FIRST AID AND HYGEINE

What is first Aid?

First aid is the emergency care given immediately to an injure person
It is the treatment/care given when an accident or sudden illness occurs or immediate care given
to a person who has been injured until he / she is taken to health facilities before medical
personnel arrive..
This is for the purpose of minimizing injury sustained and to prevent or reduce future disability
in serious cases as well as keeping the victim alive.
Personal hygiene is the steps you take to protect your own health and that of others while you are
taking care of the casualty. Your personal-hygiene and first-aid skills you have acquired could
save your life as well as the life of a casualty. This helping behaviours and initial care provided
for an acute illness or injury can be initiated by anyone in any situation including self care.

OBECTIVES
The objectives of the first aid can be encompass in the three short Phrases
1. To preserve life
2. To prevent further harm
3. To promote recovery

Preserve life

This doesn’t just refer to the injured party, but yourself and anyone helping you. Far too often, a
helper will inadvertently put themselves in danger and subsequently be another casualty for the
emergency services to deal with. Therefore, you need to take a moment to assess the situation,
and make sure there are no threats to your life before you step in to rescue others.

Prevent the situation from getting worse

If you are in no danger yourself, try to stop the situation from becoming worse by removing any
obvious dangers (such as stopping traffic, clearing people away from the casualty, opening a
window to clear any fumes, etc.). Also, act as quickly as you can to stop the casualty’s condition
from worsening.

Promote recovery
Your role as a first aider is, after ensuring that the situation can not get worse, helping the
casualty to recover from their injury or illness, or stop their condition from getting worse. If the
injury is severe, then the best you can do is try to keep them alive until the emergency services
arrive
These objectives should be demonstrated at all times while are you dealing with a casualty and
by knowing what to do, and by getting medical help quickly, you may be able to save lives,
prevent permanent disabilities, and prevent long periods of hospitalization and minimizing cost.

Purpose of first aid treatment

􀂃 To keep the injured or ill person alive
􀂃 To prevent the injured condition from becoming worse
􀂃 To help him/her to recover
􀂃 To sustains life

Why is acquisition of first aid knowledge & skill necessary?

 To promote the sense of safety and wellbeing
 To create awareness and desire to be accident free
 The differentiate between life and death
 To distinguish between temporary and permanent disability
 To set apart between rapid recovery and hospitalization
 To equip the aider
 To create confidence to care
 It encourages healthy and save living

Steps in giving emergency care:

 Look at the general situation of the casualty quickly
 Decide what is wrong and how severe or dangerous the injury is
 Give the appropriate first aid
 Practice how to transport the causality.
 Give first aid treatment for diarrheal problems.
 Provide first aid management for fever related disease.
 Give first aid management for patient who is suffering with Epilepsy.
 Notify your senior and arrange transport to hospital or health center
 Give follow up care during Journey.

Simple and basic question for first aider working in the community
Who will do first aid for casualty?
who is in emergency condition?

Characteristic of a first aider

Must be a good observant: -
Resourceful; - she/he may use to the best advantage whoever and whatever is at hand to prevent
further damage to the casualty.

Priorities of First aid

The priorities of first aid can be remembered by DR AB(C}
D- Is there any Danger to you and to the casualty?
R- Does the casualty Respond when you talk to him or her?
A-Is the air way open?
B-can the casualty actually breath?
C- This refers to circulation
If the casualty is not breathing C = chest compressions will be required.
If the casualty is breathing C = we might need to check if there is catastrophic bleeding?
To assess the quality of the circulation C = check pulse
Priorities for casualties

• Save the conscious casualties before the unconscious ones as they have a higher chance of
recovery.
• Save the young before the old.
• Do not jeopardize your own life while rendering First Aid. In the event of immediate danger,
get out of site immediately.
• Remember: One of your aims is to preserve life, and not endanger your own in the process of
rendering First Aid.
• Casualties should always be treated in the order of priority, usually given by the “3 Bs”:
– Breathing
– Bleeding
– Bones

The scope of first aid treatment:

• Assessing the situation
• Diagnosing the problems
• Giving immediate treatment
• Referring of the causality to higher health institutions

Steps involve in First Aid management include the following:

A. By observation:
􀂃 Cheek for any external bleeding and determine whether the bleeding is severe or not
􀂃 Check for breathing pattern and determine whether there is respiratory problem or not.
Note: Bleeding and respiratory problems are the top urgent emergency conditions that
need fast decision and action.

B. Brief Examination of patient

First check:
􀂃 Breathing (Listen and look at rise and fall of the chest)
􀂃 Color of skin (darks skin due to shortage of oxygen)
􀂃 Circulation of blood (by taking pulse and blood pressure)
􀂃 Pupils of the eye (large, small, altered with light)

C. Check parts of the body:

Look carefully and quickly of each part of the body in the following order or steps:
􀂃 Head
􀂃 Back
􀂃 Neck
􀂃 Arms, hands, fingers
􀂃 Chest
􀂃 legs, feet, toes
􀂃 Abdomen

D. Look for:
􀂃 Signs of internal damage to organ
􀂃 Burns
􀂃 Dislocation (broken bone)
􀂃 Wounds
􀂃 Dislocation (bone put out of place)
􀂃 Fracture
􀂃 Sprain
􀂃 Strain

Types of emergences

1. Respiratory emergencies
2. Drowning
3. Wound
4. Bleeding
5. Shock
6. Unconsciousness
7. Fracture
8. Dislocation
9. Strain and Sprain
10. Burns of the body
11. Poison
12. Bites
13. Fits
14. Eye, ear and nose injury
15. Diarrhea
16. Diseases character by fever
17. Abortion

FIRST AID KITS EQUIPMENT INCLUDED

While bandages and dressing can be improvised it is far better to have proper equipment on
hand.
- These materials should always be kept in a clean, dry, airtight container
- Do not keep the container in a damp atmosphere such as a bath room and make sure that it is
clearly labeled
- Below is a suggested list of content for a first aid kit
• 10 individually wrapped adhesive dressing
• 1 sterile eye pad with attachment
• 1-3 Triangular bandage
• 1-6 sterile covering for serious wound
• 6 safety pins
• 3 medium sized sterile unmediated dressing
• 1 large towel unmedicated dressing
• 1 Extra large sterile unmediated dressing
• 1 scissor
• 3 forceps
• 2 pairs of gloves (disposable) etc

First aid requirements

The type of first aid equipments and training required in an establishment depends on
1. The number of employees
2. The type of hazard present in the work place
3. The travel distance to a hospital/availability of professional medical assistance.
Sometimes a workplace may require additional first aid procedures and material
such as over-the-counter medications, administration of oxygen, use of epinephrine auto-
injectors, naloxone, etc.). It is suggested that such organization or employer will first seek legal
counsel so that they are aware of any liability issues, and to check with your local jurisdiction
responsible for health and safety.

What should all employees know about first aid?

Only employees trained in first aid should assist a victim. Never give first aid treatment for
which you are not trained. As part of their emergency preparedness training, employees should
know how to respond during an injury or illness situation. In terms of first aid, employees should
know:

What documentation is required?

