First Aid For All Manual by IFMSA-Egypt

FAFA MANUAL

Medical Education should be a concern of every medical student as it shapes not only the quality of future doctors but also the quality of healthcare. The International Federation of Medical Students’ Associations (IFMSA) has a dedicated organ which aims to implement an optimal learning environment for all medical students around the world the Standing Committee On Medical Education (SCOME). Through all our joint efforts we work to create sustainable changes around the world, for ourselves as medical students, for the generations to come and for our future patients and our communities who are in fact the final beneficiaries of our education. History

IFMSA-Egypt is a full member of the International Federation of Medical Students’ Association (IFMSA) which is the only official body of medical students worldwide made up of 123 countries spanning all continents. It is a Non-Governmental Association related to the World Health Organization (WHO). IFMSA-Egypt is represented by medical students from a wide range of medical schools all over Egypt. IFMSA-Egypt consists of 25 Local Committees in all medical schools around Egypt.

SCOME was one of IFMSAs first standing committees from the beginning of its foundation in 1951. It acts as a discussion forum for students interested in the different aspects of medical education in the hope of pursuing and achieving its aim. Today, SCOME works mainly in medical education capacity building. SCOME provides several platforms and methods to educate medical students worldwide on various medical education issues. Through this knowledge, it empowers them to advocate to be a part of the decision-making chain. SCOME believes in medical students as important stakeholders in creating, developing and implementing medical education systems.

Vision

Medical students attain an optimal professional and personal development to reach their full potential as future doctors for better healthcare worldwide.

Mission Our mission is to be the frame in which medical students worldwide contribute to the development of medical education. Students convene in SCOME to share and learn about medical education in order to improve it as well as benefit the most from it on a personal and professional basis.

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The Standing Committee on Public Health (SCOPH) brings together medical students from all over the world to learn, build skills, cooperate, explore and share ideas to address all issues related to Public Health, including Global Health issues, health policies, health promotion, and education activities. Medical students of the IFMSA formed the Standing Committee on Students’ Health (SCOSH) in 1952, driven by a strong will to take an active part in preventing and making policies concerning health problems. During the following years, the wide variety of activities led to the change of SCOSH to Standing Committee on Health (SCOH) in 1963. In 1983 the name of the Committee changed once more to Standing Committee on Public Health (SCOPH). During these six decades, SCOPHeroes have implemented, maintained and improved a wide variety of community-based projects on a local, national and international level. Through these activities, we are pursuing our vision of a healthy society and we are developing our own potential of being complete and skillful health professionals.

Vision

Medical Students attain the optimal skills and knowledge to contribute to their full potential towards the making of healthier communities in their capacity as medical students and as future healthcare providers.

Mission

The Standing Committee on Public Health promotes the development of medical students worldwide regarding Public Health issues through an international sharing knowledge network, projects management, community-based learning, capacity building, advocacy, exchanges placements and access to external learning opportunities.

The IFMSA was founded in 1951 in Copenhagen as a result of the post-war wave of friendship among international students and has evolved to represent more than One Million medical students from all continents and over 123 nations. The IFMSA is affiliated to the United Nations system as a nonpolitical and non- governmental organization, and is recognized by the World Health Organization as the official international forum for medical students since 1969. Since 1951, IFMSA exists to serve as a forum for sharing ideas and expertise among medical student organizations pertaining to public health, medical education, reproductive health and human rights. IFMSA also serves as an action platform to formulate policies and co-ordinate activities by its member organizations. IFMSA aims to serve medical students all over the world through its member organizations, to promote and facilitate international co-operation in professional training and to contribute to the development of culturally aware and socially responsible physicians.

FAFA MANUAL

T A B L E O F C O N T E N S Introduction 5

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A Message From Our.....

CardiopulmoFirst-Aid Basic nary ResuscitaSessions outline Skills tion 6 7 8

Chocking

Burns

Bleeding

Sun-Stroke

Animal Bites

Poisoning and Toxins

Diarrhea

Convulsions

Drowning

Fractures 30

Dehydration 38

Psychological First-Aid 46

...National Coordinator The human brain has a capacity that is ten times greater than first thought and can retain 4.7 billion books, scientists have discovered. This is according to US scientists who have measured the storage capacity of synapses - the brain connections that are responsible for storing memories. They discovered that, on average, one synapse can hold roughly 4.7 bits of information. This means that the human brain has a capacity of one petabyte, or 1,000,000,000,000,000 bytes. It is fascinating how much information we could actually hold in our brains , but are we using this capacity wisely? When it comes to your safety and your dear ones’ safety , you must have a capacity in this brain for what is called : First-Aid Basic Skills. First aid is emergency care given immediately to an injured person. The purpose of first aid is to minimize injury and future disability. A little piece of information about how to react when you find unconscious victim , you colleague going through an epileptic seizure or when the man sitting next you in the train is going through hypoglycemic coma ! A little piece of information that is typically described as a life saving and a must be known kind of knowledge. Endless lists of scientific papers , researches , articles and statistics talking about the first-aid and its importance in saving people’s lives. Yet we still encounter people in our society who knows nothing about first-aid , we still encounter people in our society who believes in myths and worst of all we still encounter people in our society who share false information about how to react in certain situations of emergency. Knowing first-aid skills and applying it to help victims in need is something we should all be ready to do. One doesn’t know when he will have to use this piece of information to help those people whom their lives area at stake. It’s also our duty to share this information with members of our society and to stand for those who have no clear no based information and claims and are sharing it among society. Aiming to reach a point where we can see a society with all its members fully aware of the first-aid basic skills and its importance.

A Message From Our.....

FAFA MANUAL

A Message From Our.....

...NPO

...NOME Develop a passion for Education. If you do, it will never cease to grow”. We have found our passion in medical education where SCOME gave us the tools not only to start asking the right questions but also to take actions to make a change. I’m Mahmoud Nassar, IFMSA-EGYPT NOME for term 2019- 2020, and on behalf of my national team, we are presenting to you this series of manuals which aims to educate different medical students in medical education topics and promote our latest activities we are doing for a better development of medical education in Egypt. In addition, those manuals would be the gate to IFMSA and nonIFMSA medical students to know more about our medical education projects and bring them closer to the work and activities that enormous NGOs as IFMSA-Egypt are initiating to improve the quality of future health professionals in the fields of public health and medical education.

It is a fact that most of accidents mortality can be prevented by basic principles of first aid. It is our responsibility to spread the word that First Aid is not exclusive only for medical career, it is a duty for everyone to learn these basic principles. Some few words and techniques could play a wide role in saving much lives in the future. It started here, between us, but the mission is to pass this legacy as far as we can.

I would like to thank everyone who worked and contributed to this marvellous work which would stand for the upcoming years as a reference to come back while looking for a credible and comprehensive resource for topics as First-Aid, Evidence-BasedMedicine, or Medical Education topics.

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Sessions Outline

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First Aid Basic skils

Dearest trainer,

Basic help that is given to someone as soon as possible after they have been hurt in an accident or suddenly become ill.

