A Hand Book for Community
Based Disaster

Dr.Habeeb Mohamed
Lecturer in Surgery, Medical College Kozhikode


1. What is First Aid, it's Aim, and Benefit
2. Body and its functions
3. First aid kit.
4. Wound and Bleeding
5. Fractures
6. Unconsciousness
7. Poisoning
8. Respiration and Asphyxia
9. Burns and Scalds
10. Miscellaneous.

Chapter 1
What is first aid

First aid is the first assistance or treatment given to a casualty for any injury or sudden illness before the arrival or an ambulance or qualified medical practitioners.

The Aims of first aid

First aid treatment is given to a casualty to:
1. Preserve life.
2. Prevent the worsening of the condition.
3. Promote recovery.

Who can give first aid?

o One who has a sound knowledge of first aid (mere enthusiasm and good intentions can be dangerous),
o One who has a desire to assist others in need,
o One who is a quick maker,
o One who can remain cool and calm under pressure.

Chapter 2

The Human Body and its Functions

The human body is made up of bones, muscles, blood vessels, nerves, connective tissues, skin. The vital functions of the body are carried out by different systems mainly the nervous system, the digestive system, the respiratory system, the excretory system, and the reproductive system.

The Skeleton
There are 213 bones in our body and the functions of the skeleton include:
1. Providing shape and structure to the body.
2. Facilitating movement.
3. Providing support to muscles and tissues,
4. Protecting the important organs of the body such as the brain, heart, lever, and the kidneys,
5. Production of blood cells through the bone marrow

Joints are at the junction of two or more bones.
1. Moveable joints
2. Immoveable joints

Muscles to the layman mean flesh which are made up of muscle fibres, meant to produce movement of the limbs and organs, and consist of two types:
1. Voluntary muscles which works as per our command such as the muscles of the limbs
2. Involuntary muscles which work independently for example muscles of heart, digestive system, respiratory system and excretory systems
Respiratory System
Oxygenated air is vital for human survival. The usual respiratory rate in an adult is 16 to 18 breaths per minute. Oxygen from air goes to the lungs through the trachea and is transported through blood vessels to the heart and from there to the different organs of the body. In the same way carbon dioxide produced by different organs comes to the lungs and is exhaled through respiration. If there is any obstruction in the breathing process the organs of the body become starved of oxygen and suffer damage. Artificial respiration is to be administered in such cases.

Excretory System
Removes waste material from the body and cleanses the body. The kidneys and skin are the main organs of this system.

Digestive System
All the food we eat is digested through the esophagus, stomach, small intestine, large intestine, and colon with the help of various juices. Through this process essential nutrients mix with the blood and are carried throughout the body. The waste material is excreted through rectum and anal canal.

Circulatory System
The circulatory system works with the respiratory system to carry oxygen to each cell of the body. The heart pumps blood to the different organs of the body. Through arteries the oxygenated blood flows to different parts of the body and through veins, blood containing carbon dioxide goes to lungs. A young adult would have five to seven liters of blood in the body.
With each heart-beat blood is ejected in to the arterial system. To accommodate this extra amount of blood the arteries expand. This expansion travels along the arteries which are accessible near the surface of the skin and is known as pulse. How to measure the pulse Place three fingers below the wrist joint towards the thumb side of the hand and feel for the pressure of the radial arteries which pass from this area. In adults the pulse rate is normally around 72 per minute. Pulse rates can be different in morning and evening or after work or exercise. The pulse rate is a very important factor in determining the condition of a patient.

Nervous system
All bodily actions are managed by the nervous system; the most important organs are the brain and the spinal cord. The brain is the most important organ of the body and regulates all body functions including the respiratory and circulatory systems. The spinal cord is a bundle of nerves extending form the brain through a canal in the spine. Nerves extend from the brain and spinal cord to every part of the body. Any small injuries to the brain or spinal cord can be dangerous and result in long term damage..