Employers are usually required to maintain written records of all injuries and treatment given in
a first aid treatment record book or log. Each event should be recorded and include:

Worker's name
Date and time of injury
Location and nature of the injury
Description of how the injury occurred
Type or description of first aid treatment given
Time first aid was given
Patient's signature
First aid attendant's signature
Date and time of reporting
Name of the person to whom the injury was reported
Where this book is kept and who has access to it may vary with the need for privacy.
What should all employees know about first aid?
Only employees trained in first aid should assist a victim. Never give first aid treatment for which you are
not trained.

1. Respiratory Emergencies

Definition: A respiratory emergency is one in which normal breathing stops or in which

breathing is so reduced that oxygen intake is insufficient to support life. In this case artificial
respiration may be required.
N.B. Artificial respiration: is a procedure for forcing air to flow into and out of persons lungs
when natural breathing is inadequate or stops.
Common causes of respiratory failure (problems)
􀂃 Obstruction of the airway by tongue is dropping back
􀂃 Inhalation of a small amount of food, smoke, irritation, foreign objects, carbon monoxide, etc.
􀂃 Compression of the neck
􀂃 Respiratory disease (Asthma, Chronic obstructive pulmonary disease (COPD), Pulmonary
fibrosis, pneumonia, lung cancer, tuberculosis, bronchitis, emphysema)
􀂃 Drowning
􀂃 Strangulation
􀂃 Combustible gases

Signs and symptoms

􀂃 Unable to breath
􀂃 Loss of consciousness
􀂃 General pallor (paleness) anemia, problems with circulatory system, shock, fainting, low
blood sugar,drugs(ketorolac, amphetamines, alchohol, cannabis)
􀂃 Difficulty in breathing
􀂃 May be no visible breathing

First Aid management of Respiratory problem

􀂃 Shout for help (depend on the condition)
􀂃 Determine the consciousness of the causality by taping the victim on the shoulder and asking
loudly “Are you okay!”
􀂃 Assess and ensure that the patient air way is clear
􀂃 Place the patient flat on his back with the head turned to one side
􀂃 Remove any thing which is preventing the taking in of air (Remove constraints from the neck)
􀂃 Kneel beside the patient’s head, place one hand under his neck and the other hand under his
lower Jaw, extend his head and neck gently back ward. This prevents the tongue from falling
back in to the throat.
􀂃 Place your cheek and ear close to the victim’s mouth and Nose. Look at the victim’s chest to
see if it rises, falls, and listen and feel for air to be exhaled for about 5 seconds.
􀂃 If there is no breathing pinch the victim’s nostrils shut with thumb and index finger of your
hand that is pressing on the victim’s forehead. This action prevents leakage of air when the lungs
are inflated through the mouth.
􀂃 Take very deep breath and hold it.
􀂃 Fit your mouth tightly over the patients open mouth and forcibly in to the lungs
􀂃 While carrying out respiration, check the patient’s pulse every 2 or 3 minutes to ensure the
heart has not stopped.
􀂃 Continue the breathing procedure at the rate 12 to 18 breaths per minute until the chest is seen
to rise and the patient is breathing for himself or until is certain that the casualty is dead.
􀂃 If a patient is child, our mouth should cover both his nose and mouth. Very gentle breathing
should be used. The younger the child, the gentler this should continues at a rate of 25 breaths
per minute.
Once the patient can breathe by himself/herself, place him/her in what is called the recovery
position
• If mouth to mouth is failed and there is no pulse then, cardiopulmonary resuscitation(CPR)
followed.
Cardiopulmonary resuscitation (CPR) or heart lung resuscitation is a combined effort to maintain
circulation and breathing.
It is an emergency procedure applied when heart and lung actions have stopped. During CPR you
will have to perform procedures to:
􀂃 Maintain an open airway to maintain circulation
􀂃 Breathe for the patient and force the patients blood to circulate.
Procedure
With one First Aider
1. Establish unresponsiveness and alert for emergency medical service and Position the causality.
2. Establish an open airway.
3. Look, Listening, and feel for breathing (3-5 seconds).
4. Ventilate twice (1 to 2 seconds) per breath.
5. If no pulse (5-10 seconds)
6. Locate Compression site
7. Position your hands
8. Began compressions
9. Ventilate twice
10. Recheck pulse after 4 cycles of ventilation, then every few minutes.

With two first aider rescuer CPR

1. Determine unresponsiveness
2. Open the air way, look, listen, (feel 3-5 seconds)
3. Ventilate twice ( 1 -2 seconds per breath ).
4. Determine no pulse and locate CPR compression site
5. Say “No pulse.” Begin compressions
6. Ventilate once (1-2 seconds) Stop mouth-to-mouth ventilation.
7. Continue with one ventilation every five compressions.
8. After 10 cycles, re-assess breathing and pulse. No pulse says, “Continue CPR.” Pulse- says,
“Stop CPR.”
NOTE: Assess for spontaneous breathing and pulse for 5 seconds at the end of the first minute,
then every few minutes thereafter.

Recovery position

• For people who are unconscious, or semiconscious, but are still breathing.
• If there are spinal or neck injuries, do not attempt to place the casualty in the recovery position.
• NOTE: Leaving the victim in this position for long periods may cause them to experience
nerve compression.
STEP 1: Kneel next to the person. Place the arm closest to you straight out from the body.
Position the far arm with the back of the hand against the near cheek.

STEP 2: Grab and bend the person’s far knee.

STEP 3: Protecting the head with one hand, gently roll the person toward you by pulling the far
knee over and to the ground.

STEP 4: Tilt the head up slightly so that the airway is open. Make sure that the hand is under the
cheek. Place a blanket or coat over the person (unless he/she has a heat illness or fever) and stay
close until help arrives.

Hyperventilation

Hyperventilation, also known as excessive breathing, causes a reduction of carbon dioxide

concentration (below normal) of the blood.
SYMPTOMS:

• Unnaturally fast, deep breathing

• Attention-seeking behaviors
• Dizziness, faintness, trembling, or marked tingling in hands, feet and lips
• Headache
• Chest pain
• Slurred speech
• Cramps in the hands and feet

CAUSES:

• Stress or anxiety
• Consequence of lung diseases, head injuries or stroke

TREATMENT:

• When speaking to casualty, be firm but kind

• If possible, lead the casualty to a quiet place where he may be better able to regain control of
his breathing
• Let him re-breathe his own exhaled air from a paper bag. (Paper bag is preferred over plastic
bag as plastic bag may cause the casualty to suffocate)

FAINTING
Fainting is a brief loss of consciousness that is caused by a temporary reduction of blood
flow into the brain.

Symptoms:

• A brief loss of consciousness causing the casualty to fall to the floor

• A slow pulse
• Pale, cold skin and sweating

causes:

• Taking in too little food and fluids (dehydration)

• Low blood pressure
• Lack of sleep
• Over exhaustion

treatment:

• Lay casualty down, and slightly elevate legs

• Make sure she has plenty of fresh air
• As he/she recovers, reassure him/her and help her sit up gradually
• Look for and treat any injury that has been sustained through falling
 Choking

When small piece of food or foreign body may be inhaled in to the windpipe when eating in
which sometimes help is needed
First aid management
N.B. Do not try to hook the foreign body out with your fingers. This is likely to push it further
down.
For babies and small children:

Hold the baby upside-down by the feet and beet him/her timely between the shoulder blades.
Lie the child face down over your knee or arm and beet them sharply between the shoulder
blades.