Here through this link you can reach a drive where you can find a proposed outline for an interactive session that can be given in a school , club or any other public place along with interactive games and activities that you can use. https://drive.google.com/open?id=1Rd6nALjvJ_Pb9aEPbTme6pPoxSVLhQzo

First steps for a first aid emergency (the 3 C's)

1. Check

a. The scene: Is it safe for you to approach? Also see how many victims there are and look for bystanders who can assist. b. The victim: Is the victim conscious?

2. Call 1-2-3 for assistance. 3. Care for life-threatening conditions until the first responder(s) arrive. a. Airway - is the victim's airway open? b. Breathing - look, listen, and feel for breathing. c. Circulation - check for signs of circulation.

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CP R In most cases, when caring for an adult in cardiac arrest(regardless of whether care is being provided by a single provider or multiple providers), the hand position,compression rate, compression depth and compression-to-ventilation ratio of 30:2 remain the same. The exception to this is when a patient has an advanced airway in place.At minimum, two providers must be present. One provider delivers 1 ventilation every 6 seconds. At the same time,the second provider performs compressions at a rate of100 to 120 compressions per minute. In this case, the compression-to-ventilation ratio of 30:2 does not apply because compressions and ventilations are delivered continuously with no interruptions.

High quality CPR The point of CPR is to circulate oxygenated blood to vital organs when the heart and normal breathing have stopped. However, even at its best, CPR provides only a fraction of the normal blood flow to the brain and heart. To optimize patient outcomes and increase the likelihood of ROSC*, providers must strive to provide the highest quality CPR at all times. *ROSC = Return of spontaneous circulation To provide high-quality CPR: 1. Position the patient supine on a firm, flat surface and expose the patient’s chest, then mediately begin chest compressions. 2. Provide compressions at the correct rate (100 to 120 per minute) and at the proper depth (at least 2 inches [5 cm] but no more than 2.4 inches [6 cm] for an adult). When given at the proper rate, it should take 15 to 18 seconds to perform 30 compressions. 3. Allow the chest to recoil fully after each compression. 4. Minimize interruptions in chest compressions. When compressions stop, blood flow to 5. vital organs stops. In addition, after stopping compressions, some time is required to regain the minimum coronary perfusion pressure (CPP) necessary to achieve ROSC. The CPP is the difference between the pressure in the aorta and the pressure in the right atrium during diastole and is a reflection of myocardial blood flow. Maintaining adequate CPP (greater than 20 mmHg) during CPR has been shown to increase the likelihood of ROSC and survival. 6. Avoid excessive ventilations. Each ventilation should last about 1 second and deliver just enough volume to make the chest begin to rise.

FAFA MANUAL Proper compression technique is important. Position the heel of one hand in the center of the chest, on the lower half of the sternum, with your other hand on top.Interlace your fingers and lift your fingers off the chest. Position yourself so that your shoulders are directly over your hands and keep your arms as straight as possible. Compress the chest using a straight up-and- down motion. Avoid leaning on the patient’s chest. High-performance CPR refers to providing high-quality CPR as part of a well-organized team response to a cardiac arrest. Coordinated, efficient teamwork helps to minimize interruptions to compressions. Inaddition, a team approach to CPR helps to maintain the quality of compressions by minimizing provider fatigue. Providers should switch off giving compressions every 2minutes—or sooner if the provider giving compressions is fatigued or the AED begins analyzing. Finally, working as a team helps to ensure that high-quality CPR is provided because the team leader is responsible for monitoring the delivery of CPR and making adjustments in real time, enabling the team to achieve quality goals. To place an adult in a recovery position: 1. I. Kneel at the patient’s side. 2. II. Lift the patient’s arm closest to you up next to their 3. head. 4. III. Place the patient’s arm farthest from you next to 5. their side. 6. IV. Grasp their leg closest to you, flex it at the hip and 7. bend the knee toward their head. 8. V. Place one of your hands on the patient’s shoulder 9. and your other hand on their hip farthest from you. 10. VI. Using a smooth motion, roll the patient toward you by pulling their shoulder and hip with your hands. 11. Make sure the patient’s head remains in contact with their extended arm. 12. VII. Stop all movement when the patient is on their side. 13. VIII. Place their knee on top of the other knee so that both knees are in a bent position. 14. IX. Place the patient’s free hand under their chin to help support their head and airway.

FAFA MANUAL

Skill sheet: Step 1: Conduct a rapid assessment • Perform a quick visual survey, check for responsiveness, open the airway, and simultaneously check for breathing and a carotid pulse for at least 5 seconds but no more than 10. • If the patient is unresponsive, isn’t breathing normally and doesn’t have a pulse, begin CPR.

FAFA MANUAL Step 4: Position your body effectively

• Position yourself so your shoulders are directly over your hands. • This position lets you compress the chest using a straight up-and-down motion. • To help keep your arms straight, lock your elbows. • If drowning or another hypoxic event is the suspected cause of cardiac arrest, deliver 2 initial ventilations before starting CPR.

Step 5: Perform 30 chest compressions

Step 2: Place the patient on a firm, flat surface •

In a healthcare setting, use a bed with a CPR feature, or place a CPR board under the patient. • Adjust the bed to an appropriate working height or use a stepstool. Lower the bed side rail closest to you. • In other settings, move the patient to the floor or ground and kneel beside them.

Step 3: Position your hands correctly • Expose the patient’s chest to ensure proper hand placement and visualize chest recoil. • Place the heel of one hand in the center of the patient’s chest on the lower half of the sternum. • Place your other hand on top of the first and interlace your fingers or hold them up so that they are not resting on the patient’s chest.

• For an adult, compress the chest to a depth of at least 2 inches (5 cm). If you are using a feedback device, make sure the compressions are no more than 2.4 inches (6 cm) deep. • Provide smooth compressions at a rate of 100 to 120 per minute. • Allow the chest to fully recoil after each compression. Avoid leaning on the patient’s chest at the top of the compression.

Step 6: Seal the mask and open the airway • Use an adult pocket mask for single-provider CPR or a BVM for multiple-provider CPR. • Seal the mask and simultaneously open the airway to a past-neutral position using the head-tilt/chin-lift technique. • Or, use the modified jaw-thrust maneuver if you suspect a head, neck or spinal injury.

FAFA MANUAL

Step 7: Provide 2 ventilations

• While maintaining the mask seal and open airway, provide smooth, effortless ventilations. Each ventilation should last about 1 second and make the chest begin to rise. Avoid excessive ventilation. • If you do not have a pocket mask or BVM, provide mouth-to-mouth or mouth-to-nose ventilations. • If an advanced airway is in place, one provider delivers 1 ventilation every 6 seconds. At the same time,a second provider performs compressions at a rate of 100 to 120 per minute. In this case, the compression-to-ventilation ratio of 30:2 does not apply because compressions and ventilations are delivered continuously with no interruptions.

Step 8: Switch positions every 2 minutes

• When providing CPR with multiple providers, smoothly switch positions about every 2 minutes. This should take less than 10 seconds. • The compressor calls for a position change by saying “switch”in place of the number 1 in the compression cycle

Step 9: Continue CPR

• Continue providing CPR until: • You see signs of ROSC, such as patient movement or normal breathing. • Other trained providers take over and relieve you from compression or ventilation responsibilities. • You are presented with a valid do not resuscitate (DNR) order. • You are alone and too exhausted to continue. • The situation becomes unsafe. • Upon achieving ROSC, supplemental oxygen should be used based on your facility’s

FAFA MANUAL Children CPR Children and infants, just like adults, may experience life-threatening cardiac and respiratory emergencies requiring basic life support (BLS) care. Although the differences in BLS care for children and infants may seem subtle, it is important to understand them in order to achieve the best possible outcomes.

