first aid for divers

© BSAC Thailand 7/2009

FIRST AID FOR DIVERS

Skill Development Course

BSAC

THE BRITISH SUB AQUA CLUB


Skill Development CourseBSAC First Aid for

Course

THE BRITISH SUB AQUA CLUB

Student Notes

Skill Development Course

First Aid for Diver

Course Manual

pdfMachine Is a pdf writer that produces quality PDF files with ease!

Produce quality PDF files in seconds and preserve the integrity of your original documents. Compatible across nearly all Windows platforms, if you can print from a windows application you can use pdfMachine.

Get yours now!

http://www.pdfmachine.com?cl


FIRST AID FOR DIVERS Student Notes

SKILL DEVELOPMENT COURSE

BSAC FIRST AID

FOR DIVERS

STUDENT NOTES

British Sub-Aqua Club, BSAC Thailand

9/ 33 Post Office Road, Mae Haad, Koh Tao, Koh Phangan, Surratthani, 84360, Thailand

Tel: 0860589408 Fax: +66 (0)77 456782 www.bsacthailand.com [email protected]

All rights reserved. This Instructor Manual may not, in whole or part, be copied, photocopied, reproduced or translated, or converted into any electronic or readable form without prior written consent of British Sub-Aqua Club

BSAC Thailand under License from BSAC International



Get yours now!

http://www.bsacthailand.com

mailto:[email protected]





COURSE AIMS

To teach the basics of First Aid likely to be needed in the sports diving environment and making use of the recourses likely to be available at the time. This will include the improvisation of dressing, splints etc using materials and equipment commonly available on the dive site or in the boat. PRINCIPLES AND PRIORITIES OF FIRST AID

What is First Aid?

The application of accepted principles of treatment on the occurrence of any injury or sudden illness, using facilities or materials available at the time. Propose of First Aid To do the minimum necessary to:

preserve life limit the effects of the condition promote recovery

The First Aider Role and Responsibilities

assess the situation diagnose what is wrong give appropriately prioritised treatment remain with the casualty until the casualty is either evacuated to medical attention or is fully

recovered responsibility ends when the casualty is handed over to medical personnel and a report

given Priorities Assessing the situation

be calm and take charge ensure the safety of yourself and the casualty guard against further casualties reassure the casualty get others to help



Get yours now!




Diagnosis

incident history signs symptoms

Priorities of Treatment Preserve life Basic Life Support

adequate airways (A) adequate breathing (B) adequate circulation (C)

Control bleeding Limit the effects of the condition

treat for shock dress the wounds immobilise large wounds and fractures comfortable position

Promote recovery

reassure casualty relieve the pain handle casualty gently keep casualty warm arrange for evacuation to medical aid

Multiple Casualties

Priorities 1 - non-breathing casualties airways and resuscitation 2 - unconscious breathing casualties / recovery position 3 - severe bleeding

identify and treat most serious condition treat others as circumstances allow noisiest casualty is rarely the most seriously injured



Get yours now!




Hygiene

Major injuries � saving life is the priority, worry about infections later Minor injuries � cleanliness essential

First Aid considerations:

body fluids have the potential to be infectious emotion should not be allowed to blow the potential risk of infection out of proportion infections need a means of entry whole skin is an effective barrier; as an added precaution, if possible, wear disposable gloves if in contact with body fluids wash with soap and water clean up spilt body fluids with household bleach any perceived risks should not discourage First Aid post event checks for possible exposure are available if in any doubt

BASIC LIFE SUPPORT (BLS) REVIEW

In water life support sequence

BLS on land

Continue Basic Life Support at a ratio of 2 breaths every 30 seconds first aid duties if more than one operator


saving life is the priority, worry about infections later cleanliness essential to prevent a minor problem being aggravated by infection

ody fluids have the potential to be infectious emotion should not be allowed to blow the potential risk of infection out of proportioninfections need a means of entry whole skin is an effective barrier; as an added precaution, if possible, wear disposable glovesif in contact with body fluids wash with soap and water clean up spilt body fluids with household bleach any perceived risks should not discourage First Aid

st event checks for possible exposure are available if in any doubt

REVIEW

at a ratio of 2 breaths every 30 seconds until assistance arrivesfirst aid duties if more than one operator

Student Notes

to prevent a minor problem being aggravated by infection

emotion should not be allowed to blow the potential risk of infection out of proportion

whole skin is an effective barrier; as an added precaution, if possible, wear disposable gloves

until assistance arrives. Share



Get yours now!