For adults: there are two methods depending up on your knowledge and practice

“Methods A” stand behind the patient and hold around the chest just under the chest hone

“Method B” Tell the patient to lean over the back of a chair holding on to the seat and the
tenanting him/her sharply 3 to 4 times between his shoulder blades whichever the method you
use, the foreign body should be coughed out
􀂃 If the breathing has stopped begin mouth to- mouth respiration
􀂃 After you have done the above, refer to the nearest hospital or health the Center

DROWNING

Definition
Death caused by water reaching the lungs and either causing lung tissue damage or spasms of the
air way that prevents the inhalation of air. Drowning can happen in many different places, Lake,
swamp and spring, rivers etc
First aid Management:
􀂃 You should begin artificial respiration as soon as possible
􀂃 Do not wait to get water out of the patient’s chest first
􀂃 If you can not get air into his/her lungs, quickly turn the patient on his/her side, putting his
head lower than the leg and push the body
􀂃 Then give mouth-to-mouth artificial respiration.
􀂃 If the condition of the victim is not improving refer the victim to the next health facility.

Wound

Definition: Wound is breaking in continuity to tissue of body, either internal or External.

Classification of Wound
1. Open: An open Wound is a break in the skin or mucous membrane
2. Closed: A closed wound involves injury to underlying tissue with out a break in the skin or
mucous membrane.
Types of Wounds
􀂃 Abrasions (torn off of the skin)
􀂃 Incisions
􀂃 Lacerated
􀂃 Punctures
􀂃 Avulsions (a forcible tearing of off of the skin or another part of the body )
Common Causes
Cause or resulting in open wounds from:
􀂃 Motor accidents
􀂃 Fall
􀂃 Mishandling of sharp objects, tools and machineries
The main aims when dealing with wound
􀂃 To control the wound, stop bleeding
􀂃 To treat and prevent shock
􀂃 To protect the wound from contamination and infection
􀂃 To prevent complication
􀂃 Obtain medical attention
Prevention of contamination and infection
􀂃 Hand washing before and after wound care (when possible)
􀂃 By avoiding contamints
􀂃 By using lean materials as much as possible
E.g. cotton gauze, towels etc...
􀂃 Wash in and around the victim’s wound to remove bacteria and other foreign Matters
􀂃 Wash the wound thoroughly by flushing with clean water, preferable running tab water
􀂃 Apply a dry sterile bandage or clean dressing and secure it firmly in place
􀂃 Small wounds even can be taken care at home
􀂃 If there is infection refer the victim to the health center

Bleeding

Definition: Defusing oozing of blood from blood vessels

(Hemorrhage)

Types of bleeding
􀂃 Arterial bleeding- bright red in color, flow from the wound inside
􀂃 Blood loss
􀂃 Venous bleeding – dark red in color, flow is steady
􀂃 Capillary bleeding –oozing from bed of capillaries, red in color, usually less bright than
arterial blood with slow flow.

Methods of controlling bleeding externally

􀂃 Direct pressure- using compresses
- Pressure bandage can be placed to hold pads of cloth.
- Put a thick pad of cloth held between the hand and wound .
• Elevation
The injured part of the body should be raised about the victim’s heart
• Applying pressure on the supplying artery specially on brachial artery in severe bleeding,
• Apply tourniquet in sever bleeding
 Shock
Definition: The reaction of the body to the failure of the circulatory system to provide enough
blood to all-the vital origins of the body.
Shock occurs when the circulatory system fails, and insufficient oxygen reaches the tissues. If
the condition is not treated quickly, vital organs can fail, ultimately causing death. Shock is made
worse by fear and pain
Cause:-
-Trauma
-Heart failures
-Sever bleeding
-Loss of plasma – in burns or crushing injures
-Allergy
-Loss of body fluid- recurrent vomiting from any cause
Symptoms of shock
• General body weakness – the most significant symptoms
• Nausea with possible vomiting
• Thirst
• Dizziness
• Restlessens, and fear /sign of shock/
• Fast breathing and shallow -
• pulse – rapid and weak
• 8. Pupils - dilated
• Face – pale
• Lips-blue
• Restlessness, become unresponsive
• Skin- cool and clammy- eyes- lack luster
• Breathing – rapid and shallow

Shock can be divided into 4 types:

• Hypovolemic shock
– caused by the loss of blood volume (such as through bleeding) or profound dehydration

• Cardiogenic shock
– a result of a weakened heart that is unable to pump blood as efficiently as it once did.
Commonly occurs after a massive heart attack

• Distributive shock
– a result of the lack of distribution of blood to the organs

• Obstructive shock
– results from an obstruction to blood flow at a site other than the heart

First aid management of shock

- Have the patient lie down and stay at rest
- Keep the air way open and preventing the forward tilting of the head
- Control External bleeding
- Keep the patient warm by covering with blanket or sheet
- Properly position the patient
- Open air way and alert for vomiting
If there is no spinal injuries use one of the following positions
- Elevate the lower extremities, place patient place patient-flat, face up, and elevate the legs 8 to
12 inches
- Do not tilt the patient's body
- Don not elevate any fractured limb unless they have been properly splinted
- Do not elevate the leg if there are fractures to the pelvic
- Nothing by mouth (NPO)
- Monitor the patient vital signs
- Refer the patient to Hospital

Unconsciousness
Definition: victim is said to be unconscious when the patient is asleep, he/she cannot speak and
has no control over his movement. Victim also cannot respond to place, people and time (PPT)
Cause of unconsciousness
􀂾 Head injury (bleeding)
􀂾 Fainting
􀂾 Heart attacks
􀂾 Asphyxia
􀂾 Poisoning
􀂾 Shock
􀂾 Epilepsy
􀂾 Diabetes
Aim of giving first aid
1. To find out the cause of the condition and manage it as quickly as possible
2. To refer to Hospital
Level of unconsciousness
– Alertness: the patient can speak, answers, questions and feels pain
– Lethargy :the patient is awake but answers questions slowly- he may be confused about what is
happening and where he is
– Drowsiness: the patient asleep and is unable to concentrate on what we are saying
– Semi-consciousness: the patient is sleepy of and has great difficulty in speaking and in
answering your questions
– Unconsciousness: the patient is sleepy we cannot speak and has no control his movements
Treatment of unconscious Patient
During treatment of unconscious patient follow principles of
A,B,C,D, i.e.
• Assessing air way
• check breathing
• check circulation using or by taking Vital sign
• check for any bleeding and attempt to stop bleeding
• If the victim is improving place in Recovery position
• Do not give to an unconscious victim anything by mouth
• Establish level of responsiveness, check pulse, breathing rate and record any observations
• Give priority to respiratory problems and heart beat.