Chapter 3

First Aid Kit

A First Aid kit should constitute the following basic materials:
1. Roller bandages of different sizes
2. Triangular bandages
3. Gauze pieces -small and large
4. Sterilized dressing
5. A pack of cotton
6. Small scissors
7. Antiseptic solution (e.g. Dettol, Savlon)
8. Antiseptic cream (e.g. Soframycin, Neomycin)
9. Small and large splints made up of wood or bamboo sticks.
10. Pain-killer tablets (e.g. Peracetamol, Ibuprofen)
11. Oral re-hydration solution ( ORS )
12. Thermometer

Any other useful material can be kept as per need.
Dressing and Bandages-
A dressing is a protective covering applied to a wound to-
o Prevent infection,
o Absorb discharge,
o Control bleeding,
o Avoid further injuries.

Dressing should be sterile (germ-free) and have a highly porous to allow for oozing and sweating.
Types of dressings
1. Adhesive dressing(e.g. band-aid )
2. Non adhesive dressing
3. Readymade sterile dressing

Dressing consists of layers of gauze covered by a pad of cotton wool and with and held firmly in place by a roller bandage. Application of dressings
Before applying a dressing or handling a wound, wash your hand thoroughly. Do not talk or cough over the wound. The dressing must be covered with adequate pads of cotton wool, extending well beyond them and retained in position by a bandage or strapping.

Sponging means application of water to any part of body by a sponge or a piece of cloth.
1. Cold Sponge: Ice or cold water can used to make a cold sponge. A cold sponge helps in reducing bleeding and fever.
2. Hot Sponge: Hot water is used to make a hot sponge. It helps in reducing pain and inflammation.

These are made from woolen cloth, cotton cloth, and elastic net or special paper and are used to:
1. Maintain direct pressure over a dressing to control bleeding.
2. Retain dressing slings and splints in position.
3. Prevent or reduce swelling.
4. Provide support for a limb or joint
5. Restrict movement
6. Assist in lifting and carrying casualties.

Types of bandages

Triangular Bandages-
A triangular bandage is made by cutting a piece of cotton cloth 100 cm square from corner to corner so as to give two triangular bandages. It is useful to make slings for injuries to the upper limb or wrist.

Roller Bandages
Roller bandages can be used to cover the wound and apply direct pressure on the wound. They are used for the routine dressing of different wounds. Roller bandages of different length or different width should be used and applied firmly and evenly.

Chapter 4

Wounds and Bleeding
A wound is break in the continuity of skin of the body.

Types of wounds-
Incised wounds
Incised wounds are caused by sharp instruments such as knifes and razors. The blood vessels are clean cut and so these wounds bleed heavily.
Contused Wounds
Contused wounds are caused by blows by blunt instruments or by crushing. The tissues are bruised.
Lacerated Wounds
Lacerated Wounds are caused fro example by machinery, falls on rough surfaces, and claws of animals. These wounds have torn and irregular edges and they bleed less.

Punctured Wounds
Punctured wounds are caused by stabs by sharp instrument like a knife or a dagger. They have small openings, but may be very deep.

Gun shot injuries
These wounds may appear small on the front side but are large in the opposite direction through which the bullet has passed Treatment of wounds
1. Wash your hands thoroughly with soap and water. Do not wipe them dry.
2. Clean the external wound with plenty of clean drinking water,
3. Wipe gently the surrounding skin and remove dirt sticking to the wound,
4. Pick away foreign material from the wound,
5. Cover the wound with dry sterile gauze if available, or a fresh, clean, soft handkerchief.
6. Apply a bandage to the wound.
7. Immobilize the wound with splint.
8. Make necessary arrangement for shifting the patient to the hospital.

Bleeding If the bleeding is from the surface of the body it is called external bleeding. If the bleeding is within the chest, skull, or abdomen and so on it is called internal bleeding. Internal bleeding is more dangerous..

Signs and symptoms of bleeding

1. The casualty feels faint and may even collapse.
2. Skin becomes pale cold and clammy.
3. Pulse gets rapid but very weak.
4. Breathing becomes shallow, casualty gasps for breath and sighs deeply.
5. There is profuse sweating.
6. The casualty feels thirsty.

Management of bleeding

1. Bring the sides of the wound together and press firmly.
2. Place the casualty in a comfortable position and raise the injured part (if no bone fracture is suspected)
3. Press on the pressure point firmly for 10 to 15 minutes,
4. Apply a clean pad larger than the wound and press if firmly with the palm until bleeding becomes less and finally stops.
5. If bleeding continues, do not take off the original dressing, but add more pads.
6. Bandage firmly but not too tightly.
7. Treat for shock.
8. Transport the casualty to hospital as soon as possible.

