First aid for the emergencies that matter

This page collects the first-aid interventions where the evidence for the immediate action is strong and where getting it wrong costs a life or a limb. None of them is a herbal remedy, and this is the most important page in the handbook.

Cardiac arrest. Bystander cardiopulmonary resuscitation roughly doubles or triples survival, and compression-only CPR is appropriate for an untrained bystander — push hard and fast in the centre of the chest, about 100-120 compressions a minute, without stopping. An automated external defibrillator should be used as soon as one is available; it is designed to be used by anyone. Call emergency services and put the phone on speaker.

Choking. An adult or child over one who is choking but able to cough should be encouraged to cough. If the cough becomes silent or ineffective: five back blows between the shoulder blades, then five abdominal thrusts (Heimlich), alternating. For an infant under one: five back blows and five chest thrusts — not abdominal thrusts. If the person becomes unresponsive, start CPR.

Anaphylaxis. Widespread hives, swelling of the lips, tongue or throat, difficulty breathing, wheezing, dizziness or collapse after a sting, drug or food. The treatment is intramuscular adrenaline into the outer thigh, immediately. Antihistamines and steroids do not treat anaphylaxis. Lie the person flat with the legs raised — do not sit or stand them up, because standing has caused deaths. A second dose can be given after 5 minutes if there is no improvement. Call emergency services.

Severe bleeding. Direct pressure, hard and uninterrupted, for at least 10 minutes — and if it continues, a tourniquet for a limb wound, placed high and tight, with the time written on it. Do not remove a tourniquet. For a wound with an embedded object, do not remove it; pack around it.

Nosebleed. Sit upright, lean forward (not back — swallowing blood causes vomiting), pinch the soft part of the nose firmly for 10-15 minutes without releasing to check. If it continues past 20 minutes, or the person is on an anticoagulant, or it followed a head injury, get medical help.

Sprain. The evidence supports early movement over prolonged immobilisation and the old RICE protocol has been revised: protection, optimal loading, ice (short-term for pain), compression and elevation. Avoid anti-inflammatory medication in the first 48 hours if the goal is optimal healing — there is evidence that NSAIDs may impair tendon and ligament healing, though pain relief matters. A sprain that cannot bear weight, that has immediate severe swelling, or with a suspected fracture needs assessment.

A knocked-out adult tooth. Handle it by the crown, not the root. If it can be replaced in the socket within minutes and held, do so; if not, keep it in milk or saliva — never in water — and get to a dentist immediately. Time is the whole prognosis.

Chemical in the eye. Irrigate immediately with copious clean water for at least 15-20 minutes, holding the eyelid open, and remove contact lenses. Do not use a neutralising solution. Then get medical assessment, and take the container.

Snakebite. Keep the person still and calm, remove constricting items, immobilise the limb at or below heart level, and get to hospital. Do not cut, suck, apply a tourniquet, or apply ice. Take a photo of the snake if it is safe to do so — identification guides the antivenom.