about electric burns? What do they look like and how would you deal with them? 29 lo what position would you place a patient before starting artificial respiration? What would be your position? Describe the movements you would make and the rhythm What apparatus might help you? The efc 30 A patient says he has got something in his eye Show me how you would examine him 31 You can see a foreign body on the white of the ese What would you do? Suppose you have to send the patient on for expert help what would you do first? 32 The patient says he was using a hammer and chisel when he got something in his cye On examination you can see nothing unusual What conclusion would you draw and what steps would you take?

·132
A Miscellanı
INDUSTRIAL
HARLOW
HEALTH
HSH
SERVICE
Edinburgh House
Templefields Harlow
Industrial First Aid Certificate
This is to certify that
has attended a course of lecture demonstrations
on Industrial First Aid, and has passed
and practical examination to the satisfaction of
the Service
an oral
Date...
Chairman of the Council
of the Service
Medical Director
FIG 72 Specimen Industrial first aid certificate issued 10 workers
in Harlow who have attended a course run by the stof of
the Industrial Health Service and passed an examination

·A Miscellany 135 First Aid in Coal Mines another St John publication prepared in association with the Medical Service of the National Coal Board is a clinical work of out standing value Apart from the specialised audience for whom it is planned it will be of help to all first aid workers in heavy industry The First Aid Coul Defence Handbook No 6 (HMSO) is a comprehensive train ing manual for civil defence workers Amficial Respiration by Dr T O Garland (Faber & Faber) is a beautifully illustrated little classic It should be read by cvery enthusiastic first aider and by every teacher of first aid Resuscitation of the Unconscious Victim by Dr Peter Safar and MC McMahon (CC Thomas Springfield Illino:s) gives a detailed account of mouth to mouth artificial respiration Accidents How they happen and how to prevent them is a quarterly journal (price is 3d per issue) published by the Factory Department of the Ministry of Labour Each issue contains much of interest to all industrial first aiders who are concerned with accident prevention ·134 A Miscellany Miscellaneous 33 Can you read a clinical thermometer? What is the reading on this one? 34 In our first aid box there are three kinds of tablet What are they and what are they used for? What is the dose of cach of them? 35 Three of you have put a patient on to a stretcher Where would you stand? How would you do the job? 36 If four of you lift someone and you had only a blanket available how would vou set about it? 37 If you were single handed how would you move an unconscious patient out of danger? llaving attended a course and passed an examination in industrial first aid will the first aider receive a certificate? He should certainly do so The certificate issued by the Harlow Industrial Health Service to its trained first anders is shown in Fig 72 Any first-aid course and certifi cate have to be approved by the Chief Inspector of Tactories Such a certificate is valid for three years Thereafter the first aider must attend a refresher course and obtain a fresh certificate of competence Books for Further Reading What other books are of value to the factory first aider who is keenly interested in his job? Health in Industry by Dr Donald Hunter of the London Hospital (Pelican Books) is a fascinating account of all aspects of industrial disease and its prevention Though technical it is easy to read But some excellent practical first aiders may find the science beyond theis comprehension First Aid to the Injured the little black book of the St John Ambulance Associa tion was discontinued at the end of 1958 Though much of it is obsolete it still has one great value - its excellent photographs showing methods of transport of injured persons First Aid the authorised manual of the St John Ambulance Association the