First Aid

Before administering any first aid we must make sure that the area is safe in order not to expose ourselves, the victim or any bystanders to risk. After that, ask a colleague for help. He/she is going to look for medical assistance on board. Finally, you must assess the victim's state of health and apply rescue actions.

• VIDEO PAS. DGT
• VIDEO PAS UCLM

Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful in many emergencies, such as a heart attack or near drowning, in which someone's breathing or heartbeat has stopped. The American Heart Association recommends starting CPR with hard and fast chest compressions. This hands-only CPR recommendation applies to both untrained bystanders and first responders.

If you're afraid to do CPR or unsure how to perform CPR correctly, know that it's always better to try than to do nothing at all. The difference between doing something and doing nothing could be someone's life.

CPR can keep oxygen-rich blood flowing to the brain and other organs until emergency medical treatment can restore a typical heart rhythm. When the heart stops, the body no longer gets oxygen-rich blood. The lack of oxygen-rich blood can cause brain damage in only a few minutes.

Here are advices:

• Untrained. If you're not trained in CPR, then provide hands-only CPR. That means uninterrupted chest compressions of 100 to 120 a minute until paramedics arrive. You don't need to try rescue breathing.
• Trained and ready to go. If you're well-trained and confident in your ability, check to see if there is a pulse and breathing. If there is no pulse or breathing within 10 seconds, begin chest compressions. Start CPR with 30 chest compressions before giving two rescue breaths (optional).
• Trained but rusty. If you've previously received CPR training but you're not confident in your abilities, then just do chest compressions at a rate of 100 to 120 a minute (details described below).

The above advice applies to situations in which adults, children and infants need CPR, but not newborns (infants up to 4 weeks old).

If you are untrained and have immediate access to a phone, call 112 before beginning CPR. The dispatcher can instruct you in the proper procedures until help arrives. To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED).

Before you begin

Before starting CPR, check:

• Is the environment safe for the person?
• Is the person conscious or unconscious?
• If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"
• If the person doesn't respond and you're with another person who can help, have one person call 112 and get the AED, if one is available. Have the other person begin CPR.
• If you are alone and have immediate access to a telephone, call 112 before beginning CPR. Get the AED if one is available.
• As soon as an AED is available, deliver one shock if instructed by the device, then begin CPR.

Remember the letters C-A-B

Chest compressions

Open the Airway

Rescue Breathing

Compressions: Restore blood flow

Compressions means you'll use your hands to push down hard and fast in a specific way on the person's chest. Compressions are the most important step in CPR. Follow these steps for performing CPR compressions:

1. Put the person on his or her back on a firm surface.
2. Kneel next to the person's neck and shoulders.
3. Place the lower palm (heel) of your hand over the center of the person's chest, between the nipples.
4. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.
5. Push straight down on (compress) the chest at least 5 centimeters but no more than 6 centimeters. Use your entire body weight (not just your arms) when doing compressions.
6. Push hard at a rate of 100 to 120 compressions a minute. The American Heart Association suggests performing compressions to the beat of the song "Stayin' Alive." Allow the chest to spring back (recoil) after each push.
7. If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over.

Airway: Open the airway

If you're trained in CPR and you've performed 30 chest compressions, open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

1. As soon as an automated external defibrillator (AED) is available, apply it and follow the prompts. Give one shock, then resume chest compressions for two more minutes before giving a second shock. If you're not trained to use an AED, a 1-1-2 operator or another emergency medical operator may be able to give you instructions. If an AED isn't available, go to step 5 below.
2. Continue CPR until there are signs of movement or emergency medical personnel take over.

How to use the AED vídeo.

CPR Poster

Choking

A foreign object that is stuck at the back of the throat may block the throat or cause muscular contraction.

The following information is for choking in adults. There is separate advice on how to stop a child from choking.

Mild choking

If the airway is only partly blocked, the person will usually be able to speak, cry, cough or breathe.

In situations like this, a person will usually be able to clear the blockage themselves.

If choking is mild:

• Encourage the person to cough to try to clear the blockage.
• Ask them to try to spit out the object if it's in their mouth.
• Do not put your fingers in their mouth if you can't see the object, as you risk pushing it further down their mouth.

If coughing doesn't work, start back blows.

Severe choking 

If choking is severe, the person won't be able to speak, cry, cough or breathe, and without help they'll eventually become unconscious. If coughing doesn't work start back blows.