Internal bleeding

Internal bleeding can be dangerous because we do not know its origin and rate of flow.
The signs and Symptoms
The signs and symptoms of internal bleeding are similar to external bleeding.
Internal bleeding from a specific area has specific signs and symptoms. For example internal bleeding from a lung will have blood in cough. The blood will be red and often TB patients cough out blood in a similar manner. An injury t the stomach may result in blood of a coffee brown color found in vomit. Injury to the kidney and urinary organs may result in bleeding in urine. Injury to the skull will lead to bleeding or the release of CSF-cerebro spinal fluid from the ear, nose or mouth. Always be conscious for internal injuries, take it seriously and do not give anything orally to the casualty, because there may be the need to give anesthesia for any operative procedure. Treat the unconsciousness and shock and arrange for the shifting the patient to the hospital.

Bleeding from nose
1. Seat the casualty with the head slightly bent forwards.
2. Ask him/her to breath through the mouth,
3. Pinch the soft part of the nostrils together firmly.
4. Apply cold compress to the nose for 10 minutes.
5. Ask the patient not to blow his nose for some hours.
6. Advise him to see the doctor.

Chapter 5
A fracture is the partial or complete bend, crack or breakage of a bone.
Types of fractures
Simple (closed) fracture - The broken ends of the bone do not cut open the skin and show on the outside. Compound (open) fracture - When the fractured bone is in contact with outside air as a result of an injury so dirt, dust and germs get into the protruding bone and the wound. Complicated fracture- In addition to the fracture, an important internal organ like the brain or major blood vessels, the spinal cord, lung, liver, spleen and so on may also be injured. Furthermore a complicated fracture may be simple or compound.

The other types of fractures are:
a. Compound: a fracture in which there is an open wound of the soft parts (skin, muscles, etc) through which the bone is visible. b. Comminuted: a fracture in which bone is broken into several pieces. c. Depressed: a fracture with inward displacement of the skull bones. d. Green stick: an incomplete fracture with the bending of a bone involving the convex side of the curve.

Signs and symptoms
1. Pain at the spot of fractures and / or around it,
2. Tenderness i.e. pain on gentle pressure over the injured spot (do not press hard),
3. Swelling of the area and discoloration.
4. Loss of normal movements of the part.
5. Deformity of limb,
6. Irregularity of the bone,
7. Grazing,
8. Unnatural movement at the spot of fracture can be felt.

The aim when treating fractures is:
1. To prevent further damage
2. To reduce pain
3. To make the patient comfortable and manage shock.
4. To get medical aid as soon as possible.

Points to remember when treating fractures
1. Fractures often occur in major accidents. Therefore it is common to find other injuries also. The First Aider must decide which is the most urgent. Heavy bleeding and severely wounded parts are more urgent and should be treated first.
2. There may be more than one fracture in the same patient or even in the same limb.
3. Treat the fracture on the spot, so that the fractured ends are established and patient is ready for transport.
4. Handle very gently and avoid all unnecessary movements of the injured parts.
5. If the broken ends of the bones show out, do not wash the wound or apply antiseptics to the ends of the bone.
6. Do not handle the fracture unnecessarily,
7. Never attempt to bring the bones to their normal positions or reduce the fracture,
8. Do not give anything by mouth as this might delay treatment under anesthesia.

Management of Fractures
1. Immobilize the fractured part and give support to it. That will prevent any further injury and will reduce pain.
2. Treat bleeding of the wounds and other injuries.
3. Mobilize using bandages and splints.
4. Use anything which cannot be bent as a splint such as, a wooden piece, any fresh roll of newspaper or a ruler.
5. Sometimes another limb such as a lower limb can be used for resting the injured limb.

Fracture of different part of the body and important notes for first aid treatment

Fracture of the skull
1. These are usually depressed fractures. If the breathing is normal than leave the casualty on his back with his head and shoulder slightly raised by cushions.
2. Turn the head on one side.
3. Do not give anything orally.
4. If there is bleeding than put a dressing and apply bandage and give support to the fracture part.
5. Arrange for shifting the patient to the hospital.

