Academiclinc OFA PPT V6 Jan 2022 (English) original.pdf

Evacuation Route
Office
Cabinets & Pantry
Classroom
Exit
Fire Escape
Staircase A
Fire Escape
Staircase B (At Lift
Lobby 1)

Health and safety briefing for
the learners
•Students shall observe one
metre space distancing
•Students to use hand sanitizer
before and after practical
•Students to scan QR code for
safe entry
•Students are to wear mask at
all times
•Those who are unwell/
surgery recently/pregnant
mother, should be certify fit
by a doctor before they
attend the class.
•Students are to take
temperature before and after
•Training centre ground
rules
•No eating and drinking in
the classroom
•TC contact 6747 4101
•No mobile phone to be use
when attending the course
•No video or photo taking
during the class
•Course eligibility: students
must be able to read and
write in the language, the
course that they are taking

Appeal Process & Assessment Criteria
In cases of Failure, Participants are to send
an email to the training director to appeal
to retake assessment
(To provide reasons of appeal)
Training Director would
evaluate and decide if the
reason of appeal is valid
Approved Disapproved
Participant would not be
allowed to retake
assessment
Participant would be
allowed to retake
assessment
Assessment Criteria
•Students must attend at least 75% of
the course
•100% on the compulsory modules –
CPR + AED/ Bandaging/Safety
•Total hours –23.5 hours (New)
•Total hours –17.5 hours-Refresher
•MCQ Questions must pass
32 out of 40 questions
•Only Upon passing both theory
assessment and practical
assessment then certificate will be
awarded
Appeal Process

OCCUPATIONAL
FIRST AID COURSE
Academiclinic Pte Ltd
Copyright ©Jan 22 V6 AcademiclincPteLtd.
Occupational First Aid Course

5
Chapter 1: Basic Principles & Practice of First Aid
Definition of First Aid
First Aid means giving emergency care or treatment to a
person who is injured or who has suddenly taken ill
before arrival of doctor, nurse or ambulance.
Aims of First Aid
•Preserve /Save life
•Promote recovery
•Prevent further injuries
•Access medical aid

6
Chapter 1: Basic Principles & Practice of First Aid
Roles & Responsibilities of an First Aider
The first-aider has 3 main responsibilities:
•Management of Casualty
•Maintenance of Treatment Record
•Maintenance of First-Aid Facilities
Management of Casualty
•Assess the situation without endangering himself
•Identify injuries; look out for mechanism of injury
•Give immediate First Aid Treatment
•Send casualty to doctor, hospital or home
•Responsibilities ends when the casualty is handed over
to medical personnel

Chapter 1: Basic Principles & Practice of First Aid
Universal Precautions of First Aid
The threat of communicable disease is a hazard in
performing first aid. Universal Precautions are steps to
protect first-aider from exposure to HIV, hepatitis B, and
other blood-borne germs when exposed to blood.
Rescuers should consider following Universal Precautions
as much as possible.

SN
Minimum Contents of
First-Aid Box
Uses
1Sterile adhesive dressingsApply to small cuts and grazes
2Crepe bandage 5 cm Give support to injured joints, secure
dressings in place, maintain pressure on
wounds, limit swelling3Crepe bandage 10 cm
4Absorbent gauze
Use as dressings, padding, or as swabs to
clean around wounds
5Hypoallergenic tape
Secure dressing or loose ends of
bandages
6Triangular bandages Folded as bandages or slings
7Scissors Cut bandages, or clothing
8
Chapter 1: Basic Principles & Practice of First Aid
First Aid Box Contents & Its Uses

SN
Minimum Contents of
First-Aid Box
Uses
8Disposable gloves
Use when dress wounds, or when handle
body fluids or other waste materials
9Safety pins Secure the end of bandages or sling
10Eye shield Protect injured eye
11Eye pad
Use for Minor eye injuries, small cuts on
eye lid
12Resuscitation mask
Prevent cross infection when giving
rescue breaths
13Sterile water or saline Flush wounds, skin abrasions
14Torch light Obverse pupils
Chapter 1: Basic Principles & Practice of First Aid
First Aid Box Contents & Its Uses –Cont’d

First-Aid Requirements in
Factories & Workplace
In Singapore the main piece of legislation governing
Occupational First Aid, Occupational Safety and Health is the:
•Workplace Safety And Health Act (WSHA)
•Workplace Safety And Health (First-Aid )Regulations
These Regulations cited as the Workplace Safety and Health
(First-Aid) Regulations 2006 and shall come into operation on
1
st
March 2006
WSH(First-Aid)(Amendment) Regulations 2011
Extend the coverage to ALL WORKPLACES, except for
hospitals and medical clinics
10
Chapter 2: First-aid Requirements in Factories & Workplace

WHY WSHA 2006?
20
th
APRIL
2004 –Nicoll
Highway
Collapse–4
Deaths
29
th
APRIL 2004
–Fusionpolis
–2 Deaths, 29
Injured
16
th
MAY 2004 –
One Raffles Quay
–Fall From Height
–2 Deaths
29
th
MAY 2004 –Fire on vessel
Almudaina at Keppel shipyard –7 Deaths
Total -15 Lives Lost In 4 Major Incidents
Total –83 Lives Lost, 3000 Injured, 93 Permanent Disability
Chapter 2: First-aid Requirements in Factories & Workplace

Three Principles of WSH Framework
1.Reduce Risk At Source -Emphasize the importance of good
Workplace Safety & Health Management System especially the
need for comprehensive Risk Assessments
2.Promote Industry Ownership of Standards and Outcomes -
Shift industry mindset from following the letter of the law to
taking responsibility of standards and outcomes. Moving from
compliant mode to ownership mode
3.Higher Penalties for poor Safety Management -Penalties must
be sufficient to reflect the cost of poor safety management and to
deter risk-taking Behaviour Moving away from stepped penalty
regime based on actual harm done to one based on potential
harm done
Chapter 2: First-aid Requirements in Factories & Workplace

13
Chapter 2: First-aid Requirements in Factories & Workplace
Workplace Safety & Health Act 2006
The new amended act includes:
1.Worker Responsibility Under WSHA
2.Penalty
3.Incident Report
4.Risk Assessment

14
Chapter 2: First-aid Requirements in Factories & Workplace
Requirements under WSH(First Aid) Regulation 2006
Components of Occupational First Aid Facilities
Thereare 3 major components :
•First Aider/s Training
•First Aid Box
•First Aid Room

Appointment of First-Aider
•Readily access First Aid Box/Container
•Appointed First Aider to be in-charge of first-aid box
•Every appointed First Aider shall be trained in first aid
treatment as may be approved by the Chief Inspector;
Retraining in first aid treatment may also be required
•Notice to display names of First Aider at every work
room/area
15
Chapter 2: First-aid Requirements in Factories & Workplace

16
Chapter 2: First-aid Requirements in Factories & Workplace
First Aider Training
•A person is considered as being trained if he
successfully completes an Occupational First Aid
Courseconducted by any recognizedinstitution
(http://www.mom.gov.sg/MOM/OHD/ar2002/pbp_industry.htm)
•First-aid certificatesare valid for 2 years only, the first
aider has to undergo a refresher course and be issued
with a new certificate

17
Chapter 2: First-aid Requirements in Factories & Workplace
Provision of First Aid Boxes
•Every first-aid box provided in a workplace shall —
be adequately equipped;
be properly maintained;
be checked frequently to ensure that it is adequately
equipped and that all the items in it are usable;
be clearly identified as a first-aid box;
be placed in a location that is well-lit and accessible;
and
be under the charge of a person appointed by the
occupier of the workplace.
•Nothing except appliances or requisites for first-aid shall
be kept in a first-aid box.

18
Chapter 2: First-aid Requirements in Factories & Workplace
First Aid Room
Factories with more than 500 personnel shall have and
maintained First Aid Room approved by Chief Inspector
(MOM)
•Provided for where there are 500 or more employees
•Large enough to accommodated a couch with space
•Provision for emergency lighting

19
Chapter 2: First-aid Requirements in Factories & Workplace
Special First Aid Room Requirement
Safe place for emergency evacuation and
availability of equipments e.g.
•Stretchers
•Wheelchairs
•Canvas sheet
•Bandages.etc
•Personal Protection Equipment(PPE) available
for First Aider
•Disposable gloves against cross infection
•Pocket mask/mouthpiece one way valve
during artificial respiration

20
Chapter 2: First-aid Requirements in Factories & Workplace
Number of First Aid Boxes
•Every workplace shall be provided with a sufficient
number of first-aid boxes.
•Where a workplace is located in a building, each floor of
the building shall be provided with a sufficient number of
first-aid boxes.

S/N Minimum Contents of First-Aid Boxes Quantity of Items
1Individually wrapped sterile adhesive dressings 40
2Crepe bandage 5cm 4
3Crepe bandage 10com 6
4Absorbent gauze (packets of 10 pieces) 15
5Hypoallergenic tape 2
6Triangular bandages 6
7Scissors 1
8Disposable gloves (pairs) 4
9Safety pins 6
10Eye shield 6
11Eye pad 6
12Resuscitation mask (one-way valve) 2
13
Sterile water or saline in 100 ml disposable containers
(only where tap water is not available)
3
14Torch light 1
21
Chapter 2: First-aid Requirements in Factories & Workplace

22
Chapter 2: First-aid Requirements in Factories & Workplace
Workplace with Toxic or Corrosive Substance
If the workplace has exposure to toxic or corrosive
substances, provision for suitable facilities is required for
emergency treatment for any personnel whom exposed to
toxic or corrosive substance, such as Quick Drenching or
Flushing system for personnel whom eyes/body may come
in contact with toxic or corrosive substance.

23
Chapter 2: First-aid Requirements in Factories & Workplace
Ratio Of First Aiders To The Number of Employees
Notice to display names of First Aider at every work room/area.
Every workplace must have sufficient numbers of First Aiders to
Cover for Each Shift.
Offences-occupier of a workplace who fail to ensure regulation
complied with in relation to the workplace ; or first-aider who
contravene regulation hall be guilty of an offences and shall be
liable on conviction to a fine not exceeding S$5000
Type of
Workplace
No. of Employee No. of First Aiders
Extend the
coverage to all
workplaces,
except for
hospitals and
medical clinics.
26 -100 One
More that 100
One for every 100
persons employed or less

24
Chapter 2: First-aid Requirements in Factories & Workplace
Category of offender Maximum fine
Maximum
imprisonment
Conditions
Individual persons $ 200,000 2 years
Either or
both
Corporate body $ 500,000
Workers for failure to use
personal protective equipment or
misuse of any safety appliance.
a.1
st
conviction-$1,000
b.2
nd
subsequent
conviction-$2,000
General Penalties For Offences
Category of offenderMaximum fine
Maximum
imprisonment
Conditions
Individual persons$ 400，000 2 years Either or both
Corporate body $ 1 million 2 years Either or both
Repeat offenders for a 2
nd
or subsequent conviction for the same
offences that causes the death of another persons
REPORT –MOM hotline : 63171111

Failure To Comply with Remedial Order or Stop Work Order
25
Chapter 2: First-aid Requirements in Factories & Workplace
Category of offender Maximum fine
Maximum
imprisonment
Conditions
Person who fails to comply
with a Remedial Order
If offence is continued
after conviction
$50,000
Additional fine of $5,000 for
each day the offence continues
12months
Either or
both
Person who fails to comply
with a Stop Work Order
If the offence is continued
after conviction
$500,000
Additional fine of $20,000 for
each day the offence continues
12months
Either or
both

26
Anatomy & Physiology of Circulatory System
Chapter 3: Managing Wounds, Bleeding & Shock

27
Chapter 3: Managing Wounds, Bleeding & Shock
Types of Bleeding –Arterial
Arterial Bleeding –bright red, spurting blood
from a wound.
The blood is bright red because it is rich in
oxygen.
As the patient’s blood pressure decrease, the
spurting may decrease. (a late sign of shock
or hypoperfusion)

28
Chapter 3: Managing Wounds, Bleeding & Shock
Types of Bleeding –Venous
Venous Bleeding —dark red blood that flows
steadily from a wound.
blood is dark red in color, it is depleted of
oxygen. (deoxygenated)
Venous bleeding may be profuse, but it is
usually easier to control than arterial
bleeding because of its lower blood pressure.

