First Aid

By  on March 14, 2007

Extracts from the ChildSafe Program of The Canadian Red Cross Society.

Children are curious - and this curiosity often leads to injury. Parents can help protect their child by creating a safe environment. They can teach their children to take responsibility for themselves so that a child develops his or her own sense of safety and self-confidence. And remember, you will be imitated. So be a positive role model.

You can also prepare for those times when you might have to take care of an injured child. We encourage you to enroll in a first aid course where you will have an opportunity to practice life saving skills like CPR. Call your local Red Cross office for more information about first aid courses and other services.

First Aid Supplies
Equip your home, car, and vacation place with a first aid kit. Store it out of reach of children. Include wound dressings, triangular bandages, a large supply of adhesive bandages in assorted sizes, gauze rolls (3 cm), non-adherent dressings (10 cm2), adhesive tape rolls, scissors, eye patches, elastic roller bandages, antiseptic soap, tweezers, oral thermometer, space blanket (foil), safety pins, and a pencil and paper pad. Restock after use.

Memo: The Canadian Red Cross Society has a variety of first aid kits for sale. Check with your local Red Cross office.

  • A dressing is the material placed on the wound. It may be a clean cloth, sterile gauze, or a commercial non-stick material.
  • A bandage holds a dressing in place. It may be cloth or adhesive tape.
  • A wound dressing is a commercial product that has a thick absorbent dressing attached to a bandage.
Preventing Injuries
Injuries are most likely to occur when:
  • Children and parents are tired, usually before nap time, in the late afternoon or before bed;
  • Children are overactive or rushed and are not allowed enough time to do things carefully;
  • Parents are ill and unable to supervise their children with their usual patience and care;
  • Parents are under emotional stress and their attention is distracted;
  • Routine is disrupted;
  • People other than usual care-givers are supervising the child.
How To Call the Emergency Medical System (EMS)
When you call 911 or local emergency number, expect to be asked for the following information:
  • Specific location of the emergency and telephone number from which the call is being made.
  • Caller's name.
  • How many people involved.
  • Condition of the casualty.
  • What is being done for the casualty.

If you are providing the first aid, it is best to send someone else to make the calls. Tell them to "hang up last", ensuring the dispatcher has all the necessary information.

  • If you are alone and know help is needed, give first aid for about a minute and then make the call.
  • Ensure that the emergency numbers and your address are near every phone in your home.
Prevent Further Injury
Dangers
Do not move an injured child unless the child is in danger in that place. Only move the child if you cannot eliminate the danger.

Call for Help
If there is an unconscious, choking, or severely bleeding child, shout for help. Send an adult or older child to call for an ambulance. If no one else can call the ambulance, you must call yourself.

Common Injuries - Bites and Stings
Human and Animal
1 If the wound is bleeding severely, apply direct pressure with a clean cloth, elevate the limb, and seek medical attention.
2 If wound is not bleeding severely, wash with mild soap and water. Do not apply antiseptics, lotions, or creams.
3 Cover the wound with sterile dressing and bandage it in place.
4 Comfort the child. Keep the child warm.

Memo: Human bites easily can become infected. If it is an animal bite, have someone note the location of the animal so it can be captured for examination.

Snakes
1 Keep the child quiet and still.
2 Seek medical attention immediately.

Call your doctor: Medical attention should always be sought. Children are at greater risk than adults because of their small body size.

If possible, carry the child. Walking increases circulation of the venom.

3 Lower the bite area below the child's heart to slow absorption of snake venom.
4 For a bite on an arm or a leg, do not apply a tourniquet. If a child cannot get advanced medical care within 30 minutes, you may apply a constricting band to slow the flow of venom throughout the body.
5 Watch for breathing problems. If the child stops breathing, begin Breathing/CPR.
6 The snake must be identified so that the correct antitoxin can be used. If you cannot identify it, take careful note of its markings.
7 Comfort the child. Keep the child warm.

Insects
1 Blood Suckers and Leeches. Sprinkle with salt, and then remove. Wash the wound area with mild soap and water.
2 Ticks. Use tweezers to remove the tick and any remaining parts. Wash with soap and water. Do not try to burn the tick off.
3 Other Insects. Find out if the child is known to be sensitive to stings. If the child has an Epi-penT kit, it should be used. Remove the stinger by gently scraping it out. Do not use tweezers as squeezing the stinger may inject more venom.

Call your Doctor: If the child develops a fever or rash during the next 10 days after a tick bite, seek medical attention immediately. Tick fever can be fatal.

Caution: Children should be checked frequently and thoroughly for ticks after outdoor activities where ticks are present.