Fracture of the spine:
The reasons may be
o Lifting heavy loads,
o Landing on the feet or buttocks after a heavy fall,
o Being thrown forward suddenly,
o A heavy object falling on the back.

What to do
1. Make the casualty lie still.
2. Never allow him to get up
3. Try to get a doctor immediately.
4. Try to shift the patient properly on stretcher.
5. Allow the patient to rest

Rib fracture
Ribs get broken by direct force from a blow or fall upon the chest. The broken end may be driven inwards causing injury to the lung, which then becomes a complicated fracture.

Signs and symptoms:
1. There is pain at the injured area, increases on coughing and deep breathing,
2. Advise the casualty to take short, shallow breaths so that the ribs do not move and increase the pain,
3. Signs of internal bleeding should be looked for,
4. If there is an open wound in the chest air is sucked in and blown out through the wound like the bellows. This is a serious condition.
What to do
1. Two broad bandages should be applied round the chest. The centre of the first should be below the area of pain and the centre of the second above it.
2. Advise the casualty to breathe out as much as possible and than tie a knot firmly so as to support the broken rib.
3. Support the arm on the sides of injury in a sling.
4. Arrange for transportation to hospital.

Fracture of the arm bone:
Lightly tie the arm to the chest. Bend the elbow and place the hand on the opposite shoulder and apply a triangular sling. For all injuries of the arm and elbow, always feel the pulse of the injured limb before the splintage and after the splintage. If the pulse weakens after splintage relax the bandage till the pulse comes back

Fracture of the lower end of the radius (one of the forearm bones):
Otherwise known as Colles' fracture is very common and is due to indirect force caused by a fall on the outstretched hand. Care must be taken not to mistake it for a sprain of the wrist. There is likely to be a considerable degree of deformity and swelling.

What to do
1. Give support with splint and apply bandage.
2. Prevent all movement of the wrist joint
3. Use a triangular bandage and make a sling to restrict the movement.
Fractures of the hand and of the fingers
These are mostly due to direct injury. There may be severe bleeding in the palm.

What to do
1. Do not allow the injured hand to hang loose by the side of the body,
2. Always keep the hand at the chest level in a sling,
3. Support the joint with a sling.

Fracture of the Pelvis This is mostly due to direct force. The bladder and urinary passages may also be injured producing grave complications.
Signs and symptoms
1. Pain in the hips and joints increased by coughing and or movement,
2. The casualty is unable to stand,
3. There are chances of internal bleeding and blood in urine

What to do
1. Allow the casualty to lie in the position most comfortable to him/her preferably on his/her back with lower limbs stretched.
2. Advise him/her to avoid passing urine.
3. Transport the patient to the hospital.
4. If the journey is long and on rough roads place the centre of the broad bandage on the hip joint of the injured side, pass one end round the pelvis and tie on the other side. Tie another broad bandage so that it overlaps the first by half its breath and tie similarly. Also place a pad between the knees and ankles and apply a figure-of-eight bandage around the ankles and the knees with a broad bandage. Fracture of the thigh bone (femur)
This bone could break at any place along its length. The fracture of the neck of the femur is very common in aged patients. There is severe pain, and the patient may go into shock. There may be bleeding in the surrounding tissues and a shortening of the limb has been observed to happen.

1. Treat shock.
2. Immobilize the thigh by bandaging it to the uninjured limb up to and below the knees with padding below the knees. If a splint is available,

a. Apply a well-padded splint between the legs from the crotch to the foot.
b. Tie the feet and ankles to the splint with a figure of eight bandage,
c. A long well padded splint from the armpit reaching up to foot should be applied.

Facture of the Knee Cap
The kneecap can get broken by direct force but usually the fracture is due to muscular force causing it to snap across into two bits.
Signs and symptoms
1. Limb is helpless as the important extensor muscle is out of action,
2. There is swelling and bleeding.