● If it has not already happened, the rescuer needs to arrange for someone to contact the emergency services ● The rescuer should remain with the casualty and continue first aid. When the emergency services arrive they should be given all details of the incident and first aid given

No two rescues will be the same. The likelihood is that there will be other divers able to render assistance from an early stage in the rescue. Whatever a rescuer does they will, by force of circumstance, have to compromise to achieve the best they can at the time. Because of the stress and exertion involved in a rescue, the more qualified assistance there is, such as good surface support, the more they can help and assist the rescuer as soon as possible. CASUALTY EXAMINATION

Assess and record: history responsiveness � sight, speech symptoms � information from the casualty physical examination

- minimal movement of the patient - head to toe sequence - compare both sides of the casualty�s body

Head

Skull � swelling, indentations Face � colour, skin, temperature, breathing Eyes � pupil size, response to light Ears � hearing, blood, fluids Nose � appearance, blood, fluid Mouth � breathing, odour, wounds, irregularity, discolouration

Neck � loosen clothing, warning medallions, vertebrate, tenderness, bruising

Trunk � chest movement, symmetrical collar bones and ribs, wounds, tenderness, incontinence

Back and Spine � vertebrate, swelling, tenderness

Upper limbs - check movement , bruising, swelling, deformity, warning bracelet, feeling

Lower limbs � check movement, bruising, swelling, deformity, feeling

Feet � movement, feeling, colour deformity



Get yours now!




SUMMONING ASSISTANCE

Diving Incident

Coastguard

VHF Radio � channel 16 (PAN PAN Medico) 999/911 Telephone

Royal Navy (UK)

Telephone 0831 151523, Duty Diving Medical Officer�s mobile number State that you have a diving emergency The Duty Diving Medical Officer will:

- give you medical advice - advice of the location of the nearest recompression facilities - advice on relevant telephone numbers

He will not be able to:

- arrange transport - advise of the availability of the recompression facility

It is the diving party�s responsibility to:

- contact the recompression facilities - establish which facility can accept the casualty - arrange for casualty evacuation via the local emergency services

Have details ready to give to the Coastguard / Duty Diving Medical Officer and go with the casualty to the medical facility:

- dive history - description of signs and symptoms and when they occurred - details of any First Aid given (e.g. Oxygen administration etc)

Non-diving incident

Ambulance service

- telephone 999/911 call - give clear and concise details of the incident - give clear and concise details of the dive location - ensure that the person making the call report back to the First Aider

Have the relevant information ready for the arrival of the medical aid



Get yours now!




SHOCK

Definition

Inadequate circulation leading to tissue damage due to inadequate tissue oxygenation and waste removal

Mechanism and causes

Reduced blood volume (Hypovolaemic Shock)

massive bleeding plasma loss due to burns plasma loss due to bruising prolonged seasickness

Massive dilation of the blood vessels (Low Resistance Shock)

fainting hyperthermia

Inadequate cardiac output (Cardiogenic Shock)

heart Attack pulmonary barotrauma

Allergic reactions (Anaphylactic Shock) � drugs, food, stings etc

Long period of immersion (Immersion Shock) - Removal from the water � keep casualty horizontal

Signs and Symptoms

casualty feels weak, faint and giddy casualty is anxious and restless casualty may feel nauseous and vomit casualty may feel thirsty pale, cold clammy skin profuse sweating rapid shallow breathing, yawning and sighing rapid weak pulse unconsciousness

First Aid measures

treat the prime cause keep the casualty quiet and reassured lay casualty down with legs raised (not if DCI burst lungs is involved)



Get yours now!