29
Chapter 3: Managing Wounds, Bleeding & Shock
Types of Bleeding –Capillaries
Capillaries Bleeding —is usually the result of an
abrasion also known as a scrape. The bleeding
is usually slow and oozing due to their small size
and low pressure.
The colour of capillary bleeding can be bright
red or darker red depending on the amount of
oxygen it is carrying.
Majority of capillary bleeding is easy to control.
But it has higher risk of infection due to
contaminants becoming embedded in the skin

30
Chapter 3: Managing Wounds, Bleeding & Shock
Management of Bleeding from Common Sites
•Apply DIRECT PRESSURE on the wound.
•Use clean or sterile dry gauze pads.
•If bleeding continues, and if you do not
suspect a fracture, ELEVATEthe wound
above the level of the heart and continue
to apply direct pressure.
•If bleeding cannot be controlled, the next
step is to apply PRESSURE at a PRESSURE
POINT.
•The final step in control bleeding is to
apply a PRESSURE BANDAGE over the
wound.

31
Contusion
Types of Wounds
Crush
Chapter 3: Managing Wounds, Bleeding & Shock

32
Chapter 3: Managing Wounds, Bleeding & Shock
Contusion (bruise) Wound
Cause by a blunt blow that rupture capillaries
Severe contusion may damage structure-fracture
Apply cold compress to minimize bleeding
Seek medical attention unless minor injuries

33
Chapter 3: Managing Wounds, Bleeding & Shock
Laceration
Ripping force ,resulting in tearing
or laceration
Often contaminated and risk of
infection is high
Control bleeding with direct
pressure
Seek medical attention

34
Chapter 3: Managing Wounds, Bleeding & Shock
Incisedwound
Clean cut cause by eg. knife, broken glass
Blood vessels, tendons may be cut -profuse bleeding
May also cut underlying tissues
Control bleeding
Seek medical attention
Stitching often required

35
Chapter 3: Managing Wounds, Bleeding & Shock
Puncture wound
Stepping on a nail, being stabbed
or gunshot
May cause deep track of internal
damage and Risk of infection is
high
Do notremove impaled object
Removal of impaled object
should be done only in hospital

36
Chapter 3: Managing Wounds, Bleeding & Shock
Abrasion (graze)
Result from a sliding fall or a friction burn
Superficial wound, which top layers of
skin are scraped off, leaving a raw and
tender area
Often embedded with dirt that may result
in infection
Remove debris
cover wound with dry gauze dressing (not
cotton wool)

37
Chapter 3: Managing Wounds, Bleeding & Shock
When part of the body has been crushed and
there is bruising of the surrounding tissues,
e.g. from a hammer or spanner blows, or blow
from a blunt object.
Crush

38
Chapter 3: Managing Wounds, Bleeding & Shock
Ripping force resulting in
tearing of skin
Skin and underlying tissue
torn off or left dangling
Seek medical attention
immediately
Avulsion

39
Chapter 3: Managing Wounds, Bleeding & Shock
Amputation
Body part is cut off or torn off
completely
Do not attempt to save body
part first
Control bleeding. Take all
amputated parts to the
doctor
Preserve amputated body
parts correctly

Proper care of the amputated
part is vital to successful
replantation
Care of Amputated Part
40
Chapter 3: Managing Wounds, Bleeding & Shock
Wrap amputated part in
dry, sterile gauze to
absorb moisture.
Put wrapped amputated
body part in a clean
plastic bag.
Place bag with the
wrapped part in an other
bag/pail of ice.

41
Chapter 3: Managing Wounds, Bleeding & Shock
Embedded Foreign Body
Figure A:
Use bulky dressing to support
an embedded object.
Figure B:
Use bandages over the
dressing to control bleeding.

42
Chapter 3: Managing Wounds, Bleeding & Shock
Penetrating Chest Wound
Do not remove or move the
impale object.
Call Ambulance 995.
Place gauze pads or ring pad
without moving the object.
Secure dressing with triangular
or crepe bandage.
Check vital signs.

43
Chapter 3: Managing Wounds, Bleeding & Shock
Penetrating Abdominal Wound
Exposing the wound will lead to
infection
Cover wound with clean dressing
which is wet.
Call ambulance 995
Keep checking vital signs
Do not attempt to replace organs

44
Chapter 3: Managing Wounds, Bleeding & Shock
•DO NOT assume that a minor wound is clean because
you can’t see anything inside, wash it.
•DO NOT breath on an open wound.
•DO NOT clean a large wound-this may cause even
more bleeding.
•DO NOT probe or retrieve debris from a wound.
•DO NOT push exposed body parts back in and cover
them with clean material.
•DO NOT try to clean a major wound after the bleeding
is under control
•Call Immediately for emergency medical assistance
Wound Management-Remarks

45
Chapter 3: Managing Wounds, Bleeding & Shock
Management of Shock
Shock-Serious condition that occurs when the
cardiovascular system is unable to supply
enough blood flow to the body.

46
Chapter 3: Managing Wounds, Bleeding & Shock
Cause of Shock
•Bleeding –hypovolemic shock when the casualty loose
2 litres of blood volume
•Dehydration–hypovolemic shock
•Heart attack/ failure –cardiogenic shock
•Infections –septic shock
•Spinal injuries/ head injuries –neurogenic shock
•Allergy –anaphylactic shock

47
Chapter 3: Managing Wounds, Bleeding & Shock
Anxiety
Cyanosis
Confusion
Cool, clammy skin
Low blood pressure
Pale
Profuse sweating
Rapid pulse
Shallow breathing
Unconsciousness
Weakness
ShockRecognition

48
Chapter 3: Managing Wounds, Bleeding & Shock
Management of Shock
Try to determine the underlying cause of shock
Give appropriate First Aid treatment for any wounds,
injuries or illness
Keep the person warm & comfortable. Loosen tight
clothing. Don’t give the victim anything to drink or eat
Place the victim in the shock position by laying the
victim on the back & elevating the lower extremities
about 8-12 inches
Keep checking vital signs

49
Chapter 3: Managing Wounds, Bleeding & Shock
Bites and Stings
•Bee & wasp stings
•Dog and cat bite
•Snake bite

50
Chapter 3: Managing Wounds, Bleeding & Shock
•Some people are allergic to stings
and can develop difficulty in
breathing fromanaphylactic shock
•Stings in the mouth and throat can
cause swelling that may obstruct the
airway.
•Multiple stings can result in death
Bee And Wasp Stings
Bee and wasp stings are painful rather
than dangerous, with these exceptions:

51
Chapter 3: Managing Wounds, Bleeding & Shock
•If the stinger is in the wound (this applies to a bee sting
but not a wasp sting), flick it out with the edge of a credit
card or knife edge
•Apply a cold compress to relieve pain
•Advise the casualty to see his doctor if the pain and
swelling persist
•For a sting in the mouth: give the casualty ice tosuck or
cold water to sip; get medical attention

52
Chapter 3: Managing Wounds, Bleeding & Shock
Allergy Management
Help the victim out of the environment
immediately
Assist casualty with their own medications.
Encourage them to see a doctor if the
condition is mild.
Shortness of breath if it occurs,
Call Ambulance 995
Check if the casualty carry an Epi-pen
Assist and allow him to jab on his own
*Epi-pen contains Epinephrine that acts quickly to
improve breathing, stimulate the heart, raise a
dropping blood pressure, reverse hives, and reduce
swelling of the face, lips, and throat.

53
Chapter 3: Managing Wounds, Bleeding & Shock
Jellyfish & Other Marine Stings
Venom is contained in special stinging cells
of the jellyfish(nematocysts) that stick to
the skin. The aim is to inactivate the
stinging cells before they release their
venom.

54
Chapter 3: Managing Wounds, Bleeding & Shock
Jellyfish & Other Marine Stings
•Sit the patient down. Pour copious
amounts of vinegar or sea water to
stop the stinging cells from releasing
venom
•Dust a dry powder over the affected
skin. The stinging cells may stick to the
powder
•Brush off the powder with a clean pad
•Monitor the casualty for difficulty in
breathing.

55
Chapter 3: Managing Wounds, Bleeding & Shock
Dog And Cat Bites
For superficialbite
•Wash wound with soap
•Pat wound dry with gauze
•Cover with dressing
•Seek medical attention

56
Chapter 3: Managing Wounds, Bleeding & Shock
•Control bleeding by applying
direct pressure and raising the
injured part
•Cover wound with sterile
dressing or a clean pad and
bandage
•Make arrangement to take or
send casualty to hospital
Dog and Cat Bites

57
Chapter 3: Managing Wounds, Bleeding & Shock
COBRA
MANGROVE SNAKE BANDED KRAIT SNAKE
SHORE PIT VIPER
SEA SNAKE

58
Chapter 3: Managing Wounds, Bleeding & Shock
•Cobra, krait –produces a neurotoxin –causes paralysis of
muscles: drooping of eyelid, double vision, difficulty of
swallowing, difficulty in breathing
•Viper –produces anticoagulant –causes bleeding in
tissues and organs: swelling, discoloration of tissues,
bleeding from site of bite
•Sea snake –produces muscle toxin –causes muscle pain
and bloody urine within 2 hours
Snake venoms

59
Chapter 3: Managing Wounds, Bleeding & Shock
How to recognise bite is poisonous?
•Look for fang marks (pair of puncture marks)
•Symptoms that may suggest poisoning:
Redness and swelling, oozing of blood (viper)
Nausea and vomiting, labored breathing and
disturbed vision (cobra, krait)
Muscle aches and blood in urine (sea snake)

60
Chapter 3: Managing Wounds, Bleeding & Shock
In Case of A Snake Bite
1.Don’t panic, otherwise the higher blood circulation will
spread the venom faster into the blood stream.
2.Don’t suck the wound and Don't apply tourniquet
3.Immobilize the bitten area and keep it lower than the
heart. Apply a pressure bandage, wrapped above the bite
to help slow the venom. Apply the bandage tight enough,
that the artery will be compressed. Every 10-15 minutes
loosen the bandage for about 5 seconds and don’t put it
on longer than 90 minutes.
Cont’d

61
Chapter 3: Managing Wounds, Bleeding & Shock
In Case of A Snake Bite(Cont’d)
4.Call 995for anambulance (Emergency Ambulance Service),
tell them it’s a snake bite and, if possible, give them a
detailed description about how the snake looked like.
There are four clinics in Singapore, which provide antivenin
•National University Hospital国大医院 6779 5555
•Tan Tock Seng Hospital陈笃生医院 6256 6011
•Singapore General Hospital中央医院 6222 3322
•Alexandra Road Hospital亚历山大医院6472 2000

62
Chapter 3: Managing Wounds, Bleeding & Shock
Type of Bandages Available
Triangular Bandages–made of cloth,
it’s valuable in emergency bandaging
since it’s quickly and easily applied,
stays on well and can be improvised
from any other pliable material of
suitable size
The triangular bandage is used to:
•Temporary or permanent bandaging of wounds
•Immobilization of factures and dislocations
•As a sling for the support of an injured part of the body

63
Chapter 3: Managing Wounds, Bleeding & Shock
Type of Bandages Available
Roller Bandages–consists of a long strip
of material (usually gauze, muslin, flannel,
or elastic), it comes in various widths and
lengths.
The roller bandage is used to:
•Hold dressing in place
•Support an injured part
•Create pressure for control of bleeding
and limit swelling
•Secure a splint to an injured part in order
to immobilize it

64
Chapter 3: Managing Wounds, Bleeding & Shock
General Principles of Bandaging
•Always reassure the casualty before applying bandage,
explain the procedure clearly, and help the casualty to sit
or lie down in comfortable position.
•Support the injured part of the body while applying
bandage.
•Never apply a bandage directly over a wound, it should be
used to hold in place the dressing which covers a wound.
•Apply bandages firmly and fastened securely, but not so
tightly that it interfere with circulation to the area beyond
the bandage.
•Cover entire dressing to minimize possibility of infection.

