What to do before you can reach a doctor.

The purpose of this section is to give you basic information on first aid. The damage from even a life-threatening situation can drastically be reduced by first-aid techniques. Having your own first-aid kit is an important step to take in preparing for emergencies. Knowing how to stop bleeding, rig a temporary splint, or make a sling can be invaluable in minimizing further damage and in possibly saving a life. Recognizing the severity of different types of injuries and burns is also important to ensure that the correct treatment is begun before you can get to a doctor or a doctor can get to you.

Bill was having dinner in a restaurant when a man at the next table started to choke. Bill had learned the Heimlich maneuver in a first-aid class at college. He immediately went over, told the man he would help him, and performed the maneuver. It dislodged a piece of steak and saved the man's life.

You may never be faced with the emergency of dealing with a choking victim, but it's a good idea to be prepared just in case. Post the phone number of your local poison control hotline or hospital emergency center where you and other students can find it immediately if it is needed.

Injuries are most likely to occur when you are under unusual mental, emotional, or physical strain. These are the times to be aware, to stay alert, to look before you leap. Simply saying no to some activity that seems imprudent may save you a lot of grief.

What should I keep in my first-aid kit?

The following items should be in a basic first-aid kit:

Other items in your first-aid kit might include the following:

What first-aid supplies should be available to treat someone who has ingested a poison?

For poisoning (not to be used until directed by a physician or a poison control center), have on hand the following:

How should I treat a victim of poison or overdose?

Treatment depends on the type of poison or pills that have been swallowed. Your first act is to call the poison control hotline or the hospital emergency room. The professional on duty can give you advice on immediate treatment before you take the victim to the hospital.

If the person is unconscious and vomiting, turn the head to the side so that the fluid drains out of the mouth and doesn't cause choking. Do not induce vomiting in an unconscious person and never try to give an unconscious person liquids. Be prepared to keep the airway open and administer CPR if you have been trained and breathing has stopped.

If the person is conscious, check with the professional to see if it is all right to give water or milk to drink to dilute the poison. But for the person who has swallowed an acid or a caustic substance, it is dangerous to drink anything.

Do not induce vomiting if the person has ingested a corrosive substance. This may inflict more damage on the victim's throat. Save the label or the container of the poisonous substance and the vomitus if the person throws up spontaneously; take these to the hospital or to the poison control center so that the poison can be identified.

There are three items that can be in your first-aid kit for treatment of poisoning, but they should be used only on the advice of a physician or a poison control center.

  1. Syrup of ipecac to induce vomiting (use only at direction of physician or poison control center)
  2. Activated charcoal to deactivate certain poisons
  3. Epsom salts to work as a laxative

Keep these items on hand, but we repeat: do not use them until you are directed to do so. When you talk to the poison control center, the hospital emergency room, or a physician, be prepared to give the following information:

  1. The victim's age and approximate weight
  2. The type and amount of poison swallowed
  3. The victim's status (conscious/unconscious; vomiting; difficult breathing)
  4. Your location and distance from the nearest hospital

What should I do if I get something in my eye?

If the natural tearing does not wash the irritant from the eye, pull down the lower lid. If you can see the object that is causing the irritation, try to lift it out with the corner of a clean handkerchief. If it is not under the lower lid, it may be stuck under the upper lid.

Gently grasp the eyelashes of the upper lid and pull the lid down over the lashes of the lower lid. This may dislodge the material and sweep it away. If this does not work, you may be able to roll the upper lid back over itself, using a Q-tip, and then dislodge the material with a clean handkerchief. Flush the eye gently with clean water or a sterile eyewash solution.

If the object was removed with difficulty and there is still pain, or if there is a sensation that something is still in the eye, there may be an abrasion or a scratch on the cornea, the surface of the eye. If the object has penetrated the eyeball or the tissue of the eyelid, do not attempt to remove it. Cover the eye (both eyes if someone else is the victim and you are assisting) with a loose dressing that does not put any pressure on the eye. Seek medical attention immediately.

In any eye irritation or injury, do not rub the eye. It may force the foreign material into the tissue and make the removal more difficult. Do not use absorbent cotton, either as a dressing or to remove a foreign object from the eye. Fibers may come loose and make the problem worse.

What should I do if I am bitten by an animal?

All bites, human and animal, that break the skin are potentially serious and need medical attention. An animal bite carries the risk of rabies and serious bacterial infection. If you are bitten by an animal, every effort should be made to restrain the animal so that it can be inspected for signs of rabies. Prompt treatment is essential because there is no cure for rabies once the infection has progressed past a certain point. See a doctor immediately if you are bitten by any wild animal or by a domestic animal that you're not certain is healthy.

Although dog bites cause more physical damage, cat bites are more dangerous because of the high risk of infection from a deep puncture.Animal bites should be treated by a physician in the first 1-12 hours. Antibiotics are usually needed.

Human bites are very likely to become infected because the mouth is heavily infested with bacteria. A human bite should always be treated by a physician. All bites, human as well as animal, require prompt cleansing, irrigation, and an updating of tetanus (lockjaw) immunization if necessary.