B

keep casualty warm and comfortable administrate 100% oxygen nothing by mouth, moisten lips only evacuate to medical attention

WOUNDS AND BLEEDING

Wounds

Definition: any damage to the skin or underlying tissues an �open� wound is where the skin is a �closed� wound occurs to underlying tissue beneath the whole skin

Types of Wound:


eep casualty warm and comfortable (DO NOT apply heat) administrate 100% oxygen nothing by mouth, moisten lips only evacuate to medical attention

any damage to the skin or underlying tissues an �open� wound is where the skin is breached a �closed� wound occurs to underlying tissue beneath the whole skin

Student Notes

a �closed� wound occurs to underlying tissue beneath the whole skin



Get yours now!




General First Aid Aims:

minimise blood loss help body cope with blood loss treat for shock

Control bleeding by:

direct pressure indirect pressure at pressure point (release every 10 minutes) elevation of the effective area DO NOT use tourniquets

Pressure Points

Definition:

a point where an artery presses skin

Bleeding

The body responds to bleeding by: Blood clotting Contraction of the blood vessels at the site of the wound

Platelets


loss

indirect pressure at pressure point (release every 10 minutes) elevation of the effective area

a point where an artery presses over an underlying bone while close to the surface of the

body responds to bleeding by:

Contraction of the blood vessels at the site of the wound

Fibrin Thread Blood Clot

Student Notes

over an underlying bone while close to the surface of the

Blood Clot



Get yours now!




Open

Locations:

Open wounds First aid for severe bleeding

apply pressure (directly or indirectly as appropriate) to control bleeding raise and support the injured part if dressing is inadequate apply further dressing on top-do NOT remove existing dressing bandage firmly over dressing immobilise affected area to prevent disturbance of blood clotting

First Aid for minor bleeding

cleanse wound dry wound apply sterile dressing apply firm bandage check circulation downstream of wound

Internal Bleeding Signs and symptoms

Pressure Points held for no more than 10 minutes

Temporal Carotid

Subclavian

Brachial

Ulnar

Radial

Femoral

Popliteal



Get yours now!




Signs of shock without obvious blood loss

pallor cold , clammy, pale skin rapid weak pulse thirst confusion, restlessness, irritability collapse, unconsciousness pain and tenderness totally out of proportion to extent of visible damage pattern bruising coughing / spitting blood of blood in faeces or urine

First Aid treatment

lie casualty down with legs raised arrange urgent removal to medical care

Check and record condition at 10 minute intervals

- breathing - pulse - level of response - If casualty looses consciousness, place them in the

recovery position

BURNS

Types of burns

Dry burns

flames hot engine exhaust �rope burns� electrical burns

Scalds

hot water steam



Get yours now!




Chemical burns

Acids (e.g. boat engine batteries)

Classification:

Area

1% or more of the body surface area affected will need medical attention The area of the hand is approximately 1% 9% or more of the body area will need hospitalization

Wallace�s rule of nine�s

head upper chest upper back 9% arm (each) 9% abdomen 9% lower back 9% thigh (each) 9% lower leg (each)

Depth

Superficial � outer layer of skin only

redness swelling extreme tenderness

Partial � thickness � can be infected

blisters surrounding area swollen and red

Full- thickness � relatively pain free due to damaged nerves

skin appears waxy and pale sometime charring


(e.g. boat engine batteries)

1% or more of the body surface area affected will need medical attentionThe area of the hand is approximately 1% of the body surface area 9% or more of the body area will need hospitalization

9% 9%

upper back 9% ) 9%

abdomen 9% lower back 9% thigh (each) 9%

9%

of skin only

can be infected

surrounding area swollen and red

relatively pain free due to damaged nerves

kin appears waxy and pale

Student Notes

1% or more of the body surface area affected will need medical attention



Get yours now!




Signs and symptoms

severe pain at the sight of injury numbness if a deep burn sometimes blistering grey, charred, peeling skin shock

Electrical burns

superficial surface injury extensive damage to lower layers Cardiac Arrest?

