THE MINIMUM REQUIREMENTS FOR AN AMBULANCE

THE AMBULANCE BOX

The contents of this should include a self inflating (AMBU) bag, face masks, oral airways, firm pads of sterile dressings, slings, crepe bandages, a headboard, a sucker, and Thomas splints or padded fracture boards. Pillows are also useful for splinting.

If you can send a suitably competent nurse or medical assistant with the ambulance, include bottles of a plasma expander or 0.9% saline, drip sets, and intravenous cannulae.

If you are called to the scene of an accident yourself, take a laryngoscope, an intubation set, a self-inflating bag, and a non-rebreathing valve.

IF YOU ARE FIRST AT THE SCENE OF AN ACCIDENT,

you may be in command, so your first duty is to supervise. Warn other traffic by displaying a red triangle, or hazard warning lights, or other lights, or by any other means. Extinguish lighted cigarettes or other fire hazards and ask drivers to switch off their engines. Get uninjured people out of vehicles onto a place of safety, then remove the casualties.

THE MINIMUM FIRST AID

Here are some of the things to teach your ambulance driver. He should be able to: (1) Clear the patient’s airway by holding his jaw forward and removing blood, vomit, and foreign bodies from his mouth. (2) Insert an oropharyngeal airway. (3) Use a sucker. (4) Place the patient in the recovery position for transport back to hospital. Not doing this is a common critical mistake. (5) Lift and carry a patient appropriately, particularly if he is suspected of having a spinal injury, as in Fig. 64-4. (6) Fit a temporary cervical collar. (7) Control bleeding by raising a wounded limb, by applying local pressure to a wound, and by pressing on the pressure points. (8) Ventilate a patient with a self-inflating bag. (9) Close an open chest wound. (10) Give external cardiac massage and mouth-to-mouth ventilation. (11) Treat shock by putting a patient into the legs-up position.

CAUTION ! (1) Transporting an unconscious accident victim on his back without proper attention to his airway is a major cause of unnecessary death. (2) The use of a tourniquet (55.1) is likely to do more harm than good.

FIRST AID FOR FRACTURES

Spine Move the patient with great care as in Section 64.3. If necessary, move him on a board or a door, or strap him to a plank.

Pelvis Tie three triangular bandages firmly round the patient’s pelvis, put pads between his legs and tie them together.

Arm (1) Put his arm in a sling and bandage it firmly to his body. Or, (2) tie his arm to a splint which reaches to his axilla.

Fractures above the knee Put the patient’s leg in a well padded Thomas splint. Take especial care to pad the neck of his fibula to prevent paralysis of his common peroneal nerve. If necessary, pad his leg well and hold it in place in a Thomas splint with a few plaster bandages.

Lower leg fractures If no Thomas splint is available, pad a piece of wood or bamboo, or even a palm branch, and tie this to the patient’s injured leg, or bandage his injured leg to his normal one.

Other sections describe the first aid for obstruction of a patient’s upper airway (52.1), burns (58.1), tension pneumothorax (65.5), and flail chest (65.6).