65
Chapter 3: Managing Wounds, Bleeding & Shock
General Principles of Bandaging –Cont’d
•Fingers or toes should be left exposed if possible, to enable
circulation check afterwards.
•Use reef knots to tie bandages. Ensure the knots do not
cause discomfort.
•Tuck in all loose ends. Loose ends may get caught on
objects and pull the dressing off.
•Check the circulation in the area beyond the bandage.

Apex
Base
End End
66
Chapter 3: Managing Wounds, Bleeding & Shock
Techniques of Bandaging
Triangular Bandage
Making a Broad Bandage & Narrow Bandage

67
Chapter 3: Managing Wounds, Bleeding & Shock
Reef Knots
Tying a reef knot
1.Take an end of bandage in each hand and lay the
left hand one over the right
2.Using the right hand, take the end from the left
down behind the other end and up to the front
again
3.Point both ends inward again, lay the right hand
one over the lefthand, then take it down behind it
and up to the front through the loop
4.Pull the knot tight
Untying a reef knot
Pull one end and one piece of bandage from the same
side of the knot firmly till bandage straightens.
Hold the knot and pull the straightened end
through it.

68
Chapter 3: Managing Wounds, Bleeding & Shock
Arm Sling
Arm Sling provides support for an injured upper arm,
forearm, wrist on a casualty that able to bent the elbow, or
to immobilise the arm for a rib fracture. It holds the forearm
in a slightly raised or horizontal position.

69
Chapter 3: Managing Wounds, Bleeding & Shock
Elevation Sling
Elevation sling supports the forearm and
hand in a raised position ( with casualty’s
fingertips at the shoulder). It used to support
the arm on the injured side shoulder, it also
helps to control bleeding from the wounds in
forearm or hand and minimise swelling

70
Chapter 3: Managing Wounds, Bleeding & Shock
Roller Bandage
Caution
•Choosing suitable width for the injured area
•Start from below the injury, working from the
inside of the limb outwards, and secure the
tails of the roll with 2 or 3 straight turns
•Wind the roller bandage in spiraling turns
form inner to the outer side of the injured
limb and work up the limb
•Apply the bandage evenly and firmly by cover
½ or 2/3 of the previous layer
•Secure the end of bandage
•Check the circulation in the limb beyond the
bandage
Copyright ©2013 Accredited First Aid Pte Ltd Pte
Lt.
Occupational First Aid Course

71
Chapter 3: Managing Wounds, Bleeding & Shock
Bandaging Hand & Foot

72
Chapter 3: Managing Wounds, Bleeding & Shock
Bandaging Eye
Caution
•Do not try to remove any object which is
penetrating the eye
•Do not apply pressure when bandaging the
eye

73
Case Scenarios
Chapter 3: Managing Wounds, Bleeding & Shock
Part One
A worker’s right hand was crushed by a
heavy metal box, finger is amputated. Blood
is spurting out and colour is bright red.
As a first aider, Which type of bleeding is
this? And how do you react?
Part Two
His pulse is weak, 120 beats per minute, his
breathing is 35 beats per minute and very
shallow, he become unconscious and skin is
cool and pale.
What condition this work may developed?
And how do you react?

74
Chapter 4: Managing Fractures & Soft Tissue Injuries
Musculoskeletal
System

75
Chapter 4: Managing Fractures & Soft Tissue Injuries
Fracture
Definition
Fracture is a complete or partial breakage of
the bone.
Close fractureComplicated fractureOpen fracture

76
Chapter 4: Managing Fractures & Soft Tissue Injuries
•A visibly out-of-place limb or joint
•Swelling
•Intense pain
•Bruising
•Numbness and tingling
•Bleeding
•bone protruding
•Limitation of movement
Signs & Symptoms of Fracture & Dislocation

77
Chapter 4: Managing Fractures & Soft Tissue Injuries
Management of Common Fractures -Skull
•History of head trauma, falls, automobile accidents, sports,
physical assault
•Visible deformity, deep laceration or severe bruise to the
scalp; Bleeding/clear fluid from nose /ear; Unequal pupils;
Loss of smell/sight; Unconsciousness
Call 995 for an ambulance
Immobilized the head & neck
Perform Primary Survey-DRSABC
Control bleeding
Treatment for shock
Perform CPR if casualty is not breathing

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Chapter 4: Managing Fractures & Soft Tissue Injuries
Management of Common Fractures -Lower Jaw
•Motor vehicle accidents, assault, sports injuries, falls
•Jaw pain; numbness of chin/lower lip; bleeding in the
mouth; malocclusion of teeth; unable to open jaw; facial
swelling/bruising; difficulty speaking
Call 995 for an ambulance/send casualty to
hospital
Help casualty to sit with head forward to
drain fluids from the mouth
Apply bandage to hold firmly against his jaw
Perform Primary Survey-DRSABC

79
Chapter 4: Managing Fractures & Soft Tissue Injuries
Management of Common Fractures -Collar Bone
•History of fall on outstretched hand
•Pain, swelling and deformity
•The casualty supports the elbow on the
injured side to relieve pain
•Head inclined to injured side
Elevation sling with broad bandage across

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Chapter 4: Managing Fractures & Soft Tissue Injuries
Management of Common Fractures -Upper Arm
•History of fall directly on to the shoulder or on to the
outstretched hand
•Pain and swelling
•Difficulty in raising the arm
Ask casualty to support injured arm
Immobilize with large arm sling
Secure limb to chest with broad bandage

81
Management of Common Fractures -Forearm
•History of fall directly on to the
outstretched hand; sports; motor vehicle
accident
•Pain, swelling, deformity of forearm
Ask casualty to support injured arm
Immobilize with large arm sling
Secure limb to chest with broad bandage
Chapter 4: Managing Fractures & Soft Tissue Injuries

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Chapter 4: Managing Fractures & Soft Tissue Injuries
Management of Common Fractures -Wrist
•History of fall on outstretched hand
•Pain, swelling and deformity
Support injured arm in a large arm sling
Seek medical attention

83
Chapter 4: Managing Fractures & Soft Tissue Injuries
Management of Common Fractures -Finger
•History of fall; traffic accident; sports
•Severe pain, swollen, deformity; inability to
move injured finger
Ask casualty to sit down, support and raise
the injured side hand.
Control bleeding and apply bandage to
wounds
Splint the broken finger to one or more
unbroken fingers (Buddy Tapping)
Elevation sling with broad bandage across

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Chapter 4: Managing Fractures & Soft Tissue Injuries
Management of Common Fractures -Lower limbs
•History of fall or direct force from a road traffic accident
•Severe pain and inability to stand
•The foot is turned outwards
Gently straighten injured leg
Apply traction to injured leg at the ankle and bring the
sound leg alongside it
Slide bandages below knees and ankles
Place padding between thighs, knees and ankles
Tie bandages round ankles, knees, above & below
fracture side

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Chapter 4: Managing Fractures & Soft Tissue Injuries
Management of Common Fractures -Pelvis
•Motor vehicle accident; fall; crush
accident
•Pain, swollen, bruise and deformity
of pelvis; Numbness/tingling at
genital area or upper thigh
•Discrepancy of the length of legs
Call 995 for an ambulance, it is life threatening
Slide bandages below knees and ankles; Place padding
between thighs, knees and ankles
Tie bandages round ankles, knees to immobilize the legs
Perform Primary Survey-DRSABC, CPR when needed

86
Management of Neck/Spinal Injuries
Call ambulance 995
Reassure casualty help is on the way
Tell him or her not to move; do not move casualty unless
in danger
Keep and support neck in a neutral position-can also
make use of a cervical collar
Move or turn patient in “one piece”-e.g. log roll on to a
stretcher, recovery position
Chapter 4: Managing Fractures & Soft Tissue Injuries

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Chapter 4: Managing Fractures & Soft Tissue Injuries
Signs & Symptoms of Soft Tissue Injuries
Strain
A Strain is an over stretching
and /or tearing of muscle or
tendons attached to the
muscle.
Sprain
A Sprainis the over-stretching
and / or tearing of ligaments
of a joint.

88
Chapter 4: Managing Fractures & Soft Tissue Injuries
Managing Soft Tissue Injuries -R.I.C.E. Procedure

89
Chapter 4: Managing Fractures & Soft Tissue Injuries
Practice on
Bandaging & Splinting

Fireman’s lift
90
Chapter5: Handling & Transportation of the Injured
Demonstration of Transportation Techniques
One Man Carry
Cradle Drag and Carry
Pick-A-BackHuman crutch

91
Chapter5: Handling & Transportation of the Injured
Two Man Carry: Fore & After Carry

92
Chapter5: Handling & Transportation of the Injured
Practice on
OneManCarry

93
Chapter 6: CPR & Use of AED
Heart

94
Five links of the Chain of Survival
Chapter 6: CPR & Use of AED

95
Five links to the Chain of Survival
1
st
Link
Early
Access
getto the
Cardiac
Arrest
casualty and
call for an
ambulance or
other medical
assistance.
2
nd
Link
Early CPR
performed by a
trained rescuer
for a casualty
who is in
Cardiac Arrest.
3
rd
Link
Early
Defibrillation
is the application
of electrical shock
to help restore the
heart’s regular
rhythm.
4th
Link
Ambulance
Quick response
by the ambulance
5th
Link
Early ACLS
Advance Cardiac Life
Support –
Action taken by
ambulance
paramedics or
doctors who
administers
specific drugs to
the casualty
which
stimulates the
casualty’s heart
Chapter 6: CPR & Use of AED

96
Chapter 6: CPR & Use of AED
Cardiac Condition
•Angina chest pain
•Heart attack—Acute
Myocardial Infarction

97
Chapter 6: CPR & Use of AED
Angina Chest Pain
•Blood flow is reduced due to
arteriosclerosis
•Inadequate blood supply during
tension/exertion
Recognition
•Chest discomfort or pain which may
radiates to neck, jaw, arms or shoulders
•Pale, cold clammy skin
•Shortness of breath
•Distress anxiety

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Chapter 6: CPR & Use of AED
Angina Chest Pain Management
•Rest and reassurance
•Place casualty in comfortable position
•Assist casualty with medication (GTN)）
•Provide Oxygen if available
•Urgent medical aid
•Be prepared for sudden cardiac arrest
•CPR

99
Chapter 6: CPR & Use of AED
Cardio Pulmonary Resuscitation(CPR)

100
Chapter 6: CPR & Use of AED
Principle of Cardio Pulmonary Resuscitation(CPR)
DRS ABC
•Danger -is there any danger?
•Response -is the casualty responsive?
•Shout-if unresponsive, shout for help
•AED –Bring AED
•Breathing -is the casualty breathing?
•Compression–if no breathing, start chest compression