How to do back blows

To help an adult or child over 1 year old:

• Stand behind the person and slightly to one side. Support their chest with 1 hand. Lean the person forward so the object blocking their airway will come out of their mouth, rather than moving further down.
• Give up to 5 sharp blows between the person's shoulder blades with the heel of your hand (the heel is between the palm of your hand and your wrist).
• Check if the blockage has cleared.
• If not, give up to 5 abdominal thrusts.

Do not give abdominal thrusts to babies under 1 year old or to pregnant women.

To perform abdominal thrusts on a person who is severely choking and isn't in one of the above groups:

• Stand behind the person who is choking.
• Place your arms around their waist and bend them well forward.
• Clench 1 fist and place it just above the person's belly button.
• Place your other hand on top of your fist and pull sharply inwards and upwards.
• Repeat this up to 5 times.

The aim is to get the obstruction out with each chest thrust, rather than necessarily doing all 5.

If the person's airway is still blocked after trying back blows and abdominal thrusts:

• Dial 1-1-2 and ask for an ambulance. Tell the 1-1-2 operator that the person is choking.
• Continue with the cycles of 5 back blows and 5 abdominal thrusts until help arrives.

The person choking should always be seen by a healthcare professional afterwards to check for any injuries or small pieces of the obstruction that remain.

Poster

If a person is unconscious but is breathing and has no other life-threatening conditions, they should be placed in the recovery position.

Putting someone in the recovery position will keep their airway clear and open. It also ensures that any vomit or fluid won't cause them to choke.

• With the person lying on their back, kneel on the floor at their side.
• Extend the arm nearest you at a right angle to their body with their palm facing up.
• Take their other arm and fold it so the back of their hand rests on the cheek closest to you, and hold it in place.
• Use your free hand to bend the person's knee farthest away from you to a right angle.
• Carefully roll the person onto their side by pulling on the bent knee towards you.
• Their bent arm should be supporting the head, and their extended arm will stop you rolling them too far.
• Make sure their bent leg is at a right angle.
• Open their airway by gently tilting their head back and lifting their chin, and check that nothing is blocking their airway.
• Stay with the person and monitor their condition until help arrives.

VIDEO

Spinal injury

If you think a person may have a spinal injury, do not attempt to move them until the emergency services reach you.

If it's necessary to open their airway, place your hands on either side of their head and gently lift their jaw with your fingertips to open the airway. Take care not to move their neck.

You should suspect a spinal injury if the person:

• has been involved in an incident that's directly affected their spine, such as a fall from height or being struck directly in the back
• complains of severe pain in their neck or back
• is not able to move their neck
• feels weak, numb or unable to move (paralysed)
• has lost control of their limbs, bladder or bowels

If someone is bleeding heavily, the main aim is to prevent further blood loss and minimise the effects of shock.

First, dial 1-1-2 and ask for an ambulance as soon as possible.

If you have disposable gloves, use them to reduce the risk of any infection being passed on.

Check that there's nothing embedded in the wound. If there is, take care not to press down on the object.

Instead, press firmly on either side of the object and build up padding around it before bandaging to avoid putting pressure on the object itself.

Do not try to remove it because it may be helping to slow down the bleeding.

If nothing is embedded:

• Apply and maintain pressure to the wound with your gloved hand, using a clean pad or dressing if possible. Continue to apply pressure until the bleeding stops.
• Use a clean dressing or any clean, soft material to bandage the wound firmly.
• If bleeding continues through the pad, apply pressure to the wound until the bleeding stops, and then apply another pad over the top and bandage it in place. Do not remove the original pad or dressing, but continue to check that the bleeding has stopped.

If a body part, such as a finger, has been severed, place it in a plastic bag or wrap it in cling film. Do not wash the severed limb.

Wrap the package in soft fabric and place in a container of crushed ice. Do not let the limb touch the ice.

Make sure the severed limb goes with the patient to hospital.

Always seek medical help for bleeding, unless it's minor.

Find out how to treat cuts and grazes and how to treat nosebleeds.

It's important to have a well-stocked first aid kit in your home so you can deal with minor accidents and injuries.

Your first aid kit should be locked and kept in a cool, dry place out of the reach of children.

Many people also keep a small first aid kit in their car for emergencies.

