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Casualty Care

Most of the information in this article links into, or should be used in conjunction with my information on casualty communication. You can find this on my website, here.

When caring for a casualty, you are trying to achieve a few things:

Avoid infection

Do not make the injury worse

Treat as fully as possible with the materials and experience you have

The most important step is to talk to the casualty calmly and gently, so that you can gather as much information as possible to relay to emergency services if they are being called. Casualties may not always be able to communicate clearly due to their injuries or the stress of the situation, so it is up to the first aider to ask the right questions and speak calmly.

To avoid wound infection, it is important to wear gloves if possible before dealing with open wounds. You should also avoid cross-infection by only using sterile bandages from a first-aid kit, rather than "making do" with other materials. Dispose of any waste after you are done.

When calling emergency services, make sure that you have the correct information about the casualty - again, by listening to them carefully and asking the right questions. There is a certain etiquette for calling emergency services that you should follow if possible, detailed in my website here. If you cannot remember how to speak to them, do not worry - they are trained to do so and will be able to get the right information.

Deaf people can use the 999 BSL app if necessary.

Test your own communication/casualty care in one of our interactive choose-your-own-path first aid training simulations! Find a variety to try here: Simulations | First Aid Hub

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Casualty Communication

How you communicate with the casualty can be as important as the actual first aid itself. In many cases, injuries can be aggravated by fear or discomfort - for example, if a casualty is bleeding severely, being anxious elevates the pulse rate which causes them to bleed out faster. So, it is important to keep the casualty calm by communicating clearly and effectively.

Younger children

Act like nothing is wrong - speak with a gentle, even excited tone if you can manage it.

Act like a professional - do not look scared where they can see you, as they will mirror that fear.

If you can, talk them through what you are doing in child-friendly language.

Praise them for being brave, staying calm, etc.

Ask questions to distract them - favourite food, pets, friends, etc.

Adults

Speak calmly and clearly

Speak on their level - explain what is happening and what you are doing

No need to act like nothing is wrong, but be careful to not emphasise severity of injuries

Ask questions to distract them - job, children, family, etc.

Also, it's important to remember that the casualty may be unable to communicate effectively - whether because of injuries or stress. So you should listen carefully to what they are saying in order to give the best care possible.

Test your own communication/casualty care in one of our interactive choose-your-own-path first aid training simulations! Find a variety to try here: Simulations | First Aid Hub

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Burns and Scalds

Burns are an umbrella term for burns and scalds. They refer to heat-related injuries that you get from anything: hot water, fire, electricity, etc. Scalds specifically refer to heat-related injuries sustained from liquids, such as hot water, hot drinks, or steam.#

What you might see:

There are different severity levels of burns, ranging from 1st (least severe) to 3rd degree (most severe). You are very unlikely to encounter third degree burns, but it is still useful to be able to distinguish the different degrees.

First degree burns:

Pain

Redness

Swelling

No blisters

Second degree burns:

Pain

Redness

Swelling

Peeling skin

Blisters

Third degree burns:

Skin is often burnt away

Tissue beneath is blackened

Skin can appear dry, leathery, waxy

Skin can appear brown, black, or white

Often painless because of nerve damage

Often surrounded by second degree burns

What to do:

Run the burn under lukewarm (not ice-cold) water for 15-20 minutes.

This cools the burn without causing further damage because of the sudden change in temperature.

Apply cling film or sterile (non-fluffy, so non-sticky) dressing.

Do not pop any blisters - take care to avoid popping them as it can lead to infection risks

Treat for shock if necessary.

Call for emergency services if:

Severe second-degree or third-degree burn

Does not heal on its own

Infection sets in

For more first aid content, like 30+ free lessons, interactive choose-your-path simulations, and downloadable resources (and much more!), check out my site: Home | First Aid Hub

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Sprains and Strains

Sprains and strains are soft tissue injuries, especially around bones and joints. They usually happen because of overexertion, especially with sport.

What you might see:

Swelling

Tenderness

Bruising

Difficulty moving the affected area.

What to do:

You can treat strains and sprains using the RICE method.

Rest: rest the injured part. Help the casualty to sit or lie down in a comfortable position.

Ice: ice the area. make sure to wrap the ice pack in a sweatshirt or towel before applying it to the affected area, so that the ice does not directly touch the skin.