1. Lay the casualty flat with head and shoulders raised. The injured limb should be raised to an easy position. This will relax the thigh muscles.
2. Apply a padded splint under the limb from the buttocks to beyond the heel. The ankles should be raised from the splint by pads,
a. Apply a broad bandage around the upper part of the thigh,
b. Apply a narrow figure of eight bandage around the ankle and foot,
c. Place a narrow bandage with its centre on the upper fractured piece, cross it behind the knee and bring it up over the lower fractured bit behind the knee and tie it off.
3. Transport the patient to the hospital.

Fracture of Leg
One or both of the bones may break as a result of direct force.

1. The limb should be tied to the sound limb with suitable padding from thigh to ankle. Pads should be placed between the knees and ankles,
2. Make a long well padded splint and place it between the lower limbs extending from the groin to feet,
3. Tie the feet and ankles with a figure of eight bandage,
4. Place a broad bandage at the upper part of the thighs,
5. Apply a broad bandage on the knees.

Fracture of the bones of the foot and toes-
This is caused by direct injury like a crush injury or wheel passing over the foot. Suspect a fracture when there is pain, swelling and loss of power.

1. Remove the footwear.
2. Treat the wound.
3. Use the other foot as a splint,
4. Apply a padded splint reaching from the heel to the toe over the sole of the foot.
5. If no wound is present or suspected and if the casualty wears shoes do not remove them.
6. Transport the casualty to the hospital.

A sprain is the tearing of the ligaments of a joint and the tissues round the joint. It is caused by a sudden wrench or twist at the joint. A sprain of the ankle is quite common.
Signs and symptoms
1. There is pain and swelling,
2. The casualty cannot use the joint without increasing the pain.

Place the limb in the position most comfortable to the casualty preferably elevated,
1. Stop joint movement,
2. Apply a firm bandage to the joint it will reduce the pain and give support to joint,
3. Keep a cold water bandage,
4. Transport the casualty to the doctor
A dislocation is the displacement of one or more bones at a joint. The most common is the shoulder joint. Signs and symptoms
1. There is severe pain at or near the joint.
2. There is difficulty in movement of the joint.
3. The joint looks deformed and the limbs may appear to be in an unnatural position
4. There may be swelling later.

What to do
1. Place the casualty in a comfortable position,
2. Do not try to fix the joint,
3. In the case of a dislocation of the lower jaw (common in old age) give support to the lower jaw and remove false teeth,
4. Transport the casualty to the hospital

Chapter 6

Unconsciousness is a state in which the casualty becomes insensible because of an interruption in the normal functions of the brain. The most common causes of unconsciousness are head injury, heart attack, paralysis, asphyxia, epilepsy, shock, poisoning and diabetes.

In which the patient has sub consciousness. The patent is able to answer some questions, the pulse rate is slow, and breathing is shallow. Gradually the patient becomes unconscious and cannot give answers to questions and the pulse becomes even slower and sometimes fast and irregular. Breathing is slow. The body becomes calm and face looks pale. Treatment of the unconscious patient
1. Open the casualty's air passages with jaw lift and head tilt, remove any obvious obstruction, lesson tight clothing, check breathing and If required continue the ABC of resuscitation. Then place the casualty in the "Recovery Position".
2. Examine the casualty quickly for serious injury. Control any severe bleeding or support suspected fractures,
3. Assess the level of responsiveness. Check breathing rate and pulse,
4. Treat serious wounds and fractures.
5. Examine the casualty for less serious injuries or possible cause of unconsciousness.
6. Place the casualty in the recovery position.
7. Cover the casualty with blanket.
8. Transport to hospital urgently, maintaining the recovery position.
o Do not attempt to give an unconscious casualty anything by mouth.
o Do not leave the casualty unattended.

Epilepsy implies a disturbance in the neuronal discharge. Epileptic fit or seizure in the brain produces the following symptoms:

1. Tonic chronic convulsions,
2. Patient can become unconscious,
3. There may be up-rolling of eyeballs.
4. Frothing in the mouth,
5. Tongue bite,
6. Urinary incontinence,
o Usually the attack lasts for a few minutes then the patient may remain irresponsive for a few minutes.
o There is pain the body,
o In some patients before an epileptic fit there is some visual disturbance.