Bleeding
Cuts and Wounds
1 Apply direct pressure to the cut with a clean cloth. Elevate a bleeding limb higher than the heart, unless you suspect a broken bone.
2 Have the child lie down and keep still.
3 For all severe bleeding, shout for help. Send someone to call an ambulance immediately.
4 If the cloth soaks through, do not remove it. Apply another cloth on top.
5 Tie the cloth in place with a bandage. Never tie a bandage around the neck; use tape.
After the Bleeding has stopped...
6 Use a sling or bandages to immobilize the injured limb if transporting the child is necessary.
7 Check circulation frequently. If the area below the wound is cold or blue compared with the other limb, the bandage is too tight.
8 Comfort the child. Keep the child warm.
9 Seek medical attention.

Caution: Handle all blood and other body fluids as infectious material. Wear disposable gloves and use protective masks when administering first aid and CPR. Wash your hands after providing care.

Scrapes
1 Clean the scraped area by rinsing it with running water.
2 Gently wash the area around the wound with mild soap and water.
3 Blot dry with a sterile gauze dressing.
4 Cover with a sterile non-stick dressing; e.g., adhesive bandage.

Caution: Seek medical attention if the scrape is over a large area or if it becomes infected. If infected, there will be an increase in redness, swelling, and pain.

Blisters
1 Do not break a blister. The body is protecting a damaged area by creating a blister.
2 Place a large loose bandage over the blister to prevent the child from breaking it.
3 If the blister has broken, gently wash it with mild soap and water. Cover the area with a sterile dressing and bandage.

Call your doctor: For large blisters or a large area of the body with blisters, seek medical attention.

Breathing/CPR
Infant Under 1 Year

Rescue Breathing - Infant

If the infant does not respond to tapping or shouting:
1 Shout for help and send someone to call for an ambulance. If alone, call first.

Call your doctor: If you are alone, call an ambulance. Take the infant to the phone with you.

2 Tilt the head to open the airway by placing your hand on the infant's forehead. With your other hand, lift the infant's chin, keeping clear of the throat.

Caution: Do not tilt the head if you suspect a back or neck injury. Gently lift the lower jaw forward without moving the neck. Tilt the head only if you cannot inflate the chest.

3 Check breathing for up to 10 seconds. Place your cheek near the infant's nose and mouth. Listen and feel for air. Look for movement of the chest.
4 If the infant is breathing, see care for Unconsciousness.
5 If the infant is not breathing, seal your mouth over the infant's mouth and nose. Attempt to gently deliver two small slow puffs. (Infants' lungs are small. Use only the air you can hold in your cheeks.) Look for movement of the chest.

Caution: Never shake a baby to restore breathing. It is just as dangerous as shaking in frustration.

Important: If the infant vomits, roll the child on to the side, clean out the mouth and continue Rescue Breathing.

6 If the chest has not moved, try blowing in again, making sure that the head is tilted correctly (see Step 2). If the chest still does not move, turn to Choking, Infant.
7 If air has entered, check for signs of circulation. (Look for movement, coughing and breathing.) Check for no more than 10 seconds.
8 If you can see signs of circulation, tilt the head again. Give one breath every 3 seconds until the infant starts breathing again.
Occasionally check for signs of circulation while doing rescue breathing.

If there are no signs of circulation:
Caution: The following procedure should only be used after you have attempted Rescue Breathing and found no signs of circulation.
1 Place the infant face up on a hard surface. Place 2 fingers on the breastbone one finger-width below an imaginary line connecting the nipples.
2 Push down 1 to 2 1/2 cm (1/2" to 1") and release, 5 times, every 3 seconds or less.
3 Tilt the head, cover the infant's mouth and nose with your mouth and give 1 slow puff.
4 Continue alternating cycles of 5 chest compressions and 1 puff.
5 Recheck signs of circulation for no more than 10 seconds, after about 1 minute of CPR.

If there are no signs of circulation, continue CPR, rechecking every few minutes thereafter.

If you find signs of circulation, stop chest compressions. Continue blowing air in every 3 seconds until the child starts breathing or the ambulance arrives.

Breathing/CPR
Child 1 to 8 Years

Rescue Breathing - Child

If the child does not respond to tapping or shouting:
1 Shout for help and send someone to call for an ambulance. If alone, call first.

Call your doctor: If you are alone, call the ambulance. If possible, take the child to the phone with you.

2 Tilt the head to open the airway. Lift the chin with one hand and push down on the forehead with the other.

Caution: If you suspect a neck, head, or back injury, do not tilt the head. Gently lift the chin without moving the neck or pressing on the forehead. Tilt the head only if you cannot inflate the chest.