Comfortable support: provide comfortable support by putting cushions/folded up blankets under the affected area. If necessary, you can give a paracetamol or ibuprofen to the casualty. Make sure to check the age allowance on pain medication, especially when working with children.

Elevate: elevate the affected limb to minimise swelling and bruising. You could do this using cushions under the body part.

For more first aid lessons, or for interactive simulations and downloadable resource packs, visit my website at Home | First Aid Hub

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Fractures and Dislocations

Fractures

A fracture is a crack or break in the bone. They are most common in the arms and feet, especially in the upper arm.

There are many types of fractures. The names for them refer to where they occur in the body (anterior, posterior, medial, lateral, etc) as well as the direction they take across a bone (spiral, transverse, etc).

Dislocation

Dislocation refers to a joint in the body being pushed out of its usual place, and it is most common in the shoulders, kneecaps, and fingers. There are two main types of dislocation:

Total dislocation - the bones in the joint are totally separated and out of place

Subluxation (partial dislocation) - the bones are still touching, just not as completely as they were before.

NEVER attempt to push a dislocated joint back into place on your own. This is extremely dangerous and can result in lifelong joint problems, nerve and blood vessel damage, as well as being severely painful.

What you may see:

Swelling

Bruising

Difficulty moving the limb

Pain

Limb bent at odd angle (severe)

Bone puncturing the skin (severe)

What to do:

Try not to let the casualty move around – this could aggravate injuries.

Support the injured limb if possible and necessary.

A dislocated/fractured finger may not need support, but a fractured arm could be supported by a cushion under it.

Try to arrange to go to the hospital without calling emergency services if the injury is not severe.

For more first aid lessons - and for interactive simulations, downloadable resources, and more - visit my website:

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Shock

Not to be confused with the emotion, medical shock happens when not enough oxygen is delivered to the brain and vital organs. People can go into shock for many reasons – it can be caused by anything that reduces the flow of blood, such as:

External bleeding

Internal bleeding

Allergic reactions

Septic shock

Loss of bodily fluids (dehydration, diarrhoea, vomiting)

Heart attack/heart failure

Symptoms of shock include:

Pale/clammy skin

On dark skin, look at the palms and soles of the feet to be sure

Weak pulse

Fast pulse

Sweating

Fast, shallow breathing

Grey-blue skin

On dark skin, this is most visible on the inside of the lips, and on the palms of the hands

Nausea and vomiting

Restlessness

Gasping for air

The casualty could become unresponsive as shock worsens.

What to do

Firstly, treat the cause of shock – the wound you would have identified by doing the DR ABC primary survey.

Use the saying: “if the face is pale, raise the tail. If the face is red, raise the head”.

This means that if the casualty’s face is pale, you should elevate their legs by lifting their feet onto a chair and making them lie down.

If their face is red, have them sit up with their back against something.

Call emergency services and explain that the casualty is in shock and what is causing it.

Cover the casualty with a blanket or coat to make sure they stay warm, and make sure their clothing is not restrictive (remove any ties etc)

Monitor them continuously. Get ready to perform CPR or other actions if necessary, if they become unresponsive.

For more first aid lessons, interactive simulations, and downloadable resources, please visit my site:

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Bandages and Slings

It is important to be able to bandage wounds correctly. This includes regular cuts and scrapes, embedded objects, head wounds, support slings, and elevated slings. 

Normal

1. Place the sterile dressing over the wound, ensuring it is fully covered.

2. Ask the casualty to hold down the shorter end if they are able to, and then wind the longer end around the limb.

3. When there is around 10cm left of the longer end, wind the shorter end around the limb until there is 10cm of this left too.

4. Tie the ends together — tight enough so that it is secure, loose enough that the casualty’s circulation is not cut off.

5. Tuck the ends under previous layers.

Embedded object

1. Place two rolled-up bandages on either side of the embedded object.

2. Take another roll of bandage and wind it around the object.

3. Make sure it is securely held in place and is not removable.

Head wound

Head wounds tend to bleed a lot and cause distressing symptoms such as fainting, unconsciousness, and vomiting. Hence, it is important to stay calm and deal with the wound confidently.

1. Unwrap the sterile dressing and place the cotton pad on the site of the wound.

2. Wrap the bandage around the head, using the ears and natural curve of the skull to keep it in place.

3. Make sure no blood can drip into the eyes by winding the bandage so that most of the strips are at the bottom of the dressing.

