First aid

Every year in the UK, thousands of people die or are seriously injured in incidents. Many deaths could be prevented if first aid is given before emergency services arrive.

What to do

If someone is injured you should:

• first check that you and the casualty aren't in any danger, and, if possible, make the situation safe
• if necessary, phone 999 or 112 for an ambulance when it's safe to do so
• carry out basic first aid

Read more about what to do after an incident.

If someone is unconscious and breathing

If a person is unconscious but breathing, and has no other injuries that would stop them being moved, place them in the recovery position until help arrives.

Keep them under observation to ensure they continue to breathe normally, and don't obstruct their airway.

If someone is unconscious and not breathing

If a person isn't breathing normally after an incident, phone an ambulance and start CPR straight away. Use hands-only CPR if you aren't trained to perform rescue breaths.

Read more about CPR, including instructions and a video about hands-only CPR.

Common accidents and emergencies

Below, in alphabetical order, are some of the most common injuries that need emergency treatment in the UK and information about how to deal with them:

• anaphylaxis (or anaphylactic shock)
• bleeding
• burns and scalds  
• choking 
• drowning 
• electric shock (domestic) 
• fractures 
• heart attack 
• poisoning 
• shock 
• stroke

Anaphylaxis

Anaphylaxis (or anaphylactic shock) is a severe allergic reaction that can occur after an insect sting or after eating certain foods. The adverse reaction can be very fast, occurring within seconds or minutes of coming into contact with the substance the person is allergic to (allergen).

During anaphylactic shock, it may be difficult for the person to breathe, as their tongue and throat may swell, obstructing their airway.

Phone 999 or 112 immediately if you think someone is experiencing anaphylactic shock.

Check if the person is carrying any medication. Some people who know they have severe allergies may carry an adrenaline self-injector, which is a type of pre-loaded syringe. You can either help the person administer their medication or, if you're trained to do so, give it to them yourself.

After the injection, continue to look after the person until medical help arrives. All casualties who have had an intramuscular or subcutaneous (under the skin) injection of adrenaline must be seen and medically checked by a healthcare professional as soon as possible after the injection has been given.

Make sure they're comfortable and can breathe as best they can while waiting for medical help to arrive. If they're conscious, sitting upright is normally the best position for them.

Read more about treating anaphylaxis.

Bleeding

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

First, phone 999 and ask for an ambulance as soon as possible.

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

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

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

If nothing is embedded:

• apply and maintain pressure to the wound with your gloved hand, using a clean pad or dressing if possible; continue to apply pressure until the bleeding stops 
• use a clean dressing to bandage the wound firmly
• if bleeding continues through the pad, apply pressure to the wound  until the bleeding stops and then apply another pad over the top and bandage it in place; don't remove the original pad or dressing, but continue to check that the bleeding has stopped 

If a body part, such as a finger, has been severed, place it in a plastic bag or wrap it in cling film and make sure it goes with the casualty to hospital.

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

If someone has a nosebleed that hasn't stopped after 20 minutes, go to your nearest accident and emergency (A&E) department.

Read more about how to treat minor bleeding from cuts and grazes and how to treat nosebleeds.

Haemostatic dressings and tourniquets

In certain situations, where bleeding is very severe and from the body’s extremities, such as the head, neck and torso, it may be appropriate to use haemostatic dressings or a tourniquet.

Haemostatic dressings contain properties that help the blood to clot (thicken) quicker. A tourniquet is a band that's wrapped tightly around a limb to stop blood loss. Haemostatic dressings and tourniquets should only be used by people who have been trained to apply them.

Burns and scalds

If someone has a burn or scald:

• cool the burn as quickly as possible with cool running water for at least 10 minutes, or until the pain is relieved
• phone 999 or seek medical help, if needed
• while cooling the burn, carefully remove any clothing or jewellery, unless it's attached to the skin
• if you're cooling a large burnt area, particularly in babies, children and elderly people, be aware that it may cause hypothermia (it may be necessary to stop cooling the burn to avoid hypothermia) 
• cover the burn loosely with cling film; if cling film isn't available, use a clean, dry dressing or non-fluffy material; don't wrap the burn tightly, because swelling may lead to further injury
• don't apply creams, lotions or sprays to the burn

For chemical burns, wear protective gloves, remove any affected clothing, and rinse the burn with cool running water for at least 20 minutes to wash out the chemical. If possible, determine the cause of the injury.

In certain situations where a chemical is regularly handled, a specific chemical antidote may be available to use.

Be careful not to contaminate and injure yourself with the chemical, and wear protective clothing if necessary.

Phone 999 or 112 for immediate medical help.

Read more about how to treat burns and scalds.

Choking

The information below is for choking in adults and children over one year old.

Mild choking

If the airway is only partly blocked, the person will usually be able to speak, cry, cough or breathe. In situations like this, a person will usually be able to clear the blockage themselves.