St Andrews Ambulance Association and the British Red Cross Society is now the standard text book of the three great national first and teaching organisations It contains much theoretical physiological detail which we purposely omit On many subjects for example bandaging it is far more comprehensive than our teaching Its disadvantage is that it covers so much that the learner may become confused Nevertheless every intelligent first aider will find it an invaluable work of reference The Administration and Training Manual of the British Red Cross Society con lains an extensive and valuable section on the transport of casualties Fundamentals of First Aid by Dr R A Mustard the official publication of the St John Ambulance of Canada covers much of the ground dealt with in this book It represents an original approach to the teaching of first and it is however hard 1o obtain in this country Orcupational First Aid the St John manual for first aid workers in industry is complementary to this book and to the standard St John and British Red Cross first and manual It does not deal with clinical first and other than asphyxia in industry but has valuable chapters on industrial safety record keeping and indus trial legislation ·137 Page Bruises 46 Byssinosis 91 Calculated risk in first aid 15 Capıllaries dilation of 49 leakage from 49 Casbolsc acid 79 Carbon dionde 89 Carbon monoude Carbon tetrachtonde 74 90 Caming patients 113-121 Carrying weights 68 69 Caustic soda burs from 80 10 се 107 Cement in ce 107-109 Central Middlesex Industrial Health Service 15 Certificates in industrial first aid 132 134 Cetrimde 28 37 38 72 127 128 Chairlift 119 120 Chauffeurs fracture 57 Chemical injures and poisons 78-82 burns 78 prevention of 80 splashes in eye 106-109 Chest injury to 43 bandaging 44 Chisel mushroom headed 105 Chloride 89 Claviclc fracture of 55 56 treatment of fracture of 62 63 Clove hitch 28 Closed fracture 54 Collar bone fracture of 55 56 62 63 Colless fracture 57 Compound fracture 56 Compress cold 46 Conjunctiva bleeding under 105 Conjunctivitis 105 Contuscd wounds 32 Contusions 46 Convulsions 86 Cornea 102 103 104 scratches of 105 Cotton wool 22 23 tye app calor 23 103 Harlow dispenser for 21-22 Crush syndrome 32 33 Cyanide poisoning 90 Defomity as a sign of fracture 56 Dermatitis industrial 81 Diabetes 87 Disc slipped prevention of 68 Dislocations 69 Dressings adhesive 23 burn 22 field individual stenlized 20 21 22 123 she 26 72 Page Drowning 83 Dusts 82 91 Ear bleeding from 60 Electric burns 74 Electric shock 74 76 83 rescue from 76 symptoms of 75 treatment of 75 76 83 what happens in 74 75 Electric welding 106 Elisha, artificial respiration by 93 Epilepsy symptoms of 85 86 treatment of 86 Epistaxis 44 Eves rocking stretcher 97-101 Examination of first aiders 130 131 133 134 Expiration 96 Eye in industry 102-110 arc injury 106 bandage for 109 burns of 106 cement in 107 chemical splashes in 106-108 drops 26 dust in JOS examining 102 103 foreign bodies in 102-101 glass in 104 lime in 107 ointment 26 28 104 125 pads 110 prevention of injury to 110 welding effects of on 106 Face wounds of 33 Factory doctor 17 Factory housekeeping 19 Fainting 53 8S Farm first aid equipment on 126 Feet bones injury to 60 63 Femur fracture of neck of 58 fracture of shaft of 58 treatment of fracture of 61 62 Fettling 110 Fibula fracture of 59 60 treatment of fracture of 62 Field dressing 22 Fingers sjury to 33 Fire extinguishers danger from 74 Fireman shift 119 120 First aid competitions fundamentals of 13 15 general propositions 14 15 industrial nature of 12 14 job analysis of 11 leaming and teaching 18 planning & course in 129 130 present teaching of 12 Syllabus for teaching 129 130 work study of tullc gras ·136 INDEX sprains of Page Abdominal wounds 43 44 Abrasions 32 42 Accident book 121 Acids antidotes 79 burns 78 quick acting 78 slow acting 79 splashes in eye 106-108 splashes on skin 79 Aches and pains 111 113 Adhesive plaster 23 123 124 Adhesive wound dressings 23 123 124 Acoholic Intoxication 87 Alkal antidotes 79 80 burns 80 splashes in esc 107-109 splashes on skin 81 Ammonia bums 80 splashes 80 cas 89 Ankle fracture of 59 60 60 treatment of fracture of 63 Antidotes 79 80 Anuseptics 26 Apoplery 86 Arc eye 106 lotion for 106 Artificial respiration 92-101 Eve s rocking stretcher method 97-101 Indications for 92 Holger Nielsen method 93 94-99 mouth to-mouth method 93 preparation for 93 94 prinaples of 9. 