Support sling

1. Ask the casualty to support their arm with their other hand.

2. Gently slide the triangular bandage under their arm — the point of the triangle should be under the elbow of the injured arm.

3. The top end of the bandage goes around the back of their neck.

4. The other end of the bandage goes around their shoulder.

5. Tie these two ends together where they meet.

Elevated sling

1. Triangular bandage is draped over the chest, on top of the injured arm.

2. Tuck the lower part of the bandage underneath the injured arm.

3. Tie off the ends, making sure they are tied tightly because all of the support in this bandage comes from the knot.

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Bleeding

With severe bleeds, you may see signs of shock in the casualty. You may also see an object embedded in the wound — if you do, do not remove it as it could be plugging the wound.

What to do?

If the object is embedded, do not remove it. Instead, place a rolled-up bandage on either side and then bandage around it, trying to hold it in place. Call emergency services as these types of wounds require emergency care.

If there is no embedded object, simply apply pressure on the wound. Apply a sterile dressing to it and support the injured area.

If necessary call emergency services — this could be because of severe signs of shock, the bleeding getting worse, or the casualty becoming unresponsive.

Treat the casualty for shock if necessary. Symptoms of shock include:

Pale skin

Sweating

Fast pulse

Weak pulse

Nausea

Gasping for air

Unresponsiveness

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Involuntary Amputation

tw: non-graphic descriptions of amputation meant for first aid training purposes. not gore, not graphic at all.

This can be a very distressing, even scary situation. There will be a lot of blood on the scene, as well as a severed body part that may make the first aider squeamish. However, it is important to try and push away these feelings to act as quickly as possible.

What you may see:

Severed limb/part of limb

Signs of shock, such as pale skin, fast/weak pulse, nausea or vomiting, and the casualty becoming unresponsive.

What to do:

1. Call emergency services immediately — this is a situation that requires urgent and advanced first aid.

2. Apply pressure or a tourniquet to stop the bleeding — if there is another person with you, tell them to do this while you complete the following steps:

3. Put on gloves and wrap the severed limb in cling-film if possible. If cling film is not available, wrap it in something else — as sterile as possible.

4. Put the limb on ice ONLY IF it is covered by something.

5. Label this and give it to the paramedics when they arrive, as they may be able to reattach it.

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Asthma Attacks

Asthma attacks have very visible outward symptoms like breathlessness, coughing and wheezing, which is why it can be scary to try and deal with them. However, most asthmatics will have an inhaler on them, or — in schools — one will be close by — so staying calm and acting quickly can make all the difference.

Symptoms

Asthma attacks have symptoms that are very easy to spot. These include:

Breathlessness

Wheezing

Coughing

Distress/anxiety

Signs of hypoxia - grey-blue lips, earlobes and nailbeds

What to do

1. Sit the casualty down in a comfortable position — make sure their back is supported and leaning against something, and their knees are drawn up to their chest.

2. Ask them to take their usual dose of inhaler (usually blue). If they have no inhaler, call emergency services immediately. If they have a spacer, ask them to use it with their inhaler as this works best, especially for young children.

3. Ask the casualty to take a puff every 30–60 seconds, until they have had 10 puffs. If the attack has not eased by now, it is likely a severe attack.

4. If the attack is severe and the casualty is getting worse/becoming very tired, call emergency services immediately.

5. Keep monitoring the casualty and be ready to perform CPR if they become unresponsive.

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Stabbings

Stabbings can be an extremely distressing situation for both the casualty and the first aider. Because of the severity and risk of further complications like shock, bleeding out, and internal damage, it is more important than ever to stay calm.

Firstly, call emergency services as soon as possible: this is an emergency.

Secondly, you should not remove the embedded object. This is because it often is preventing further bleeding by plugging the wound, so removing it would cause further complications.

You should keep calm and reassure the casualty. Ask them to lie down, or at least sit back with their back supported against something.

Put pressure around, not on the wound, and if possible — if you have a first aid kit present, put a rolled-up bandage on either side of the knife/embedded object to put pressure. Then secure it as tightly as possible (without cutting off circulation) using bandages, wrapping around and over the rolls of bandages. In essence, moving the object as little as possible is best.

Constantly monitor the casualty — keep checking their pulse and breathing, especially if the object is near the neck/chest — and watch for signs of shock.

Try to avoid giving the casualty food or drinks — as they may need surgery depending on where the object is embedded, giving them food is discouraged since it can delay surgery.