A Basic First Aid Kit may contain

• plasters in a variety of different sizes and shapes
• small, medium and large sterile gauze dressings
• at least 2 sterile eye dressings
• triangular bandages
• crêpe rolled bandages
• safety pins
• disposable sterile gloves
• tweezers
• scissors
• alcohol-free cleansing wipes
• sticky tape
• thermometer (preferably digital)
• skin rash cream, such as hydrocortisone or calendula
• cream or spray to relieve insect bites and stings
• antiseptic cream
• painkillers such as paracetamol (or infant paracetamol for children), aspirin (not to be given to children under 16), or ibuprofen
• antihistamine cream or tablets
• distilled water for cleaning wounds
• eye wash and eye bath

It may also be useful to keep a basic first aid manual or instruction booklet with your first aid kit.

Medicines should be checked regularly to make sure they're within their use-by dates.

Epilepsy is a common condition that affects the brain and causes frequent seizures.

Seizures are bursts of electrical activity in the brain that temporarily affect how it works. They can cause a wide range of symptoms.

Symptoms of epilepsy

Seizures can affect people in different ways, depending on which part of the brain is involved.

Possible symptoms include:

• uncontrollable jerking and shaking, called a "fit"
• losing awareness and staring blankly into space
• becoming stiff
• strange sensations, such as a "rising" feeling in the tummy, unusual smells or tastes, and a tingling feeling in your arms or legs
• collapsing

Sometimes you might pass out and not remember what happened.

Generalised Onset Seizure with Motor Features (Tonic-Clonic, Tonic, Clonic, Atonic)

• Stay calm and time the seizure
• Don’t restrain the person - unless they are in danger
• Let the seizure run its course
• Put nothing in the mouth (but do wipe away saliva)
• Protect the head if necessary
• Turn the person on their side after the seizure stops
• Stay with them until they recover and respond fully

Focal Impaired/Complex Partial Seizures

• Stay calm and time the seizure
• Don’t restrain (unless the person is in real danger)
• Let the seizure run its course
• Guide the person away from danger
• Don’t agitate them
• Speak gently and reassure them
• Stay with them until they recover and respond fully

Absences, Minor Seizures, Focal Aware/Simple Partial

• Stay calm and time the seizure
• If they wander guide them gently from danger
• Wait until the person is fully recovered and responsive Reassure them and explain what happened

When to call an ambulance

• if it is the first known seizure 

• the seizure lasts over 5 minutes 
• more seizures follow without recovery 
• the person is injured, pregnant, has another medical condition or you are in any doubt.

Download your Tonic-Clonic Seizure awareness poster here.

Download your Complex Partial/Focal Seizure awareness poster here.

Find out what to do if someone has a seizure

Find out more about living with epilepsy

VIDEO

A low blood sugar level, also called hypoglycaemia or a "hypo", is where the level of sugar (glucose) in your blood drops too low.

It mainly affects people with diabetes, especially if they take insulin.

A low blood sugar level can be dangerous if it's not treated quickly, but you can usually treat it easily yourself.

Symptoms of a low blood sugar level

A low blood sugar level can affect everyone differently. You'll learn how it makes you feel, although your symptoms may change over time.

Early signs of a low blood sugar level include:

• sweating
• feeling tired
• dizziness
• feeling hungry
• tingling lips
• feeling shaky or trembling
• a fast or pounding heartbeat (palpitations)
• becoming easily irritated, tearful, anxious or moody
• turning pale

If a low blood sugar level is not treated, you may get other symptoms, such as:

• weakness
• blurred vision
• confusion or difficulty concentrating
• unusual behaviour, slurred speech or clumsiness (like being drunk)
• feeling sleepy
• seizures or fits
• collapsing or passing out

A low blood sugar level, or hypo, can also happen while you're sleeping. This may cause you to wake up during the night or cause headaches, tiredness or damp sheets (from sweat) in the morning.

How to treat a low blood sugar level yourself

Follow these steps if your blood sugar level is less than 4mmol/L or you have hypo symptoms:

1. Have a sugary drink or snack – like a small glass of fizzy drink (not a diet variety) or fruit juice, 4 to 5 jelly babies, 4 to 6 glucose tablets or 2 tubes of glucose gel.
2. Test your blood sugar after 10 minutes – if it's improved and you feel better, move on to step 3. If there's little or no change, treat again with a sugary drink or snack and take another reading after 10 to 15 minutes.
3. You may need to eat your main meal (containing a slow-release carbohydrate) if it's the right time to have it. Or, have a snack that contains a slow-release carbohydrate, such as a slice of bread or toast, a couple of biscuits, or a glass of cows' milk.