I come back from every field trip with annoying insect bites and stings. What can I do about them?

Apply ice and a soothing lotion such as calamine, Rhuligel, or Cortaid to the bitten area. If you are stung by a bee, use tweezers to remove the stinger from your skin. Ice the area to retard absorption of the venom. The greatest danger from bee stings and other insect bites is an allergic reaction. (See section on allergies in chapter 3.)

If you know you are allergic to insect stings, do not wait for symptoms to appear before you seek medical help. You can take a Benadryl tablet (antihistamine - 25 to 50 milligrams) immediately. It might be wise to ask your physician for a prescription for a bee sting kit to use in case of a severe allergic reaction.

If you suspect an allergic reaction in someone else, be prepared to administer mouth-to-mouth respiration if you have been trained, and seek medical help immediately. If you think you have been bitten by a black widow, brown recluse, or tarantula spider, seek medical care immediately.

Apart from cuts, scrapes, and bites, are there any other common skin Injuries I should know how to treat?

Burns are a very common injury-from the sun, chemicals, an iron, a hot stove, motorcycle exhaust pipes, or even a curling iron. Almost everyone has been burned at some time. Knowing what to do in the first few minutes after you have sustained a burn will greatly reduce the pain and limit your chances of infection.

What are the differences between first, second-, and third-degree burns?

A first-degree burn usually shows redness and mild swelling and is painful. It involves the epidermis, the outer layer of the skin, and is often the result of overexposure to the sun, brief contact with a hot object, or scalding with hot water or steam. The pain may not become noticeable for an hour or more after exposure, as in a mild sunburn.

A second-degree burn is more severe than a first-degree burn and involves both the epidermis and the dermis, the layer below the epidermis. It has a mottled red appearance and shows considerable swelling with blisters. Severe pain is immediate, even on a small burn. The surface of the skin may be wet because of the leakage of plasma through the damaged layers.

A third-degree burn involves even deeper tissue destruction, removal of all layers of skin, and possible damage to underlying structures. Initially, a second-degree burn may be more painful than a third-degree burn because a third-degree burn destroys the nerve endings in the skin. First- and second-degree burns will usually heal without scarring if infection doesn't set in. It can be difficult at first to distinguish between second- and third-degree burns because of their initial similarity in appearance.

How should a first-degree burn be treated?

Immerse the burned area in cold water or use an ice pack for 5 to 10 minutes to relieve the pain. Continue to use cold compresses every 2 to 4 hours, for 1 to 3 days, as needed for pain. A topical skin solution such as Solarcaine may be used to reduce pain. Protecting the area from air exposure with an antibiotic ointment may also help.

The burned area should be protected from sunlight for at least a week after all pain is gone. Breaking a vitamin E capsule and rubbing the oil on the burn may help in the healing process. Although a first-degree burn may be uncomfortable for several days, it does not usually require a physician's attention.

What about a second-degree burn?

Second-degree burns are more serious. The body's natural protective barrier against infection has been broken, and the possibility of infection is much greater. For a small second-degree burn, immerse the injured area in cold water as soon as possible. Immediate cooling may minimize damage to the deeper layers of the skin. Gently pat the area dry with sterile gauze or a clean cloth, and apply a sterile gauze dressing.

Do not apply ointment, cream, or salve to a severe burn unless prescribed by a doctor, and do not pop the blisters or try to remove shreds of skin. If the burn is on the arm or the leg, keep the limb elevated. If the burn is on the foot, several days of bed rest will facilitate the healing process. As with a first-degree burn, protect the area from exposure to sunlight or heat until long after it is fully healed.

A second-degree burn on the hand, foot, or face, or any burn larger than a square inch or two, needs prompt medical attention. Second-degree burns over a large area are very serious and are given the same treatment as third-degree burns.

What about a third-degree burn?

It is very important that third-degree burns receive immediate medical attention. Do not remove burned pieces of clothing attached to the skin. Cover the burned area with a sterile dressing or a freshly laundered cloth. Elevate burned extremities, supporting them with pillows if possible.

If the burn is extensive, it may cause a shock reaction. Do not immerse the area in cold water because you may intensify the shock reaction. A small burn area can be treated with ice packs to reduce pain. A burn that covers more than 10 to 15 percent of the body area will require hospitalization.

If the face is burned, the victim should sit up to facilitate breathing. Because the person may have inhaled smoke, there is the possibility of damage to the respiratory tract. Be prepared to tilt the victim's head back to open the airway, and use some kind of tongue depressor to maintain the airway.

Do not apply lotion, grease, ointment, or any other substance to the burned skin. It is likely to cause complications and make the physician's job more difficult. Get medical care as soon as possible.

If you are more than an hour away from medical help, begin giving the victim sips of water or sips of a solution made of 1 teaspoonful salt and 2 teaspoonful baking soda per quart of water. This will help replace the fluids the body loses through the skin and will help prevent shock.

A classmate was splashed with chemicals in a chemistry lab accident. Is this a type of burn?