Commence CPR -Perform
Chest Compression
* Define carotid pulse and normal
breathing within 10seconds-For
Trained Healthcare Providers Only
Check breathing by looking at
the chest
Shout:" Help! Call 995for an
ambulance! Get AED!"
(Active EMS)
Tap victim‘s shoulder firmly;
ask loudly:“ Hello! Hello! Are
you ok? ”
Ensure safety for rescuer and
victim
Danger
Responsiveness
No
Shout for Help
AED
Breathing
No
Chest
Compression
Yes
Recovery
Position
Yes
Check for Other
Injuries
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Chapter 6: CPR & Use of AED

102
Chapter 6: CPR & Use of AED
Universal Precautions
•Wash hands before and after each medical procedure
•Wear gloves whenever there is a possibility of coming
in contact with blood or other potentially infectious
materials (body fluids and tissues)
•Wear facemask and eye protection whenever there is
a possibility of blood splashing into the rescuer’s face
•Use resuscitation mask to perform mouth-to mouth
resuscitation to the casualty
•Dispose of all contaminated sharp object in an
appropriate puncture-proof container
•Dispose of all contaminated Personal Protective
Equipments(PPE) in an appropriate biohazard
container

1)D-Danger
Check / survey the scene for danger
before approaching casualty.
2)R-Response
Establish unresponsiveness
•Tap or gently shake the victim’s shoulder
•Shout “Are you okay, are you alright?”
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Chapter 6: CPR & Use of AED
One Man Cardio Pulmonary Resuscitation(CPR)

104
Chapter 6: CPR & Use of AED
3)S-Shout for Help
If unresponsive,
•Shout for help, call 995 for ambulance,
get first aid box and Automated
External Defibrillator (AED) if there is
one within 1 minute walking distance
•If there is an other person, ask him/her
to call 995 for ambulance, get first aid
box and AED
•Position victim on his back as a unit
supporting the head and neck. Victim
must be supine and on a flat firm
surface

105
Chapter 6: CPR & Use of AED
4)A-AED
5)B-Breathing
•Look at the rise and fall of the chest

106
Chapter 6: CPR & Use of AED
6)C -Chest Compression
If unsure of the presence of normal
breathing within 10 seconds, start
chest compressions/CPR.
Continue performing CRP until medical
assistanceor AED arrives and ready to
takes over, or victim starts moving.

107
Chapter 6: CPR & Use of AED
Chest Compression Landmark
Place index finger
beside middle
finger.
Remove hand from
forehead & place
hand beside tow
fingers.
(Lower half of
sternum)
Locate landmark for
chest compression.
Run middle finger
along bottom edge
of rib cage to center
of chest “notch”.
(Tip of sternum)

Chest Compression Techniques
•Remove two fingers and place hand
onto another,interlock both hand and
interlace fingers keep off the chest.
•Bring body forward & interlock elbow
•Compress vertically downwards for at
least 4 –6 cm, compression rate at
least 100 -120 per minute
•Count aloud:
1&2&3&4&5&; 1&2&3&4&10&; 1&2&3&4&15;
1&2&3&4&20;
1&2&3&4&25; 1&2&3&4&30
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Chapter 6: CPR & Use of AED

109
Chapter 6: CPR & Use of AED
•Maintain open airway, seal rescuer’s
mouth to victim’s mouth.
•Give 2 slow breathsso that the victim’s
chest just rises (1 second per breath with
400-600 ml of air)
•Observe chest rise
•Allow lung deflation between breaths
•Do not take more that 6 seconds to
perform the 2 ventilation
Mouth to Mouth Techniques (For healthcare worker only)
After each 30 chest compression, perform 2 mouth to mouth
rescue breathing; the ratio of chest compressions and rescue
breathing is 30:2

110
Chapter 6: CPR & Use of AED
30 Compression and 2 Breath is only one cycle,
Perform Cycles of CPR until:
•Medical assistance has arrived and ready to take over
•Automated External Defibrillator is ready
•Victim starts to moving

111
Chapter 6: CPR & Use of AED
Automated External Defibrillation
(AED)

112
Chapter 6: CPR & Use of AED
Introduction of Automated External Defibrillation
•AutomatedExternal Defibrillator(AED) are approved
method of reducing morbidity and mortality from
Sudden Cardiac Arrest.
•To provide a realistic chance of survival, defibrillation
must be administered within five minutes or soon after
Sudden Cardiac Death attacks a victim.
•Even non-medical person can effectively use AEDs to
revive a Sudden Cardiac Death victim.

113
Chapter 6: CPR & Use of AED
Features ofAED
•The AED is able to detect, analyze and
interpret the heart rhythm of the victim
and will prompt the operator through a
voice prompt or text message to whether
or not defibrillation is required
•Shockable rhythm is usually VF
•Non-Shockable rhythm is usually asystole
or NSR

114
Chapter 6: CPR & Use of AED
Indication for using AED
Important criteria must be established before using the AED,
ONLY use the AED if the victim is:
•Unresponsive to verbal and physical stimulation.
•NObreathing.
•NO pulse or signs of circulation (coughing, consciousness,
movement, breathing)
If it is not witnessed collapse, perform CPR until AED is ready.

115
Chapter 6: CPR & Use of AED
Dangers & Safety Precautions for AED Operation
•Exclude AED Danger (Gas, Water, Metal)
–Ensure there is no flammable gas nearby
–Ensure surface is not wet
–Ensure victim is not lying on any metal
•Defibrillation Danger
–Ensure no one is touching the victim before defibrillation
•Use Pediatric Defibrillation pad
–For child aged 1 to 8 years old
–For those below 25 kg

116
Chapter 6: CPR & Use of AED
SUDDENCARDIACDEATH
Singapore‘sSilentKiller
A Sudden Cardiac Death (also called sudden cardiac arrest)
as implied, occurs unexpectedly and usually happens out of
hospital.
SCA can be reversed if actions are taken during the first few
minutes of a critical emergency. Cardiac-Pulmonary
Resuscitation (CPR) may help to support the Heart and
Lungs to function.
SCA is most often caused by an abrupt loss of heart function
caused by sudden chaotic rhythm. This is usually due to a
potentially fatal electrical rhythm dysfunction in the heart
called Ventricular Fibrillation.
The only effective treatment for VF is defibrillation
An electrical shock !

117
Chapter 6: CPR & Use of AED
Common Heart Rhythms -Normal Sinus Rhythm (NSR)
AED recognize NSRas a “Non shockable rhythm”
Normal ECG

118
Chapter 6: CPR & Use of AED
SCA Heart Rhythms -Ventricular Fibrillation (VF)
•A diseased heart, the ventricle can develop a highly chaotic
and disorganized electrical rhythm known as Ventricular
Fibrillation (VF). This results in a “quivering” of the ventricles.
•In this situation, the victim loses his pulse immediately. Rapid
defibrillation can stop VF and is the major determinant for
survival in a VF victim.
•AED detects and recognizes VF as a “Shockable rhythm”.
VF ECG

119
Chapter 6: CPR & Use of AED
SCA Heart Rhythms -Asystole (Flat Line)
•The heart does not have any electrical activity and has
stopped pumping.
•VF will degenerate into Asystole when not treated.
•AED detectsAsystole and recognizes as a “Non shockable
rhythm”.
Asystole

120
Chapter 6: CPR & Use of AED
The Importance of Early Defibrillation

121
Chapter 6: CPR & Use of AED
Chest Preparation
•Remove clothing from the victim
chest
•Remove jewellery away from the
path between the two pads
•Shave Very Hairy Chest, if
necessary
•Dry Wet Chest
•Remove Medication Patches
•Place pads at least 4 fingers
breadths away form Pacemaker
•Ensure pads are place in the
correct position on the exposed
chest.

122
Chapter 6: CPR & Use of AED
Electrode Pads Placement
•Place one pad to the right below the
collar bone
•Place the other pad below the left
nipple (female casualty-do not place
the pad over the breast)
•Ensure both defibrillation pads are
firmly attached by pressing gently over
center of the pad to ensure good
contact and around the edges for good
adhesion

123
Chapter 6: CPR & Use of AED
Breathing Present
Recovery
Position
NO
YES
Check
responsiveness
shake and shout
Open Airway
head tilt/chin lift
Check Breathing
look/listen/feel
Check
Danger
Chest Compressions
100/min. ratio 30:2
compressions to
Rescue Breaths
AED Danger
Chest Preparation
Stop CPR Analysing
Heart Rhythm
CPR for 1 minute
If Breathing absent,
Place victim to
Recovery position,
if Breathing present
Wait for Ambulance
Check breathing and
signs of
circulation
Shock
Advised
(VF/Pulseless VT)
Shock x 1 as necessary
No Shock
Advised
AED
Procedure

124
Chapter 6: CPR & Use of AED
Documentation
•Time of collapse
•Time of CPR
•Time of AED being applied
•Time of each shock and number of shock
•Time of Ambulance arrived
•Name of victim, AED & CPR Provider
•Which hospital is the victim going to

125
Chapter 6: CPR & Use of AED
Housekeeping-Stock Replenishment

126
Chapter 6: CPR & Use of AED
Complications in Relation to Techniques applied
CPR
•Rib fracture
•Distension of the stomach
•Laceration of the Liver
Defibrillation
•Skin Burns
•Injury to the heart muscles
•Abnormal heart rhythms
•Blood clots

127
Chapter 6: CPR & Use of AED
Practice on
Cardio Pulmonary
Resuscitation (CPR)
&
Automated External
Defibrillation (AED)

128
Chapter 7: Managing Breathing Difficulties
Anatomy & Physiology of Respiratory System
Basic Function of Respiratory System
Supply blood with oxygen through breathing

Normal Breathing Rates per Minute
Gaseous Exchange
129
Chapter 7: Managing Breathing Difficulties
Infant
•24-40per
minute
Child
•20-30 per
minute
Adult
•12-18 per
minute
Inspired Air
•21% oxygen
Expired Air
•16% oxygen
Oxygen
absorbed
•5% oxygen

130
Chapter 7: Managing Breathing Difficulties
Breathing Difficulties
Difficulty Breathing is labored breathing accompanied by an
unpleasant awareness of one’s own breathing. There are
many different causes for breathing problems, common
causes include:
•Airway Obstruction
(Choking)
•Asthma
•Being at a high altitude
•Fumes inhalation
•Lung disease
•Heart attack
•Heart disease
•Injury to the neck, chest or
lung
•Allergic reaction
•Respiratory infection
•Emotional distress

131
Chapter 7: Managing Breathing Difficulties
Signs& Symptoms of Breathing Difficulties
A person with breathing difficulty may have:
•Bluish lips, fingers and fingernails
•Chest moving in an unusual way as the person breathes
•Chest pain
•Confusion, light-headedness, weakness, or sleepiness
•Cough
•Mucus and phlegm
•Fever
•Gurgling, wheezing, or whistling breathing sounds

132
Chapter 7: Managing Breathing Difficulties
Management of Choking
Signs& Symptoms
•Cyanosis /blueness of skin colour
•Difficult in speaking
•Problem in breathing
•Clutching to neck (Universal Signs)

133
Chapter 7: Managing Breathing Difficulties
Casualty is
unconscious
Chest
Compression
Casualty suffers from fully
obstructed airway
(choking)
Abdominal Thrust /
Chest Thrust
Management of Choking

134
Chapter 7: Managing Breathing Difficulties
Abdominal / Chest Thrust
1.Ask casualty “Are you choking?”
2.Encourage casualty to cough harder
3.If coughing fails and casualty cannot speak,
perform abdominal thrust
4.If casualty is obese or pregnant, perform
chest thrust

135
Chapter 7: Managing Breathing Difficulties
Abdominal Thrust (Heimlich Manoeuvre)
1.If the victim is upright, the rescuer stands
behind the victim. If the victim is sitting or petit,
the rescuer should kneel down and position
behind the victim.
2.Put your arms around the victim’s abdomen
and locate victim’s navel.
3.Place 2 fingers’ breadth above the navel and
well below the tip of the tip of breast bone
( xiphoid process).