When determining which CPR/AED protocol to follow, use these guidelines: An infant is defined as someone under the age of 1. When providing BLS care, follow infant guidelines and use appropriately sized equipment. A child is defined as someone from the age of 1 to the onset of puberty as evidenced by breast development in girls and underarm hair development in boys (usually around the age of 12). When providing BLS care, follow child guidelines and use appropriately sized equipment. The use of pediatric versus adult AED pads or settings for children varies by age and weight. An adolescent is defined as someone from the onset of puberty through adulthood. When providing BLS care, follow adult guidelines and use appropriately sized equipment. The five links in the Pediatric Cardiac Chain of Survival are: 1. Prevention of arrest. Prevention is key because cardiac arrest in children often occurs as the result of a preventable injury (such as trauma, drowning, choking or electrocution). 2. Early, high-quality CPR. CPR, starting with compressions, should be initiated within 10 seconds of recognizing cardiac arrest. 3. 3Rapid activation of the emergency medical services (EMS) system or response team. Immediate recognition of cardiac arrest and activation of the EMS system or response team quickly gives the patient access to necessary personnel, equipment and interventions as soon as possible after arrest. 4. Effective, advanced life support. Effective, advanced life support gives the patient access to emergency medical care delivered by specially trained professionals. 5. Integrated post-cardiac arrest care. After return of spontaneous circulation (ROSC), survival outcomes are improved when providers work to stabilize the patient, minimize complications, and diagnose and treat the underlying cause.

FAFA MANUAL

Recovery position for children:

Step 3: Position your hands correctly

For children, use the same approach and technique for recovery positions as you would for an adult. Technique may differ for infants. Infants with a suspected head, neck, spinal, hip or pelvic injury should not be placed in a recovery position unless you are unable to manage the airway effectively or you are alone and do not have a mobile phone or other form of communication.To place an infant in a recovery position, use the same technique you would apply for an older child. You also can hold an infant in a recovery position by: Carefully positioning the infant face-down along your forearm. Then supporting the infant’s head and neck with your other hand while keeping the infant’s mouth and nose clear.

• Expose the child’s chest to ensure proper hand placement and visualize chest recoil. • Place the heel of one hand in the center of the child’s chest on the lower half of the sternum. • Place your other hand on top of the first and interlace your fingers or hold them up so that they are not resting on the child’s chest. • Alternatively, for a small child, you may only need to use one hand, instead of two. Place the heel of one hand in the center of the child’s chest.

Skill sheet:

• Position yourself so your shoulders are directly over your hands. This position lets you compress the chest using a straight up-and-down motion. • To help keep your arms straight, lock your elbows.

Step 4: Position your body effectively

Step 1: Conduct a rapid assessment • Perform a quick visual survey, check for responsiveness, open the airway, and simultaneously check for breathing and a carotid pulse for at least 5 seconds but no more than 10. • If the child is unresponsive, isn’t breathing normally and doesn’t have a pulse, begin CPR.

Step 2: Place the child on a firm, flat surface • In a healthcare setting, use a bed with a CPR feature, or place a CPR board under the child. • Adjust the bed to an appropriate working height or use a step stool. Lower the bed side rail closest to you. • In other settings, move the child to the floor or ground and kneel beside them. (If drowning or another hypoxic event is the suspected cause of cardiac arrest, deliver 2 initial ventilations before starting CPR.

Step 5: Perform chest compressions • For a child, compress the chest to a depth of about 2 inches (5 cm). • Provide smooth compressions at a rate of at least 100 to 120 per minute. • Allow the chest to fully recoil after each compression. Avoid leaning on the patient’s chest at the top of the compression. • If you are a single provider, perform 30 chest compressions. • If you are working with a team of providers, perform 15 chest compressions for a child

FAFA MANUAL Step 6: Seal the mask and open the airway • Use an appropriately sized pocket mask for single-provider CPR or a BVM for multiple-provider CPR. • Seal the mask and simultaneously open the airway to a slightly past-neutral position using the head-tilt/chin-lift technique. Avoid any hyperextension of flexion of the neck.

Step 7: Provide 2 ventilations • • While maintaining the mask seal and open airway, provide smooth, effortless ventilations. Each ventilation should last about 1 second and make the chest begin to rise. Avoid excessive ventilation. • • If you do not have a pocket mask or BVM, provide mouth-to-mouth or mouth-tonose ventilations.

FAFA MANUAL Step 9: Continue CPR • • Continue providing CPR until: • You see signs of ROSC, such as patient movement or normal breathing. • • Other trained providers take over and relieve you from compression or ventilation responsibilities. • • You are presented with a valid do not resuscitate (DNR) order. • • You are alone and too exhausted to continue. • • The situation becomes unsafe.

Kids save lives: It is well known and scientifically proven that initiation of CPR by lay bystanders increases survival rates at least 2‐ to 3‐fold. If we could achieve lay CPR rates of 60% to 80% all over the world, this would immediately result in 200 000 to 300 000 additional survivors after OOHCA*. There are several effective ways to increase lay CPR rates, for example, through continuous media activities, dispatcher‐assisted “telephone CPR,” CPR education in adults, CPR education in schoolchildren, and first‐responder systems. All these options are recommended in the 2015 CPR guidelines and all are useful and feasible. We have seen in several countries that educating schoolchildren in CPR is particularly associated with an increase in lay CPR rates and survival following OOHCA. Training schoolchildren in CPR is easy and cost‐effective and has already become a worldwide initiative. We know that such training should start by age ≤12 years and should last for at least 2 hours per year as long as children go to school. Training can be conducted effectively by both medical professionals and educated teachers, and high‐fidelity or low‐cost manikins and equipment can be used successfully. Educating schoolchildren in CPR not only increases their capabilities in CPR but also enhances social interaction and social competencies and is often a lot of fun for the pupils and the teachers.Following their training, schoolchildren serve as multipliers. A homework assignment could be to show 10 additional people how to do CPR within the next 2 weeks. * OOHCA = Out-of-hospital cardiac arrest

Step 8: Switch positions every 2 minutes • When providing CPR with multiple providers, smoothly switch positions about every 2 minutes. This should take less than 10 seconds. • The compressor calls for a position change by saying “switch” in place of the number 1 in the compression cycle.

FAFA MANUAL

Mild chocking

Choking

Definition

Choking occurs when an object gets stuck in the throat and partly or completely blocks the airway, meaning they may be unable to breathe properly. In adults, a piece of food often is the culprit. Young children often swallow small objects which may lead to chocking.

Signs and symptoms of choking include: • • • • • •

FAFA MANUAL

The universal sign for choking is hands clutched(crossed) to the throat. Inability to talk. Difficulty breathing or noisy breathing. Coughing, which may either be weak or forceful. Red face that steadily turns blue. Loss of consciousness.