Yes. Most chemicals, including solutions of bleach and cleansers used in the home, cause what is known as a chemical burn. Also, chemicals can be absorbed through the skin and can get into the bloodstream-pesticides, for example.

How should a chemical burn be treated?

The first thing to do for a chemical burn is to wash the chemical off with copious amounts of cold running water. Remove the victim's clothes from the burned area and flush the area with water from a hose or a shower for at least 5 minutes. Most chemistry labs have a shower nearby for just such a purpose. Then treat the burn the same way you would treat any other first-, second-, or third-degree burn.

In a chemical burn of the eye, forcibly open the eyelids and irrigate the eye with as much cool water as possible for 5 minutes. Then take the victim to a medical center immediately.

Check the chemical's container for specific instructions regarding exposure, and follow the recommendations. Take or send the container to the emergency room so that the physician can use it as a reference for treatment.

Sunburn may not seem so serious, but it can be very uncomfortable. How can it be prevented?

Limit your exposure to sunlight to the hours before 11 a.m. and after 3 p.m., and always use a sunscreen. Remember, the force of the sun reflected off water and sand is more intense. There is a current epidemic of skin cancer associated with overexposure to sunlight. The sun can also be responsible for premature aging of the skin.

Most sunburns are mild, first-degree burns, but serious second-degree sunburns over a large area of the body need treatment by a doctor. Caution: Never fall asleep while lying in the sun or under a sunlamp. Serious burns can result from extended exposure.

If blisters develop, take care not to break them. If you think that medical attention is needed, don't apply ointments or creams to the affected area before you see a doctor.

Doesn't a sunscreen lotion prevent burning?

Even the best sunscreens do not give complete protection. They only extend the time you can be out before you burn. The SPF (sun protection factor) 15 you see on sunscreens means you can be in the sun 15 times as long before you will burn.

Is it a good idea to prepare for summer sun by using a sunlamp or by going to a tanning salon?

No. The best preparation is to plan to limit your exposure, protect yourself with sunscreens and sunblocks, and cover up before you begin to burn. Sunlamps and tanning salons increase your exposure to harmful ultraviolet rays, which prematurely age the skin and can cause not only wrinkles but cancer.

After a day at the beach I wasn't too sunburned, but I felt just awful. What happened?

You were probably suffering from the effects of heat exhaustion and dehydration. The symptoms are headache, nausea, dizziness, and muscular weakness. This condition is also caused by exercising in the heat. Severe heat exhaustion can be very serious and may require hospitalization so that fluids can be replaced intravenously. You can ruin a weekend quickly by overexposure to sun, heat, and exercise and by not drinking enough fluids to replace what your body loses as perspiration.

Drink plenty of fluids (at least eight 8-ounce glasses a day), but not alcohol, when you are at the beach or any other time you are in a very hot environment. Alcohol and beverages containing caffeine contribute to dehydration. Wear a lightweight hat that will shade you and a lightweight cover-up if you are going to be in the sun for any amount of time.

If you start to feel a headache or dizziness coming on, get out of the sun and start drinking fluids. See Exercise for a discussion of heatstroke during exercise.

What is the best way to help someone who has fainted?

Keep the victim lying flat and immediately elevate the person's legs so that they are much higher than the hips. Activate the emergency response system by shouting for help and having a respondent call the emergency response telephone number. If the person has stopped breathing, establish an airway and begin artificial respiration if you have been trained. Loosen tight clothing. Feel for a pulse. Do not pour water on the victim's face because of the danger of its being inhaled. Check for any injury that may have occurred in the fall when the person lost consciousness. Sometimes an injury can be more serious than the fainting episode.

What causes fainting?

The most common cause of fainting is the so-called vasovagal reaction, in which the heart rate slows and the blood moves away from the head and pools in the legs and the feet. This is what usually happens when someone faints at the sight of blood. It is the body's response to the stress of an event, a way of "checking out" of potential trouble.

Most people recover quickly when their feet are elevated. Don't let someone who has fainted stand up too soon; he or she may faint again. Once consciousness has been regained, keep the person lying flat for 5 minutes while you check for a strong pulse (faster than 60). You can also offer sips of fruit juice or a sugared drink if full consciousness has returned.

What are convulsions and what causes them?

Convulsive seizures are uncontrollable attacks that may occur without warning, usually rendering the victim unconscious and moving involuntarily. Most seizures of this type are epileptic seizures, but they can be a result of high fever, meningitis, encephalitis, tetanus, rabies, or some other central nervous system infection. They can also be caused by a head injury; drug or alcohol withdrawal; carbon monoxide poisoning; metabolic disturbances like thyroid disease, hypoglycemia, and phenylketonuria; and lead, alcohol, cocaine, or other poisoning.

Epileptic seizures can usually be controlled with the use of drugs, and there is no reason someone with epilepsy cannot live a normal life.

What can be done if a classmate or a dorm mate who has epilepsy starts to have convulsions?