93 pull methods 93 push and pull methods 93 push methods 93 rocking methods 93 94 97-101 Schafers method 93 Silvester s method 93 Stevensons Minuteman Resuscitator 93 suck and blow methods 93 91 Asb stos. Poisoning by 90 Aspha Aspina phenacetin and caffeine 113 1.5 71 Atom bomb fiash 63-67 Back injury to 34.5 128 Bandage roller 26 27 triangular Bandı-chair lift Page Barrier cream 81 Bee sting 45 129 Bismuth tablets 112 125 Bites animal and human 43 insect 45 snake 45 spider 45 Black eys 46 Blanket lift 117 118 Blankets, on stretcher 113 114 Bleeding 33-37 control of 33 34 internal 49 nose pressure points 35 pressure to stop shock caused by 49 varicose veins Blasters 46 Blood clotting of loss of 36 transfusion 36 volume of 36 Bones injury to 54-60 Books on first aid for further reading 134 135 Bottles hot water S1 S2 Botes first aid 20-30 123-127 building site requirements 126 contents of 124 dock requirements 126 factory requirements 123-125 farm requirements 126 Harlow supplement 28 124 large size 20 124 medium size 20 124 siting of 30 small size 20 124 stocking of 31 Buffered phospate solution 79 Burning building rescue from 73 Burns 70-74 area of 70 chemical 78 depth of 70 electrical 74 first aid treatment of 71-73 flash 71 friction 71 medium 73 rule of nines 70 severe 73 innal 72 tablets 119 ·139 Pad ning Page Slethane 89 Methyl bromide Moning an injured person 113-121 Muscles injury 10 67 Mushroom headed chisel IOS Mustard Dr RA on first aid 13 15 Meck broken 65 Neck drag 120 121 Nenes injury to 65 Nitnc acid 79 Nitrogen 89 Nitro hydrochloric acid 79 Nose bleeding from 4+ "No touch" technique 39 Oil protection of wounds from 24 Open fracture 54 56 Ocalic acid 79 Oxygen administration of 101 Pad and bandage 20 21 41 Pain relief of 52 Paralysis in fractured spine 65 in strokes 86 87 Penetrating wound 32 33 of abdomen 43 44 of chest 43 44 Phenol poisoning 79 Phosgene 825 89 Planning a first aid course 129 130 Poisons industrial 82 Potts fracture 59 60 Pressure bandage 124 125 Pressure points 35 Prevention of shock 50-52 Principles of industrial first aid 14 15 Pronc position 84 Pseudomonas plocoyanca 128 Puls in shock 48 in fainting S3 Punature wound 32 33 42-44 Radius fracture of 55-57 treatment of fracture of 63 64 Records in industry 121 Respiration artificial 92--101 Respirators types of 88 compressed air 88 filter 88 flexible hose 88 oxygen 88 Ribs fracture of 59 60 treatment of fracture of 65 Riley rocking stretcher 98-101 Ring pad 41 Rocking stretcher 98-101 Roller bandages 24 25 124 104 Salt drinks to prevent heat injury 77 Scalds 70 71 care of Scalp wounds of 128 129 Page Schafers method of artificial respiration 93 Sclenious acid 79 Semi pronc position 51 84 85 Sepsis prevention of 37 Serious injury effects of 47-53 Shin bones fracture of 59 60 treatment of fracture of 61-63 Shock bleeding as a cause of 49 causes of 48 electric 74-76 fluids in treatment of 52 heat in treatment of 51 management of SO 51 morphia in S2 mythology of 47 position in treatment of 51 types of 47 what happens in 48-50 Shocked patient appearance of 48 Shoulder dislocation of 70 Silica poisoning by 91 Single handed lift 119 120 Skin disease of 81 industrial irritation of 81 Skull fracture of 60 Slings triangular bandage 27 improvised 29 collar and cuff 28 Slough Industrial Health Service 15 Siow acting acids 70 Smothering gases 89 Snake bite 45 46 Solvents in eye 108 protection of wounds from 128 Spider bites banana 45 Spine fracture of 65 movement of patients with fracture of 66 67 Splints use of 26 61 Spot welding 106 Sprains 67 68 Sterilization 37 38 Stings 45 Stomach ache 111 113 bleeding from 49 Stretcher