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(First aid at a scene of fire)

Kitakyushu City Fire and Disaster Management Department

First Aid II

JICA"Fire Fighting Techniques "2010

Todays themes

Treatment of burns Hemostasis methods Immobilization of a broken bone Emergency rescue from a vehicle involved in a traffic accident

Understanding external injuries and acquiring appropriate first aid skills


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Burn

Skin trouble due to heat The degree of seriousness depends on the temperature and the time of contact. Kinds of causes *Fire *Electricity *Chemical substance Burns caused by fire reach deeper than those caused by *Radiation boiling water. *Boiling water
They are more likely to become serious.
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Depths and characteristics of burns

Burns are classified into first-degree, second-degree and third-degree burns. FirstFirst-degree burn Small-scale disorder of tissue limited Smallto the outer surface of epidermis -Surface: Red spots -Symptoms: Sharp pain, feeling feverish -Time for healing: Several days
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SecondSecond-degree burn Disorder of the whole layer of epidermis and a part of dermis

SecondSecond-degree burns can be divided into shallow and deep ones.


-Surface: Blisters -Symptoms: Strong sharp pain, burning sensation -Time for healing: About 10 days to three weeks Shallow seconddegree burn Deep seconddegree burn
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ThirdThird-degree burn Disorder of all the layers from epidermis to dermis Surface: Necrosis, burnt and semitransparent Symptoms: Painless, paralysis of sense It does not recover spontaneously and a contracted scar remains. Skin grafting is necessary.

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Seriousness of burn
The seriousness of burn depends on the area, depth, age and body part. Area: Nine rules (for adults) The ratio of the palm of a hand to the whole body: 1% Age: The elderly tend to be more seriously affected than adults. Body part: Face, eyeball, ear, hand, leg, private parts, etc. Problem in cosmetic surgery Possibility of loss of function
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Cases that require treatment at hospitals specialized in burns

When a person under 10 years of age or over 50 years of age suffers a first- or second-degree burn first- secondon 10% of the surface area of the body When anybody (irrespective of age) suffers a second- thirdsecond- or third-degree burn on 20% of the surface area of the body When a person suffers a burn on the face, a hand, a leg, sex organs, private parts or the skin over a major joint When a person suffers a third-degree burn on 5% thirdof the surface are of the body
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Cases that require treatment at hospitals specialized in burns

Special burns
* * * * Burns due to electric shock, including lightning Chemical burns Injuries to the respiratory tract due to inhalation Burns on the whole chest or the whole limbs

Serious basic disease Existence of another serious external injury

JICA"Fire Fighting Techniques "2010

Outward seriousness makes it difficult to observe a burnt victim. It is rare for a burnt victim to die early. If a burnt victim dies early, this is due to another external injury that accompanies the burn or due to occlusion of the respiratory tract or inhalation of smoke. The priority of the treatment of a burn itself is low. Basically, the observation procedure for a burnt victim is the same as that for other injured victims.

Observation of a burnt victim

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Observation of a burnt victim

Check the condition of the scene. Pay full attention especially to the safety of the rescuer himself. Protect the cervical vertebra. Move the victim to a safe place. Check the level of consciousness. Secure the respiratory tract. Check the victims breathing, circulation and excessive bleeding.
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Observation of a burnt victim

Serious condition that requires emergency treatment Occlusion of the respiratory tract Decrease in the level of consciousness Existence of a serious injury other than the burn Symptoms of a disorder of the respiratory tract A burn on the face or the head skin Phlegm mixed with the color of soot Burnt nostril hairs or eyebrows
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Control of breathing

Causes of disorder of breathing just after suffering a burn


Toxic gas poisoning Oxygen deficiency Burn on the respiratory tract

Causes of disorder of consciousness


External injury to the head Disorder of cerebral blood vessels Poisoning

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Cooling a burn down


If there is no life-threatening injury, lifePromptly cool down the affected part. If the thickness of the burn is about 1 to 2 mm, cool down for about 10 minutes. Long cooling leads to; Low temperature Shock

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Method of Cooling Burns

Do not remove clothes

Cool the burned area through clothes.


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Carbon monoxide poisoning

The main causes of early death due to a burn are carbon monoxide poisoning and suffocation. Carbon monoxides affinity with hemoglobin is 257 times as high as oxygens. A clear symptom is a decrease in the level of consciousness. First aid: Dosage of high-flux oxygen high(Hyperbaric oxygenation is effective)

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Burn on the respiratory tract


Inhalation of heat selectively injures the upper respiratory tract. Edema is likely to occur on the mucous membrane over the upper larynx (lower pharynx). Symptoms of a burn on the upper respiratory tract Swelling of lips Hoarse voice Stridor Burn on the face, such as burnt nostril hairs and eyebrows Phlegm mixed with the color of soot
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Burn due to smoke inhalation


Inhalation of toxic chemical substance may cause structural damage to pulmonary cells. Synthetic resin (such as plastics) is the most dangerous. It often takes several days for a disorder to appear.