Keep the casualty comfortable and reassured by talking to them calmly until emergency services arrive. If possible, try to note down details for emergency responders, including what the object is, how/when the injury occurred, and what first aid has already been given.

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Heart Attack

Heart attacks are some of the most common emergencies that bystanders have to assist with — they come on suddenly and often lead to a quick loss of consciousness.

Early symptoms of a heart attack include:

Chest pain (central or on the left side)

Pain radiating to the jaw and/or left arm

Pressure/squeezing/tightening of chest

Shortness of breath

Nausea

Dizziness

Pale/clammy skin.

Many of these symptoms are signs of other problems too — such as dizziness and nausea coming before a faint. However, it is important to remember some “Quick Red Flags” — if any of these occur, you should contact emergency services as soon as possible.

Pain lasts more than a few minutes

Doesn’t improve with rest

Comes with breathlessness or collapse

The person becomes unconscious — doesn’t respond to voice or pain stimuli

As always — first conduct a primary survey.

If the person is conscious, they have not gone into cardiac arrest. It is important that emergency services are still called, because cardiac arrest can still occur (delayed onset).

You should ask them if they are allergic to aspirin. If they are not, give them one 300mg tablet to chew slowly. This thins the blood, limiting the damage.

Then, help them to sit in a comfortable position — ideally semi-reclined, with their back supported and knees drawn up, as this redces strain to the heart.

Monitor the casualty continuously; if they become unconscious, notify emergency services and begin cardiac arrest protocol immediately.

Cardiac Arrest

A cardiac arrest can be caused by a heart attack. It is where there is a complete blockage of blood flow to the heart, and leads to abnormal/absent breathing.

If you detect a cardiac arrest (unresponsive/unconscious and absent/irregular breathing), immediately call emergency services and begin CPR. Fetch a defibrillator if possible, as they greatly increase survival rates if used early.

Remember: In adults, the rhythm of CPR is 30 compressions to 2 rescue breaths. In children older than 1 year, it is the same, except preceded by 2 rescue breaths (so 2–30–2–30… etc).

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Recovery Position

The recovery position is an extremely useful piece of first aid to know. It is used when:

The person is unconscious — so, does not respond to voice or touch

Breathing normally

Pulse is present and regular

No suspected spinal injury

There are many scenarios that recovery position can be used in. Some of the most common include after a fainting episode, when unconscious but breathing well, post-seizure, once breathing normalises, and after a drug/alcohol overdose — again, only if breathing and pulse is normal.

Recovery position is beneficial because it provides a safe and comfortable position for an unconscious person to wake up in — because their airway is open in this position there is no risk of choking or obstruction.

When should you not use the recovery position?

If the casualty is not breathing/breathing is irregular — instead, start CPR immediately

Suspected spinal injury — keeping the casualty still is the priority as moving them can cause further damage

Conscious and responsive — no need to roll over.

How to put someone in the recovery position?

So, to put someone in the recovery position, follow these steps. Note that it does not matter what side they are rolled onto unless they are bleeding. If they are bleeding on their side, roll them on to the side that the wound is, because it can help put pressure on the wound.

1. Take the arm closest to you, and place in a right angle with the palm facing upwards.

2. Take the arm further away from you and place the back of their hand against the casualty’s cheek (the cheek closest to you).

3. Hook your arm around the back of the knee furthest away from you, and bring it over them so that they roll onto their side and the hand that you placed against their cheek is being used as a pillow.

4. Place this leg in a right-angle.

5. In the upwards-facing palm (step 1) place any of their possessions that you can see/reach easily (like a small bag, phone, purse, keys). This helps to reassure them when they become conscious.

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Defibrillation

Defibrillation involves delivering an electric shock to the heart to restore a normal rhythm. As it can often take some time to get a defibrillator, you should start with CPR first and then use a defibrillator when it is available. Most AEDs (Automated External Defibrillators) will advise you when to continue with CPR after a shock has been delivered.

Most public places will have a defibrillator available — schools, airports etc are required by law to have them, and most high streets have one close by. If there are bystanders around you, ask them to fetch the defibrillator while you begin CPR. 

When the defibrillator arrives, you do not need to remove jewellery. Doing so delays the shock and can lead to treatment not being given in time. However, bras should be removed because the pads of the defibrillator need to be in full contact with skin. You can, however, lay the bra back over the person after the pads have been placed to preserve dignity. 

