Check the Airway / protect the spine.

Where possible, get a bystander to support the casualty's head by placing their hands on either side of the casualty's head. If the casualty is unconscious, you must protect their airway as the tongue may fall back obstructing it. Place one hand on the forehead (to prevent head movement) and have a quick look in the mouth for any obvious obstructions.

NON TRAUMA PATIENTS! Keep your hand on the forehead and tilt the head back gently. As you do this, lift the chin by placing two fingertips of your other hand under the point of the chin. These actions will ensure the airway remains open.

TRAUMA PATIENTS. If the patient may have been subjected to a severe force which could have caused head / neck - spinal injuries / broken bones, DO NOT TILT THE HEAD. Use the chin lift only to maintain the Airway. Only use minimum head tilt if the chin lift fails to maintain the Airway properly.

If the Emergency Services have not been called, send a bystander to call for an Ambulance. Make sure they know the exact location of the accident and can tell the Ambulance controller if the casualty is conscious or unconscious, breathing or not breathing.

Breathing but unconscious.

NON TRAUMA. If the nature of the incident is such that you do not believe the casualty has sustained trauma injuries (such as head / neck injuries, serious internal injuries, broken bones etc), place the casualty in the Recovery position (SEE RECOVERY PAGE).

TRAUMA. If there is any chance the casualty may have been exposed to a traumatic force, which could have broken bones and or caused injury to the head, neck, back or internal organs, DO NOT MOVE THE CASUALTY, treat them in the position found. Maintain an open airway using the chin lift only. Only use minimum head tilt if the chin lift fails to maintain the Airway properly.

Check for a pulse.

When checking for a pulse, use the carotid Artery in the neck, DO NOT check the pulse in the wrist as this can be unreliable. To find the pulse in the neck, run two fingers down the windpipe until you come to the voice box. Slide your fingers to the left or right and press in with your finger tips just as you come off of the windpipe. Check for a pulse for up to 10 seconds. Finding the pulse can be difficult so if you are having problems, check the pulse in both sides of the neck and look for other signs of life such as skin colour / temperature, movement, coughing / breathing etc.

Check for and treat serious bleeding.

Carry out a full body scan for any signs of bleeding. If possible always put on a pair of disposable gloves before you start. Run your hand over and under the casualty's body. Feel for blood / other fluids and look at the casualty's clothing for any signs of discoloration caused by bleeding. As you pull your hand out from under the casualty, check your gloves for any signs of blood.

If possible, expose any wounds and apply direct pressure with either your hand or with a suitable dressing. Do not worry if you can not tie the dressing in place, just keep the pressure on. If blood soaks through the first dressing, put another one on top of the first one. If there are any foreign objects imbedded in the wound, do not remove them and do not apply pressure (i.e. a dressing) on top. Instead, apply pressure to either side of the wound by squeezing the sides together. Never use tourniquets to control bleeding and never prevent blood / fluid from draining from the ear.

Check for signs of and treat shock.

Shock is the body's reaction to loss of fluids (normally blood). If a casualty is showing signs of shock they must be losing fluids either externally or more seriously, internally. The signs of shock are cold clammy skin and paleness or blueness of the lips and extremities. The pulse will become very rapid, well over a 100 beats per minute, but will get weaker and become irregular.

To check for skin temperature, place the back of your hand against your own forehead, then place it on the casualty's forehead and make a comparison. Check for colour by turning the casualty's lip back and look at the inside edge (it should be a red / pinky colour). Check the pulse in the wrist or the neck. The normal adult pulse rate at rest is between 70 and 80 beats per minute. Record the results of your checks (and the time you made them) and repeat every couple of minutes. Give the record of your observations to the Ambulance crew on their arrival.

If the casualty has serious wounds and or is showing signs of shock, treat them as follows. Lay the casualty down and if their injuries allow, raise their legs about 6-10 inches off the ground to improve blood flow around the body. Keep the casualty warm but do not overheat them as this will make the condition worse. Do not give them anything to eat or drink, in case they require an anaesthetic.

Continue to monitor the casualty's condition until the Ambulance crew arrives. Be aware that the casualty's condition may change so you must continue to repeat the above checks every couple of minutes.