carrying 116 117 loading 113 114 preparing 113 114 Strains 67 Strokes 86 Sulphur dioxide 89 Sulphuric acid 80 Sunstroke 77 Swarf 110 Tablets 112 113 125 Tar burns 81 Thermometer how to read 111 112 Thigh bone 58 62 Rust ning 71 72 ·338 Page care of First aiders cestificates for 132 duties of 17 educational work of 17 18 examination of 130 131 133 134 training of 129 130 Fish tail blankets on stretcher 113 114 Fits 85 86 Flash burns Fluid loss 47-30 73 Food industry regulations $27 Forearm fracture of bones of 55-57 treatment of fractures of 63 64 Foresan bodies In eye 102-104 10 wounds 41-43 within globe of eye JOS Fractures 54-67 61-67 closed and open 54 56 compound 56 definition of 54 diagnosis of 56 ndividual bones 56-60 moving patients with 61 63 principles of management of 63 62 recovering 65 66 Tole of first a sdess s care of 54 simple 54 splinting of 61 62 types of 54 56 Fundamentals of First Aid by RA Mustard 13 33 Fures 82 91 Gallipot 28 38 Gas casualt es 83 89-91 rescue of 87 88 treatment of 91 89 90 Gases industrial 89-91 Asphyxiating 89 iriant 89 Barcousing 90 tissue poisoning 89 Gas welding General praciples of industrial first aid 14 15 General register of factories 122 Gossles Grazes 42 Green stick fracture 55 57 Gradiag wheels TOZ TIO Haemorrhage 33-37 control of 34 36 48 from nose from varicose vein 44 45 Hand bones injury to 60 63 Harlow cotton wool 21 32 38 dispenser Page Harlow Industrial Health Service 15 Harlow supplement to official first aid boxes 28 124 Head nun to 60 Healing by first intention 39 Heat jury 76 77 cause 76 77 exhaustion 76 77 prevention 77 stroke 76 77 symptoms treatment Bsp fracture of 58 59 treatment of fracture of 61-63 Hotcer Nielsen method of artificial respiration 93 94-99 Hot water bottles 51 Housekeeping aadustrial 19 Humerus fracture of SS 56 treatmeot of fracture of Hydrobromic acid Hydrochloric acid Hydrofluoric acid Hydrogen cyande 90 Hydrogen sulphide 90 Hystena 87 Ice pack 45 Incised wound 37 Industnal diseases notfiable 82 Industrial first aid 11 12 14 16 18 who should learn 18 Industrial health cerstre 16 Industrial health team 15 organisation of 16 Infection of wounds 37 injury senous effects of 47-53 crush 52 Inspiration 96 lodtsed throat tablets 513 125 Jaw dislocation of 69 Job analysss in first aid Joints dislocation of 69 sprains of 67 69 kidneys in crush syndrome 53 Anee injury 10 knots for bandages 25 28 {abous Ministry of health and safety exhibition 18 82 Litt blanket 117 118 chass 119 120 firemans 119 120 stretcher 116 117 lifting weight nghe way 69 wrong way 69 Ime in the eye 107 108 109 Machiner trapping by 53 Magnesium carbonate tablets 125 Vagnesium trusilicate tablets 1.5 Vetal fumes 91 types of Lead poisoning in shock

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·140 Page Thippers 10 eye 109 protection of wounds from 128 Three man lift 114 115 Tibia fracture of 59 60 treatment of fracture of 61 62 Tongue in the unconscious patient 84 in epilepsy 86 Tools first aiders 20-31 Tourniquer 26 36 Transport of injured 113-121 Thangular bandages 26 27 61 124 Trichlorethylene 90 Tubular dressings 129 Tulle gras 26 72 Two-man lift 116 Ulna fracture of 55 56 57 treatment of fracture of 63 64 Unconsciousness 83-87 care of patient 84 causes of 83 internal causes of 85 obvious causes of 83 probable causes of 83 with no obvious cause 83 Vancose vein rupture of 44 Vomiting 48 111 Warmth in the treatment of shock 51 52 Wasp stings 45 129 Welders flash 106 Work study of first aid 11 Page Wounds abdominal 43 44 abrasions 32 42 bites animal and human 43 blood loss from 36 chest 43 cleaning of 37 38 closing and covering 38 complications of contused deep at waist 36 dressing of 40 41 foreign bodies in 41 healing of 39 incised lacerated machinery causing major ПІДОГ 32 40 penetrating position of 33 pressure on 34 puncture 32, 42 redressing of 41 scalp 128 129 special 40 stab 32 33 treatment of 32-42 127-129 types of 32 33 Wrist, fractures of 57 treatment of fractures of 63 64

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