You do not usually need to get medical help once you're feeling better if you only have a few hypos.

But tell your diabetes team if you keep having hypos or if you stop having symptoms when your blood sugar level is low.

How to treat someone who's unconscious or very sleepy (drowsy)

Follow these steps:

1. Put the person in the recovery position and do not put anything in their mouth – so they do not choke.
2. Call 1-1-2 for an ambulance if an injection of glucagon is not available, you do not know how to use it, or the person had alcohol before their hypo.
3. If an injection of glucagon is available and you know how to use it, give it to them immediately.
4. If they wake up within 10 minutes of getting the injection and feel better, move on to step 5. If they do not improve within 10 minutes, call 999 for an ambulance.
5. If they're fully awake and able to eat and drink safely, give them a carbohydrate snack.

They may need to go to hospital if they're being sick (vomiting), or their blood sugar level drops again.

Tell your diabetes care team if you ever have a severe hypo that caused you to lose consciousness.

How to treat someone who's having a seizure or fit

Follow these steps if someone has a seizure or fit caused by a low blood sugar level:

1. Stay with them and stop them hurting themselves – lie them down on something soft and move them away from anything dangerous (like a road or hot radiator).
2. If an injection of glucagon is available and you know how to use it, give it to them immediately. After they've recovered, give them a carbohydrate snack.
3. Call 112 for an ambulance if a glucagon injection is not available or you do not know how to use it, if they have not recovered 10 minutes after giving a glucagon injection, or if they had alcohol before their hypo.

Tell your diabetes care team if you ever have a severe hypo that caused you to have a seizure or fit.

What causes a low blood sugar level

In people with diabetes, the main causes of a low blood sugar level are:

• the effects of medicine – especially taking too much insulin, medicines called sulfonylureas (such as glibenclamide and gliclazide), medicines called glinides (such as repaglinide and nateglinide), or some antiviral medicines to treat hepatitis C
• skipping or delaying a meal
• not eating enough carbohydrate foods in your last meal, such as bread, cereals, pasta, potatoes and fruit
• exercise, especially if it's intense or unplanned
• drinking alcohol

Sometimes there's no obvious reason why a low blood sugar level happens.

Very occasionally, it can happen in people who do not have diabetes.

Preventing a low blood sugar level

If you have diabetes, you can reduce your chance of getting a low blood sugar level if you:

• Check your blood sugar level regularly and be aware of the symptoms of a low blood sugar level so you can treat it quickly.
• Use a continuous glucose monitor (CGM) or flash monitor to see how your blood sugar levels are changing. Ask your diabetes care team about getting a monitor if you do not already have one.
• Always carry a sugary snack or drink with you, such as glucose tablets, a carton of fruit juice or some sweets. If you have a glucagon injection kit, always keep it with you.
• Do not skip meals.
• Be careful when drinking alcohol. Do not drink large amounts, check your blood sugar level regularly, and eat a carbohydrate snack afterwards.
• Be careful when exercising; eating a carbohydrate snack before exercise can help to reduce the risk of a hypo. If you take some types of diabetes medicine, your doctor may recommend you take a lower dose before or after doing intense exercise.
• Have a carbohydrate snack, such as toast, if your blood sugar level drops too low while you're asleep (nocturnal hypoglycaemia).

If you keep getting a low blood sugar level, talk to your diabetes care team about things you can do to help prevent it.

POSTER

Burns are tissue damage from hot liquids, the sun, flames, chemicals, electricity, steam and other causes.

Major burns need emergency medical help. Minor burns can usually be treated with first aid.

When to seek emergency care

Call 112 or seek immediate care for major burns, which:

• Are deep, involving all layers of the skin
• Cause the skin to be dry and leathery
• May appear charred or have patches of white, brown or black
• Are larger than 3 inches (about 8 centimeters) in diameter
• Cover the hands, feet, face, groin, buttocks or a major joint, or encircles an arm or leg
• Are accompanied by smoke inhalation
• Begin swelling very quickly

Electrical burns, including those caused by lightning, and major chemical burns need emergency medical care. A minor burn might need emergency care if it affects the eyes, mouth, hands or genital areas.