Recovery position of unconscious patient

Bandaging and Dressing

Made from flannel, elastic net or special paper cotton cloth
- Bandages are used-
• To hold splint in proper place
• To maintain direct pressure over dressing to control bleeding.
• To retain dressings and splints in position
• To prevent or reduce swellings
• To restrict movement etc
-Bandage should never be used directly over a wound
-Bandaging a wound should be applied firmly enough to keep dressing and splints in position
The common types of bandages
• Triangular bandages
• Roller gauze bandage
• Elastic bandage
T- blinder bandage
• Many tailed abdominal bandage
- Bandage should not be tight, may cause injury to the part or impair circulation of blood
- Lose bandage is also useless
Dressings
A dressing – is protective covering applied to a wound to:
-Prevent infection
-Absorb discharge
-Control bleeding
-Avoid further injury
- An efficient dressing should be sterile (germ free) with high degree of porosity and allow for
oozing of discharge of fluid.

CRAMPS

Cramps are painful sensations caused by contraction or over shortening, usually of muscles.
causes:
• Cold or overexertion

treatment:
• Stretch the muscle and apply heat or cold (preferably heat)
• Cramps from lack of salt and water: Stretch the muscle, drink water and increase salt intake

FRACTURE
Description: Is a breakage of bone tissue or discontinuation of bone tissue due to different causes
or accidents.

Possible cause: 1. accident / trauma

2. pathological due to bone infection
3. tumor of the bone

Types of Fracture
• closed
• open
• compound/complicated
Signs and symptoms of fracture:
- Pain - protruding of the parts
- Swelling - mispositions
-Deformity - Unable to function
-Numbness or tingling sensation - Patient may shout due to
-Discoloration severe pain

Complications
Immediate complications
- Hemorrhage/ bleeding
- Severe pain
- Hypotension ( shock) due to bleeding

Late complications
• Disability
• Disfiguring
• Deformity
• Malunion
• Delay in union

General First aid management of Fracture

• Assess carefully but by fast
• Check respiratory condition
• Check bleeding / hemorrhage
• Consider the amount of loss
• Determine and arrange referral
• Asphyxia, bleeding, and severe wounds must be dealt with before treating any fracture
• Support the injured part with supporting device, immobilize the fracture, bandaging and use
splints
• Refer the patient to hospital urgently
NB: Proper immobilization is important to prevent further trauma, pain and complications.

DISLOCATION

Definition:- When bone is no more in an anatomical position or the displacement of one or more
bone at a joint.

Cause:-
-Strong force acts directly or indirectly on a joint
- Sudden muscular contraction
N.B:- Joints which are most frequently dislocated are
- shoulder, elbow, thumb, finger, Jaw
Signs and symptoms
- Pain, near the joint, victim can not move it, deformity abnormal appearance, swelling and brusy
are usually present
First aid and managenent:-
- support and secure the part in most comfortable position
- obtain medical aid at once
- Do not attempt to replace the bones to normal position
Note: - The causes,
- the signs and symptoms
- First aid management, quite similar to fracture.
NB. Do not delay to refer patient with fracture or dislocation since proper investigation and
management is done at hospital

STRAIN AND SPRAIN

STRAIN

Definition: over stretching of muscles due to over pulling of muscles.

Causes:
• Lack of pre- exercise before doing sport activity
• Lifting of heavy loads
• Lifting of heavy weight
• The most common one is back strain.

Signs and symptoms

􀂃 Pain (sudden sharp pain at the site of the injury)
􀂃 Stiffness of muscles
􀂃 Difficulty in moving the affected parts

Management and First Aid

􀂃 Place the victim in the most comfortable position
􀂃 Cold compress during fracture phase Warm compress (physiotherapy)
􀂃 Ant pain support and elevate the inured part or limb and give antipain
􀂃 If not improved refer the victim
􀂃 In case of back strain use a hard board under the bed or lay the victim down on a firm surface

SPRAIN

Definition: An injury which occurs at a joint when the ligaments and tissue around particular
joints are suddenly twisting or torn.
􀂃 Sprain is more severe than strain
􀂃 It usually happens or occurs at joint especially at ankle joint.
􀂃 It might involve bone (broken)
􀂃 Sprain is also tearing of ligaments

Signs and symptoms

􀂃 Pain specially on movement
􀂃 Swelling
􀂃 Loss of movement
Treatment:
-Raise the limb
-Put on a cold compress
-Renew the compresses when they get warm and dry
-Support the joint in most comfortable position with bandage
-Bandage firmly with figure of eight bandage
- Refer for further treatment

Bandage of strained ankle

BURN OF THE BODY

Fire is an accident that causes great damage to life and properties. Children are the most
vulnerable to burn. Burns that occur around the mouth and nose and in general in the face are
more dangerous and can cause death.

Causes of burns:
• Fire, boiled water, steam, boiled oil and milk etc;
• Sun-rays;
• Electric and thunder accidents; and
• Different chemicals;
Effects/hazards of the burn accident:-
Immediate effects/hazards:-
• Burns and wounds of the body;
• Severe pain;
• Oozing and reduction of body fluid from the wound;
• Difficulty in breathing because of suffocation from smoke, severe burns around the throat and
face; and
• Drowziness, restlessness and unconsciousness.

Delayed effects/hazards:
• Infections of the wound, septicemia, and high fever;
• Disability;
• Scar;
• Contracture; and
• Tetanus infection

Classification of burns:
Burns are usually classified in three levels based on the depth or degree of skin damage. These
are:-
• First degree burn;
• Second degree burn, and
• Third degree burn.

1st degree burn:

• Redness or discoloration;
• Mild swelling and pain; and
• Rapid healing.

2nd degree burn:

• Greater depth than first degree burns;
• Redness and mottled appearance;
• Blisters;
• Severe pain;
• Swelling; and
• Prone to infection.

3rd degree burn:

• Deep tissue distraction;
• White appearance;
• No pain and blisters; and
• Complete loss of all layers of skin.
This type of burn results in severe disability and/or death.

First-aid measures:
􀂃 If the victim is burned with fire apply cold applications, immerse the burned area in cold water
or cover with water socked thick cloth or blanket and put out the fire. If the accident is of electric
source, quickly disconnect at the electric meter or check point, or use rope wooden stick, dried
cloth etc. to disconnect;
􀂃 Move the victim from the accident place to avoid further injury;
􀂃 Loosen and/or remove burned dresses and lay down the victim on his/her back and let him/her
breathe fresh air and ensure that no foreign objects have entered and blocked the passage of the
respiratory system;
􀂃 If the victim is not breathing properly, initiate mouth to mouth artificial respiration;
􀂃 Thoroughly check the wound to determine the size, and the degree of burn;

Measures for 1st degree burn:

• Apply cold water application or submerge the burned area in cold water;
• If the wound is minor and small, clean daily the area with boiled cold water cover it with clean
cloth to prevent contact with flies, if the wound located is in a joint, immobilize the joint area
until the wound is cured;
• If the wound is from boiled water, chemical (acid), take out his/her dress and cover it with
clean cloth.