3 Check for breathing for up to 10 seconds. Place your cheek near the child's nose and mouth. Listen and feel for air. Look for movement of the chest.
4 If the child is breathing, see care for Unconsciousness.
5 If the child is not breathing, pinch the nostrils closed.
6 Seal your mouth around the child's mouth. Blow in 2 slow breaths of air. Look for movement of the chest.
7 If the chest has not moved after the first breath, make sure the head is tilted enough. Pinch the nostrils closed and try again.
8 Check for signs of circulation (movement, coughing, breathing) for no more than 10 seconds.
9 If you see signs of circulation, tilt the head again. Give one breath every three seconds until the ambulance arrives, or until the child starts breathing. Check for signs of circulation periodically while doing rescue breathing.

Important: If the child vomits, roll the child on to the side, clean out the mouth, and continue rescue breathing.

If there are no signs of circulation: (This procedure should only be used after you have attempted Rescue Breathing, and found no signs of circulation.)
1 Gently tuck your hand under the child's far armpit and then slide over to the breastbone.
2 Use one hand. Keep the arm straight with the elbow locked. Push down 21/2 to 31/2 cm (1" to 11/2") and release, keeping your hand on the child's chest.
3 Push down and release 5 times in 3 or 4 seconds. Tilt the head and give 1 slow breath.
4 Continue alternating cycles of 5 chest compressions and 1 breath.
5 Recheck for signs of circulation for no more than 10 seconds; about one minute of CPR. If there are no signs of circulation, continue CPR, rechecking every few minutes.
6 If you find signs of circulation, stop chest compressions and continue with rescue breathing.

Choking
Infant Under 1 Year
If the infant can breathe or cough forcefully, do not interfere with the infant's efforts to free the object.

Do not hit the baby on the back. Stay with the infant and monitor carefully.

If there is no breathing, coughing, or there is a high pitched noise:

Conscious Choking Infant
1 Place the infant face down on your hand and forearm with the head lower than the body, supporting the head firmly by holding the jaw. Rest your forearm on your thigh.
2 Deliver 5 sharp back blows between the shoulder blades. Use the heel of your hand.
3 Roll the infant face up with the head lower than the body. Support the head.
4 Place two fingers on the breastbone, one finger-width below an imaginary line connecting the nipples.
5 Give 5 chest thrusts. Thrust approximately 1 to 2 cm.
6 Alternate back blows and chest thrusts until the object is dislodged.
7 Comfort the child and keep the child calm and warm. Have the infant checked by medical aid.

Unconscious Choking Infant
If the infant becomes unconscious:
1 Shout for help and send someone to call for an ambulance. If alone, call first.
2 Check the mouth. Grasp the tongue and the lower jaw. If you can see the object, remove it with your little finger.
3 If you cannot remove the object, tilt the head to open the airway by placing your hand on the infant's forehead. With a finger of your other hand, lift the infant's chin.
4 Check for breathing for up to 10 seconds. If there is no breathing, seal your mouth over the infant's mouth and nose. Gently deliver 1 small puff of air. Watch for movement of the chest.
5 If the chest does not rise, do another set of 5 back blows and 5 chest thrusts.
6 Repeat steps 2 through 5 until the object is cleared.
7 If the object is cleared, but the infant is NOT breathing, continue to blow air in once every 3 seconds, Turn to Breathing/CPR.

Choking

Child 1 to 8 Years
If the child can breathe, speak, or cough forcefully, encourage the child to bend forward and cough up the foreign object.

Do not hit the child on the back. Stay with the child and monitor closely.

If the child is:

  • Not breathing, coughing, or talking
  • Turning blue
  • Making a high pitched noise
1 Stand behind the child and place your arms around the waist.
2 Make a tight fist. Place it just above the navel and well below the ribs, thumb against the abdomen.
3 Place your other hand over the fist.
4 Commence quick upward thrusts and continue until the object has been expelled.
5 Comfort the child. Keep the child calm and warm. Have the child checked by medical aid.

Unconscious Choking Child
If the child becomes unconscious:
1 Call for help and send someone for an ambulance. If alone, call first.
2 Check the mouth. Grasp the tongue and lower jaw. If you can see the object, remove it, taking care not to push it further down the throat.
3 If you cannot see it, tilt the head to open the airway. Lift the chin with one hand and push down on the forehead with the other. Check for breathing for up to 10 seconds. If not breathing, pinch the nostrils closed between your thumb and forefinger of the hand on the child's forehead.
4 Seal your mouth tightly around the child's mouth. Blow in one slow breath. Look for movement of the chest.
5 If the chest does not rise, deliver 5 sharp back blows between the shoulder blades. Use the heel of your hand.
6 Roll the infant face up with the head lower than the body. Support the head. Begin the CPR sequence.
7 Continue steps 2 through 6 until the object is dislodged and removed.
8 If the child's airway is clear, check for signs of circulation for no more than 10 seconds. If there are no signs of circulation, turn to Breathing/CPR.
9 If you find signs of circulation, tilt the head again. Give one breath every 3 seconds until the ambulance arrives or the child starts breathing again.