How to react:

The airway is only partly blocked Yes

Severe chocking The airway is completely blocked

Ask “Are you choking?” Other signs speak, cry, cough or breathe How to 1.Encourage them to react keep coughing to try to clear the blockage. 2. Ask them to try to spit out the object if it’s in their mouth. 3. If coughing doesn’t work, start back blows. 4.If this does not remove the blockage call 123. * Don’t put your fingers in their mouth to help them as they may bite you accidentally or you might worsen the situation and block the airway completely.

Unable to speak, may nod. can’t talk, cry or laugh forcefully • In Conscious person: * The American Red Cross recommends a “five-and-five” approach: 1. Give 5 back blows. Figure (1) • Stand to the side and just behind a choking adult. • Place one arm across the person’s chest for support. • Bend the person over at the waist so that the upper body is parallel with the ground. • Deliver five separate back blows between the person’s shoulder blades with the heel of your hand. 2. Give 5 abdominal thrusts. Perform five abdominal thrusts (also known as the Heimlich maneuver-steps mentioned below-). 3. Alternate between 5 blows and 5 thrusts until the blockage is dislodged. 4.Call 123 if this doesn’t remove the blockage. * The American Heart Association doesn’t teach the back-blow technique, only the abdominal thrust (Heimlich maneuver) procedures. In unconscious person: 1.Call 123 for an ambulance. 2.Check the airway and breathing. 3.Begin CPR-if no response nor breathing.

FAFA MANUAL

How to perform abdominal thrusts (Heimlich maneuver) on yourself: 1. Make a fist with one hand. Place the thumb of that hand below your rib cage and above your navel. 2. Grasp your fist with your other hand. Press your fist forcibly into the upper abdominal area with a quick upward movement. 3. Repeat this motion until the object blocking your airway comes out.

How to perform the Abdominal Thrusts (Heimlich Maneuver):

The Heimlich maneuver should only be used when a person is responsive and older than one year of age. 1. Stand behind the responsive person. Wrap your arms around their waist under their ribcage. 2. Put the side of your fist above the person’s navel in the middle of their belly. Do not press on the lower part of the sternum (Figure 3A). 3. With your other hand, hold the first fist and press forcefully into the person’s abdomen and up toward their chest (Figure 3B and 3C).

4. Continue performing these thrusts until the obstruction is relieved or until the person becomes unresponsive

You can also lean over a table edge, chair, or railing. Quickly thrust your upper belly area (upper abdomen) against the edge. How to perform chest thrusts (Heimlich maneuver) in case of a pregnant woman or an obese person: 1. Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs. 2. Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick thrust. 3. Repeat until the food or other blockage is dislodged.

FAFA MANUAL Mild chocking Signs

Severe chocking

Child is coughing forcefully or Child’s coughing isn’t effective (it’s silent or has a strong cry can’t breathe in properly

How to 1.Encourage them to carry react on coughing to bring up what they’re choking on. 2.If you can see the object, try to remove it. Don’t poke blindly or repeatedly with your fingers. You could make things worse by pushing the object further in and making it harder to remove. 3. Call 123 if this doesn’t remove the blockage.

If conscious: 1. Place the infant face down on your forearm. Use your hand to support the infant’s head and jaw. 2. Give up to 5 back slaps between the infant’s shoulder blades with the heel of your other hand. 3. If the object does not come out after 5 back slaps, turn the infant onto his back. Support his head and neck as you turn him face up on your forearm. 4. Give up to 5 chest thrusts with 2 fingers of your other hand placed in the middle of the infant’s breastbone and give quick downward thrusts. (Figure 6) 5. Repeat giving 5 back slaps and 5 chest thrusts until the infant can breathe, cough or cry or until he stops responding. 6. Call 123 if this doesn’t remove the blockage. If unconscious: 1. Call 123 for an ambulance. 2. Check the airway and breathing. 3. Begin CPR for infants-if no response nor breathing.

FAFA MANUAL

Burns Definition:

A burn is an injury to the skin or other organic tissues, primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals.

Causes: Burns are caused by a variety of external sources classified as:Chemical/Electrical/ Radiation/Thermal

Degrees of thermal burns: There are three primary degrees of burns: first,second,

and third-degree. Each degree is based on the severity of damage to the skin, with first-degree being the most minor and third-degree being the most severe.

First degree: It also called “superficial burns” because they affect the outermost layer of the skin.

Signs: Pain, redness of the skin and may be some swelling. Second degree: It is more serious because the damage extends beyond the top layer of skin and reach the internal layer of skin.

Signs: Severe pain, red skin, secretion of yellowish fluid, swelling and formation of blisters.

N.B: • Never stick your fingers down a baby’s throat, or anyone else’sin an attempt to remove an object while they are coughing. • Never slap a choking person on the back unless you know how to perform the back blows technique —let the person cough and the object may dislodge itself. If the person stops coughing or breathing, then perform the Heimlich maneuver.

FAFA MANUAL How to react in these burns: 1)

Take the person away from source of burn.

Smoothly remove all clothes, rings or any jewelers from the injured skin.

FAFA MANUAL How to determine the percentage of burn?? In adults: By the rule of nines

3) Put the injured part under running water or in cold water to a period of 10 to 45 minutes. 4)

Put a clean sterilized bandage on the injured skin.

Call for help if burns are extreme and extends for wide region.

Don’t do: 1)

Using ice.

Evacuate blisters.

Put honey, toothpaste or any other substance.

Third degree burns: It is burns which extend all over all layers of the skin and reach fatty tissues and muscles.

Signs: 1.

Waxy Grayish or darkly brown “charred” skin.

Internal organs like muscles may appear.

No pain as nerve endings is damaged.

These burns almost occur in big fires so breathing may be affected as a result of inhalation of heat or burn substances.

How to react: 1)

First aid to keep airway opened.

Put a clean sterilized bandage on the burn.

Immediately call for help.

If the person is shocked, raise his legs and keep him warm.

Note: The seriousness of the burn isn’t determined only by the degree of burn, but also by its percentage. 26

Other types of burns

FAFA MANUAL

Chemical burns: It is burns occur when an irritant substance such as an acid or a base come into contact with skin or eyes.

Signs: 1.

Severe pain at the position of injury “Skin or affected eye”

Redness and swelling of the affected skin and eye.

Severe lacrimation of the affected eye.

How to react: 1)

First of all, you must wear gloves for your personal safety.

2) Put the affected area under running water for a period more than 10 minutes and wash the affected eye by warm water from nasal side. 3)

Try to keep a sample from the chemical substance or know its name.

Call for help or transport the injure person to the hospital.

Internal burns “mouth and throat burns”: It is burns occurs to mouth and throat as a result of ingestion of very hot liquid or chemical irritant substance. * It is very dangerous burns as it leads to swelling of throat and suffocation.

Signs: 1.

Severe pain.

Injury of skin around the mouth.

Difficulty of breathing.

Loss of consciousness in sometimes.

Electrical burns: It is a burn caused by passing of electrical current inside the body

which lead to local burn at the site of entry and exit of current and may affect internal organs like heart.

How to react: 1)

Call 123.

Shut down the source of electricity.