2nd and 3rd degree burn:-

• Cover the wound with clean cloth;
• If the victim is conscious, his/her respiratory parts such as mouth, nose and throat are free from
burn injury and give him/her frequently plenty of liquid such as ORS or similar solution (prepare
the solution from eight tea spoons of sugar, one spoon salt in one liter of boiled cold water). If
the victim is a child below two years old give it one spoon every two minutes and if the child is
over two years give it with a cup or glass in small amount every two minutes;
• Advise the victim or his family to get tetanus toxoid vaccine;
• Refer the victim to the nearest health facility.

Take immediately to a nearby health facility burn victims with the following signs:
• First degree burn with sizeable area;
• 2nd and 3rd degree burns;
• If the victim is drowsy, restless and has breathing problem;
• If the victim has burns on his face, eye, extremities, joints and around genital organs;
• If the source of the burn is electrical, chemical or thunder;
• If the patient has chronic disease such as epilepsy, diabetes etc.; and
• If the burn accident is on elderly persons or children,

Follow up and education on preventive measures:

• Educating on the consequence of severe burns and the importance of referring the victim to a
nearby health facility;
• Education to prevent using harmful foreign substances on the burned area, frequent touching of
the wound, moving joints etc; and
• Identify the causes of the burn accident and give appropriate education to the family and the
community.

Measures to prevent burns:

• Keep away from children items such as matches, burning lamp and candles;
• Prepare and place stoves and other cooking installations in a safe way. E.g. locally made
standing stove;
• Keep away from fire inflammable materials and don’t' come with materials such as nylon close
to fire-place;
• Educate smokers not to smoke inside a house and if they smoke give them strict advice to put
off the burning left over cigarette;

POISON

Definition: Any substance that, if taken in to the body in sufficient quantity, can cause
temporary or permanent damage.
Note: get the poisoned to the hospital or health center immediately.
The extent of danger depends upon:
The amount and type of poison
The age of the person
Whether the person vomits
Where the accident takes place

There are different types of poisons:

- Acids - Insecticides
- Alkalis - Drugs given for allergy (antihistamines)
-Aspirin over dose in children
- sleeping pills (sedatives)
- Iron - mercury
- lead - paraffin, petrol (Gasoline)
- Lysol

General signs and symptoms

􀂃 Nausea
􀂃 Vomiting
􀂃 Abdominal pain
􀂃 Change in consciousness
􀂃 Change in vital signs
􀂃 Change in pupils

Poisons enter the body either accidentally or intentionally through

􀂃 Ingestion (through the mouth)
􀂃 Inhalation (by breathing in)
􀂃 Absorption (through the skin) through contact with poisonous sprays, pesticide, and
insecticides
􀂃 Injection into the skin as the result of bites from some animal, insects, poisonous fish or by
syringe

Steps to treatment of poison:

􀂃 Remove the poison from the body
􀂃 Give the patient the antidote
􀂃 Treat symptoms
􀂃 Give comfort and confidence

How to remove the poison from the body

􀂃 Make the victim vomit it
􀂃 Give plenty of tap water.
􀂃 If it is a child give them syrup or water.
􀂃 Repeat the procedure
􀂃 Refer the victim if it is not improving
NB. Do not make patient vomit if the poison e.g. parafin or kerosene
Do not make the patient vomit if unconscious
For poisoning by acid, give alkali, anti acids

BITES

A. SNAKE BITE

Signs and symptoms

􀂃 Disturbed vision
􀂃 Feel nauseated or vomiting
􀂃 One or two small puncture wounds with sharp pain and local swelling
􀂃 Symptoms and sign of shock
􀂃 Sweating and salivation in advanced stages of venom reaction

First aid management

􀂃 Lay the victim down and advise not to move
􀂃 Calm the victim
􀂃 Immobilized the affected part and keep it below the level of the heart
􀂃 Wipe the wound of venom
􀂃 Apply firm cord just above the bite
􀂃 This must be removed in 15 minutes if you are sure that anti venoum has been injected and
you cannot get the victim to hospital in time. If there is no antivenoum do the following:
􀂃 Tie a cord tightly around the limb just above the bite
􀂃 Using a razor blade or a clean knife make a cut 1 cm deep
􀂃 Suck the liquid which is coming out of the wound
􀂃 Continue to suck and dispose for 5-10 minutes
􀂃 Loosen the cord around the patients limb
􀂃 Disinfect the wound
􀂃 Refer to hospital for anti- venom injection.

Snake bite
 B. DOG BITE
Rabies is a sickness due to an infection from an animal usually a rabid dog, cat, fox, wolf, and
bats. The infection grows in the animal’s nerves, may develop the disease, if the saliva enters a
wound or scratch on a human being.

Signs and symptoms of a rabid dog.

􀂃 has difficulty in swallowing
􀂃 rarely bites
􀂃 Is lethargic /lazy/
􀂃 hides itself
􀂃 does not want food, but swallows, pieces of wood stone etc
􀂃 barks in unusual way and never stop barking
􀂃 Saliva runs out of its mouth

First aid management

1. Clean the wound with soap and water
2. Cover the wound with dressing ointment/powders
3. Find out if anyone knows the dog that bit the patient
4. If the dog is known, ask its owner to watch the dog carefully for lodges and to let you know it
shows any of the above sign and symptoms in that time
- See, during that time, it begins to show any of the above signs and symptoms
- get the dog Killed
- Send the person to hospital or Health center immediately for antirabies vaccination

FIT
Fit (convulsions)
When someone has jerking movements and which cannot be controlled, it is called fit or
convulsion.

Signs and symptoms:-

- uncontrolled jerking movements
- Unconconscious to the environment

Management:
􀂃 Keep the air way clear and lie him on one side
􀂃 Remove any clothes which is too tight
􀂃 Keep from biting his tongue by putting tongue depressor in the mouth
􀂃 Note vital signs and time of fit
􀂃 Prevent from injury or sharp objective
􀂃 Educate the victim and the family to go to health center or a hospital for further investigation
and management
 EYE, EAR AND NOSE INJURY

INJURY TO THE EYE

Since the eyes are delicate, they can be affected easily therefore; immediate help should be
given.

Signs and symptoms

􀂃 Pain inside the eye
􀂃 Wound or cut around the eye ball
􀂃 Different between the size of eye ball
􀂃 Sight decreases
􀂃 Inflammation and infection

Management of the eye injury

􀂃 Avery light covering be applied to an injured eyes
􀂃 Do not apply pressure
􀂃 Reassure the patient
􀂃 If no improvement in few days, Refer the victim to the nearest health facility
Foreign bodies in the eyes:
A foreign body can be; dust, ash, particles of sands, or small fly etc. Often you can remove
foreign from the eyes by flooding it with taped boiled cool water.

If it does not work:

Instruct the patient not to rub his eyes, while the patient is looking up; gently draw the lower lid
down and out. If the foreign body is seen on the lower lid removes it with moistened cotton wool
or the corner of a clean hand kerchief,
If it does not
􀂃 Stand behind the patient
􀂃 Carefully place a smooth match stick at the base lid and pull and turn it inside out over the
math stick
􀂃 Remove the foreign body with wisp of cotton wood
Note: - Do not try to remove a foreign body from the eye ball
- If an acid or alkali gets in to the eye, this can be very dangerous hence, flood the eye with
running water for several minutes
 PROBLEMS WITH EAR:

Bleeding from the ear:

Bleeding from the ear may be due to broken (fractured) skull
􀂃 Cover the ear with a clean material (sterile if available) dressing.
􀂃 Do not plug the ear with wool
􀂃 Do not put in drops
􀂃 Refer the victim to the nearest health facility

Foreign body in the ear:

􀂃 Turn the patient’s head to the affected part of the ear so that the foreign body may drop out.
􀂃 If it is an insect which is inside the ear, direct torch- light to the ear- the insect may follow the
light and come out of the ear. If this does not succeed
􀂃 Pour in taped boiled water, the insect may float out
􀂃 If neither these treatment is successful refer the client to the next health facility.