To use a defibrillator/AED:

Turn on the defibrillator and follow the voice prompts for instructions. 

Apply the pads as instructed: place one on the upper right chest below the collarbone and the other on the lower left side below the armpit. Use the provided diagrams/instructions for guidance.

Let the AED carry out the analysis — ensure that no one is touching the casualty while this is happening. 

Deliver the shock if advised (on a semi-automatic defib) or (on a fully automatic defib) let the shock be carried out itself. 

Resume CPR — perform compressions immediately, until the AED reassesses or until the ambulance arrives. 

CPR and defibrillation are not mutually exclusive. In fact, they work together as part of the “Chain of Survival”, which aims to maximise survival changes. This sequence includes:

Early recognition and calling for help.

Immediately starting CPR.

Defibrillation as soon as possible to reset the heart’s rhythm.

Further care by emergency responders.

CPR keeps oxygenated blood flowing around the body, to the brain especially, while the AED assesses and delivers a shock to restart the heart’s rhythm. The sooner these are performed, the more likely the casualty is to survive and the lower the chances of complications.

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CPR

CPR (Cardiopulmonary resuscitation) is ONLY used when a casualty has stopped breathing or has agonal (irregular) breathing — meaning their chest rises and falls from time to time.

The DR ABC sequence must be performed before carrying out CPR, to ensure that the casualty is not breathing and is unresponsive.

Before carrying out CPR, call emergency services and put them on speakerphone. This means you can communicate with them while carrying out CPR, and they can guide you if needed.

Performing CPR on adults To perform CPR on adults, you should carry out cycles of 30 chest compressions followed by 2 rescue breaths. This should be at a rate of roughly ~100–120bpm — a good way to measure this is by carrying out the compressions to the beat of “Stayin’ Alive” or “Baby Shark”.

Chest compressions should aim to push 5cm/2 inches into the chest, which requires a lot of force. You might often hear a creaking/cracking sound under your hands while performing CPR — this is likely to be the cartilage in the sternum/ribs breaking, rather than the ribs themselves.

However, it is not uncommon for ribs to break during CPR, and while this can be uncomfortable for the rescuer you should not stop CPR because of it. While skeletal injuries can be extremely painful, and add to the recovery time, an injury is much preferable to death which would certainly occur if compressions are stopped. In addition, most countries have Good Samaritan laws that protect rescuers from being prosecuted as a result of performing first aid. You are extremely unlikely to find yourself facing legal consequences if the patient doesn’t like the way you delivered CPR, as long as you were clearly acting to the best of your ability and in good faith.

Performing CPR on children Performing CPR on children has slightly different requirements to performing it on adults due to the size and oxygen requirement differences. You should start with 5 rescue breaths, before beginning cycles of 30 compressions and 2 rescue breaths. To view this more visually, this is what it should look like:

5–30–2–30–2–30–2 etc, until an ambulance arrives.

The depth of compressions should be the same — roughly 5cm, which should be one-third of the chest diameter.

Performing CPR on babies When performing CPR on babies, you should not perform compressions with your whole hand. Instead, you should do it with the tips of two fingers. Compression depth should be 4cm, because of the baby’s smaller size. However, the depth of compressions is the most important part. So, if you cannot achieve a depth of 4cm with just the tips of your fingers, you should use the heel of your palm instead.

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Response: ACVPU

Response is the second step in the primary survey, after checking for danger.

There are five different levels to responsiveness, which determine how you need to act. These levels follow the acronym ACVPU — Alert, Confused, Voice, Pain, and Unresponsive.

A: Alert Alert means that the casualty is awake and able to respond to you. This is the best situation, and you can test it by asking them a question — for example, “Are you okay?” or “What is your name?”

C: Confused Confused means that the person is awake, but may be unable to speak properly or respond to your questions. This could be a sign of shock or a head injury.

V: Voice This means the person is able to react to the sound of your voice when you ask them a question, even if they are not able to respond verbally. Alert or Voice are good signs — it means the person is breathing.

P: Pain If the casualty does not respond verbally, you can check if they are responsive to pain. First, lightly shake their shoulders. If they do not respond, then pinch their earlobe gently or pinch the top of their shoulders. If they do not respond to this, they are deemed unconscious.

U: Unconscious If the casualty does not respond to any of the above, they are deemed unconscious. At this point, you must call emergency services and move on to the next step of the primary survey — checking their airways.