136
Chapter 7: Managing Breathing Difficulties
Abdominal Thrust (Heimlich Manoeuvre)
Cont’d
4.Make a fist with one hand, place the thumb-side
of the fist against the abdomen above the 2 fingers’
spacing
5.Lean the victim slightly forward and grasp the
fist with the other hand.
6.Apply 5 successive inward, upward thrusts with
both hands, each thrust should be forcefully
delivered. Check if foreign body is expelled
7.Repeat until the foreign body is expelled

137
Chapter 7: Managing Breathing Difficulties
ChestThrust
This techniques is used as an alternative for obese
or pregnant victims
1.If the victim is upright, the rescuer should stand
behind the victim. If the victim is sitting or petit,
the rescuer should kneel down and position
himself/herself behind the victim.
2.Place arms under the victim’s armpits, encircling
the chest.
3.Make a fist with one hand

138
Chapter 7: Managing Breathing Difficulties
ChestThrust -Cont’d
4.Place thumb-side of the fist on the middle of
the victim’s breast bone (sternum).
5.Grasp the fist with the other hand and give 5
successive and quick inward thrusts. Check if
foreign body is expelled.
6.Repeat until the foreign body is expelled.

Fumes Source Signs & Symptoms
Carbon
Monoxide
Motor vehicles exhaust
fume; fire smoke;
blocked chimney flues;
emission of defective
gas or paraffin heater
Prolong exposure to low level: headache;
confusion; aggression; nausea& vomiting;
incontinence
Brief exposure to high level: Grey-blue skin;
rapid, difficult breathing; impaired
consciousness; unconsciousness
Smoke Fires
Rapid, noisy & difficult breathing; coughing&
wheezing; burning in the nose/mouth; Soot
around the nose/mouth; unconsciousness
Carbon
Dioxide
Deep, enclosed spaces
Breathlessness; headache; confusion;
unconsciousness
Solvents
& Fuels
Glues; cleaning fluids;
lighter fuels; propane-
fuelled stoves
Headache& vomiting; impaired consciousness;
unconsciousness
139
Chapter 7: Managing Breathing Difficulties
Management of Fumes Inhalation

140
Chapter 7: Managing Breathing Difficulties
Management of Fumes Inhalation
•Call for help/dial 995 for an ambulance
•Do not attempt to rescue if it is likely to put your own life at risk
•If it is necessary to escape from the source of the fumes, help
the casualty away from the fumes into to fresh air
•Primary Survey (refer to Chapter 13)
•Support and encourage the casualty to breath normally and
treat other injuries
•Monitor the casualty's breathing& pulse while waiting for help

141
Chapter 7: Managing Breathing Difficulties
Management of Hyperventilation
Hyperventilation is a condition in which a person develops
an imbalance in the levels of oxygen and carbon dioxide in
the body. The victim starts to breath a faster rate than is
necessary.
Hyperventilation may result from a variety of
causes, including:
•Stress related to anxiety or fear
•Hysteria
•Panic attack

142
Chapter 7: Managing Breathing Difficulties
Hyperventilation Sign & Symptoms
•Shallow, rapid breathing
•Feeling of suffocation
•Fear and anxiety
•Dizziness
•Numbness or tingling of fingers and toes
•Claw-like spasm of the hand
Managing Hyperventilation
•Remain calm and offer reassurance, Encourage casualty to
breath slowly
•Explain that the symptoms will disappear when breathing
returns to normal
•Let him re-breath his own expired air

143
Chapter 7: Managing Breathing Difficulties
Management of Asthmatic Attack

144
Chapter 7: Managing Breathing Difficulties
What causes asthmatic attack?
•Weather changes
•Allergies
•Respiratory infection
•Exercise
Allergic reaction causing narrowing of airway
•Inflammation of bronchioles
•Mucus secretions
•Muscle spasms

145
Asthmatic Attack Recognitions
Severe attack
•Pale
•Distressed
•Breathless
•Inspired &
expired
wheeze
Very Severe attack
•Exhaustion
•Altered
responsiveness
•Cyanosis
•Speech difficulties
•No wheeze
•Collapse
Mild attack
•Cough
•Rapid
breathing
•Wheeze
•Rapid pulse
Chapter 7: Managing Breathing Difficulties

146
Management of Asthmatic Attack
•Primary survey (refer to chapter13)
•Reassurance
•Position of comfort sitting upright
•Bronchodilator medicine
•Medical aid(urgent if severe)
•Oxygen administration
•Perform CPR (refer to chapter 8) if casualty
is not breathing
Chapter 7: Managing Breathing Difficulties

Respiratory
Arrest
A condition in which breathing has stopped.
Brain dies if it has no oxygen for ONLY 4 -6
minutes
147
Chapter 7: Managing Breathing Difficulties
Management of Respiratory Arrest
Respiratory Arrest is caused by airway obstruction, decreased
respiratory drive, or respiratory muscle weakness, signs &
symptoms include:
•Absence of spontaneous breathing
•No chest rise and fall
•Progressive colour change due to lack of oxygen
•Unable to feel air coming from mouth & nose

148
Chapter 7: Managing Breathing Difficulties
Management of Respiratory Arrest
•Primary Survey –DRSABC (refer to
chapter13)
•Perform CPR (refer to chapter 8) if
casualty is not breathing
•Secondary Survey (refer to chapter13)
and place casualty in Recovery Position
(refer to chapter 8) if casualty have
spontaneous breathing
Chance of success
reduced 7-10%
each minute

149
Management of Drowning
•Call for help and get an ambulance
•Help the casualty to lie down with the
head lower than the rest of the body
•Keep the casualty warm, cover with dry
blanket or replace wet clothing with dry
clothes
•Primary survey(refer to chapter13) and
monitor the casualty's breathing & pulse
while waiting for help
•If the casualty is unconscious, perform
CPR(refer to chapter 8)
Chapter 7: Managing Breathing Difficulties

150
Chapter 7: Managing Breathing Difficulties
Practice on
Abdominal Thrust &
Rescue Breathing
Copyright ©2013 AFA Pte Ltd.
Occupational First Aid Course

151
Chapter 8: Managing Unconscious Casualties
Management of Heat Disorders
Some factors about temperature
•Normal body temperature is 36.9 C
•Tissue damage occurs if body temperature is more than
42.2C
•Temperature beyond 39C should be sponged and
medical attention sought
Three stages of progressive severity
•Heat cramps
•Heat exhaustion
•Heat stroke

152
Chapter 8: Managing Unconscious Casualties
•Stop all activity and sit in a cool place
•Drink enough water
•Seek medical attention if the cramps do
not subside in 1 hour
•Do not return to strenuous activity for a
few hours after the cramps subside
Heat Cramps

153
Chapter 8: Managing Unconscious Casualties
Heat Exhaustion
Severe tiredness due to loss of body fluid through
excessive sweating from strenuous activity. If the
person continues, heat stroke may result.
The warning signs include ：
•Heavy sweating
•Muscle cramps in legs, arms or abdominal wall
•Tiredness, weakness. Dizziness, headache
•Pale, clammy skin
•Rapid pulse and breathing
•Nausea or vomiting

154
Chapter 8: Managing Unconscious Casualties
Heat Exhaustion What to do ?
Help casualty to a cool place, lay him
down & raise legs
Monitor & record breathing, pulse,
response every 10 minutes
Even if casualty recovers quickly, ensure he
see a doctor

Heat stroke occurs when the body becomes
unable to control its temperature. The
temperature rises, the sweating mechanism fails,
and the body is unable to cool down.
Body temperature may rise to43c or higher
within 10 to 15 minute, may due to:
•High fever,
•Prolonged heat exposure
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Chapter 8: Managing Unconscious Casualties
Heat Stroke

156
Chapter 8: Managing Unconscious Casualties
Heat Stroke
Signs & Symptoms
•Throbbing headache, dizziness, acute discomfort
•Restlessness and confusion
•Hot flushed and dry skin
•Rapid, strong pulse
•Body temperature above 40c
•Can progress to unconsciousness within minutes

•This is a life-threatening Emergency
•Quickly move the casualty to a cool place.
Remove clothing if possible
•Cool the casualty Rapidly with whatever
methods you can
wrap casualty in a cold wet sheet and keep it
wet until body temperature falls to 38
If no sheet is available, constantly fan the
casualty or sponge him with cold water
If casualty deteriorates, prepare to resuscitate
Heat Stroke
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158
Management of Drowning
Drowning can result in death from:
•Hypothermia -immersion in cold water
•Sudden Cardiac Arrest –cold water
•Airway Obstruction –inhalation of water/spasm of throat
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Chapter 8: Managing Unconscious Casualties
Management of Electric Shock
Electric Shock occurs when a person comes into contact
with an electrical energy source, electrical energy flows
through a portion of the body causing a shock
Cause
•High/Low voltage electrical energy
•Lightening
Signs & Symptoms
•Cardiac Arrest
•Burns
•Pain in hands or foot, or deformity of body part
•Other injuries

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Chapter 8: Managing Unconscious Casualties
Management of Electric Shock
•Breaking contact with the electricity, do not touch the
casualty if he is still contact with the electrical current,
do not approach high voltage wires until the power is
turned off
•Primary survey –DRSABC (refer to chapter13)
•Perform CPR (refer to chapter 8) if casualty is not
breathing
•Secondary survey if casualty is breathing
•Treat the casualty for shock (refer to chapter 2)
•Treat the burns (refer to chapter 3) and other injuries
(refer to chapter 4)

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Chapter 8: Managing Unconscious Casualties
Management of Overcome by Gases
The inhalation gases or toxic vapors can be lethal (refer to
chapter 6 for causes), casualty is likely to have low levels of
oxygen in the body and needs urgent medical attention.
•Call for help/dial 995 for an ambulance
•Do not attempt to rescue if it is likely to put your own life at
risk; If it is necessary to escape from the source of the fumes,
help the casualty away from the fumes into to fresh air
•Primary Survey (refer to Chapter13)
•Support and encourage the casualty to breath normally
•Monitor the casualty's breathing& pulse while waiting for
help, and treat other injuries
•Perform CPR (refer to chapter 8) if casualty is not breathing

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Chapter 8: Managing Unconscious Casualties
Management of Fainting
Fainting –“Black out”or Syncope is the temporary loss of
consciousness follow by the return to full wakefulness, may
also accompanied by loss of muscle tone that can result in
falling or slumping over.
Causes
•Decreased blood flow to the
brain
•Heart rhythm changes
•Abnormal heart conditions
•Sudden cardiac death, heart
attack
•Postural hypotension
•Vasovagalsyncope
•Anemia
•Dehydration
•Pregnancy
•Other medication or drugs

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Chapter 8: Managing Unconscious Casualties
Management of Fainting
•When a casualty feels to faint, lie the casualty down, raise
the casualty’s leg (as in managing shock) to improve blood
flow to the brain
•Monitor casualty's conditions (breathing & pulse)
•Perform CPR if casualty is not breathing
•Reassure the casualty if he regain consciousness, help him
sit up gradually
•Repeat the steps above until he recovers fully

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Chapter 8: Managing Unconscious Casualties
Nervous System

The spine (backbone) is made up of
small bones (vertebrae).。
It forms a canal through which the spinal
cord runs.
The vertebral column is made up of 33
vertebrae：
•7 cervical
•12 thoracic
•5 lumbar
•5 sacral vertebrae fused as the sacrum
•4 coccygeal vertebrae fused as coccyx
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Chapter 8: Managing Unconscious Casualties
Nervous System

Epidural
Hematoma
Bleeding
between skull
and protective
covering of brain.
Subdural
Hematoma
Bleeding due to
tearing of blood
vessels on
surface of brain.
Bruising of brain
tissue, Swelling
of brain tissue
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Chapter 8: Managing Unconscious Casualties
Management of Head Injuries
Coup –Contrecoup Injury
Acceleration –Deceleration Injury