Bleeding from the Nose:

􀂃 If the foreign body is either beans, peas, avoid putting water or any fluid
􀂃 Get the patient to pinch the lower part of his nose firmly for 10 minutes, while breathing
through his mouth
􀂃 Loose tight clothing around his neck
􀂃 Tell the patient not to blow his nose for several hours
􀂃 If bleeding persists, refer the client to the next health facility

How to stop nose bleeding

Foreign body in the nose:

In an adult, a foreign body may enter the nose by accident, but mostly common in children who
insert a pea or a bean in to their noses.
NB. - Do not attempt to remove it, refer to the next health facility.
 DIARRHEA
If someone has over three frequent/subsequent loose stool in a day, it is called diarrhea. When an
individual loses much fluid from the body due to diarrhea and vomiting, it is likely that he/she
becomes unconscious and /or dies.

Causes of diarrhea and/or vomiting:

• Food poisoning; and
• Intestinal parasites.
Emerging adverse consequences:
• Depletion of body fluids;
• Unconsciousness;
• Failure of kidneys;
• Malnourishment and dehydration; and
• Death, if untreated in time.

Signs of dehydration/excessive loss of body fluids:

• Body debilitation or loss of weight;
• Dryness of the mouth or tongue, sunken eye balls, eye drops, and sunken fontanel, in children;
• Dry and wrinkled skin, and when the skin on the stomach is stretched up with fingers and let
down, it remains as wrinkled;
• Reduced amount of urine are observed and ; and
• Restless and unconscious.

First-aid measures:
• First, ensure that there are no adverse signs that are usually precipitated by diarrhea and
vomiting such as:- Sunken eye balls, wrinkled skin, restlessness; and unconsciousness; and in
children, continuous vomiting after taking fluids, shivering etc.
• Prepare ORS in one litter of boiled and cold water. If ORS is not available prepare home made
solution as follows. Mix eight spoon of sugar, with half a spoon salt in one litre (three normal
beer bottles) of boiled cold water. If available, add half a glass of orange or banana juice into the
solution;
• The ORS or home-made solution is prepared for an adult.
Therefore, he/she must take the fluid in small amount every five minutes. If the one liter solution
is not finished in 24 hours, prepare and give a new/fresh solution in the following day. In
addition frequently provide the victim soup, rice water, gruel/oatmeal (an adult can take daily up
to three liters of fluid);
• For children give ORS or a solution mix of eight spoon of sugar and half spoon of salt in one
liter of boiled coldwater or mix of 2 times rice flour or corn or wheat or smashed potato in one
liter of water and boiled for 5-7 minutes. Feed children after it is properly cooled in the following
manner.
• Children 2 months to 2 years old must get 50-100 milliliters (1 or 2 cups), a maximum of 500
milliliters in one day (one spoon every 2 minutes);
• Children 2-10 years old must get 100-200 milliliters or 2-4 cups of ORS or home-made
solution after every diarrhea episode the child can take up to one liter of the solution);
• If the victim is over 10 years old, give the fluid until satisfied;
• If the victim vomits the fluid, wait for about 10 minutes, and give one spoon of the solution
every three minutes;
• Frequently breast feed the victim and add in small amount other supplementary foods such as
gruel/oat meals every 10 minutes; and
• Continue the supplementary feeding for about two weeks after the diarrhea ceased.

Rationale for referral

• Persistent vomiting after taking fluids;
• If the diarrhea is stained/mixed with blood and the victim has high fever;
• If the vomiting is accompanied with sign such as tenderness and sever cramp of the stomach;
and
• If the diarrhea continues for 3 days in children and 4 days in adults without improvement.

Measures to be taken after first-aid assistance:

• Explain the causes of diarrhea and vomiting'
• Observe on the presence of precipitating factors in the household, such as the maintenance of
house cleanliness and personal hygiene, water source usage, the handling of food and feeding
practices. Based on the findings educate the household or the community with demonstrations.

Preventive Measures:
• Educate and demonstrate to the household on the importance of washing hands with soap and
water, or sand and water etc. before eating;
• Feed children supplementary food and milk with cup and spoon or breast-feed instead of bottle
feeding;
• Keep children in clean areas and keep them always away from dirty area;
• Don’t feed on unclean and unprotected food stuff;
• Use always latrines/toilets; and
• Maintain personal hygiene and clean environment

DISEASES CHARACTERIZED BY FEVER

When an individual’s body temperature is too hot than normal (above 37.5 oc) he/she has a
fever. Fever itself is not an illness, but a sign of many different illnesses.
Common diseases that precipitate fever:-
􀂃 Yellow fever;
􀂃 Typhus, relapsing fever etc;
􀂃 Typhoid;
􀂃 Meningitis’
􀂃 Influenza; and
􀂃 Malaria
Emerging adverse consequences of febrile diseases
􀂃 Mental confusion, unconsciousness;
􀂃 Reduction of body fluid;
􀂃 Convulsion; and
􀂃 High fever precipitates brain damage, paralysis, low blood pressure, dysfunction of kidneys,
inability to hear, speak, and liver damage.

First-aid Measures for febrile cases in general

• Cover with or put light dress on the victim. If the victim is a child, cover it with light cloth and
carry it in your arms;
• replace fluids lost by profuse sweating give frequently the victim, soup, gruel oatmeal, if the
victim is a child, give frequently breast-milk;
• Put cloth soaked in lukewarm water on the chest, face and abdomen to bring down the fever;
• Ask or ensure perhaps the presence of convulsion, chillness, vomiting, diarrhea, meningitis etc;
• If the area is malarious and the fever has lasted for at least two days, give the victim malaria
treatment according to the guidelines on malaria case treatment (refer to the malaria prevention
and control extension package).
• If the victim has not improved three days after he/she got the malaria treatment and if he/she
has signs and symptoms such as vomiting, diarrhea, meningitis, jaundiced eyes, convulsion,
inability to breathe, rapid and intermittent breathing, dyspnea, no urination after drinks, mental
confusion, unconscious etc. and if the locality is not malarious and the cause of the fever is
unknown, bring the victim immediately to a nearby health facility for treatment. If the victim is a
child and has not improved with first-aid treatment, take him rapidly to the next health facility;
• Consult the professional staff in the health facility to find out whether the cause of the fever is
or not an infectious disease;
• Assess if similar illness is observed in the same community; follow and register if the number
of cases is rising. Then report and solicit support from the nearby health facility; and
• Give health education on the causes and preventive measures of the illness.
• If the cause is identified, treat accordingly or refer when necessary because meningitis and
cerebral malaria are serious condition to refer soon.