The first thing to do for someone having convulsions, or generalized involuntary body movements, is to clear the area so that the person cannot harm himself or herself. If readily available, pillows should be placed near the person's arms and legs to protect them from nearby furniture. Do not try to restrain the person or to put anything in the victim's mouth. That could endanger you and the person having the convulsions. You are likely to get bruised or bitten, and you might force the person's tongue backward and block breathing.

If the seizure victim stops breathing, most likely he or she will start again within 30 seconds with a deep breath. If not, begin mouth-to-mouth or mouth-to-nose resuscitation if you have been trained in this technique.

If the person vomits, turn the head to one side so the fluid drains out. This prevents its being inhaled into the lungs or obstructing the airway. Never try to give liquids to an unconscious person.

Although the person will probably have no memory of the episode or the preceding events, his or her physician should be consulted for advice and treatment.

I know that frostbite is one of the hazards of skiing and cold-weather hiking. What does it feel like, and how can it be prevented?

Prolonged exposure to extremely cold temperatures plus high winds can actually freeze tissue. Frostbite, or frost nip, usually affects the fingers, toes, cheeks, nose, and ears. Sometimes an area is painful before frostbite occurs, but often there are only intense cold and numbness. The skin may be flushed at first but then turns white or gray as the problem gets worse. If you feel the warnings, get out of the cold immediately. If that isn't possible, add more layers of protection to the affected area until you reach shelter. Avoid drinking alcohol, which can intensify the effects of cold exposure and give a false sensation of warmth.

How should frostbite be treated?

Seek shelter immediately and warm the affected area quickly in warm (102 to 105 degrees), not hot, water. The effects will be worse if the tissue is thawed and re-frozen, so take care not to let this happen. Massage of thawing tissue can inflict more damage. Severe swelling is likely to follow thawing. Seek medical attention as soon as possible. Frostbite must be treated with care; it can mean the loss of limbs if it results in gangrene.

What is hypothermia?

Hypothermia is the subnormal temperature of the body and is precipitated by exposure to cold. Symptoms of hypothermia include shivering, numbness, drowsiness, marked muscular weakness, and mental confusion. We've all heard of stories of skiers who have died just several hundred yards from safety. This can often be attributed to the mental confusion and drowsiness associated with the condition. The victim of hypothermia experiences generalized cold over the entire body, not in a specific part as in frostbite.

How is hypothermia treated?

Shelter should be sought immediately. If conscious, the person should be given hot drinks (not alcohol), and all wet or frozen clothing should be removed. The person should be warmed in blankets or placed in a tub of warm water (102 to 105 degrees) and dried thoroughly after being removed. Seek medical attention as soon as possible.

How can you determine If someone who has been cut or is bleeding from an injury should be seen by a doctor?

Here is a list of the conditions that require medical help for an open wound.

  1. Blood is spurting from the wound. (Apply compression.)
  2. The bleeding continues despite all efforts to stop it.
  3. It is impossible to remove all foreign material from the wound.
  4. Something is buried deep in the flesh, or the injury is a puncture wound-that is, made by a nail or other penetrating instrument.
  5. The wound is caused by an animal bite or a human bite.
  6. The wound has been contaminated by soil or organic fertilizer.
  7. The wound is on the face or some other part of the body where scar tissue would be undesirable.
  8. There is suspicion of a crushed tendon, muscle, or nerve.
  9. The wound is a deep puncture, laceration, incision, or tear extending below the outer layer of skin.
  10. The person needs a tetanus shot (for minor wounds if tetanus shot has not been administered within 10 years; for major wounds, within 5 years).
  11. There are questions or doubts about what action to take.

What is the best way to care for a cut that doesn't require immediate medical attention?

If the wound seems minor, is not deep, and gapes only slightly, you should be able to clean, dress, and bandage it with no problem. If swelling, redness, pain, or pus develops around the wound, it may have become infected and should be seen by a physician.

To clean the wound, first wash it with water and then use a non-stinging dilute iodine solution like Betadine. This is an indispensable aid for cuts, blisters, or scrapes. You can self-close minor cuts with butterfly bandages, which pull the edges of the wound together.

Cover the wound with a sterile gauze dressing and hold the dressing in place with a gauze or an elastic bandage. Make sure that the bandage is not so tight that it cuts off circulation. This often occurs if there is swelling after the wound has been wrapped. Bandages that are too tight can inflict permanent damage to nerves and blood vessels. If there is any numbness or a tingling sensation, the bandage should immediately be loosened.

If the cut is very small, after cleansing it can be covered with a Band-Aid. Band-Aids on minor cuts speed the healing process considerably. Make sure you change the Band-Aid at least daily. At that time clean the cut with water and rinse with Betadine to prevent infection.

What are the different types of open wounds?

Abrasions are painful surface scrapes of the epidermis that usually result in minor bleeding. They should be cleaned thoroughly with soap and water and then 'painted" with an antiseptic solution (Betadine) to prevent infection. Skinned knees and hands from falls or bicycle accidents (road burns) are common. Covering abrasions with a loose dressing will help prevent their contact with clothing or sheets, but they should receive plenty of air circulation, allowing them to dry and scab over.