Treating major burns

Until emergency help arrives:

• Protect the burned person from further harm. If you can do so safely, make sure the person you're helping is not in contact with the source of the burn. For electrical burns, make sure the power source is off before you approach the burned person. Don't try to remove clothing stuck in the burn.
• Make certain that the person burned is breathing. If needed, begin rescue breathing if you know how.
• Remove jewelry, belts and other tight items, especially from the burned area and the neck. Burned areas swell quickly.
• Cover the burn. Loosely cover the area with gauze or a clean cloth.
• Raise the burned area. Lift the wound above heart level if possible.
• Watch for signs of shock. Signs and symptoms include cool, clammy skin, weak pulse and shallow breathing.

Treating minor burns

For minor burns:

• Cool the burn. Hold the area under cool (not cold) running water for about 10 minutes. If the burn is on the face, apply a cool, wet cloth until the pain eases. For a mouth burn from hot food or drink, put a piece of ice in the mouth for a few minutes.
• Remove rings or other tight items from the burned area. Try to do this quickly and gently, before the area swells.
• Don't break blisters. Blisters help protect against infection. If a blister does break, gently clean the area with water and apply an antibiotic ointment.
• Apply lotion. After the burn is cooled, apply a lotion, such as one with aloe vera or cocoa butter. This helps prevent drying and provides relief.
• Bandage the burn. Cover the burn with a clean bandage. Wrap it loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain and protects blistered skin.
• If needed, take a nonprescription pain reliever, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others).

1. Panic Attacks

Panic attacks are brief episodes of intense fear or anxiety that can last between 5 and 20 minutes. They develop quickly and can be triggered by various situations or personal problems. According to the DSM-V, they are characterized by the temporary presence of intense discomfort.

2. Differences between Anxiety Attacks and Panic Attacks

Panic attacks do not have a specific trigger and are diagnosable, while anxiety attacks are not recognized as a formal diagnosis. Panic attacks are sudden and can occur without warning.

3. Symptoms of Panic Attacks

Symptoms can vary between individuals but include:

• Tension, agitation, or nervousness.
• Sense of impending doom.
• Increased heart rate and rapid breathing.
• Excessive sweating.
• Fatigue or weakness.
• Difficulty concentrating.
• Chest pressure and headache.
• Uncontrollable crying and stomach discomfort.
• Fear of losing control or dying.

4. When to Consult a Professional

It is recommended to seek professional help if:

• The worry affects all aspects of life.
• The attacks are frequent and difficult to control.
• You feel depressed or have increased substance use.
• They are related to physical or mental health problems.

5. Causes of Panic Attacks

The causes are multifactorial and include:

• Physical illnesses (diabetes, respiratory problems).
• Substance withdrawal.
• Stress and significant life changes.
• Genetic factors and family history.
• Traumatic experiences.

6. Complications of Panic Attacks

Frequent attacks can lead to:

• Depression and substance abuse.
• Sleep and intestinal problems.
• Social isolation and low quality of life.
• Suicidal ideation.

7. Risk Factors

Risk factors include:

• Childhood or adulthood traumas.
• Stress from serious illnesses.
• Personality prone to anxiety.
• Family history of anxiety disorders.

8. Prevention of Panic Attacks

There is no exact way to prevent them, but measures can be taken such as:

• Seeking social support.
• Staying active and participating in enjoyable activities.
• Avoiding drug and alcohol use.

9. How to Act During Panic Attacks

Gaining control during panic attacks is challenging, but you can try implementing some of these tips:

• Stay in a calm place and close your eyes: Being in a place that inspires tranquility will help you calm down faster. Similarly, closing your eyes will reduce stimuli, which can also help calm you.
• Distract your attention by focusing on something different: During a panic attack, it can be helpful to count backward from 100 by threes or focus on a physical object.
• Visualize a place that makes you feel calm: Recall a landscape you liked and try to remember the sounds and sensations you felt there.
• Remind yourself that all signs and symptoms are a reaction to a non-threatening situation: Repeat in your mind that the reactions generated in your body do not represent any threat or danger; it is a situation that will pass shortly. This means setting a temporal limit.
• Try to control your breathing during the panic attack: If breathing is not controlled and hyperventilation occurs during the panic attack, there is an imbalance between CO₂ and oxygen. Therefore, it is crucial to control breathing during an attack.
• Practice the following exercise: Inhale through your mouth while counting to 4, noticing your abdomen and chest filling. Hold the air for a few seconds and then release it slowly. Pursing your lips as if blowing out a candle or breathing into a paper bag can also help.
• Relaxing your muscles can also help: Focus on your body and consciously release the muscles from your feet to your head.