Broken Bones
What to Look For:
Call your doctor: The presence of only one of these signs is sufficient to call an ambulance.
  • Severe pain or tenderness to the touch.
  • Distortion of a limb.
  • Loss of circulation in a limb (toes/fingers are white or blue).
  • Loss of feeling in a limb (can the child feel a squeeze of the fingers or toes?).
  • Swelling and discolouration.
  • Child reports having heard a cracking sound.

Call your doctor: Do not move a child who has a broken bone. Call an ambulance; the attendants will splint the bone.

What to Do:
1 Immobilize the broken limb where the child is lying. Use towels or blankets to stabilize the limb.
2 Use ice wrapped with cloth to cool the area for 15 minutes each hour.
3 Call an ambulance.
4 Comfort the child. Keep the child warm.

Memo: The treatment for dislocations is the same as for broken bones.

Broken Bones
With a Wound - What to Do:
1 Gently place a cloth over the wound. Use a sterile dressing or clean cloth.
2 Apply slight pressure around but not on the wound, without moving the broken bone.
3 Do not elevate the limb.
4 If bleeding is not controlled, apply another bandage over the first.
5 Call an ambulance immediately.
6 Comfort the child. Keep the child warm.

Burns - Chemical
Caused by Exposure to Chemicals, Powder, Liquid, Gas - What to Do:
1 Flush the skin with large amounts of cold water for at least 15 minutes, or as long as pain persists. Immerse the child for large body areas.

Important: If the chemical is a powder, brush off as much as possible with a clean cloth before flushing with water.
2 Remove loose, contaminated clothing while continuing to flush the skin with water.
3
Cover the burned area with a non-stick dressing.
4
Seek medical attention immediately.
5
Comfort the child. Keep the child warm.

Memo: Acid or alkali should be flushed longer - up to 60 minutes by the clock. The water temperature for flushing should be comfortable.

Burns - Heat
Caused by Over-exposure to Excessive Heat, Possible Sources: Fire, Steam, Sun. What to do:
1 Immerse the burned area in cold water for at least 5 minutes or as long as the pain lasts. Do not use ice.

Important: Remove loose clothing around the affected area. Do not break blisters. Never use greasy ointments, butter, lotions, or creams.
2
Cover the burn with a dry, sterile, non-stick dressing.
3
Serious burns require immediate medical attention. These include red burns 5 cm (2") or more in diameter and all burns which are blistered, white, or black. Call for an ambulance.
4
Comfort the child. Keep the child warm.

Call your doctor: With all electrical burns, call for an ambulance and look for possible entry and exit burns that may need treatment. Carefully watch for breathing problems. See Breathing/CPR.

Electric Shock
Do not touch the child until the power has been switched off. What to Do:
1 Shout for help and send someone for an ambulance.
2 Indoors: Be sure the power is off by switching off the breaker.
Outdoors: Stay away from downed power lines as they may electrify the ground.
3 When safe to do so, tap the child and ask, "Are you OK?" If no response, turn to Unconsciousness.
4 If the child is conscious, watch the child carefully.
5 Check for and treat burns (see Burns).
6 Comfort the child. Keep the child warm.

Memo: With all electrical burns, look for possible entry and exit injuries. See Breathing/CPR.

Hyperventilation
What to Look For:
  • Uncontrolled gasping for air
  • Dizziness
  • Panic
  • Anxiety
What to Do:
1 Comfort the child. Encourage the child to take long, slow breaths, and to hold his or her breath before breathing out slowly.
2 If the child faints, turn to Unconsciousness.

Important: Make sure any medical condition or trauma has been ruled out.

Hypothermia
Definition: Dangerous lowering of inner body temperature that may occur when a child is exposed to cold air, cool wind, wet clothing or prolonged immersion in water.

Mild Hypothermia - What to Look For:
  • Complaints of feeling cold
  • Usually shivering
  • Irritable
  • Uncharacteristic clumsiness
What to Do:
1 Replace wet clothing with dry clothes and blankets.
2 Cover the head and neck.
3 If the child is fully conscious and can swallow, give the child a warm, sweet, non-alcoholic liquid.
4 Apply warmth such as hot water bottles to the armpits and groin, avoiding direct contact with the skin.