Move the person away from source of electricity.

Put a clean sterilized bandage on the place of burn.

Care about vital signs and do CPR.

FAFA MANUAL

Bleeding Definition: Bleeding, also called hemorrhage, is the name used to describe blood loss. It can refer to blood loss inside the body, called internal bleeding, or to blood loss outside of the body, called external bleeding. Control of bleeding is a core first aid skill. There is evidence to support various first aid interventions that can be used in different circumstances to control bleeding. The aim of the first aid provider is to stop the bleeding as quickly as possible.

Symptoms: 1. weak, rapid pulse 2. pale, cool, moist skin 3. pallor, sweating 4. rapid, gasping breathing 5. restlessness 6. nausea 7. thirst 8. faintness, dizziness or confusion 9. loss of consciousness How to react: 1. Remove any clothing or debris on the wound. Don’t remove large or deeply embedded objects. Don’t probe the wound or attempt to clean it yet. Your first job is to stop the bleeding. Wear disposable protective gloves if available. 2. Stop the bleeding. Place a sterile bandage or clean cloth on the wound. Press the bandage firmly with your palm to control bleeding. Apply constant pressure until the bleeding stops. Maintain pressure by binding the wound with a thick bandage or a piece of clean cloth. Don’t put direct pressure on an eye injury or embedded object. 3. Help the injured person lie down. If possible, place the person on a rug or blanket to prevent loss of body heat. Calmly reassure the injured person. 4. Don’t remove the gauze or bandage. If the bleeding seeps through the gauze or other cloth on the wound, add another bandage on top of it. And keep pressing firmly on the area.

FAFA MANUAL

1. Tourniquets: A tourniquet is effective in controlling life-threatening bleeding from a limb. Apply a tourniquet if you're trained in how to do so. When emergency help arrives, explain how long the tourniquet has been in place. 2. Immobilize the injured body part as much as possible. Leave the bandages in place and get the injured person to an emergency room as soon as possible. Call 123 for severe bleeding that you can’t control.

How to react with children: 8. The loss of blood could cause the baby to develop shock. Treat them for shock by loosening any tight clothing around their chest or waist.

9. Keep monitoring their level of response until help arrives.

If a foreign body is embedded in the wound:

1. First aid gloves

2. Apply direct pressure to the wound using a sterile dressing if possible or a clean non-fluffy cloth, to stop the bleeding.

3. Call 123

1. DO NOT remove it but apply padding on either side of the object and build it up to avoid pressure on the foreign body. 2. Hold the padding firmly in place with a roller bandage or folded triangular bandage applied in a criss-cross method to avoid pressure on the object.

Nose bleeding: 1. The patient needs to hold the head well forward and breathe through the mouth while pinching the entire soft part of the nose for 10 to 20 minutes. 2. The patient must be sitting down and at total rest until the bleeding stops.

4. Firmly secure the dressing with a bandage to maintain pressure on the wound.

6. circulation beyond the bandage.

7. If bleeding shows through the pad or dressing, don’t remove it and apply a second dressing on top of the first.

FAFA MANUAL

Wou nds 1. Superficial wounds and abrasions should be irrigated with clean water, preferably tap water because of the benefit of pressure. 2. First aid providers may apply antibiotic ointment to skin abrasions and wounds to promote faster healing with less risk of infection. 3. First aid providers may apply an occlusive dressing to wounds and abrasions with or without antibiotic ointment. 4. The use of triple antibiotic ointment may be preferable to double- or single- agent antibiotic ointment or cream. 5. If antibiotic is not used, antiseptic could be used. 6. There is some evidence that traditional approaches, including applying honey,are beneficial and may be used on wounds by first aid providers.

Fractures Definition: It is a medical condition in which there is injury to the bone which cause discontinuity or laceration of the bone.

FAFA MANUAL 2) Hairline fracture: a partial fracture of the bone. Sometimes this type of fracture is harder to detect with routine x-rays. 3) Impacted fracture: when the bone is fractured, one fragment of bone goes into another. 4) Compression fracture/wedge fracture: usually occurs in the vertebrae, for example when the front portion of a vertebra in the spine collapses due to osteoporosis. 5) Comminuted fracture: the bone is shattered into many pieces. 6) Intra-articular fracture: where the break extends into the surface of a joint. 7) Fracture dislocation: a joint becomes dislocated, and one of the bones of the joint has a fracture. 8) Longitudinal fracture: the break is along the length of the bone. 9) Oblique fracture: a fracture is diagonal to a bone's long axis. 10) Transverse fracture: a straight break right across a bone. 11) Pathological fracture: when an underlying disease or condition has already weakened the bone, resulting in a fracture (bone fracture caused by an underlying disease/condition that weakened the bone). 12) Spiral fracture: a fracture where at least one part of the bone has been twisted. 13) Avulsion fracture: a fracture where a fragment of bone is separated from the main mass. 14) Stress fracture: more common among athletes. A bone breaks because of repeated stresses and strains.

Causes: 1) Falls like falling from a high place or over a running vehicle like motorcycles and car accidents. 2)

Hitting the bone by a heavy moving instrument.

3) Gunshots. 4) 1st degree muscle convulsions with hypocalcemia may cause bone fracture. 5) Some medical conditions which cause weakness of muscles like osteoporosis and some cancer may cause bone fracture. Types: According to the state of the skin: 1)

Closed fracture “the skin is intact”

Open fracture “the skin is injured”

According to the state of fractured bone: 1) Greenstick fracture :the bone partly fractures on one side, but does not break completely because the rest of the bone can bend. This is more common among children whose bones are softer and more elastic.

FAFA MANUAL

Signs: 1. A snap or grinding sound when the injury occurs. 2. Pain, swelling and bruising. 3. Discolored skin around the affected area. 4. Angulation - the affected area may be bent at an unusual angle. 5. The patient is unable to put weight on the injured area. 6. The patient cannot move the affected area. 7. The affected bone or joint may have a grating sensation. 8. If it is an open fracture, there may be bleeding.

1. Stop pain in the injures limb.

When a large bone is affected, such as the pelvis or femur:

2. Support the bony ends at region of fracture as it is very sharp and if it mobile it may injure any blood vessel or internal organ.

1. 2. 3.

The person may look pale and clammy. There may be dizziness (feeling faint). Feelings of sickness and nausea.

Splinting Definition: It is putting splint to support the leg or arm of the person who suspected to be broken. Aim:

3. Facilitate moving of injured person. Types:

How to react:-

1) Hard splint: Any hard object like a piece of wood used to support the fractured limb.

General:

2) Soft splint: Any soft flexible thing like a piece of cloth used to support the joints around fractured limb.