Incisions are slashes in the skin and deeper flesh caused by a sharp instrument such as a knife or glass. Blood vessels, muscles, tendons, or nerves may be cut. Even minor incisions may need stitches to prevent excess scarring. Spurting blood indicates severed arteries. First aid should be provided and medical attention sought without delay to prevent blood loss and shock.

A laceration is a torn, jagged wound to the flesh that may result in severe bleeding and tissue damage. Infection is common and surgery is often necessary to repair the injury.

Puncture wounds may show only slight damage at the skin surface, but there may be severe internal injury such as broken bones, internal bleeding, and organ damage. They can be caused by bullets, nails, or splintered wood, and may deposit infectious material, including tetanus, deep in the flesh. Even minor puncture wounds should be watched carefully for signs of infection, and a tetanus shot should be given as soon as possible if one has not been received in the last five years.

An avulsion results when tissue is torn or ripped off. It requires immediate medical attention. The torn-oft part should be wrapped in a clean cloth and sent to the hospital with the victim. The removed part should be kept cool but it should not come into direct contact with ice and it should be prevented from freezing.

What type of coverings are used for open wounds?

Dressings are a thin cover to protect the wound from additional contact and infection with foreign material. Sterile gauze is the most desirable covering, but clean cloth can be used if no sterile material is available.

Compresses are used to control bleeding. They are thick gauze or cloth pads used to apply pressure and absorb blood. If they become soaked with blood, they should not be removed. Instead, another layer of compress should be applied.

Bandages are used to hold dressings and compresses in place and to support injured areas to prevent further damage. They can be made from rectangles, triangles, or strips of cloth.

What causes nosebleeds, and can they be avoided?

Nosebleeds are usually the result of broken blood vessels in the front of the nose. Direct injury, dry weather, frequent nose-blowing, allergies, cocaine use, and nose-picking are common causes. A cotton swab coated with antibiotic ointment will lubricate the outer nasal passages and lessen the effects of dry weather. Occasionally, recurrent nosebleeds may be a sign of an underlying problem like high blood pressure. Seek medical attention for any recurrent nosebleed or one whose cause is not readily apparent.

What's the best way to deal with a nosebleed?

If a nosebleed occurs when you are lying down, immediately sit up or stand up. This will reduce the amount of blood flowing to the nose and make it less likely that blood will drip down the back of the throat. Firmly pinch together both sides of the soft part of your nose with your thumb and fingers and maintain a steady pressure for at least 10 minutes. A period of 20 minutes is often necessary. If your nosebleed doesn't stop in 20 minutes, go to the nearest emergency room for treatment by a physician.

After the bleeding has stopped, avoid forceful nose-blowing for several days to keep from disrupting the clot that has formed.

Are accidents always unexpected and unavoidable?

In reality accidents are not the unavoidable events that many people believe them to be. Only 10 to 20 percent of all accidents are of the type no one has control over. Over 80 percent are caused by what people do and don't do; with care, foresight, and alertness, you may avoid inflicting serious injury or death on yourself or others.

According to the U.S. Department of Health and Human Services, accidents are one of the leading causes of death among young people aged 15 to 24, and alcohol is involved in 50 percent of all fatal traffic accidents, fire deaths, and suicides. Nonfatal accidents are the primary cause of hospitalization of college-age adults. See Prevention for information on reducing your risk of being in an accident.

What are some of the ways to prevent or minimize injuries from car accidents?

If you are in an auto accident and are wearing a seat belt, you cut your chance of being fatally injured in half. If you wear a helmet when you ride a motorcycle or a bicycle, you reduce your chance of injury by 50 percent.

If you are going out to a party, appoint a member of the group to stay sober and be the designated driver, or take a taxi back to the dormitory. Some areas have organizations, such as Mothers Against Drunk Driving (MADD), that offer a ride-home service. Do not get behind the wheel if you are intoxicated, and never get in a car if the driver is intoxicated.

What is the first thing to do to help someone who is seriously hurt in a traffic accident?

First, you must stabilize the victim and protect him or her from further injury. Do not move the victim unless it is necessary for the person's safety. For example, you may have to carry the person from a burning building or move him or her from a face down position in the water. Unless you have no choice, it is better to wait for paramedics or emergency medical technicians to evaluate and move the victim. Movement of the victim by an untrained bystander may further endanger the victim and even injure the rescuer. Use your energy to organize a safe area around the victim to protect him or her from further trauma, and recruit another person to call for help.

How should severe bleeding be controlled?

Bleeding can usually be controlled by applying direct pressure over the entire area of a wound and elevating the wound above the level of the heart. In cases of severe bleeding, prompt attention is essential because extreme loss of blood can lead to death in a matter of minutes. Elevation uses the force of gravity to decrease the blood flow to the area and should only be used if you are sure there are no broken bones involved.

Use a clean cloth (or your bare hand if necessary) and apply constant, even pressure directly to the wound with the palm of your hand for 5 to 20 minutes. If the cloth becomes blood-soaked, do not remove it. Add another cloth on top of it to absorb the flow. The blood will eventually clot in the cloth, and if you remove it, you run the risk of opening the wound again.