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Criterion for dosage of oxygen and matters requiring attention


If respiratory disorder is clearly shown in the victims breathing or on the face, positively give a dosage of oxygen early. (Matters requiring attention) Do not neglect to check that the respiratory tract is open. Give high-density oxygen. high Make humidification. Precedence is given to the dosage through a mask with a reservoir.

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Hemostasis methods

An adults circulating blood volume is 80 ml/kg. If the ratio of bleeding volume to circulating blood volume is:
10% or less 2020-30% : Increase in the pulse rate : Decrease in the blood pressure, thirst, pale and cold skin 30% or more : Disorder of conscious, heavy breathing 40% or more : Coma, danger of cardiac arrest

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Kinds of hemostasis methods

Direct pressure

Basic method of stopping external bleeding Correct anatomical knowledge is necessary. Application to the thigh and the upper arm is the most suitable. If the wound is tied up too fast, a nerve may be damaged. Do not tie up the wound for more than one hour. If the would is tied up for a long time, restart the flow of blood from time to time.
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Indirect pressure

Use of a tourniquet

Immobilization by a splint

Purposes
To keep the affected part quiet and reduce the sharp pain To prevent a secondary injury

Types of splints usually used at a scene of emergency


Schiene Stiffneck Vacuum splint Shock pants

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Immobilizing equipment

Splint

Stiffneck

Vacuum splint

Shock pants
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The fixation by a splint

a fixation of the leg

a fixation of the arm


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JICA"Fire Fighting Techniques "2010

Immobilization by a splint

A splint can be substituted with what is available at hand. When applying a splint, it is desirable to make the posture of the arm or leg proper after restoring the bone. In principle, when applying a splint, make the posture of the arm or leg proper, including the two joints above and below the injured part. Do not put a bandage too tightly. If the wound is open, treat it appropriately before applying a splint.
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Simulation 1

A fire has occurred at an ordinary house. The rescue team has not arrive yet. The victim is a 50-year-old man, who has clear 50-yearconsciousness and can have a conversation.

* He has suffered a 7% second-degree burn on the secondlower left leg. * Because he inhaled smoke when taking refuge, he is coughing. * Because he thrust the right arm into glass, the upper right arm is bleeding a lot. Consider what first aid treatment is necessary, and prioritize them.
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Simulation 2

Hazardous materials caused the fire. The rescue team has not arrive yet. A 30-year-old male firefighter was blown off by 30-yearthe explosion.
* No consciousness * Bone fractures in the right forearm and the right knee * 8% third-degree burn on the chest third* No breathing or pulse Consider what first aid treatment is necessary, and prioritize them.
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Dull external injuries


Deaths by external injuries More than 90% are due to excessive bleeding. Golden hour (within one hour after the victim suffered an injury) It is necessary to begin hemostasis within one hour after the victim suffered an injury. The time for operation at the scene is within 10 minutes Load & Go (General ideas about the judgment and action to provide only the treatments necessary for the maintenance of life and to carry the victim to a hospital specialized in the treatment of external injuries)
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Injury to the spinal cord due to a dull external injury

Causes: No. 1: Traffic accident No. 2: Downfall No. 3: Falling to the ground

It is also reported that 25% of injuries to spinal cords were caused by hospitals improper treatment.

When firefighters take action, they should consider the victims convalescence and assume that the victim has suffered an injury to the spinal cord (cervical vertebra).
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Approach that gives priority to the protection of the cervical vertebra

The CABC approach is the most important for the treatment of an external injury at a scene of emergency. C: C-spine immobilization A: Air way B: Breathing C: Circulation
The protection of the cervical vertebra has priority over any observation. Continue to protect the cervical vertebra until a hospital denies an injury to the cervical vertebra.
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Emergency rescue from a vehicle

Application of emergency rescue


* Abnormality in A, B or C * Cardinal or pulmonary arrest * When a danger is approaching the victim and the rescuer (vehicle fire, etc.)

Rescue with a blanket


Advantage: A small number of people can promptly rescue the victim.

Disadvantage: Because only the upper part of the body can be fixed, immobilization is imperfect.
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Rescue with a blanket

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Simulation Training 3
A passenger car crashed against the wall, and white smoke is rising from the bonnet. bonnet. A rescue party has not arrived yet. yet. 50-year-old man, unconscious 50-yearBreathing, having a pulse Bleeding massively from the right lower leg

Rescue and give him necessary first-aid treatment.


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Simulation Training 4
A passenger car crashed against the wall. wall. A rescue party has not arrived yet. yet. 30-year30-year-old man Unconscious No breathing, no pulse 20-year-old woman 20-yearConscious Bleeding slightly from the head

Rescue and give them necessary first-aid treatment.


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