167
Chapter 8: Managing Unconscious Casualties
Management of Head Injuries
Trauma resulting to injury to Brain

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Chapter 8: Managing Unconscious Casualties
The different types of head injury beyond scalp
laceration needs to be recognized:
•The drowsy casualty may have concussion or be
actively bleeding in the brain.
•The conscious or drowsy casualty bleeding from ear or
nose has a base of skull fracture.
•The casualty who improved and then deteriorated in
conscious level has a brain hematoma or subdural
hematoma.
Management of Head injury

Call for ambulance –alert the
ambulance staff of the situation
Place the drowsy or
unconscious casualty in the
recovery position
Monitor and record
•Breathing
•Pulse
•Level of response(AVPU)
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Chapter 8: Managing Unconscious Casualties
Management of Head Injury
•Alert and consciousA= Alert
•Responds to verbal
stimulus
V = Verbal
•Responds to painful
stimulus
P= Pain
•Unresponsive to any
form of stimulus
U=
Unresponsive
AVPU Assessment Tool

170
Chapter 8: Managing Unconscious Casualties
Fits(Convulsion)
•A fit is a sudden loss of consciousness follow by
uncontrolled movements of the limbs.
•It may be alarming to see someone unexpectedly having
a seizure.
•It generally lasts a few minutes and it cannot be stopped.
Causes
Epilepsy
Acute injury to the brain
Fever-any child less than 2 years old with a fever more
than 38.5C may throw a fit.
Uncontrolled blood pressure during pregnancy (life
threatening emergency)
Management of Fits

171
Management of Fits
Management
if you casualty is falling –support or ease his fall
Make space around him –ask bystanders to move away
Loosen clothing around the neck eg Necktie
After the fit is over, if casualty is drowsy, place in the
recovery position
Remarks
•Do not lift or move casualty unless he is in immediate
danger
•Do not use force to restrain him
•Do not put anything in his mouth
•Put pillow to support casualty head
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Chapter 8: Managing Unconscious Casualties
Hysteriais a mental disorder
arising from intense anxiety. It
characterized by lack of control
over acts and emotions, and by
sudden seizures of
unconsciousness with
emotional outbursts. Most
common in young females
Causes
Stress
Perverted habits of thought
Idleness
Sexual repression
Signs & Symptoms
•Heaviness in the limbs,
severe cramps
•Difficulty in breathing,
suffocation
•Palpitation
•Headache
•Clenched teeth
•Swelling of the neck
•Wild and painful cries
•Incomplete loss of
consciousness
Management of Hysteria

173
Chapter 8: Managing Unconscious Casualties
•Keep cool and composed when dealing with a person who
is having a hysteria attack
•Do not retaliate, argue or fall into a conflict when the
person is having hysteria attack
•Ensure safety
•Treat for hyperventilation if needed
•Treat for fits if needed
•Treat for other injuries if needed
•Monitor victim’s breathing and pulse if she become
unconscious
•Comfort the victim when she recovers
•Seek for professional medical advise when necessary
Management of Hysteria

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Chapter 8: Managing Unconscious Casualties
Management of Stroke
Definition :
A disruption of the blood flow to a part of the brain which
due to blood clot or bleeding
Normal blood pressure
(120-130mmgh)/(80-90mmgh)
Causes
Blood clot
High blood pressure
Blockage of cerebral blood vessel narrowed by
degenerative changes in the wall

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Chapter 8: Managing Unconscious Casualties
Signs & Symptoms
•Loss of function –slurred speech, weakness
of limbs on one side of body
•Sudden severe headache followed by
unconsciousness
•Uncontrolled bladder or bowel
•Impaired vision
Management
If the casualty is unconscious, conduct a
primary survey & turn casualty to Recovery
Position
Call for an ambulance to send the casualty to
hospital
Management of Stroke

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Chapter 8: Managing Unconscious Casualties
Management of Diabetic Coma
Unconsciousness in diabetes can due to:
Hypoglycemia-Low blood sugar
•Failure to eat before exercise or heavy work
•Overdose of insulin injection
How to recognize?
•Well before the coma occurs
•Unconsciousness is sudden during or after physical exertion
Management
Seek medical aid urgently
Give small amounts of sugary water (1/2 teaspoon dilute
with water or sweet drinks)

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Chapter 8: Managing Unconscious Casualties
Hyperglycemia -High blood sugar
•Undiagnosed diabetes mellitus
•Failure to take medications or insulin
How to recognize?
•Unwell several days before coma
•Drowsiness going to unconsciousness over a few days
Management
Seek medical aid urgently
Management of Diabetic Coma

178
Case Scenarios
Chapter 8: Managing Unconscious Casualties
Part One
Male, 40 years old, lying on the wet floor in
wash room. He is unconscious with lots of
blood on the floor behind his head, left
forearm swollen badly.
Demonstrate how do you managing the
unconscious casualty.
Part Two
His eyes starts to rolling up, Teeth clenching
and twitching and jerking limbs, frothing at
the mouth
What condition this casualty may
developed? And demonstrate how do you
react to his conditions

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Chapter 9: Managing Occupational Eye Injuries
Anatomy of
the Eye

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Chapter 9: Managing Occupational Eye Injuries
Common Causes of Eye Injuries
Eye can be bruised by a direct blow, cut, fall or penetrates
by a flying object. Or being expose or in contact with
chemicals.
Workers must always put on goggles if there is risk of
hazards at work place.
All eye injuries are potentially serious, cause the
casualty’s vision is at risk.

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Chapter 9: Managing Occupational Eye Injuries
Examination of Eyes (Pupils)
Dilated pupils
May suspect shock, cardiac arrest
Unequal pupils
May suspect stroke, head injury or
an artificial eye
Constricted pupils
May suspect heat stroke, central
nervous system disorder

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Chapter 9: Managing Occupational Eye Injuries
Signs & Symptoms of Eye Injuries
•Pain
•Redness
•Irritation
•Tearing
•Inability to keep the eye open
•Sensation of something in the eye
•Swelling of the eyelids
•Blurred vision
Burns by Chemical/Heat

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Chapter 9: Managing Occupational Eye Injuries
Signs & Symptoms of Eye Injuries
•Mild to severe pain, starting a
few hours after the incident
•Bloodshot eyes
•Light sensitivity
•Watery eyes
•Blurred vision
•The feeling of having something
in your eye
Radiation Injuries (Arc Eye)

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Chapter 9: Managing Occupational Eye Injuries
Signs & Symptoms of Eye Injuries
•Sensation of something in the eye
•Tearing
•Blurred vision
•Light sensitivity
•Decreased vision, double vision
•Pain
•Rust ring or rust stain if the foreign body is metal
Foreign Bodies in Eye

185
Chapter 9: Managing Occupational Eye Injuries
Signs & Symptoms of Eye Injuries
•Discoloration of eye
•Swelling
•Pain
•Blurry vision, double vision
•Headache
•Inability to move eye
•Blood on the eye surface
•Loss of sight
•Loss of consciousness
“Black Eye”-result from facial/head injuries

186
Chapter 9: Managing Occupational Eye Injuries
•Lay the casualty on his back
•Tell the casualty to keep both eyes still
•Cover with a sterile, dry pad over the
affected eye with eye shield or eye
pads and bandage both eyes
•Retain the SDS if it’s chemical splash
into eye and treat according to the
First-aid instructions in SDS
•Send the casualty to hospital
Management of Eye injuries

Case Studies
187
Chapter 9: Managing Occupational Eye Injuries
As a First Aider, how do
you react to the eye
injury?

Anatomy of the Skin
188
Chapter10: Managing Burns Injuries
Definition of the Skin
The body’s outer covering, which protects against heat
and light, injury, and infection. Skin regulates body
temperature and store water, fat and vitamin D. it’s the
body’s largest organ
Functions
•Protects from injury
•Protects from infection
•Regulates temperature

189
Classification of Burns by Causes
Chapter10: Managing Burns Injuries
Type of Burns Causes
Electrical Burns
Low voltage current used by domestic appliances; High
voltage current; Lightning strikes
Dry Burns Flames; Contact with hot objects; Friction
Scalds Hot liquids; Steam
Chemical BurnsIndustrial chemicals; Domestic chemicals and agents
Radiation Burns
Sunburn; Over-exposure to ultraviolet lights; Exposure
to a radioactive source
Cold Burns Frostbite; Contact with freezing metal or vapours

190
Signs & Symptoms of Electrical Burns
Chapter10: Managing Burns Injuries
•Tenderness
•Blistering
•Redness
•Scorching & charring
•Swelling
•Skin wounds at the points
of entry and exit of
current
•Numbness
•Tingling
•Headache
•Dizziness
•Fever
•Altered heart rhythm
•Breathing problems
•Shock

191
Management of Electrical Burns
•Remove the electrical source before touch the casualty
•Flood the injury with cold water at the entry and exit point
until the pain is relived
•Remove any constricting objects (jewellery, watches, belts
or clothing) from the injured area before the swelling
begins
•Use a sterile dressing or a clean, non-fluffy pad to bandage
loosely
•Call 995 for an ambulance or sent the casualty to hospital
for medical treatment.
•Monitor the casualty's breathing and pulse while waiting
for help to arrive, treat for shock when necessary
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192
Signs & Symptoms of Dry Burns (Flame Bruns)
Chapter10: Managing Burns Injuries
symptoms of a dry burn will vary
depending on the severity:
•Red skin
•Pain at site
•Blisters
•Intense pain
•White to red skin
•Moist and mottled skin
•Charring, dark brown or white
•Skin hard to touch
•Little or no pain
•Pain at periphery of burn

193
Management of Dry Burns
•Put out any fire or flames. Remove hot or burned clothing,
if possible. Or stop contact with the hot object
•Cool the injured area with cold water until the pain is
relieved
•Remove any constricting objects (jewellery, watches, belts
or clothing) from the injured area before the swelling
begins
•Use a sterile dressing or a clean, non-fluffy pad to bandage
loosely and consult a doctor urgently for further treatment
•Call 995 for an ambulance or sent the casualty to hospital
if the burns are deep or extensive. Monitor casualty's
breathing and pulse while waiting for help to arrive.
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194
Signs & Symptoms of Scalds
Chapter10: Managing Burns Injuries
Symptoms of a scald will
vary depending on how serious it is
•Red skin
•Pain at site
•Blisters
•Intense pain
•White to red skin
•Moist and mottled skin
•Charring, dark brown or white
•Skin hard to touch
•Little or no pain
•Pain at periphery of burn

195
Management of Scalds
•Remove the source of burn (Steam, hot liquid). Remove
hot clothing, if possible.
•Cool the injured area with cold water until the pain is
relieved
•Remove any constricting objects (jewellery, watches, belts
or clothing) from the injured area before the swelling
begins
•Use a sterile dressing or a clean, non-fluffy pad to bandage
loosely and consult a doctor urgently for further treatment
•Call 995 for an ambulance or sent the casualty to hospital
if the burns are deep or extensive. Monitor casualty's
breathing and pulse while waiting for help to arrive.
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196
Signs & Symptoms of Chemical Burns
Chapter10: Managing Burns Injuries
•Redness, irritation, or burning
•Pain or numbness
•Blisters or black dead skin
•Vision changes if the chemical gets into eyes
•Cough or shortness of breath
•Vomiting
•Low blood pressure
•Faintness, weakness, dizziness
•Headache
•Seizures
•Irregular heartbeat or Cardiac arrest