Preventive measures:
􀂃 Clear and level all mosquito breeding places such as water collections, ditches etc;
􀂃 Undertake insecticide residual house spraying; and
􀂃 Advise households to use insecticide treated nets
􀂃 Avoid over crowding
􀂃 Maintain hygiene
􀂃 Residence/houses must have windows and the windows must be kept open;
􀂃 Let air come through windows and doors in prisons, schools and in public meeting places;
􀂃 If any disease exists in the community report to the nearby health facility and in the meantime
undertake a survey or assessment of the situation; and
􀂃 If the number of sick people increases, advise the community to stop gathering and in the
meantime solicit and organize for vaccination programme.

Signs and symptoms:

􀂃 Unconsciousness;
􀂃 Convulsion;
􀂃 Foaming at the mouth;
􀂃 Only the white part of the eye ball becomes visible; and
􀂃 When the convulsion subsides, the victim gradually becomes conscious. The victim is weak
and dizzy for sometime.

Emerging adverse consequences

􀂃 Depletion of oxygen in brain, dysfunction and retardation of the brain;
􀂃 The victim incurs head damage, wound, body burns etc. during the attack; and
􀂃 Perhaps death

First-aid measures:
• Move or push the victim from potentially dangerous site to prevent him/her from further
accident or injury while in convulsion;
• Remove nearby objects to avoid further accident;
• Loosen tight dress, necktie, belt etc.;
• Lay him/her on his/her side, to prevent the biting of his/her tongue, insert splint of wood
wrapped by stripes of cloth in between his/her teeth;
• Clean the fluid or the saliva coming out through the victim’s mouth;
• Keep him/her laid down on his/her side until jerking is over.
When the jerking is over, bring him/her immediately to a nearby health facility;
• Understand the cause of the sudden illness, and if the victim was already on drugs, advise and
educate him/her to take medicine regularly. Also keep record of the victim and follow him/her
and advise him/her not to come near fire, or to stay always where there are people; and
• Advise the victim to refrain from crossing deep rivers or climb high trees.

MANAGEMENT OF ABORTION

Danger signs in pregnant women

If in spit of all care and advice, any of the following happens urgent medical help should be
obtained at once.
Bleeding
If a pregnant woman loses any amount of blood however little from the breathing- opening
(Vaginal) she should be treated as an emergency.
Vaginal bleeding due to abortion
Definition Abortion is an expulsion of the fetus from the womb during the first weeks of less
than 28 weeks, of pregnancy.
NB. There are two types of abortions
1. This is loss of the unborn fetus during the first 3 months of pregnancy
2. Therapeutic Abortion
This abortion which is legally induced by drugs in order to save the woman’s life.
a) Criminal abortion
This is abortion which is illegally induced in order to end the life of on unwanted fetus.

First Aid and Management:-

• Arrange for urgent referral, until then:-
􀂃 Keep the woman quiet and clean
􀂃 Observe and record pulse and respiration rate
􀂃 Collect any tissue or collected blood which may be discharged from the womb
􀂃 Put clean piece of cloth as a pad on the genitalia

Addendum to Resuscitation
Resuscitation with chest compressions only
An adult cardiac arrest casualty will probably still have oxygen in their blood stream. If there is
any reason you cannot give the casualty rescue breaths, you can still help the casualty by giving
them ‘chest compression only’ resuscitation. Although not ideal, it will still circulate the residual
oxygen in their blood to their vital organs, so it is better than no CPR.
If you are only giving chest compressions, the continuous rate should be 100-120
compressions per minute.
If you have someone with you, take it in turns to administer chest compressions. Every 1-2
minutes, change over so one person administers chest compressions while the other rests and
maintains the casualty’s airway. Ensure there is as little delay in swapping as possible, so the
casualty is constantly receiving chest compressions.
Vomiting during CPR:
It is not uncommon for an unconscious casualty who has stopped breathing to vomit. This is an
autonomic reaction from the unconscious casualty which you may not notice until you come to
give a rescue breath, or their breath comes out with a gurgling noise.
If this happens, turn their head to the side and allow the vomit to drain.
Before continuing resuscitation, clean the casualty’s face, and if you have a face shield handy
use it.
Points of hygiene during resuscitation:
Use a cloth, or whatever you have to hand to wipe the casualty’s mouth clean.
Face shields are useful to have on you, as they protect you from any serious infections such as
TB, Hepatitis, etc. Always use one if you have it with you.
If you do not have a face shield to hand, a piece of plastic with a hole cut or torn into it will
suffice, as will a handkerchief or any piece of material which will help to prevent direct contact.
If you are in any doubt about the safety of giving rescue breaths, you can perform ‘chest
compression only’ resuscitation as a last means (this is described above).
If you have protective gloves, use these. Always wash your hands afterwards to prevent any
contamination.
Place the heel of one hand in the centre of the casualty’s chest. Place the other hand on top and
interlink your fingers.
Take a position next to the casualty’s chest, kneeling at whichever side feels more comfortable
for you.
Press down firmly on the casualty’s breastbone current guidelines suggest pushing down to a
depth of 6cm) then release the pressure, but try not to lose contact with the casualty. This is
known as a chest compression. When applying pressure, avoid doing so on the ribs, upper
abdomen or the end of the casualty’s breastbone.
Each compression should take the same amount of time.
Carry out 30 chest compressions at a speed of 100-120 compressions per minute.
After 30 chest compressions, you must administer two rescue breaths (see images below).
In an ideal situation, the casualty will be on a flat hard surface to be able to administer CPR.
However, this isn’t always the case, and you may find that you need to perform CPR on a
casualty who is, for example, in bed. If this situation arises, try to get the casualty onto the floor
without hurting yourself or the casualty. If it is not possible, remove any pillows or cushions so
the casualty is lying flat and attempt CPR. This is still better than doing nothing.
Combining chest compressions with rescue breaths:
After chest compressions, make sure the casualty’s airway is clear by tilting their head back.
Pinch the casualty’s nose closed; this will make sure the breath you give them does not escape.
Take a breath and place your mouth over the casualty’s, forming a seal.
Steadily blow into the casualty’s mouth, making sure their head is tilted back and the airway is
open. Keep your eyes down on the casualty’s chest to make sure it rises (this should take about a
second). This is known as a rescue breath.
Remove your mouth from the casualty’s and leave enough room for you to take a fresh breath
of air. Keep the casualty’s airway open and watch for the chest deflating, as the air is expelled.
Place your mouth over the casualty’s forming the seal again and give another rescue breath.
You need to do this twice.
Replace your hands on the casualty’s chest immediately and perform another 30 chest
compressions, followed by 2 more rescue breaths.
Continue swapping between 30 chest compressions and 2 rescue breaths.