If direct pressure to the wound is unsuccessful or if there is a gushing or spurting source of bleeding, pressure should be applied directly to the artery supplying blood to the extremity. Use the flat surface of your fingers or the heel of your hand to compress the artery against the bone. You may have to lean quite hard in the groin area to stop severe leg bleeding. Usually this technique, accompanied by elevation of the injured limb, will stop severe bleeding.

Only in extreme cases, such as an amputation or a crush wound, should a tourniquet be applied. Using a tourniquet is very risky and is best left to the experts. If a tourniquet is used, it must be removed only by a physician.

Summon aid as quickly as possible. If someone else is available, have that person call for help while you administer first aid.

To stop bleeding in the arm, apply pressure to the brachial artery. The arm pressure point is located approximately midway between the elbow and the armpit on the inside of the arm in the groove between the biceps and the triceps muscles.

Approach from behind, elevate the bleeding area, and apply pressure with the flat part of your fingers to the area of the brachial artery. Severe bleeding may cause shock and fainting, so the victim should lie down and avoid activity.

Use the flat part of your fingers on the pressure point and do not dig in with your fingertips. It may take considerable pressure to stop or slow the flow of blood.

To stop bleeding in the lower extremities, pressure must be applied to the femoral artery at the groin, which is at the crease between the trunk and the leg, not on the leg itself. Use the heel of your hand and a straight arm to push hard with the weight of your upper body. Elevate and apply direct pressure to the wound while continuing to apply pressure to the femoral artery.

Several people on campus have been wearing thick, soft collars because of whiplash. What is a whiplash injury?

Whiplash is an acute injury to the neck caused by a very rapid flexion (bending forward) and extension (bending backward). Even in a low-speed car accident, the neck and head can be thrust back and forth several times, especially if the back of the seat doesn't come above the level of the head. Whiplash injury can also occur in body surfing, in horseback riding, or in contact sports like football.

What happens in a whiplash injury?

The muscles and ligaments of the neck can be stretched. The pain of the injury can cause a reflex, protective spasm of the neck muscles, limiting movement and increasing the pain. The pain may not begin until 4 to 48 hours or more after the accident.

In any case of neck pain or suspected neck injury, you should see a physician, not a chiropractor, for a full evaluation and possible X rays to rule out a fracture. There is the possibility of a more serious injury, particularly if there is pain, numbness, or tingling in your arms or hands.

How long does whiplash last and what can be done to treat it?

It may take weeks to recover from a whiplash injury. While you are still in pain, avoid stretching or flexing the head and neck to try to "work it out." This may only further damage the injured tissue. Wear a soft neck collar during the day to let your muscles rest and recover. Your chin can rest in the soft material of the collar, which relieves your neck of the strain of fully supporting the 6-to-11-pound weight of your head.

Applying heat may relieve the pain, but sometimes ice feels better for the first few days. A physician or a physical therapist can advise you on the correct position for sleeping, sitting, and studying and can also prescribe exercises that will strengthen and rehabilitate your neck. Caution: Don't do any exercises that have not been recommended by a doctor or a therapist.

A classmate got a concussion in a bicycle accident and couldn't remember anything about what happened. What caused the loss of memory?

A concussion is an injury to the head that causes momentary or prolonged (1 to 10 minutes) loss of consciousness. It is usually caused by a direct blow or a fall. In lay terms, a concussion is like a temporary short circuit of the brain, which accounts for the memory loss. The worse the concussion, the greater is the memory loss.

In serious cases there may be bleeding, or hemorrhage, inside the brain. The buildup of pressure from this bleeding may occur quickly, or it may develop slowly over a period of 24 to 36 hours. Either way it is very serious. A concussion should be evaluated as soon as possible in the emergency room or by a physician. If a neck injury is suspected, use the guidelines on page 146 for protecting the spine.

The possibility of internal bleeding is the reason many persons with a concussion are hospitalized overnight for observation. The only clue to bleeding in the brain may be a slowly deteriorating level of consciousness. Sometimes specialized X rays are taken to detect intracranial bleeding.

How long does it take to recover from a concussion?

That can depend on the severity of the concussion. Recovery from even a mild concussion may take several weeks while the brain restores some of those "blown circuits." During that time it is common for the patient to experience headaches, dizziness, balance problems, loss of appetite, occasional double vision, nausea, or difficulty in thinking clearly. These symptoms are called postconcussion syndrome and will usually pass within 2 to 6 weeks after the injury.

What should and should not be done while recovering from a concussion?

During that time avoid central nervous system stimulants (caffeine) or depressants (alcohol), don't drive or play contact sports, and see your physician again. It is wise to slow down during the recovery period. Taking naps, avoiding stress and fatigue, and trying to eat and sleep normally will all help to speed the recovery period. Unless your doctor advises you not to take pain-relief medication such as acetaminophen or aspirin, either remedy can help reduce the discomfort of a headache.

What are for the warning signs that indicate someone with a head injury should have an immediate medical evaluation?

