The most important principle of first aid is the ABC of resuscitation, which stands for Airway, Breathing, and Circulation. This is a life-saving procedure that will enable you to decide whether a victim who has collapsed needs rescue breathing or CPR (cardiopulmonary resuscitation). The airway must be open, breathing must be checked, and circulation must be assessed. Always follow the ABC sequence before giving any other treatment if the victim is unconscious.
Resuscitation is the name given to the set of procedures that are applied when a person is not breathing, and their heart has possibly stopped. The full set of procedures is known as cardiopulmonary resuscitation (CPR). Cardio relates to the heart and pulmonary to the lungs.
A person whose heart stopped (cardiac arrest), or who is not breathing (respiratory arrest), needs immediate treatment to improve the chances of survival. Since speed is a key factor in survival, treatment needs to be started before the arrival of the emergency ambulance and, since most cardiac arrests happen in home or in the presence of a family member, friend, or colleague, CPR skills are essential for everyone to know.
The best outcomes from cardiac or respiratory arrest are achieved when all the steps in the Chain of Survival (see panel) are in place.
CHAIN OF SURVIVAL
• Early call for help
• Early CPR
• Early defibrillation
• Early medical care
The first two of these steps are often in the hands of the first aider.
ABC OF THE RESUSCITATION
Lay the victim on his back, tilt the head back, and lift the chin to open the airway. Look at the victim’s chest for signs of breathing.
If the victim is not breathing, pinch the nose shut and keep the chin tilted. Seal your mouth over the victims’ and give 2 breaths.
Place interlocked hands on the victim’s breastbone, press down. Then release. Alternate 15 chest compressions with 2 rescue breaths.
WHAT CAN BLOCK THE AIRWAY
The airway is made up of nose, mouth, and windpipe (trachea). These carry air, containing oxygen, to the lungs and remove the waste product carbon dioxide from the lungs. If the airway becomes blocked, the oxygen levels in the body drop and eventually the vital organs such as the brain and heart stop working. Death will follow unless action is taken.
A number of things can block the airway: blood, food, and vomit are among the main culprits. In an unconscious person, however, the biggest risk is from the tongue. When a person loses consciousness the muscles relax. If the person is lying on his back the tongue will fall to the back of the mouth, blocking off the windpipe and stopping the oxygen getting into the body.
Clearing the airway is the first step of the essential ABC of first aid. The method of clearing an airway blocked by the tongue is very dimple. By tilting the head back and lifting the chin, the tongue is prevented from falling to the back of the throat and the windpipe remains clear.
AN EARLY CALL FOR HELP
Ambulances today carry a range of equipment and treatments vital to the survival of seriously ill victims. Calling for an ambulance early is an essential part of the Chain of Survival, particularly for a victim whose heart has stopped.
CPR Works by putting the oxygen into the blood through breathing into the victim’s mouth or nose and by pushing the blood around the body by pressing on the chest and compressing the heart.
The goal is to keep the person alive until emergency help arrives. Sometimes CPR alone will revive somebody whose heart has stopped but more often it is used to buy time until more advanced procedures are available.
The most effective treatment for an adult whose heart has stopped pumping blood is defibrillation. In simple terms, this is an electric shock delivered in a very specific way to encourage the heart to begin beating effectively again.
Defibrillators are carried in most ambulances but are also increasingly found in public places such as shopping malls, railway stations, and airports, where local workers will have been trained in their use. Their early use is an essential factor in their effectiveness, highlighting again the need for an early call for help.
EARLY MEDICAL CARE
Medical treatments following cardiac and respiratory arrest are improving all the time. Early access to such treatments in the ambulance and in hospital play a major role in long-term survival rates.