197
Management of Chemical Burns
•Make the surrounding area safe
•Wear protective gloves to protect yourself and handle the
chemical with care
•Flood the burn with plenty of water to disperse the
chemical and gently remove any contaminated clothing
•Obtain the Safety Data Sheet (SDS) if it is a industrial
chemical substance, and follow instructions of first aid
from SDS
•Seek for medical treatment urgently, monitor casualty's
breathing and pulse while waiting for help to arrive.
•Provide the details of the chemical to medical staff if
possible
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198
Signs & Symptoms of Radiation Burns
Chapter10: Managing Burns Injuries
•Redness
•Blistering
•Ulceration
•Skin peeling
•Skin pigmentation
•Fever
•Nausea or vomiting

199
Management of Radiation Burns
•Remove the casualty away from the radiation sources
•Remove any constricting objects (jewellery, watches,
belts or clothing) from the injured area before the
swelling begins
•Use a sterile dressing or a clean, non-fluffy pad to
bandage loosely and consult a doctor urgently for further
treatment
•Call 995 for an ambulance or sent the casualty to hospital
if the burns are deep or extensive. Monitor casualty's
breathing and pulse while waiting for help to arrive.
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200
Management of Sun Burns
•Remove the casualty from the Sun, or cover the skin with
light clothing
•Encourage the casualty to drink water frequently
•Cool the affected skin by dabbing with cold water
•Apply calamine lotion of the burns are mild, if the
sunburn is server, seek for a doctor urgently
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201
Chapter10: Managing Burns Injuries
The severity of a burn depends on：
•Burn Depth
•Burn Size
•Infant, child or adult
Assessment on the Severity of Burns

Superficial (1
st
degree)
•Red skin
•Pain at site
Partial Thickness(2
nd
degree)
•Blisters
•Intense pain
•White to red skin
•Moist and mottled skin
Full Thickness(3
rd
degree)
•Charring, dark brown or white
•Skin hard to touch
•Little or no pain
•Pain at periphery of burn
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Burn Depth

203
Chapter10: Managing Burns Injuries
Size and Area of Burns –The “Rule of Nines”

204
Chapter10: Managing Burns Injuries
Management of Burn –General
•Check for danger to the rescuer
•Stop the burning
Wrap casualty with a big sheet of material
quickly. (if available)
Lie casualty on the ground and roll him
•Check DRSABC –Danger, Response, Shout for help
if no response, no breathing, perform Chest
Compression
•Assess and give first aid treatment

205
Chapter10: Managing Burns Injuries
Partial Thickness & Superficial Burns
•Put under running tap until pain is
reduced or approximately 10-15 minutes
•Remove constrictors before swelling
occurs
•Cover the burn & surrounding area with a
loose dressing such as clean non-
adhesive dressing

206
Chapter10:Managing Burns Injuries
Severe Burns
•Call ambulance 995
•Cooling the burns with plenty of cold water,
but do not over-cool the casualty
•Do not touch a full-thickness burn
•Gently remove constrictors before swelling
occur, do not remove clothing if it stuck to
the burn
•Cover the injured area with non-adhesive
dressing
•Observe casualty's breathing and pulse while
waiting for help, treat for shock if necessary

Hospital treatment is needed for
•Any full-thickness burn
•A partial-thickness burn over 9% surface area as
it will cause shock to develop
•Burn areas around neck, nose or mouth as it
may cause swelling and result in life threatening
airway obstruction
•Burn to the eye as it may lead to impaired or
lost vision
207
Chapter10: Managing Burns Injuries

208
Chapter10: Managing Burns Injuries
Management of Burns –Don’ts
Do not …
•Apply butter or oils on a burn –makes it difficult
to clean the wound and does not help
•Ice or cool to near freezing temperatures –this
can cause additional tissue injury
•Neutralize a chemical burn with a reciprocal
chemical –a chemical reaction that results could
result in a thermal burn too
•Disregard an electrical burn –the actual site of
damage can be internal and may not be visible
on the skin surface

Case Studies
209
Chapter10:Managing Burns Injuries
As a First Aider, how do
you react to the
incident scene?

210
Chapter11: Industrial Toxicology
Definition
The study of the actionsoftoxic chemicals on man and his
environment.Work situation may exposed a person to
chemicals, which may cause harmful ill effects on body.
Eg: Cyanides, lead compound, arsenic, carbon tetrachloride,
etc.

211
Route of Entry of Chemicals
in the Workplace
•Inhalation (Breathing)
•Skin absorption or direct contact
•Ingestion
•Injection
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212
Importance of
Safety Data Sheet (SDS)
SDS is a document containing
important information about a
hazardous chemical.
it provides employers, workers
and other safety & health
personals with the necessary
information to assist in safely
managing the risk from
hazardous substance exposure.
Chapter11: Industrial Toxicology

213
Chapter11: Industrial Toxicology

214
Importance of SDS
Find out what chemicals are used in various processes in the
workplace & what are the harmful effect for the purpose of:
•Help preventing accidents by being proactive -reading
about the types of chemicals used in your company via SDS.
•If accident occur, First Aider would know how to deal with
situation under SDS section 4 -First Aid Measures
Chapter11: Industrial Toxicology

215
Acute & Chronic Effects of Chemical Exposure
Toxic chemical
may cause ill
effects
Immediately -Acute
effect E.g. breathing of
chlorine gas
Long time to cause
harmful effects E.g.
breathing of silica dust
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216
•Dangerous situations arise when harmful chemicals
are misused or mishandled by accidental release,
spillage or leak.
•Lack of awareness, working in a confined space or
poorly ventilated room –inhaling toxic vapours, gas
or fumes at shipyards. (petroleum oil vapour,
welding fumes, etc)
•Inhaling chemical Cyanides in or accidentally taking
into mouth because of dirty hands. (chemical used
in electroplating process)
Accidental release of chemicals
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217
Accidental release of chemicals
Chemicals Chronic Effect -Skin Rash or
“dermatitis”. E.g. Solvents, greases, oils,
chromium compound, cement, etc
Simple Treatment
•Obtain SDS
•Chemical to handle with care
•Wear protective clothing, gloves &
goggles
•Follow instructions of first aid from
SDS (Flushburn with water)
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218
Inhaling in or accidentally taking into the mouth because of
dirty hands; maybe be absorbed through the skin
Simple Treatment
•Antidote like amyl nitrite must be available with
instructions on how to administer it.
•Apply to handkerchief and get him to breathe from it
•Break another ampoule at 10-15 minutes interval
•Send casualty to hospital immediately
Chapter11: Industrial Toxicology
Accidental release of chemicals

219
•Working situation inside manholes –accumulation of
Hydrogen Sulfide or methane gases & carbon dioxide–
Safety committee members assess the risk before worker
can get permit to work.
•Using solvents as degreasers & cleaning agents.
(chloroform, carbon tetrachloride)
Confined space
Read tag before entering
No person shall work or enter in the confined space if oxygen have been
reduced to below 19.5%by volume.
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220
Toxic Vapour, Gas or Fumes in Confined Spaces
•Dangerous at high level
•IF fire occurs, Carbon Monoxide (CO) produced would
causeunconsciousnessrapidly
•Lack of Oxygen (O2) due to rusting of metal in confined
space can causeunconsciousness or even death
•Accumulation of hydrogen sulphide or methane gases
are dangerous
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221
Toxic Vapour, Gas or Fumes in Confined Spaces
Simple Treament
•EnsureFirst Aider is adequately protected
before attempt to save casualty
•Remove casualty from enclosed space
immediately
•Only By Trained Person(Make sure you
are equip with breathing apparatus if
there is insufficient oxygen in manhole or
confined space)
•If no breathing , commence CPR
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222
Common Industrial Accidents &
Unsafe Work Procedure
Direct (immediate) Causes：
•Unsafe act by injured victim or other party
•Damage/defective machines
•Not following Safety Rules
•Not using safety devices and protective
equipment
•Taking risk –shortcuts
•Using the wrong tools for the job
•Poor housekeeping
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223
Personal Protective Equipment (PPE)
Helmets –Head Goggles –Eyes
Face Shield –
Face & Eyes
Gloves –
Hands & fingers
Safety Shoes –
feet
Respirators –
Respiratory Tract
Safety Belt–
Fall from Height
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224
Use Personal Protective Equipment (PPE)
As an employee: You must use, in proper manner, any
Personal Protective Equipment(PPE), devices, equipments or
other means provided to secure your safety, health and
welfare while working. Must not tamper or misuse such
items provided
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225
Precautions to Take During Rescue Operation
•Assess the situation quickly and calmly
•Never put yourself at risk, protect yourself and casualties
form danger
•Wear PPE to prevent cross infection
•Assess casualty’s condition quickly
•Give early treatment
•Arrange for appropriate help early
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226
Rationale for understanding the effects of
chemicals on the body
•Inhalationof CYANIDESmay cause: chest tightness,
confusion, convulsions, cough, dizziness, headache, labored
breathing, nausea, shortness of breath, unconsciousness,
vomiting, weakness, red coloration of the skin.
•Ingestion of ARSENICmay cause: abdominal pain, diarrhea,
nausea, vomiting, burning sensation in the throat and chest,
shock or collapse, unconsciousness.
•Absorptionof CARBON TETRACHLORIDEonto skin may
cause: redness and pain
•On Contactwith VINYL CHLORIDE on skin: frostbite
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227
Safe work practice
Very toxic chemicals should be handled in
enclosed systems, which must be adequately
ventilated. Partial enclosures can also be very
useful.
•Placing guards and hoods over machining
operations using cutting fluids.
•Using pumps to enclose and transfer
solvents rather than pouring manually from
one container to another.
•Using glove boxes to handle highly toxic and
radioactive materials.
•Enclosing dipping and electroplating tanks
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228
Definition of Safety –Freedom of Hazards
Occupational/ Workplace Safety --Deals with the safety
and well being of workers engaged in daily work activities
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229
Simple Prevention Measures
Safe Work Practices
Safe work practices are sequence of plan of actions,
in consistent with the generally accepted safe and
sound practice, established for the purpose of
carrying out work safely. The scope of safe work
practices must include:
•Provision of suitable Personal Protective
Equipment(PPE) to persons carrying out the work
•Safety precautions to be taken in the course of work
and during an emergency
•Must be Documented and produced for inspection
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230
Good personal hygiene
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231
Good personal hygiene
Chapter11: Industrial Toxicology

First-Aid Requirements in
Factories & Workplace
In Singapore the main piece of legislation governing
Occupational First Aid, Occupational Safety and Health is the:
•Workplace Safety And Health Act (WSHA)
•Workplace Safety And Health (First-Aid )Regulations
These Regulations cited as the Workplace Safety and Health
(First-Aid) Regulations 2006 and shall come into operation on
1
st
March 2006
WSH(First-Aid)(Amendment) Regulations 2011
Extend the coverage to ALL WORKPLACES, except for
hospitals and medical clinics
232
Chapter12: Occupational Safety & Accident Prevention

233
Importance of Safe Work Measures
The Workplace Safety and Health Act (WSHA) requires all
stakeholders to take reasonably practicable measures to
ensure the safety and health of workers and other people
that are affected by the work being carried out.
If the risk cannot be eliminated, the employer and
principal( including contractor and sub-contractor) must
take reasonably practicable measures to minimise the risk.
Chapter12: Occupational Safety & Accident Prevention

Chapter12: Occupational Safety & Accident Prevention
Definition of Hazards
A condition in which there is:
•Potential of causing injuries to
personnel
•Damage to equipment and
structure
•Loss of material or
•Lessening of the ability to
perform a prescribed function

235
Occupational Accident: An unplanned and
unwelcome event which interrupts work activities,
Which may cause
•Injuries to workers
•Damage to equipment
•Damage to properties
Chapter12: Occupational Safety & Accident Prevention

236
ECONOMIC COST HUMAN COST
Damage to property Lowers morale
Damage to equipment Sickness
Replacement cost Pain
Litigation cost Injury
Lost time (downtime) Anxiety and stress
Lost productivity Death
Consequences of Industrial Accident
•Hardship to victims and their love ones
•Losses to injured worker
•Losses to the organization
Chapter12: Occupational Safety & Accident Prevention

237
Chapter12: Occupational Safety & Accident Prevention
Duties of Employer
Must as far as reasonable practicable, protect the safety and
health of employees or workers working under employer
direct control, as well as who my be affected by their work,
employer’s duties include:
•Conducting risk assessment to remove or control risks
•Maintaining safe work facilities and arrangements
•Ensuring safety in machinery, equipment, plant articles,
substances and work processes at the workplace
•Developing and implementing control measures for dealing
with emergencies
•Providing worker with adequate instruction, information,
training and supervision

238
Chapter12: Occupational Safety & Accident Prevention
Duties of Employee/Worker
•Must follow the safe working procedures and principles
introduced at the workplace
•Must not engage in any unsafe act at that may endanger yourself
or others working around you
•Must use, in proper manner, any Personal Protective equipment
(PPE), devices, equipments or other means provided to secure the
safety, health and welfare while working. Employee/worker must
not tamper or misuse such items provided
•Must not engage in any negligent act that may endanger
themselves or other people in the workplace.