Warning signs indicating a need for prompt medical attention are as follows:

  1. Unusual drowsiness, especially progressive drowsiness. During the first 24 hours after a head injury, someone should arouse the person from sleep every 2 hours. If the individual has difficulty awakening, medical attention should be sought.
  2. Persistent vomiting.
  3. Oozing of blood or fluid from the nose or ears.
  4. Uncontrollable twitching or convulsions.
  5. Sudden or progressive impairment of vision.
  6. Weakness or numbness of the extremities.
  7. Unexplained fever

Just about every sport or activity involves some risk of breaking a bone. What's the best way to deal with a fracture?

If there is any suspicion of a broken spine or neck or of a skull fracture, call for assistance and do not move the victim until professional help arrives. Be prepared to maintain an airway for the victim if breathing difficulty develops, but move the head as little as possible.

If a limb is affected, rig a temporary splint to avoid unnecessary movement and then transport the injured person to the hospital. Do not try to set the bone. If the bone is sticking out through the skin, do not try to put it back in and do not clean the wound.

If a leg is broken, the simplest way to immobilize it is to secure it to the uninjured leg. Put some padding between the legs and tie them together with handkerchiefs, belts, ties, or strips of torn cloth. Makeshift splints can be made of cardboard, rolled~up newspapers, boards, sticks, and blankets. A splint should extend from well above the broken area to well below

it. If the arm or shoulder is broken, secure the arm in a sling, using a large piece of triangular cloth. It may be necessary to strap the upper arm to the chest to prevent excessive movement. Immobilize the area as best you can, and seek immediate medical attention.

What can be done to help someone who is choking?

The Heimlich maneuver, or abdominal thrust, can be used to clear the choking victim's airway. If you learn this one technique, you can save a life.

An unconscious choking victim sometimes slips to the floor without warning. A conscious choking victim is often unable to talk because speech depends on the flow of air through the larynx, or voice box. A conscious person who can neither breathe nor talk is probably choking. The victim may be very agitated, with flushed face and flailing arms. Or the victim may be using the universal sign for choking-the placement of one or both hands around the throat. (The sign was suggested by Henry Jay Heimlich, the American surgeon who developed the maneuver.)

To help, first get the choking person's attention. Establish eye contact and ask, "Are you choking?" Say you are going to help. Then the person won't fight you. Use words like, "I know you are choking. I am going to get it out. Let me stand behind you and I will grip you around the waist."

To perform the Heimlich maneuver, stand behind the victim and wrap your arms around the victim's waist. Grabbing your clenched fist with your other hand, rapidly press into the abdomen with a sudden upward thrust. This motion forces a large quantity of air to be expelled by the lungs; the airflow dislodges the object blocking the windpipe. Repeat thrusts, making each one distinct, until the object is expelled. Quickly remove the object by sweeping your fingers from the back of the victim's mouth to the front. Be careful not to force the foreign body back into the airway.

This procedure works best when the victim's head is bent forward. Repeat the procedure several times if it does not work initially. Back blows do not work for an adult. If you are short, you may have to stand on a chair behind the victim or put the victim on the floor to press on the abdomen. If the victim is lying down, you must straddle the person or kneel in front. If you are larger than the victim, be careful not to use too much force, which may break ribs.

If the person does not begin to breathe, you may have to repeat the maneuver or start CPR (cardiopulmonary resuscitation) while someone else calls for backup help. It is wise to practice this technique before being faced with an emergency. Your local American Red Cross chapter usually teaches the Heimlich maneuver along with the basic CPR.

What if I'm choking and I'm alone?

You can use the same technique to rescue yourself. Close one fist with the thumb and knuckles facing inward over your abdomen. Grasp that fist with your other hand and quickly brace yourself face-to-face against some substantial stationary object such as the back of a straight-backed chair, a tabletop, or a bookcase at about the height of your upper abdomen. Forcefully pushing against the back of the chair (or other support), push your fist in and upward, dislodging whatever is choking you.

What can be done if the choking person is unconscious and is lying flat? Can the Heimlich maneuver be used?

Yes. Roll the victim onto his or her back. Use the tongue-jaw lift to open the mouth, and sweep to try to remove the object. (In the tongue-jaw lift, grasp both the tongue and the lower jaw between the thumb and the finger. Then lift. This action draws the tongue away from the back of the throat and partially relieves the obstruction.) Make a fist and place the thumb side in the middle of the abdomen just above the navel (belly button) and 2 to 4 inches below the breastbone. Kneeling in front of, or straddling, the victim, use the heel of two interlocked hands to push in and up. Follow each series of six thrusts with a finger sweep from the back of the mouth to the front to clear out any food.

For a baby or a young child, place him or her over your leg or your forearm with the face down. Support the head and the neck with one hand, put the baby's head lower than the trunk, and deliver four back blows between the shoulder blades, using the heel of the hand. If the foreign object doesn't come out, turn the baby on its back, the head lower than the trunk. Deliver four abdominal thrusts, using the heel of one hand. Continue until the foreign object comes out. If the baby becomes unconscious, perform the tongue-jaw lift. Do not do a blind sweep in an infant or a young child. Try to remove the object only if you can see it.