General treatment � superficial burns and scalds

reassure the casualty cool the affected area

- gently running cold water - 10 minutes minimum

remove constrictions before swelling starts

protect the affected area DO NOT :

- break blisters � natures natural protection - apply lotions, ointments etc - use adhesive dressings

General treatment � partial and full thickness burns

Note: for electrical burns ensure electricity supply is disconnected

lay casualty down gently remove constriction before swelling starts Carefully remove fluid soaked clothing, DO NOT remove dry clothing use unmedicated sterile dressings immobilize badly burned limbs treat for shock If Conscious, give frequent sips of cold water recovery position evacuate to medical attention if burns are greater than 1% of body surface area

General treatment � chemical burns

flood the affected part with water



Get yours now!




flood for a minimum of 10 minutes ensure water drains clear of the unaffected areas gently remove contaminated clothing avoid spreading the contamination avoid self contamination continue as for partial and full thickness burns

MISCELENAEOUS INJURIES

Mask squeeze

Cause

Inadequate equalization of the mask volume on decent

Signs

bruised/swollen facial tissue bruised haemorrhaged eyes

First Aid treatment

self healing reassurance medical attention if painful casualty should reframe from diving until clear and taught how to prevent a recurrence

EAR PROBLEMS

Structure

Causes

Inadequate ear clearing on decent Tight hood on decent


for a minimum of 10 minutes ensure water drains clear of the unaffected areas gently remove contaminated clothing avoid spreading the contamination

continue as for partial and full thickness burns

Inadequate equalization of the mask volume on decent

ed/swollen facial tissue ruised haemorrhaged eyes

edical attention if painful asualty should reframe from diving until clear and taught how to prevent a recurrence

Inadequate ear clearing on decent

Student Notes

asualty should reframe from diving until clear and taught how to prevent a recurrence



Get yours now!




Blocked Eustachian tube on ascent

Sign and symptoms

pain � which maybe suddenly reduce giddiness/vertigo hearing disturbances � tinnitus deafness possible bleeding from the ear

First Aid treatment

cover the ear with a sterile dressing place head in an attitude that allows the blood to drain out of the ear obtain medical attention refrain from diving until cleared by a doctor to resume

SINUSES

Frontal Ethmoidal

TEETH

Causes

air pockets trapped behind fillings cavities with narrow openings

Signs and symptoms

Maxillary

Cause

Blocked entry to sinus

Signs and symptoms

acute pain in the affected area possible blood discharge from

nose

First Aid Treatment

no direct first aid possible pain killers medical aid in serve cases



Get yours now!




se

Injuries

sensitivity/pain in tooth during ascent and /or descent dislodged filling /split tooth possible bleeding from the gum

First Aid Treatment

for pain only, refer casualty to dentist for rectification of cavity before further diving for damage to tooth /bleeding, place pad to prevent contact of injured area with other teeth

and evacuate to medical attention

BLAST INJURY

Injuries are due to:

overpressure bruising separation between adjacent tissues soft tissue damage limbs damaged or amputation

Shrapnel

high velocity /energy particles possible multiple wounds small entry wounds / serve underlying tissue damage major organ damage

First Aid treatment

no specific treatment � combined normal First Aid actions for various types of injury counter bleeding treat fractures make casualty comfortable treat for shock arrange for medical attention at the earliest point that priorities dictate

Causes

exploding cylinder burst (failing hose) explosives - extremely unlikely in SPORT

Injuries in air can be very dramatic. Underwater can produce profound internal damage with injuries


ensitivity/pain in tooth during ascent and /or descent

possible bleeding from the gum

or pain only, refer casualty to dentist for rectification of cavity before further divingfor damage to tooth /bleeding, place pad to prevent contact of injured area with other teeth

o medical attention

separation between adjacent tissues

limbs damaged or amputation

igh velocity /energy particles

serve underlying tissue damage

combined normal First Aid actions for various types of injury

make casualty comfortable

attention at the earliest point that priorities dictate

extremely unlikely in SPORT diving

Injuries in air can be very dramatic. Underwater can produce profound internal damage with little or no visible

Student Notes

or pain only, refer casualty to dentist for rectification of cavity before further diving for damage to tooth /bleeding, place pad to prevent contact of injured area with other teeth

combined normal First Aid actions for various types of injury



Get yours now!




