First Aid for Common Emergencies: Bleeding, Fractures, Burns, Poisoning, Bites, Heat & Choking

First aid is the immediate care given to an injured or suddenly ill person, using available materials, until medical help takes over. It is a separate Annexure-II subject, and practical-skills questions often present a roadside or ward emergency and ask for the first correct action.

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1. Aims, Priorities and Golden Rules

Aims (the 3 Ps): Preserve life, Prevent the condition from worsening, Promote recovery.

Primary survey (DRSABC):

1. Danger: make the scene safe for yourself, bystanders and the casualty.
2. Response: tap and shout; check consciousness.
3. Send for help: call 108/112 or the hospital emergency team.
4. Airway: head-tilt chin-lift (jaw thrust if spinal injury is suspected).
5. Breathing: look for normal breathing for up to 10 seconds; start CPR if absent.
6. Circulation: control severe bleeding; treat for shock.

Golden rules: act calmly; treat the most life-threatening problem first (airway, breathing, severe bleeding); do no further harm; do not give food or drink to someone who may need surgery or is drowsy; record what happened and what you did; hand over clearly.

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2. Bleeding and Shock

• External bleeding: apply firm direct pressure with a clean pad; add more pads on top rather than removing soaked ones; elevate the limb if no fracture is suspected.
• Tourniquet: only for life-threatening limb bleeding that direct pressure cannot control; apply 5–7 cm above the wound, never over a joint, and note the time.
• Nosebleed (epistaxis): sit the person up and lean forward; pinch the soft part of the nose for 10–15 minutes; do not tilt the head back (blood is swallowed or aspirated).
• Shock (pale, cold, clammy skin; rapid weak pulse; rapid breathing; anxiety): lay the person flat, raise the legs only if there is no leg, pelvic or spinal injury, keep warm, loosen tight clothing, give nothing by mouth, and arrange urgent transfer.

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3. Fractures, Sprains and Spinal Injury

• Signs of fracture: pain, swelling, deformity, loss of function, crepitus, abnormal movement.
• Immobilise in the position found, including the joint above and the joint below; pad splints; check circulation, sensation and movement beyond the splint.
• Open fracture: cover the wound with a sterile dressing; do not push bone ends back.
• Sprains and strains: RICE—Rest, Ice (wrapped, 15–20 minutes), Compression bandage, Elevation.
• Suspected spinal injury (fall from height, diving, road accident): do not move the person unless in danger; hold the head and neck in line; log-roll with several helpers if movement is essential.

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4. Burns

Never apply ice, toothpaste, oil, butter, ink or turmeric paste; do not burst blisters. Keep the person warm, because cooling large burns can cause hypothermia.

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5. Poisoning

• Identify the poison, the amount and the time; keep the container or a sample.
• Do not induce vomiting, especially after corrosives (acids, alkalis) or kerosene and other hydrocarbons (risk of aspiration pneumonitis).
• Pesticide (organophosphate) poisoning, common in rural Odisha: remove contaminated clothing, wash the skin with soap and water, protect yourself with gloves, place the person in the recovery position if drowsy, and transfer urgently for atropine and pralidoxime.
• Inhaled poisons (smoke, carbon monoxide): move to fresh air if safe; give high-flow oxygen when available.
• Activated charcoal is given only by trained staff for suitable poisons, usually within 1 hour of ingestion.

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6. Snakebite

India's "Big Four" venomous snakes are the spectacled cobra, common krait, Russell's viper and saw-scaled viper. Polyvalent anti-snake venom (ASV) covers all four.

First aid—"Do it R.I.G.H.T."

• Reassure the victim (most bites are from non-venomous snakes or are dry bites).
• Immobilise the bitten limb like a fracture, without tight bands.
• Get to hospital fast (call 108).
• Tell the doctor about any symptoms (ptosis, difficulty swallowing or breathing, bleeding gums, dark urine) that develop on the way.

Do not: apply a tourniquet, cut or suck the wound, apply ice, use chemicals or herbal remedies, or wait for symptoms before going to hospital. Remove rings, bangles and tight clothing from the bitten limb.

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7. Dog Bites and Rabies Exposure

• Wash the wound immediately with soap and running water for about 15 minutes, then apply an antiseptic such as povidone-iodine. Avoid suturing if possible.
• WHO exposure categories:

• Vaccine schedules used in India: intradermal (two sites on days 0, 3, 7 and 28) or intramuscular (days 0, 3, 7, 14 and 28).

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8. Heat Illness, Drowning and Fainting

• Heat exhaustion: heavy sweating, weakness, headache, normal mental status—move to shade, lie down, give oral rehydration fluids.
• Heat stroke: core temperature above 40 °C with confusion, seizures or coma, often with hot dry skin—a medical emergency. Cool immediately (cold-water immersion or continuous wetting and fanning, ice packs to neck, axillae and groin) and transfer.
• Drowning: remove from water safely; open the airway and start CPR with rescue breaths (hypoxia is the cause); do not try to drain water from the lungs.
• Fainting (syncope): lay the person flat and raise the legs; loosen tight clothing; ensure fresh air.

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9. Choking (Foreign-Body Airway Obstruction)

If the person becomes unresponsive, call for help and start CPR; look in the mouth before rescue breaths and remove a visible object, but never do a blind finger sweep.

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10. Moving Casualties and the First-Aid Box

• Methods of transport: human crutch, two-handed or four-handed seat, fireman's lift (only if no spinal injury), blanket lift, and stretcher (preferred for serious injuries). Unconscious casualties are carried in the recovery position unless spinal injury is suspected.
• First-aid box: sterile dressings and gauze, roller and triangular bandages, adhesive tape, cotton wool, scissors, gloves, antiseptic solution, ORS packets, splints, safety pins, a thermometer, a torch and a record notebook.