1) Ask patient to remain as still as possible. 2) Use broad bandages (where possible) to prevent movement at joints above and below the fracture. 3) support the limb, carefully passing bandages under the natural hollows of the body. 4) Place a padded splint along the injured limb. 5) Place padding between the splint and the natural contours of the body and secure firmly. 6) For leg fracture, immobilize foot and ankle. 7) Check that bandages are not too tight (or too loose) every 15 minutes. 8) Watch for signs of circulation loss to hands and feet. 9) Call 123. Open fractures: 1) 2) 3) 4)

Stop bleeding by using bandages on the wound without mobile fractured bone. Work on the fracture from healthy not injured side. If there is a penetrated bone act with it like a foreign body and don’t move it. Check the pulse at the position of bandage every 10 minutes

1) Make the injured area visible. 2) Stop bleeding by using bandages but without touching the injured area. 3) If the fractured bone penetrates the skin, put the splint without moving this bone or try ing to return it to its place. 4) Keep the fractured bone stable without any move through: 5) If the fracture in the arm, keep shoulder and elbow joints stable. And if it in the forearm keep elbow and wrist joints stable. 6) If the fracture in the femur, keep hip and knee joints stable. And if it in the lower part of leg keep knee and ankle joints stable. 7) Bind the splint carefully to make sure that the injured bone doesn’t move, but care about that you don’t bind it tightly to don’t prevent running of blood. 8) Bind it in the most comfort position to the injured person. 9) If there is someone call the ambulance and it is in its way to you don’t do anything just keep the injured person in his position and if there is bleeding stop it.

Pelvic fracture: 1) 2) 3) 4)

General principle of splinting:

Keep the person lying on his back. Fixing the legs and feet. Call 123. Check vital signs tell the help come.

FAFA MANUAL

How to prevent:

Sun Stroke Defenition: It is a medical condition occurs when the body temperature raise rabidly above 40 C by a high rate in which body can’t tolerate or returning it to its normal range, and this occur because of exposure to the sun for a long time or doing hard physical exertion in a hot moist weather without having inadequate supply of liquids. Causes: 1) Exposure to a hot environment. 2) Strenuous activity. 3) Wearing excess clothing that prevents sweat from evaporating easily and cooling your body. 4) Drinking alcohol, which can affect your body's ability to regulate your temperature. 5) Becoming dehydrated by not drinking enough water to replenish fluids lost through sweating. Symptoms: 1. 2. 3. 4. 5. 6.

1. Drink plenty of cold drinks, especially when exercising. 2. Wear lightweight, light-colored clothing, preferably with a loose-weave material that lets air get to your skin. 3. Avoid strenuous activity in the hottest part of the day (between 10 a.m. and 4 p.m.). If you must participate, take frequent breaks, limit the time that you wear a helmet by taking it off between activities, and avoid wearing heavy uniforms or equipment. 4. Take cool baths or showers. 5. Protect against sunburn. Sunburn affects your body’s ability to cool itself, so protect yourself outdoors with a wide-brimmed hat and sunglasses and use a broad-spectrum sunscreen. 6. Avoid excess alcohol.

Animal Bites Snake bite

Headache Dizziness Weakness Muscle cramps & Abdominal cramps Nausea & Vomiting Heavy sweat or a lack of sweat

When heat stroke starts, neurological symptoms include: 1. Odd or bizarre behavior 2. Irritability 3. Delusions 4. Hallucinations 5. Seizures 6. Coma

Signs: 1. Fear and phobia of the person. 2. Dizziness, vomiting and diarrhea. 3. Tachycardia and loss of consciousness. 4. Pain with redness in site of bite. 5. Mark of one or two points or row of small teeth.

Scorpion bite Signs:

How to react: 1) 2) 3) 4) 5) 6) 7) 8)

FAFA MANUAL

Move the person away from sun to a cool place. Call 123. Take away his clothes if possible. Make him to lie down. Fan air over the patient while wetting his or her skin. Apply ice packs to the patient's armpits, groin, neck, and back. Immerse the patient in a shower or tub of cool water. Continuously measuring body temperature and vital signs and care about it.

1. 2. 3. 4. 5.

Pain. Widespread anesthesia. Difficulty of swallowing. Blurring vision. Epileptic attacks with drop of saliva and difficulty of breathing.

How to react:

Take the person away from the position biting. 2) Try to calm him down and don’t move as possible as he can. 3) Call 123. 4) Tourniquets and cutting wounds can worsen the effects of the venom and should not be used as first aid. 1)

FAFA MANUAL

Symptoms:

Dog bites Treatment depends on the location of the bite, the overall health condition of the bitten person and whether or not the dog is vaccinated against rabies. The main principles of care include: 1) 2) 3) 4) 5) 6)

early medical management; irrigation and cleansing of the wound; primary closure if the wound is low-risk for developing infection; prophylactic antibiotics for high-risk wounds or people with immune deficiency; rabies post-exposure treatment depending on the dog vaccination status; administration of tetanus vaccine if the person has not been adequately vaccinated.

Cat bites Treatment depends on the location of the bite and the rabies vaccination status of animal species inflicting the bite. The main principles of care include: 1) 2) 3) 4)

FAFA MANUAL

early medical management including wound cleansing; prophylactic antibiotics to decrease infection risk; rabies post-exposure treatment depending on the animal vaccination status; administration of tetanus vaccine if the person has not been adequately vaccinated.

Poisoning Definition: A large number of poisonous substances are found at home and workplace. Poisoning with carbon monoxide and carbon dioxide can also occur in a domes- tic and workplace environment.

Causes: 1. Swallowing 2. inhaling 3. touching 4. injecting various drugs 5. chemicals 6. venoms or gases

1. Burns or redness around the mouth and lips 2. Breath that smells like chemicals, such as gasoline or paint thinner 3. Vomiting 4. Difficulty breathing 5. Drowsiness 6. Confusion or other altered mental status How to react: • For all poisoning: 1. In giving first aid to a casualty, the first priority is the safety of the first aid provider, meaning that any direct contact with gases, fluids or any other material possibly containing poisons should be avoided. (Good Practice Point) 2. If life-threatening conditions exist, call EMS for further help. (Good Practice Point) 3. If non-life threatening conditions exist, call the poison control centre for guidance. (Good Practice Point) • For ingestion poisoning: 1. Activated charcoal should be used as a first aid measure only if directed by the poison control centre or equivalent agency. 2. Ipecac syrup must NOT be used by a layperson as a first aid treatment in cases of acute poisoning. 3. For casualties who have ingested a caustic substance, administration of a diluent by a first aid provider is NOT generally recommended. But in remote areas where further care is delayed and when advised to do so by a poison control centre, EMS or local equivalent, giving a diluent (milk or water) may be appropriate. 4. The casualty should preferably be laid on his or her left side. • For gaseous poisoning: 1. Flammability warning: In rooms which are potentially filled with carbon monoxide exposure to all sources of ignition such as naked flames, electrical equipment, oxidizing chemicals and the smoking of tobacco products should be prevented. (Good Practice Point) 2. Move the casualty out of the area with gas immediately, but only if this can be done without endangering the first aid provider (Good Practice Point). In most cases the rescue has to be carried out by a professional rescue service. 3. Only trained first aid providers should administer oxygen to casualties of carbon monoxide and carbon dioxide poisoning. (Good Practice Point)

FAFA MANUAL Call 123 or your local emergency number immediately if the person is: 1. Drowsy or unconscious 2. Having difficulty breathing or has stopped breathing 3. Uncontrollably restless or agitated 4. Having seizures 5. Known to have taken medication