SEASICKNESS

Cause

effect of motion on balance mechanism frequency and nature of the motion affect people different

Prevention /minimization

diet location in the boat visual horizon constrictions anti-seasickness measures different motion once in the water

Signs and symptoms

nausea pallor vomiting headache loss of co-ordination casualty becomes irrational

Treatment

lay /sit casualty down keep warm secure casualty to prevent injury or from falling overboard remove to stable environment

HYPOTHERMIA

Definition

body temperature drops below 35 C moderate hypothermia recovery is unlikely when

fallen below 26-24 C

Cause

Inadequate protection against a cold environment


ffect of motion on balance mechanism frequency and nature of the motion affect people different

seasickness measures- tables, pads, wristbands, adaptation ifferent motion once in the water

asualty becomes irrational

ecure casualty to prevent injury or from falling overboard emove to stable environment

ody temperature drops below 35 C oderate hypothermia

ecovery is unlikely when the body temperature has

Inadequate protection against a cold environment

Student Notes



Get yours now!




water conducts heat 25 times faster than air wind chill /evaporation

Signs and symptoms

Treatment

insulation, around and underneath lay casualty down, keep quiet place casualty in the recovery position if unconscious keep hand and arms away from direct contact with the body trunk place in a warm sheltered environment replace or cover wet clothing administrate hot sweet drinks BLS if required evacuate to medical attention

Do not:

give the casualty alcohol rub or massage the casualty limbs allow the casualty to perform any exercise

In extreme circumstances where medical aid is not available:

Apply GENTLE heat to the bod Aim to re-warm at the same rate that the body was originally cooled

HYPERTHERMIA

Heat exhaustion is the aspect of hyperthermia most likely to be encountered in the UK. Other aspects of hyperthermia, such as heat stroke, aThey are not covered in this course when it is run in the UK.

Causes

exercise in warm climates, e.g. on diving holiday in the Tropics overheating in the UK summer temperatures when wearing dry suit,

involved in heavy exercise sweating results in loss of salt from the body aggravated by stomach upset with diarrhea and vomiting

Signs and symptoms

casualty feels exhausted and restless


ater conducts heat 25 times faster than air

nsulation, around and underneath the casualty ay casualty down, keep quiet lace casualty in the recovery position if unconscious

keep hand and arms away from direct contact with the body trunk place in a warm sheltered environment replace or cover wet clothing

drinks

evacuate to medical attention

ive the casualty alcohol rub or massage the casualty limbs allow the casualty to perform any exercise

In extreme circumstances where medical aid is not available:

heat to the body trunk, not to the extremities warm at the same rate that the body was originally cooled

is the aspect of hyperthermia most likely to be encountered in the UK. Other aspects of hyperthermia, such as heat stroke, are only likely to be encountered in hot climates. They are not covered in this course when it is run in the UK.

xercise in warm climates, e.g. on diving holiday in the Tropics in the UK summer temperatures when wearing dry suit,

involved in heavy exercise sweating results in loss of salt from the body aggravated by stomach upset with diarrhea and vomiting

asualty feels exhausted and restless

Student Notes

is the aspect of hyperthermia most likely to be encountered in the UK. Other re only likely to be encountered in hot climates.

in the UK summer temperatures when wearing dry suit, particularly when



Get yours now!




headache, dizziness, nausea muscular cramps in lower limbs pale face, cold clammy skin breathing fast and shallow, pulse rapid and weak temperature normal or falls

Treatment

lay casualty down in a cool place if conscious give slips of cold water if sweating profusely, diarrhea and /or vomiting give half a teaspoonful of salt to each litre of

water place in recovery position if unconscious evacuate to medical aid

Exhaustion

Cause

overexertion aggravated by heat, cold, depth illness

Signs and symptoms

deep labored breathing headache confusion body unable to respond, either physically or mentally, to the demands placed upon it

First Aid Treatment

cease physical activity lay casualty down keep casualty quiet if underwater

- settle on a stationary object - regain control of breathing - control buoyant ascent - provide surface buoyancy - assist from the water

Exhaustion is a common indicator of decompression sickness



Get yours now!




