First aid priorities

The priorities of first aid are:

Preserve life – protect the casualty from further harm and check vital signs.

Prevent worsening – treat any life-threatening conditions such as bleeding, choking or shock.

Promote recovery – provide comfort and reassurance, seek medical help if needed.

The priority order in first aid when dealing with a casualty is known as the ‘Primary Survey’ and it will depend on two factors:

The situation the casualty is in.

The history of what has happened.

But generally, the following steps are carried out:

Danger, airway, breathing and circulation.

The first aider will check for any danger to themselves. This could be water, gas, electricity or even another human being. Once satisfied that the area is safe, the first aider can then approach the casualty. It is important to ascertain whether the casualty is conscious or unconscious. If the casualty is conscious, we can proceed to speak to the casualty regarding the nature of their injury. However, when dealing with an unconscious casualty, there have been occasions when a first aider has approached a casualty, moved too close to the individual and startled a sleeping casualty who has then defended themselves by lashing out.

So, in the interest of your own safety the first aider needs to alert the casualty of their presence before they get to the sweep of their arms. This is done by asking the casualty what’s happened, can you hear me and to open their eyes.

Once you have confirmed that they are indeed unconscious the first aider can then continue with the primary survey.

The first aider needs to check the casualty’s responsiveness, this is done by kneeling next to the casualty and gently shaking their shoulders and talking into both ears. We talk into both ears because the casualty could be deaf in one ear. We can adopt the AVPU scale: A for alert, V for voice, P for pain / pressure, and U for unresponsive. Once we have checked for the responsiveness of the casualty this is when we can call the emergency services.

There are three protocols we adopt:

The first is if you have a mobile phone on you, call the emergency services, staying with the casualty and continuing to appraise the call handler with the condition of the casualty.

Secondly, if there is a passerby who has come to your assistance you can pass on all the relevant information to them and get them to call the emergency services, also asking them to obtain an Automatic External Defibrillator (AED). Location should be given by the call handler along with the combination code to access the AED box.

Thirdly, if you are on your own and have no mobile phone or anyone to assist then you would place the casualty in the recovery position and leave to make the call.

With anyone that is unconscious there is no muscle tone and this includes the two muscles that control the position of the tongue in a conscious person. So, if the casualty is on the ground on their back there is a likelihood that the back of the tongue has relaxed and caused the airway to be blocked. The first aider needs to place the tongue back into its natural position of rest. This is accomplished by placing two fingers under the chin with one hand and placing the other hand palm down on the forehead and slowly tilting the head back. This is known as the ‘Head Tilt Chin Lift’.

With the hand remaining on the forehead, the first aider will bring their head down close to the nose and mouth of the casualty. This will allow any movement of air from the mouth and nose to be felt against the cheek of the first aider. The first aider will be looking along the chest cavity for any movement of the chest indicating that the casualty is breathing. This is done for 10 seconds. Enough time to see the chest rising and falling once, maybe twice.

Checking the casualty for circulation, such as checking for colour in the face, indicating that blood is still being pumped around the body, slight movement, eyelids moving minutely, movement or groaning. We can use ‘capillary refill’, the pressing of the nail and releasing to see if there is blood flow.

Source: Dave Brush

St John Ambulance, First Aid reference guide, assessing a casualty, page 15

NHS First Aid – after an incident, page 1