FAFA MANUAL

Diarrhea Definition: Diarrhea is characterized by abnormally loose or watery stools.That happens frequently three or more times a day. Diarrhea may be acute, persistent, or chronic. Acute diarrhea is a common problem that typically lasts 1 or 2 days and goes away on its own. Persistent diarrhea lasts longer than 2 weeks and less than 4 weeks. Chronic diarrhea lasts at least 4 weeks. Chronic diarrhea symptoms may be continual or may come and go

D ehy drat io n Definition: Dehydration can be a consequence of a wide range of health impairments (vomiting and diarrhea, heat stress, fever, etc.) or vigorous exercise and hard physical work. Symptoms: 1. pale and dry skin 2. dry mouth and tongue 3. weakness 4. delayed capillary refill 5. change in mental status (as dehydration becomes more severe) How to react: 1. Give advice to prevent dehydration, e.g. do not expose head and body to excessive heat, especially if not used to the warm climate 2. Wear a hat (especially small children and babies). 3. Wear cool clothing that allows air circulation. 4. Drink enough water during the day; increase normal liquid intake by at least one to two litres for adults. 5. Avoid extensive sport activities around noon and mid-day. 6. Protect skin with high protection sunscreens. 7. Give the body time to adapt to the environment, especially for people notused to a hot and humid climate.

Causes: Most cases of diarrhea are caused by an infection in the GIT. The microbes responsible for this infection include: a) bacteria b) viruses c) parasitic organisms Acute diarrhea The most commonly identified causes in the United States are the bacteria Salmonella, Campylobacter, Shigella, and Shiga-toxin-producing Escherichia coli. Chronic Diarrhea Some cases are called "functional" because a clear cause cannot be found. In the developed world, irritable bowel syndrome (IBS) is the most common cause of functional diarrhea. • Inflammatory bowel disease (IBD) is another cause of chronic diarrhea. It is a term used to describe either ulcerative colitis or Crohn's disease. There is often blood in the stool in both conditions. • Other major causes of chronic diarrhea include:

In the absence of pre-prepared packets, a homemade solution can be made using (other alternatives also exist): 1. half teaspoon of salt 2. six teaspoons of sugar 3. one litre of water

FAFA MANUAL

FAFA MANUAL In the absence of pre-prepared solutions, a homemade solution may be used for dehydration. using (other alternatives also exist): i. ii. iii.

Half teaspoon of salt Six teaspoons of sugar One literof water

If symptoms of gastrointestinal distress appear suddenly, are serious or are accompanied by dehydration (or the latter appears alone), emergency treatment should be sought. Even mild cases of gastrointestinal distress may require a medical examination although the need is not necessarily urgent How to react in adult, infants, child cases. Dehydration can be a consequence of a diarrhea,which means your body lacks enough fluid and electrolytes to work properly. In cases of dehydration: rehydration is the key: 1. In Mild-Moderate cases, Fluids can be replaced by simply drinking more fluids at home, it can be treated simply, effectively and cheaply in all age groups using beverages such as, coconut water, milk, lemon tea and Chinese tea with caffeine. If these alternative beverages are not available, potable water may be used, or alternated with commercial carbohydrate-electrolyte drinks. 2. In severe cases, first aid providers should rehydrate the patient by giving him by mouth an adequate glucose electrolyte solution called “Oral Rehydration Salts (ORS) solution”. Either a commercially prepared ORS or a pre-prepared salt package for oral rehydration that complies with World Health Organization recommendations. 3. Steps to follow when preparing packaged ORS to manage dehydration: 1. 2. 3. 4.

Wash hands with water and soap. Follow preparation directions on the ORS packet. Put one liter of safe water in a clean pot. Empty packet of ORS into the water while stirring

Some extra notes: -Some people frequently pass stools, but they are of normal consistency. This is not diarrhea. - Breastfed babies often pass loose, pasty stools. This is normal. It is not diarrhea. -IBS is a complex of symptoms. There is cramping abdominal pain and altered bowel habits, including diarrhea, constipation, or both. - It was observed that milk is more effective than water for fluid replacement in the dehydrated individual

FAFA MANUAL

C o nvuls io ns

FAFA MANUAL How to react in adult, infants, child cases. a. First aid providers may place a person experiencing a seizure on the floor to prevent him or her from being injured.

Definition: Convulsions is general term that people use to describe uncontrollable muscle contractions. convulsions may occur due to irregularity in brain electrical activity that leads to a loss of body control, muscle twitching, loss of consciousness and/or staring off. Some people may use it interchangeably with the word "seizure," although a seizure refers to an electrical disturbance in the brain. Seizures may cause a person to have convulsions, but this is not always the cause. Chronic seizures are called epilepsy, which is usually treated with medication. Causes: Convulsions occur when injury, disease, fever, poisoning or infection disrupts the normal electrical functions of the brain. Conditions cause convulsions:

During the seizure:

1. Remove nearby objects that might cause injury; 2. Protect the person’s head by placing a thinly folded towel or clothing beneath it. Do not restrict the airway while doing so; • do not hold or restrain the person; • Try to move them (only do so if they are in danger) • Do not place anything between the person’s teeth or put anything in his or her mouth. The person will not swallow his or her tongue. c. Once the seizure has ended, first aid providers should assess the airway and breathing and treat accordingly. Comfort and stay with the person until he or she is fully conscious. d. However, if the seizure goes on for more than 5 minutes, or if the child does not recover quickly, it is essential to call an ambulance.

Fever According to the National Institute of Neurological Disorders and Stroke (NINDS), febrile seizures can affect children between the ages of 6 months and 5 years who are experiencing a fever. Febrile seizures cause convulsions that typically last up to 5 minutes. Epilepsy Chronic seizures due to electrical disturbances in the brain can cause a person to experience convulsions. The most common type is called tonic-clonic seizures. “Tonic” means stiffening while “clonic” means jerking Mental Stress Some non-epileptic seizures occur due to mental or emotional stress. For this reason, doctors sometimes refer to them as “psychogenic non-epileptic seizures.” psychological therapies are recommended to help a person manage the underlying stress causing the seizures.

. Some extra notes: In febrile seizures: The majority febrile seizures do not have any lasting negative impact on a child. They are generally harmless and do not require treatment. Call emergency immediately if: 1. 2. 3. 4. 5.

A seizure lasts longer than five minutes or is repeated. The person does not regain consciousness after five to ten minutes. The person has diabetes or is injured. The person has never had a seizure before. Any life-threatening condition is found.

FAFA MANUAL

Drowning Definition: Drowning, is the process of experiencing respiratory impairment from submersion/immersion in liquid, usually water. Causes: It begins when the person’s airway lies below a surface of liquid, at which time the individual voluntarily attempts to hold his or her breath. This may be followed by the person involuntarily allowing liquid into the airway. If there is no rescue and/or reverse of this cascade, the hypoxia increases and multi-system failure occurs. How to react in adult, infants, child cases. The first aid provider should attempt to save the person drowning without entering the water, by talking reaching with a rescue aid (e.g. stick or clothing), or throwing a rope. First aid providers should enter the water only if it is essential and they have the required training, if they can use a floating device or boat or if they are not alone and it is safe (in case of drowning children for example) • Airway management & ventilation 1. Put the person in a horizontal position 2. Open the upper airway to allow oxygen to reach some functional lung tissue and minimizing aspiration obstruction of the airway 3. These clear procedures allow the patient to cough and resume spontaneous breathing themselves. If not, ventilation will be need by giving effective breaths. 4. Resuscitation should begin immediately unless fluids obstruct the airway. The first aid provider must continue rescue breath or ventilation until the rescue team arrives on scene. 5. In case the patient is in cardiac arrest, he or she should be placed on their back to perform resuscitation give two to five initial effective rescue breaths before compressions. 6. If you are alone (sole rescuer), perform CPR for approximately one minute before seeking help.