INJURIES TO MUSCLES, BONES AND JOINTS

The skeleton

Provides support to the body tissues Protects the major organs Enable moment

The muscles

Cause movement Operate vital functions

- respiration - circulation

Strains

Definition � overstretching of a muscle

Signs and symptoms

sudden sharp pains at the site swelling in limb muscle

Sprain

Definition � wrenching or tearing of ligaments or tissue at a joint

Sign and symptoms

pain at joint swelling bruising and discolouration (later) inability to move joint without pain

First Aid Treatment of strains and sprains

R � rest, supported in the most comfortable position I � ice bag or cold water compress C - compression with cotton wool and bandage E � elevation of the injured area and evacuate to medical aid

FRACTURES

Definition � broken or cracked bone


INJURIES TO MUSCLES, BONES AND JOINTS

Provides support to the body tissues Protects the major organs

overstretching of a muscle

udden sharp pains at the site of injury welling in limb muscles

wrenching or tearing of ligaments or tissue at a joint

ruising and discolouration (later) nability to move joint without pain

strains and sprains

rest, supported in the most comfortable position ice bag or cold water compress compression with cotton wool and bandage elevation of the injured area and evacuate to medical aid

cracked bone

Student Notes



Get yours now!




Causes

Indirect Force Direct Force

Muscle contraction

Types

Closed Fracture � Broken bone under the skin

Open Fractures � Bone protruding through the skin

Associated, organs, tissue, nerve or blood vessel

Sign and symptoms

sound visible bone ends pain deformity crepitus tenderness to gentle pressure swelling / bruising loss of power to the limb shock

General rules for treatment

rarely life threatening immobilize where lay


Indirect Force Direct Force

Broken bone under the skin

Bone protruding through the skin

Associated, organs, tissue, nerve or blood vessel

enderness to gentle pressure

Student Notes



Get yours now!




steadily until splinted gentle traction above and below break support in the most comfortable position dress open fracture before splinting transport slowly and deliberately don�t miss other less obvious condition

treat for shock nothing by mouth

Practical considerations

Uninjured limbs make good splints Splint

- sufficient rigidity - sufficient length

padding use natural hollows tie knots on uninjured side or against splints don�t bind too tightly

- impedes circulation - allow for swelling - raise injury if possible

Dislocation

Definition � displacement of one or more bones at a


entle traction above and below break upport in the most comfortable position ress open fracture before splinting ransport slowly and deliberately on�t miss other less obvious conditions

Uninjured limbs make good splints

ie knots on uninjured side or against splints

aise injury if possible � minimizes bleeding / swelling

displacement of one or more bones at a joint

Student Notes



Get yours now!




Sign and symptoms

pain fixity of joint deformity /abnormal appearance of joint swelling and bruising

First Aid Treatment

support in the most comfortable position refer to medical aid DO NOT attempt to reset the joint

May accompany a fracture � if in doubt treat as a fracture

FIRST AID KIT

Small boat kit

2 - large sterile dressings 2 � triangle bandages rescue blanket or large polyphone bag several safety pins

Items should be individually wrapped in sealed plastic bags.

The whole kit should be housed in a waterproof container

Supplement kit by improvisation using boat equipment and diving kit

Dive Marshal�s Kit

Contents

First aid instructions 6 each, small, medium and large standard dressing Large pack of assorted adhesive dressing 4 large triangle bandages 50 mm crepe bandage 10 assorted safety pins 3 - 50 mm of roller bandages Roll of 25 mm zinc oxide plaster Scissors, tweezers Pack of sterile cotton wool Disposable gloves and a rescue blanket / plastic bag



Get yours now!




BSAC SKILL DEVELOPMENT COURSES (SDC�s)

www.bsacthailand.com [email protected]

If you enjoyed this course why not try one of the following courses; available from any

of our BSAC Dive Centres

Rescue Courses

- Oxygen Administrator - First Aid for Divers - Rescue Manager - Lifesaver Award - Advanced Lifesaver Award

Technical Diving Courses

- Deep Air Diver - Nitrox Diver - Combined Advanced Nitrox - Extended Range Diving - Gas Blender - Compressor Management - Full Face Mask - Equipment Care

Seamanship Courses

- Powerboat Handling for Divers - Dive site location and Surface

Navigation (Chart work and Position Fixing)

- Diver Coxswain Award - Outboard Engine Maintenance

Other Specialized Courses

- Buoyancy Workshop - Digital Underwater

Photography - Pro - Videographer - Dive Site Mapping



Get yours now!

http://www.bsacthailand.com

mailto:[email protected]


first aid for divers

Documents

quality pdf files

pdf writer

bsac international pdfmachine

windows application

divers course aims

windows platforms

thailand tel

diver course manual