Caution: Alcohol increases heat loss and should never be given to a person suffering from hypothermia.

Severe Hypothermia
What to Look For:
  • Lack of coordination
  • Fumbling hands
  • Slurred speech
  • Memory lapse
  • Blurred vision
  • Shivering stops
  • Muscles become stiff
  • Unconsciousness
Infants may show the following signs:
  • Mottled cheeks and limbs
  • No crying
  • Weak sucking
What to Do:
1 Call an ambulance immediately.
2 Place the child in a warm, dry place.
3 Do not allow the child to exercise. Treat very gently.
4 Replace all wet clothing with dry clothes and blankets. Prevent further heat loss.
5 Monitor the child's breathing and circulation.
6 If the child becomes unconscious, turn to Unconsciousness.

Poison
Inhaled - What to Look For:
  • Irritated eyes, nose, or throat
  • Vomiting, convulsions
  • Bluish colour around the mouth
  • Unconsciousness
  • Coughing, shortness of breath, dizziness
What to Do:
1 Protect yourself from the gases. Ensure the air is safe (the child may have to be moved).
2 If the child is experiencing any difficulties with breathing or is unconscious, call an ambulance. Turn to Breathing/CPR, or Unconsciousness.
3 If not, call the Poison Centre for advice.
4 Comfort the child. Keep the child warm.

On the Skin
What to Look For:
  • Burning, itching, swelling, blisters
  • Headache, fever
What to Do:
1 If the child is experiencing any difficulties with breathing or is unconscious, call an ambulance. Turn to Breathing/CPR, or Unconsciousness.
2 If not, identify the poison and call the Poison Centre for advice.
3 Remove chemically contaminated clothing. Be careful not to contaminate yourself.
4 Flush the skin with cool water for at least 15 minutes. Be careful to avoid getting any of the chemical into the child's eyes.
5 Do not break blisters.
6 Comfort the child. Keep the child warm.

Caution: Chemicals such as pesticides and weed killers will irritate an adult's skin. For an infant, the same skin exposure could be fatal.

Swallowed
What to Look For:
  • Burning sensation in the mouth, throat or stomach
  • Cramps, gagging, diarrhea
  • Unconsciousness  

Caution: Never attempt to make an unconscious child vomit.

If a Plant or Drug Has Been Swallowed:
  • Vomiting, convulsions
  • Irregular pulse
  • Drowsiness, slurred speech, dizziness, lack of coordination
What to Do:
1 If the child is experiencing any difficulties with breathing or is unconscious, call an ambulance. Turn to Breathing/CPR, or Unconsciousness.
2 If not, identify the poison and call the Poison Centre for advice.
3 Take a sample of the poison and any vomit with the child to the hospital.
4 Comfort the child. Keep the child warm.

Slivers
What to Do:
1 Wash the area around the sliver.
2 If the sliver is sticking out of the skin, use tweezers to pull it out. Pull in the same angle and direction that the sliver entered the skin.
3 If the sliver is embedded under the skin, use a needle to remove it. With the needle, gently pull the skin away from around the sliver where it entered the skin. Remove it with tweezers.
4 Wash the area with soap and water. Cover the opening with a bandage.

Call your doctor: If the skin around the cut becomes infected (red and sore to the touch), seek medical attention.

Unconsciousness
What to Do:
1 Tap the child and ask, "Are you OK?" If no response, shout for help and send someone to call for an ambulance.

Caution: If a neck or back injury is suspected, be very careful to keep the neck from moving.
2 If the child is breathing, place the child in the recovery position.
3 Turn the body as a unit. Avoid twisting the neck. Ask other adults to assist you. Keep the mouth clear of blood and vomit
4 Constantly check breathing. If the child is not breathing, turn to Breathing/CPR.
5 Comfort the child. Keep the child warm.

Injury is no accident
Thousands of children are seen in hospital emergency departments each year in Canada. For children under 10, home is the most common place for injury. The main causes of death of the home are fire, falls, poisoning, choking, suffocation, and drowning. Home safety is about creating a safe environment for children.

Preventing injury
Remember:
  • Recognize the safety-related problem
  • Remove the safety-related problem, if it is safe to do so.
  • Limit the safety-related problem, if it is safe to do so
  • Give care, if an emergency does occur BCCE
This ChildSafe first aid material is copyrighted and is used with permission from The Canadian Red Cross Society. ChildSafe is a registered trademark of The Canadian Red Cross Society.

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