Hazard Identification
Chapter12: Occupational Safety & Accident Prevention

Determine Risk Level
(Example)
Chapter12: Occupational Safety & Accident Prevention

Risk Management Plan (Sample)
Chapter12: Occupational Safety & Accident Prevention

Hierarchy of Controls
Chapter12: Occupational Safety & Accident Prevention

243
Indirect (underlying) Causes：
•Poor safety design
•Lack of training
•Lack of awareness
•Lackof supervision
•Lack of maintenance
•Lack of enforcement
•Lack of morale and interest in safety
Chapter12: Occupational Safety & Accident Prevention
Common Industrial Accidents &
Unsafe Work Procedure

244
Direct (immediate) Causes of Accidents
in workplace
Chapter12: Occupational Safety & Accident Prevention

245
Preventing Occupational/WorkplaceAccident
Principles to note
•No jobis so important that it cannot be done safely
•Accidents occur as a result of errors, oversight or
miscalculation
•Unsafe conditions should be corrected immediately
•Personal unsafe acts are the causes of many accidents
•The unsafe acts of employees frequently endanger the
lives of others
•The majority of accidents can be prevented
Chapter12: Occupational Safety & Accident Prevention

246
Role of First Aider inPreventing
Occupational/WorkplaceAccident
Chapter12: Occupational Safety & Accident Prevention
•Attending to casualty
•Aware of and correct potentially
hazardous situation and unsafe
conditions in workplace
•Know and apply the general principle
of safety and accident prevention
•Maintain a record of all treatment
rendered by him

247
Case Scenarios
LOOK, THINK, DO
247
Chapter 12: Occupational Safety & Accident Prevention
AC&CS(PTE.) LTD
Loading on Vehicles

248
Case Scenarios
LOOK, THINK, DO
248
Chapter 12: Occupational Safety & Accident Prevention
AC&CS(PTE.) LTD
Working on Roofs

249
Case Scenarios
LOOK, THINK, DO
249
Chapter 12: Occupational Safety & Accident Prevention
AC&CS(PTE.) LTD
Working at Heights

250
Case Scenarios
LOOK, THINK, DO
250
Chapter 12: Occupational Safety & Accident Prevention
AC&CS(PTE.) LTD
Lifting Operations

251
Case Scenarios
LOOK, THINK, DO
251
Chapter 12: Occupational Safety & Accident Prevention
AC&CS(PTE.) LTD
Traffic Management

252
Case Scenarios
LOOK, THINK, DO
252
Chapter 12: Occupational Safety & Accident Prevention
AC&CS(PTE.) LTD
Electrical Equipment

253
Case Scenarios
LOOK, THINK, DO
253
Chapter 12: Occupational Safety & Accident Prevention
AC&CS(PTE.) LTD
Working with Machine

Case Scenarios
254
Chapter12: Occupational Safety & Accident Prevention

Primary Survey
( DRS ABC)
•Danger -is there any danger?
•Response -is the casualty responsive?
•Shout -if unresponsive, shout for help
•Aed –Bring AED
•Breathing -is the casualty breathing?
•Compression-if no breathing, start chest
compression
255
Chapter 13: Managing Medical Emergencies
Chance of success
reduced 7-10%
each minute

256
Chapter 13: Managing Medical Emergencies
1)D-Danger
Check / survey the scene for danger before
approaching casualty.
2)R-Response
Establish unresponsiveness
•Tap or gently shake the victim’s shoulder
•Shout “Are you okay, are you alright?”

257
Chapter 13: Managing Medical Emergencies
3)S-Shout for Help
If unresponsive,
•Shout for help, call 995 for ambulance,
get first aid box and Automated
External Defibrillator (AED) if there is
one within 1 minute walking distance
•If there is an other person, ask him/her
to call 995 for ambulance, get first aid
box and AED
•Position victim on his back as a unit
supporting the head and neck. Victim
must be supine and on a flat firm
surface

258
Chapter 13: Managing Medical Emergencies
4)A-AED
5)B-Breathing
•Look at the rise and fall of the chest;

259
Chapter 13: Managing Medical Emergencies
6)C -Chest Compression
If unsure of the presence of normal
breathing within 10 seconds, start
chest compressions/CPR. Continue
performing CRP until medical
assistanceor AED arrives and ready to
takes over, or victim starts moving.

260
Chapter 13: Managing Medical Emergencies
Secondary Survey
•Identify yourself and obtain symptoms and signs
•Assessing symptoms
•Looking for signs
•Examine casualty-top to toe survey
•Recovery position
•Assess vital signs

261
Chapter 13: Managing Medical Emergencies
Secondary Survey
History Taking -S.A.M.P.L.E

262
Chapter 13: Managing Medical Emergencies
Secondary Survey
Monitoring -D.O.T.S.
DeformityD
Open
wounds
O
Tenderness T
SwellingS

Secondary Survey-Head to Toe Examination
HEAD & FACE --Deformity, fractures, bleeding & swelling.
Check eyes for dilation & reaction to light. Check ears &
nose for CSF (brain fluid)
NECK & THROAT --Check the “C” spine for deformity, and
fractures. bleeding, swelling & injury to windpipe.
263
Chapter 13: Managing Medical Emergencies

264
Chapter 13: Managing Medical Emergencies
CHEST -Deformity, fractures, bleeding and swelling.
ABDOMEN -Deformity, bleeding & swelling which may
indicate internal bleeding & swelling. Visual check for bruising
(internal bleeding).
BACK -At rear of ribs checking for deformity, fractures,
bleeding & swelling. Check lumber spine as best you can
without moving the casualty too much.

265
Chapter 13: Managing Medical Emergencies
1
2
3
4 5
Recovery Position
If there is no secondary injury, place
casualty into recovery position.
Keep checking vital signs every 5-10
minutes until the arrival of ambulance
crew or other medical personnel.

266
Chapter 13: Managing Medical Emergencies
Infant
120-150 per min
Child
80-120 per min
Adult
60-80 per min
Normal Pulse Rate per minute
Carotid Pulse Radial Pulse Brachial Pulse

267
Chapter 13: Managing Medical Emergencies
Emergency Action Plan
Types of Emergencies
Traumatic
Emergencies
•Profuse
bleeding
•Suffocation
•Burns
Medical
Emergencies
•Heart attack
•Stroke
•Industrial
poisoning
Major
Incidents
•Structural
collapse
•Explosion

268
Chapter 13: Managing Medical Emergencies
Action In An Emergency
Assess the Situation
Make the Area safe
Give Emergency Aid
Get Help

269
Chapter 13: Managing Medical Emergencies
Role of a First Aider
•Assessing Risk-Protect casualties and others at site from
possible danger.
•Attending to casualty to provide early appropriate
treatment, treating the most serious first and get help.
•Prevent cross infection between casualty and yourself.
•Organize Care-Remain with casualty until appropriate
care arrive.
•Reporting and record keeping

270
Chapter 13: Managing Medical Emergencies
An emergency response plan is a written plan for
identifying accident scenarios and dealing with emergency
saturations.
An emergency action plan is need to minimise the loss of
life or property or damage to the environment and
infrastructure.
Emergency Action Plan

•Recognizing Danger Source at work site
•Estimation of the personnel & equipment
•Have a good communication system
The Preventive
Action
(Pre-incident Period)
•Basic principles during disaster
•Be calm, to avoid confusion
•Practice “selective first aid”
•Grouping into groups 1,2,3,etc.
Immediate
Intervention
(The Incident Period)
•Acopyofthereportonallcasualtiesshould
besenttomanagement
•The immediate family of the casualties will be
informed as soon as possible
Damage Repair
(post-incidentPeriod)
271
Chapter 13: Managing Medical Emergencies
Emergency Action Plan

272
Chapter 13: Managing Medical Emergencies
A communication system must established to alert
employees or an employee alarm system with a distinctive
signal for each purpose.
There must be a means of communication for the purpose
of notifying personnel of the emergency
Communication System

273
Chapter 13: Managing Medical Emergencies
Grouping of
Casualties
Group 1
Casualties who
have minor
injuries
Group 2
Casualties who have
injuries that would
benefit from some
medical treatment but
do not require
hospitalization
Group 3
Casualties who
require early
transport in
order to survive,
or surgical
attention

274
Chapter 13: Managing Medical Emergencies
Before Moving a Casualty
•All serious bleeding must stop
•All facture must be immobilized
•All unconscious casualties must be placed in recovery
position
•Documentation-name, address, nature of injuries etc.
Post-incident
•A copy of the report on all casualties should be sent to
management
•Contacting casualties family
Evacuation & Transporting System

Rescue
team
Render
first aid
First aid
post with
medical
staff
Ambulance
transport
To
hospital
275
Chapter 13: Managing Medical Emergencies
Moving of the Casualty

276
Chapter 13: Managing Medical Emergencies
Record & Reporting System
•Record keeping –Specimen Form 1
•Daily Attendance Record
•Injury Report
•Referral Letter

277
Chapter 13: Managing Medical Emergencies
Daily Attendance Record
•Summary of all employees
seen during shift
•Person in charge of
recording of First Aid Room
•Statistical & Logistical
Information in weekly/
monthly/ quarterly
Personal Record
•History-what, where, when
& patient complaints
•On examination-
observation, vital signs,
draw picture
•Assessment-facts obtained
•Management-methods,
medication, treatments
•Follow up-continuing
management,
recommendations

Chapter 13: Managing Medical Emergencies
Injury Report
•Personal detail
•Supervisor’s name
•Witness
•Injury sustained
•Location
•Cause (employee’s full description)
•Nature of injury
•Personal Safety Protection
•Action/ management/ referral
•Signature (employee/ First Aider)
Obtain S.A.M.P.L.E
•Signs and symptoms
•Allergy
•Medication
•Past medical history
•Last oral intake
•Events

•Statutory requirement under Factories Act Chapter 104,
section 72: Records must be kept for 5 years
•Workmen’s Compensation Act requires
•States in respect of work injury or illness, name, address,
date ,place & causes in ordinary language
•For medical-legal reason
Monitoring of employees for preventive health purpose like
SARS or outbreak of disease
•Provide data for evaluation or injury trends
•To monitor any work related causing injury so as to make
sure that there is no breach of safety regulation & immediate
notification to the Ministry of Manpower
279
Chapter 13: Managing Medical Emergencies

Case Scenarios
280
Chapter 13: Managing Medical Emergencies
As a First Aider,
how do you react
to the incident
scene?

Revision
281

282

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