First-Aid: How to Assess the Situation and Act

The first aider has to act decisively, quickly, calmly and correctly in order to give efficient first aid. This is achieved by following the measures, given below :

1. A calm and controlled approach.
2. Giving one’s identification before taking charge of the situation if there are no doctors, nurses or other trained persons.
3. Avoiding placing oneself in danger when approaching the casualty.
4. A quick assessment of the situation and the casualty.
5. A correct diagnosis of the condition based on the history of the incident, symptoms and signs.
6. Immediate and appropriate treatment of any conditions.
7. Proper disposal of the victim depending on his condition.


Any further damage to the victim and any risk to self and to bystanders are minimized as follows.

Situation and Measures

Road accidents. (1) Instruct a bystander to control the traffic, keeping it away from oneself and the victim. (2) Switch off the ignition of the vehicles concerned. (3) Watch out for risk of fire from petrol spillage.

Electrical contact. (1) Break the contact. (2) Take the necessary measures to prevent further contact.

Gas and Poisonous fumes. Cut off the source.

Fire. Move the victim to a safe place immediately.

Collapsing building. Move the victim to a safe place immediately.


Bystanders should be asked to perform the following tasks.

1. Control traffic.
2. Stand with their backs to the victim to give her privacy and keep others away.
3. Telephone for assistance.
4. Telephone for ambulance to shift the victim.
5. Perform tasks outlined under assessment of situation.
6. Help control bleeding or apply splints.


The following checks should be done immediately.

Airway. The airway is checked to confirm that it is not blocked.
Breathing. The victim’s breathing is checked to see that it is normal.
Circulation. Presence and adequacy of the pulse and heart beat are confirmed.
Consciousness. If the victim is unconscious, he is placed in the recovery position, unless there is risk of spinal injury.
Hemorrhage. Any severe bleeding is looked for and controlled.

Based on the findings of the history, these factors, and clinical examination, the priority list is as follows :

1. Vital parameters : temperature, pulse rate, respiratory rate per minute. Temperature is judged by touching the victim’s forehead with the back of the hand. Respiratory rate is counted by observing the chest wall movements. Pulse rate is counted by feeling the pulsations at the wrist.

2. Level of consciousness.

3. Paleness (pallor) : indicates anemia or acute blood loss.

4. Ability to move the limbs.

5. Features of injury : bleeding, external wounds, features of fractures and dislocations.

6. Pupils : size, equality on both sides, reaction to light. The pupils should be equal, small, and should constrict when light is shone over them.


1. Scalp : bleeding, swelling, depression; 2. Response to speech in each ear, bleeding, watery discharge; 3. Eyes : appearance, movements, pupils; 4. Nose : bleeding, watery discharge; 5. Breathing : rate, depth, regularity; 6. Skin : colour, temperature, state; 7. Neck : pulsations, tracheostomy hole, warning medallion, spine tenderness; 8. Chest : expansion with breathing, rib fractures; 9. Collar bone and shoulders : tenderness, deformity; 10. Upper limbs : movements, tenderness, deformities; 11. Lower back : swelling, tenderness; 12. Abdomen : swelling, tenderness, guarding, rigidity; 13. Pelvis and hips : tenderness, bleeding from orifices, hip movements; 14. Lower limbs : movements, tenderness, deformities; 15. Toes : movements, feeling, colour.


Abnormality – Causes

Rapid, good volume – Anxiety, fear, heat stroke, overexertion, early stage of hemorrhage.
Slow, good volume – Stroke, fracture of skull.
Rapid, weak – Severe hemorrhage, shock, diabetic coma.
Absent – Cardiac arrest.


Observation – Causes

Rapid, shallow – Shock, heart disease, heat exhaustion, insulin shock.
Deep, gasping – Airway obstruction, chest injury, lung injury, heart failure, lung disease, diabetic coma.
Snoring – Stroke, fractured skull, alcohol, drugs abuse.
Gurgling – Fluid in airway, lung diseases.
Coughing blood – Chest wound, fractured rib, lung puncture, heart disease.


Abnormality – Causes

Unequal – Head injury, hemorrhage within skull, stroke.
Dilated – Alcohol intoxication.
Dilated, not responding to light – Coma, cardiac arrest, drug toxicity.

Constricted, not responding to light – Damage to brain, drug toxicity.

Various levels of consciousness are as follows :

1. Conscious : normal.
2. Restless.
3. Stuporous : apparently sleeping, but can be woken up by giving painful stimuli.
4. Coma (unconsciousness) : apparently sleeping, but cannot be awakened even by giving painful stimuli.


Abnormalities of skin colour may be due to any of the causes shown in the following table.

Abnormalities of Skin Temperature

Abnormality – Causes

Hot, dry – High fever, heat stroke.
Hot, moist – Infection.
Cool, dry – Exposure to cold.
Cool, clammy – Shock.

Abnormalities of Skin Colour

Abnormality – Causes

Red – High blood pressure, heart attack, heat stroke.
Cherry red – Carbon monoxide poisoning.
Blue – Heart failure, airway obstruction, lung diseases.
Pale – Shock, bleeding, heart attack, fright.


Type – Causes

All four limbs – Injury to cervical spinal cord.
Lower limbs – Injury to thoracic or lumbar spinal cord.
Single limb – Fracture of the limb bones.
One side limbs – Stroke.



1. Support the ankle and remove the shoe carefully.
2. Slit long shoes down the back seam with a sharp knife.


1. Pull them off gently.
2. If that cannot be done, lift each one away from the leg with a finger passed into it and cut it with scissors.


1. Pull up the trouser leg gently and expose the calf and knee.
2. Pull the trouser down from the waist to expose the thigh.


1. Remove the victim’s uninjured arm from its sleeve.
2. Ease the sweater from his head without disturbing the injured arm.
3. Support the injured arm and slip off the sweater.

Shirt or coat

1. Unbutton it.
2. Remove the uninjured arm from its sleeve first.
3. Pull the shirt/coat round the injured side.
4. Support the injured arm and slip the shirt/coat off the arm.


If the victim can do so, get him to remove it himself. If he cannot do so, it is best left on, and is removed only if absolutely necessary, e.g. for performance of artificial ventilation. Two persons are required to remove it. One should support the victim’s head and neck. The other should remove the helmet.

Open-face helmet

1. Align the victim’s head with his spine in neutral position.
2. Unfasten the buckle or cut through the chinstrap.
3. If the helmet has sides, grip it from above and force the sides apart to take the pressure off his head.
4. Lift the helmet upward and backwards gently and remove it.

Full-face helmet

1. Align the victim’s head with his spine in neutral position.
2. Unfasten the buckle or cut through the chinstrap.
3. Working from the base of the helmet, ease the fingers of both of your hands under the rim.
4. Support the neck with one hand and hold the lower jaw firmly.
5. Ask your helper to work from above. Get him to tilt the helmet backwards without moving the head and lift the front clear of the chin gently.
6. Continuing to support the neck and jaw, get the helper to gilt the helmet forwards slightly so that it can be passed over the back of the head. Then get him to lift it straight off the victim’s head.

After observation of these important abnormalities, a detailed examination should be done from the head to toe. Any abnormalities should be noted and recorded carefully. Based on the diagnosis, appropriate treatment should be given. An observation chart should be made as shown below.


Name : Date : Time :
Parameter Time and Observation
Temperature (every 10 min)
Pulse (every 10 min)
Respiration (every 10 min)
Consciousness (every 10 min)
Limb movements
Body movements
Temperature (every 10 min)
Skin colour (every 10 min)
External injuries
Urinary incontinence
Fecal incontinence
Treatment given

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