Dealing with the aftermath of any first aid situation encompasses two aspects, practical issues
and emotional issues. Practical issues include:
-completion of accident reports or log book entries
-restocking the first aid kit and returning it to its storage point
-cleaning up any body fluid spills safely
-participation in any accident investigation
- participation in any accident investigation

,
DOs AND DON'Ts OF FIRST AID
When giving first aid to a casualty, remember the following:
 DO act promptly but calmly.
 DO reassure the casualty and gently examine him to determine the needed first aid.
 DO give lifesaving measures as required.
 DON'T position a soldier on his back if he is unconscious or has a wound on his face
or neck.
 DON'T remove clothing from an injured soldier by pulling or tearing it off.
 DON'T touch or try to clean dirty wounds, including burns.
 DON'T remove dressings and bandages once they have been put on a wound.
 DON'T loosen a tourniquet once it has been applied.
 DON'T move a casualty who has a fracture until it has been properly splinted,
unless it is absolutely necessary.
 DON'T give fluids by mouth to a casualty who is unconscious, nauseated, or
vomiting, or who has an abdominal or neck wound.
 DON'T permit the head of a casualty with a head injury to be lower than his body.
 DON'T try to push protruding intestines or brain tissue back into a wound.
 DON'T put any medication on a burn.
 DON'T administer first-aid measures which are unnecessary or beyond your ability.
 DON'T fail to replace items used from the first-aid case.

PERSONAL HYGIENE
Personal hygiene consists of practices which safeguard your health and that of others. It is often
thought of as being the same as personal cleanliness. While cleanliness is important, it is only
one part of healthy living. Personal hygiene is important to you because:
 It protects against disease-causing germs that are present in all environments.
 It keeps disease-causing germs from spreading.
 It promotes health among others.
 It improves morale.
PERSONAL CLEANLINESS
Skin. Wash your body frequently from head to foot with soap and water. If no tub or shower is
available, wash with a cloth and soapy water, paying particular attention to armpits, groin area,
face, ears, hands, and feet.
Hair. Keep your hair clean, neatly combed, and trimmed. At least once a week, wash your hair
and entire scalp with soap and water. Also, shave as often as the water supply and tactical
situation permit. Do not share combs or shaving equipment with other soldiers.
Hands. Wash your hands with soap and water after any dirty work, after each visit to the latrine,
and before eating. Keep your fingernails closely trimmed and clean. Do not bite your fingernails,
pick your nose, or scratch your body.
Clothing and Sleeping Gear. Wash or exchange clothing when it becomes dirty (situation
permitting). Wash or exchange sleeping gear when it becomes dirty. If clothing and sleeping gear
cannot be washed or exchanged, shake them and air them regularly in the sun. That greatly
reduces the number of germs on them.
CARE OF THE MOUTH AND TEETH
Regular and proper cleaning of the mouth and the teeth helps prevent tooth decay and gum
disease. The most healthful oral hygiene is to clean your mouth and teeth thoroughly and
correctly after each meal with a toothbrush and toothpaste. If a toothbrush is not available, cut a
twig from a tree and fray it on one end to serve as a toothbrush. If mouthwash is available, use it
to help kill germs in your mouth. To help remove food from between your teeth, use dental floss
or toothpicks. Twigs can also be used for toothpicks.
CARE OF THE FEET
Wash and dry your feet daily. Use foot powder on your feet to help kill germs, reduce friction on
the skin, and absorb perspiration. Socks should be changed daily. After crossing a wet area, dry
your feet, put on foot powder, and change socks, as soon as the situation permits
FOOD AND DRINK
For proper development, strength, and survival, your body requires:
 Proteins.
 Fats and carbohydrates.
 Minerals.
 Vitamins.
 Water.
Issued rations have those essential food substances in the right amounts and proper balance. So,
eat primarily those rations. When feasible, heat your meals. That will make them taste better and
will reduce the energy required to digest them. Do not overindulge in sweets, soft drinks,
alcoholic beverages, and other nonissued rations. Those rarely have nutritional value and are
often harmful.
Drink water only from approved water sources or after it has been treated with water-purification
tablets. To purify water from rivers or streams:
 Fill your canteen with water (be careful not to get trash or other objects in your
canteen).
 Add one purification tablet per quart of clear water or two tablets per quart of
cloudy or very cold water. (If you are out of tablets, use boiling water that has been
boiled for 5 minutes.)
 Replace the cap loosely.
 Wait 5 minutes.
 Shake the canteen well and allow some of the water to leak out.
  Tighten the cap.
 Wait an additional 20 minutes before drinking the water.
EXERCISE
Exercise of the muscles and joints helps to maintain physical fitness and good health. Without
that, you may lack the physical stamina and ability to fight. Physical fitness includes a healthy
body, the capacity for skillful and sustained performance, the ability to recover from exertion
rapidly, the desire to complete a designated task, and the confidence to face any eventuality.
Your own safety, health, and life may depend on your physical fitness.
There are lulls in combat when you will not be active. During such lulls, exercise. That helps to
keep the muscles and body functions ready for the next period of combat. It also helps pass the
time in the lulls.
REST
Your body needs regular periods of rest to restore physical and mental vigor. When you are tired,
your body functions are sluggish, and your ability to react is slower than normal. That also
makes you more susceptible to sickness. For good health, 6 to 8 hours of uninterrupted sleep
each day is desirable. As that is seldom possible in combat, use rest periods and off-duty time to
rest or sleep. Do not be ashamed to say that you are tired or sleepy. Do not, however, sleep when
on duty.
MENTAL HYGIENE
The way you think affects the way you act. If you know your job, you will probably act quickly
and effectively. If you are uncertain or doubtful of your ability to do your job, you may hesitate
and make wrong decisions. Positive thinking is a necessity. You must enter combat with absolute
confidence in your ability to do your job.
Fear is a basic human emotion. It is both a mental and physical state. Fear is not shameful if it is
controlled. It can even help you by making you more alert and more able to do your job. Fear
makes the pupils of your eyes enlarge, which increases your field of vision so you can detect
movement more easily. Fear also increases your rate of breathing and heartbeat. That increases
your strength. Therefore, control your fear and use it to your advantage.
Do not let your imagination and fear run wild. Remember, you are not alone. You are part of a
team. There are other soldiers nearby, even though they cannot always be seen. Everyone must
help each other and depend on each other.
Worry undermines the body, dulls the mind, and slows down thinking and learning. It adds to
confusion, magnifies troubles, and causes you to imagine things which really do not exist. If you
are worried about something, talk to your leader about it. He may be able to help solve the
problem.
You may have to fight in any part of the world and in all types of terrain. Therefore, adjust your
mind to accept conditions as they are. If mentally prepared for it, you should be able to fight
under almost any conditions.
RULES FOR AVOIDING ILLNESS IN THE FIELD
 Don't consume foods and beverages from unauthorized sources.
 Don't soil the ground with urine or feces. (Use a latrine or "cat-hole.")
 Keep your fingers and contaminated objects out of your mouth.
 Wash your hands following any contamination, before eating or preparing food, and
before cleaning your mouth and teeth.
 Wash all mess gear after each meal.
 Clean your mouth and teeth at least once each day.
 Avoid insect bites by wearing proper clothing and using insect repellents.
 Avoid getting wet or chilled unnecessarily.
 Don't share personal items (canteens, pipes, toothbrushes, washcloths, towels, and
shaving gear) with other soldiers.
 Don't leave food scraps lying around.
 Sleep when possible.
 Exercise regularly.