FAFA MANUAL 7. Continue to give CPR as to an adult or a child; If the person does not respond and has normal breathing, they should be in lateral position if possible, with the head dependent to allow free drainage of fluids. 8. Spinal precautions while removing the person from the water, such as limiting neck flexion and extension, are unnecessary unless there is a history of diving in shallow water, or signs of severe injury in the water and it does not impede treatment of life-threatening conditions. 9. For an unconscious or recovering casualty, or while transporting him or her, he or she should be in as near a true lateral position as possible, with the head dependent to allow free drainage of fluids. 10. If the patient has regurgitation of stomach contents, turn the person immediately on their side, remove the regurgitated material as much as possible, put the patient on their back and continue resuscitation. 11. Compressions should not be performed in water. Compressions may be performed on the way to shore if the person can be placed on a solid object such as a rescue board. 12. Any pressure on the chest that impairs breathing should be avoided. 13. In-water resuscitation consisting of airway and ventilation management should NOT be attempted in deep water by a single first aid provider without flotation support. In this case, the priority should be rescue to shore. Some extra notes: An attempt to remove water from the airways using abdominal thrusts is unnecessary and potentially dangerous. Supplemental oxygen for the drowning process resuscitation may be used, but doing so should never delay resuscitation, including opening the airway and providing ventilation and compressions as needed.

FAFA MANUAL

Pyschological first aid

FAFA MANUAL

Risk factors of crisis event and violent act:

Definition: Psychosocial support, as defined by the IFRC Reference Centre for Psychosocial Support, refers to the actions that address both the psychological and social needs of individuals, families and communities after critical events and aim at enhancing the resilience of the affected individuals, group and community. Target: Psychological first aid is for distressed people who have been recently exposed to a serious crisisevent. You can provide help to both children and adults. However, not everyone who experiences a crisis event will need or want Psychological First Aid(PFA). Do not force help on people who do not want it, but make yourself easily available to those who may want support. Symptoms of distressed people: Physical symptoms (for example, shaking, headaches, feeling very tired, loss of appetite, aches and pains) 2. Crying, sadness, depressed mood 3. Anxiety 4. Being “on guard” or “jumpy” 5. Worry that something really bad is going to happen 6. Insomnia, nightmares 7. Irritability, anger 8. Guilt, shame (for example, for having survived, or for not helping or saving others) 9. Confused, emotionally numb, or feeling unreal or in a daze 10. Appearing withdrawn or very still (not moving) 11. Not responding to others, not speaking at all 12. Disorientation (for example, not knowing their own name, where they are from, or what happened) 13. Not being able to care for themselves or their children (for example, not eating or drinking, not able to make simple decisions)

a. b. c. d. e. f. g. h. i. j. k. l. m.

Age (higher risk if less than 30 years old) Sex (higher risk if male) Unstable relationship Instable employment History of repeated impulsive behaviors and problems with authority Previous history of violence presence of personality disorders (e.g. antisocial type, impulsive type) presence of other mental disorders (e.g. schizophrenia with psychotic symptoms rela ted to violence, morbid jealousy) history of childhood problems (e.g. behavioral and conduct problems) presence of alcohol and substance abuse presence of brain injury presence of pain lack of social support

Safety & Security

Social Support

Assessment of Needs

PFA Stabilization

Empowerment & Information Hope

FAFA MANUAL 1. Safety and security: Ensure security and enhance immediate and ongoing safety and provide physical and emotional comfort. Allow the person a period of rest and provide an opportunity to discuss feelings and experiences if he or she wants to. If the person talks about thoughts, feelings or emotions in relation to the event voluntarily, listen in a calm, non-judgmental way. 2. Assessment of needs: Provide practical and emotional support to the affected person according to needs (e.g. shelter, financial assistance, social network, medical and legal assistance). 3. Stabilization: In some cases, the person may have an initial state of daze, in which his or her field of consciousness is constricted and attention narrowed, with a loss of the ability to comprehend stimuli (symptoms of acute stress reaction, i.e. the immediate and brief responses to a sudden intense stressor). Calm and orient emotionally overwhelmed persons. Give the affected person opportunities to distance him or her from the traumatic event. Give children opportunities to play. 4. Information: Provide useful information related to the event including the state and place of missing persons, the resources in the community, and where the person can seek help in case emotional or mood problems develop in the future, as appropriate. Providing psycho-educational supports the healing process: Explain normal reactions to abnormal situations, to help prepare the person for reactions that may come in the following days and weeks and how to best cope in a healthy manner. 5. Connect to social support and collaborating services: Social and peer support has been found to be useful and should be facilitated as should help-seeking behavior. Help establish contact with primary social support persons or other sources of support such as family members or friends. Link with available services at the time or in the future. 6. Empowerment and hope: Help the person to be active and take their own decisions wherever possible. Support in planning small steps into the near future.

FAFA MANUAL

Don’t

1. Keep them warm and safe. 2. Keep them away from loud noises and chaos. 3. Give cuddles and hugs. 4. Keep a regular feeding and sleeping schedule, if possible. 5. Speak in a calm and soft voice. 6. Give them extra time and attention. 7. Remind them often that they are safe. 8. Explain to them that they are not to blame for bad things that happened. 9. Avoid separating young children from caregivers, brothers and sisters, and loved ones. 10. Keep to regular routines and schedules as much as possible. 11. Give simple answers about what happened without scary details. 12. Allow them to stay close to you if they are fearful or clingy. 13. Be patient with children who start demonstrating behaviors they did when they were younger, such as sucking their thumb or wetting the bed. 14. Provide a chance to play and relax, if possible.

• Don’t pressure someone to tell their story. • Don’t interrupt or rush someone’s story (for example, don’t look at your watch or speak too rapidly). • Don’t touch the person if you’re not sure it is appropriate to do so. • Don’t judge what they have or haven’t done, or how they are feeling. Don’t say: “You shouldn’t feel that way,” or “You should feel lucky you survived.” • Don’t make up things you don’t know. • Don’t use terms that are too technical. • Don’t tell them someone else’s story. • Don’t talk about your own troubles. • Don’t give false promises or false reassurances. • Don’t think and act as if you must solve all the person’s problems for them. • Don’t take away the person’s strength and sense of being able to care for themselves. • Don’t talk about people in negative terms (for example, don’t call them “crazy” or “mad”).

References: You can find all the references used to make this manual in the following drive: https://drive.google.com/open?id=1gt0s45LkTav-s7bhyaFNb6KEPjb2zUeP

FAFA MANUAL

Dina Tarek Bekhiet ASSA-Alexandria (Manual Coordinator)

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