What Is CPR?

Cardiopulmonary resuscitation (CPR) is a technique to provide circulation and breathing to a person who has suffered heart and respiratory failure. It should not be used until you have learned the procedure in a course given by the American Red Cross or by some other authorized agency or qualified instructor. Before applying CPR, you must be very certain that the person has stopped breathing and has no pulse. Serious injury can be inflicted by the incorrect use of CPR.

If someone stops breathing and has no pulse, you should first call the emergency care system (911). Then if you are trained CPR should be started immediately. If the heart is still beating, it is necessary only to clear or open the airway and to restore breathing by performing artificial respiration. When the oxygen supply to the brain is interrupted, there are only 4 to 6 minutes before permanent brain damage or brain death results.

We highly recommend that you take a class in CPR given by the American Red Cross. In cities like Seattle, where a large number of the general population has been trained in CPR techniques, there has been a drastic reduction in out-of-hospital deaths.

What can be done to help the victim of a swimming, diving, or surfing accident?

First, safely remove the victim from the water. If you are not a strong swimmer or trained in lifesaving techniques, do not get into the water to attempt a rescue. Instead, extend a stick or a pole or throw a life ring to the near-drowning person. If available, a surfboard, a float, or a boat can be used to reach and transport the victim.

If the person is unconscious when brought to safety, check to see if he or she is breathing. Tilt the head back, lift the chin, look for the rise and fall of the chest, listen for breathing sounds, and feel for breath with your cheek.

If breathing has stopped, immediately begin mouth-to-mouth resuscitation. There may be water in the lungs, so it may be necessary to breath more forcefully than usual. It is not possible to pour water out of the lungs! This should not be attempted, even though it seems like the logical procedure.

Do not press on the abdomen while the victim is lying face up, as this may force water or vomit out of the stomach into the airway. If the victim's abdomen is swelled with swallowed water that is interfering with breathing, roll the person onto his or her stomach and lift the abdomen to force the water out. Clear the mouth then roll the person back and continue resuscitation. This procedure alone sometimes allows breathing to resume spontaneously.

What action should be taken if there's a possibility that the victim has spinal cord injuries?

If there is a suspicion of a neck or a spinal injury, which frequently occurs in diving and surfing accidents, the victim should not be removed from the water until a backboard and experienced rescuers to use it can be located-unless without assistance the victim is in immediate danger of drowning.

If there is such a danger and you must move the victim, keep the person's neck as level with the back as possible. Place the heels of your palms at the back of the victim's head and extend your fingers down onto his or her shoulders to form a supporting triangle. Very carefully remove the victim from the water, keeping the spine and the head in a straight line.

Isn't talking about suicide just a way of letting off steam for someone who won't ever actually do it?

No. Any threat to commit suicide should be treated seriously, even if it is presented in a joking manner. A person who is feeling sad, hopeless, inadequate, or rejected may seriously be considering suicide. Almost every suicide victim has in some way given a warning of intent. The threat to kill oneself is usually a desperate attempt to communicate, to get the message across of pain and need.

College students are often under pressure. Keeping up with course work, maintaining a part-time job, participating in extracurricular activities, partying with classmates, and finding quiet time to spend with a boyfriend or a girlfriend can sometimes seem too much to cope with. If you or a friend begins to feel anxious or depressed by the demands of campus life, it's important to get some perspective on the source of those feelings before they become overwhelming and self-destructive.

What are the warning signs of suicide?

Sudden noticeable changes in behavior are clues-lack of energy, difficulty in sleeping, eating problems, loss of interest in academic and social life, or the use of drugs or alcohol. A student who is highly irritable, isolated, and secretive could be in serious distress.

What can be done to help someone who is in that state of distress?

If you know someone who is exhibiting some signs of this behavior, letting that person know you care is an important first step. Talk to the person and encourage him or her to get help through the student health center. Many people-men and women-have feelings of hopelessness and despair during times of stress. These feelings are not permanent and do not mean the person who has them is going crazy. But for a time they can make the world look pretty unfriendly.

By listening, sharing, caring, being optimistic, and trying to hear the message, you can help a classmate over a rocky period. Self-limited depressions of this type are not unusual and are usually temporary. But suicide is permanent. A single event - the loss of a girlfriend or a boyfriend, an unwanted pregnancy, the death of a friend or a relative, a poor grade, or a family fight - can be all it takes for a suicide attempt. See chapter 8 for more information.

What kind of outside help is available in an emergency?

Many campuses have suicide prevention hot lines that are available 24 hours a day. There are also 1-800 telephone numbers in the resources section at the back of this book. Here are some guidelines for dealing with someone who is threatening suicide:

In an emergency, you can make a very great difference in your own life and in the life of others by knowing the principles and techniques we have discussed in this chapter. There is nothing so rewarding as saving someone's life or helping to relieve pain and suffering. Staying calm during an emergency is perhaps the most difficult requirement. However, now that you know what to do, you will find that when the time comes to apply that knowledge, taking action in itself has a calming influence.