What to do
1. Lay the patient on one side.
2. Place a handkerchief or gauze pieces in the mouth to prevent tongue bite,

What not to do
1. Don't leave the patient alone and observe him/her continually,
2. Don't try to stop convulsions as this may click to fracture,
3. Don't try to open the jaw forcibly,
4. Don't introduce any hard object into the mouth as it may damage the teeth,
5. Don't force the patient to smell an onion or shoes, this will not work,

Chapter 7

Any substance which, taken into or formed in the body, destroys or impairs health is poisonous.
Means of poisoning
a. By swallowing
b. By breathing poisonous gases
c. By injections
Poisoning by swallowing
Poisonous substance may be taken with a view to committing suicide, taken by mistake or given by an enemy.

What to do
1. Assess the physical condition of the person,
2. Check for pulse and respiration,
3. Check for consciousness,
4. Try to find out which poison has been taken from the label,
5. If an empty bottle is found, write down the name and take it to the hospital,
6. Check for vomits and utensils used by the patient and take these samples to the hospital.
7. If the patient is conscious and there is no mark of corrosive poisoning then aid vomiting by tickling the back of the throat or make him/her drink warm water mixed with 2 table spoons of common salt for a tumbler of water,
8. If the lips, mouth and the skin show grayness, white or yellow patches then the poison may be corrosive. In cases of corrosive poisoning do not induce vomiting because the acid might gullet or the passage in the neck by which food is taken into the stomach. If vomiting is once again induced then it will again burn the gullet and oral cavity and will damage further.
9. Give water to the patient to reduce the severity of the burning,
10. If patient is unconscious then don't induce vomiting,
11. Make the casualty lie on the back on a hard flat bed without any pillow and turn the head to one side so that the vomit will not go into the voice box and the tongue will not close the air passage.
12. Give artificial respiration if required.

Poisoning through injection
Snake bites, scorpion bites and bites from certain insects can introduce poison in the body.

What to do
1. Try to give mental support to the patient.
2. Try to find out whether the snake is poisonous or nonpoisonous..3. Ask the patient not to move the limb because the movement can spread the poison very fast.
4. Apply a tight bandage above (towards heart) bite mark and release the bandage for half to one minute at every 2 to 10 minutes,
5. Do not to suck the poison,
6. Treat for unconsciousness or shock and arrange for shifting the patient to the hospital,
7. ASV-Anti Snake Venom is the main treatment for snakebite so try to shift the patient to a hospital where this is available.

Chapter 8

Asphyxia-Suffocation and respiratory obstruction
Asphyxia is a condition in which the lungs do not get sufficient supply of air for breathing. If this continues for minutes, breathing and heart action stops and death occurs.

1 Condition affecting air passage
o Bronchial Asthma
o Water in to air passage in drowning
o Foreign body in air passage
o Tongue falling back
o Swelling of tissues of the throat Compression
o Hanging
o Smothering
o Strangulation
2 Condition affecting the respiratory mechanism
o Epilepsy, tetanus, Rabies etc.
o Nervous diseases causing paralysis of chest muscles
3 Condition affecting respiratory centre
o Electric Shock
o Stroke
4 Compression of the chest

The signs and Symptoms of Asphyxia:
1. Patient shows signs of restlessness.
2. Rate of breathing increases
3. Breath gets shorter,
4. Veins of the neck become swollen
5. Face, lips, nails, fingers and toes turn blue
6. Pulse gets faster and feebler.

1 Remove the cause, if possible
2 Loose the tight clothing
3 Resuscitations
o Opening the airway
o Checking the breathing.o Clearing the airway
o Artificial Respiration
o Circulation- External Chest Compressions
o Remove the patient to the hospital.
v Drowning
Drowning causes asphyxia by water weeds and mud entering the lungs or by causing the throat to go in to spasm so constricting the air passage.If water has gone into the lungs then the face becomes swollen and the patient turns purple. There is froth in the mouth and eyes are red.
If water has not gone into the lungs then the face is pale, there is less froth in the mouth and the muscles of the face are loose.

What to do
1. Quickly remove any obstructions such as weeds from the casualty's mouth
2. Remove water from the stomach and lungs. Lay the patient on his stomach; keep the mouth in one side, and give pressure on the back so that the water in the stomach and in the chest can be removed.
3. Provide warm clothing if required.
4. Give artificial respiration if required
Choking (asphyxia due to obstruction in the windpipe) This is most common with children. A marble, a seed or button may get stuck in the air passage. In adults food may go down the wrong way causes choking. The aim of first aid is to remove the foreign body or obstruction.

What to do
1. If the victim is standing the First Aider should stand behind the victim and wrap his arms around the waist.
2. Grasp the fist with the other hand and place the thumb of the first against the abdomen, slightly above the navel and below the rib cage.
3. Press the fist into the victim's abdomen with a quick upward thrust. Repeat several times if necessary. In the case of a infant
1. Hold the infant upside down by the legs and smack his back gently but firmly three or four times.
2. If not successful, lay the child close with the head hanging downwards over the knee and give sharp smacks between shoulders.
3. Try to shift the patient to the hospital.

Chapter 9

Burns and scalds
Burns are injuries that result from dry heat like fire, flames, a piece of hot metal, the sun, and contact with wire carrying high tension electric current or by lightning or friction.
Scalds are caused by moist heat due to boiling water, steam, oil, hot tar, and so on.
Chemical burns are caused by strong acids or by strong alkelies.
The degree of burns indicate the damage to the tissues

First Degree: - when the skin is only reddened.
Second Degree: - when there are blisters on the skin.
Third Degree: - when there is destruction of deeper tissues and charring.
There is pain in the First and Second degree burns but in Third Degree burns there is usually no pain because the nerve endings are also burnt and that is dangerous.
Patients with deep burns of over 15 percentages in adults and 10 percentages in children should be hospitalized immediately.

While helping the person whose clothes have catch fire
1. The First Aider should put out the flames by whatever means available. Water is a good medium as it will also help the casualty to cool down,
2. Hold a rug, blanket, coat or table cover in front of you while approaching the person whose clothing has caught fire.
3. Lay the casualty down quickly on the ground and wrap tightly with any thick piece of cloth, rug or coat. Smoother the flame by gentle pats over the covering but do not roll the casualty,

Management of serious burns and scalds:
1. Keep the casualty quiet and reassure him/her,
2. If not required don't touch the burnt area,
3. Wash your hands before touching the patient and after touching the patient.
4. Do not remove particles of charred clothing sticking to the body,
5. Use plenty of water that will reduce the pain and internal damage caused by extreme heat,
6. Cover the burnt area with sterile or clean dressing and bandages,
7. Do not burst blisters,
8. Do not apply any oils, creams or scent on the burnt area.
9. Place the casualty in a comfortable position,
10. Treat the casualty for shock,
11. Transport the casualty to a hospital.

Chapter 10

Ophthalmic injury
In an ophthalmic emergency there may be a foreign body in the eye, an ophthalmic injury, an infection, redness or watering form the eye.

What to do
1. Don't rub the eye,
2. If the foreign body or dust is present in the eye place the patient in a comfortable position. Try to clean the eye with clean water or use a clean cotton handkerchief to remove the foreign body.
3. If there is a chemical burn in eye or chemical in eye than clean the eye with plenty of fresh water.
4. If there is injury or some part of the eyeball has come out then keep a clean dressing over eyeball and shift the patient to the hospital.

Dog Bite
If the dog is suffering from Rabies then it will be transmitted to the person. The dog should not be killed but it must be chained and kept under observation for 10 days. Rabies is also caused by infected cats, monkeys and jackals.
What to do
All dog bites must be treated as potentially bitten by a rabid dog.
o Wipe the saliva away from the wound.
o Wash the wound with plenty of soap and water
o Cover the wound with dry sterile dressing.
o Shift the patient to the hospital
Indigestion or contaminated food can cause diarrhoea. Loss of water and electrolytes in watery loose motions is responsible for diarrhoea related complications and death. ORS-Oral rehydration solution can be useful. ORS packets are available in the market or at PHC. If ORS is not available then it can be prepared by mixing 8 tea spoonful of sugar (40 grams) and ¾ tea spoonful of common salt (5.5 grams) in a litre of water. Coconut water, buttermilk with salt, rice water, dal or dal water or even potable water may be used if nothing is available till doctor's aid is sought.