If choking is mild:

• encourage the person to cough to try to clear the blockage
• ask them to try to spit out the object if it’s in their mouth
• don't put your fingers in their mouth to help them because they may accidentally bite you

If coughing doesn’t work, start back blows (see below).

Severe choking 

If choking is severe, the person won’t be able to speak, cry, cough or breathe, and without help they’ll eventually become unconscious.

To help an adult or child over one year old:

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

Abdominal thrusts shouldn't be used on babies under one year old, pregnant women or obese people.

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

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

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

If the obstruction doesn't clear after three cycles of back blows and chest thrusts, phone 999 or 112 to ask for an ambulance, and continue until help arrives.

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

Drowning

If someone is in difficulty in water, don't enter the water to help unless it's absolutely essential.

Once the person is on land, if they're not breathing, open the airway and give five initial rescue breaths before starting CPR. If you're alone, perform CPR for one minute before phoning for emergency help.

Find out how to give CPR, including rescue breaths.

If the person is unconscious but still breathing, put them into the recovery position with their head lower than their body and phone an ambulance immediately.

Continue to observe the casualty to ensure they don't stop breathing or that their airway becomes obstructed.

Electric shock (domestic)

If someone has had an electric shock, switch off the electrical current at the mains to break the contact between the person and the electrical supply.

If you can't reach the mains supply:

• don't go near or touch the person until you're sure the electrical supply has been switched off  
• once the power supply has been switched off, and if the person isn't breathing, phone 999 or 112 for an ambulance

Afterwards, seek medical help - unless the electric shock is very minor.

Fractures

It can be difficult to tell if a person has a broken bone or a joint, as opposed to a simple muscular injury. If you're in any doubt, treat the injury as a broken bone.

If the person is unconscious, has difficulty breathing or is bleeding severely, these must be dealt with first, by controlling the bleeding with direct pressure and performing CPR.

If the person is conscious, prevent any further pain or damage by keeping the fracture as still as possible until you get them safely to hospital.

Assess the injury and decide whether the best way to get them to hospital is by ambulance or car. For example, if the pain isn’t too severe, you could transport them to hospital by car. It's always best to get someone else to drive, so that you can deal with the casualty if they deteriorate – for example, if they lose consciousness as a result of the pain or start to vomit.

However, if:

• they’re in a lot of pain and in need of strong painkilling medication, don't move them and phone an ambulance
• it's obvious they have a broken leg, don't move them, but keep them in the position you found them in and phone an ambulance
• you suspect they have injured or broken their back, don't move them and phone an ambulance

Don't give the casualty anything to eat or drink, because they may need an anaesthetic (numbing medication) when they reach hospital.

Heart attack

A heart attack is one of the most common life-threatening heart conditions in the UK.

If you think a person is having, or has had, a heart attack, sit them down and make them as comfortable as possible, and phone 999 or 112 for an ambulance.

Symptoms of a heart attack include:

• chest pain – the pain is usually located in the centre or left side of the chest and can feel like a sensation of pressure, tightness or squeezing
• pain in other parts of the body – it can feel as if the pain is travelling from the chest down one or both arms, or into the jaw, neck, back or abdomen (tummy) 

Sit the person down and make them comfortable.

If they're conscious, reassure them and ask them to take a 300mg aspirin tablet to chew slowly (unless you know they shouldn't take aspirin – for example, if they're under 16 or allergic to it).

If the person has any medication for angina, such as a spray or tablets, help them to take it. Monitor their vital signs, such as breathing, until help arrives.

If the person deteriorates and becomes unconscious, open their airway, check their breathing and, if necessary, start CPR. Re-alert the emergency services that the casualty is now in cardiac arrest.

Poisoning

Poisoning is potentially life-threatening. Most cases of poisoning in the UK happen when a person has swallowed a toxic substance, such as bleach, taken an overdose of a prescription medication, or eaten wild plants and fungi. Alcohol poisoning can cause similar symptoms.

If you think someone has swallowed a poisonous substance, phone 999 or 112 to get immediate medical help and advice.

The effects of poisoning depend on the substance swallowed, but can include vomiting, loss of consciousness, pain or a burning sensation. The following advice is important:

• Find out what's been swallowed, so you can tell the paramedic or doctor.
• Do not give the person anything to eat or drink unless a healthcare professional advises you to.
• Do not try to cause vomiting.
• Stay with the person, because their condition may get worse and they could become unconscious.

If the person becomes unconscious while you're waiting for help to arrive, check for breathing and, if necessary, perform CPR.

Don't perform mouth-to-mouth resuscitation if the casualty's mouth or airway is contaminated with the poison.

Don't leave them if they're unconscious because they may roll onto their back, which could cause them to vomit. The vomit could then enter their lungs and make them choke.

If the casualty is conscious and breathing normally, put them into the recovery position and continue to monitor their conscious state and breathing.

Shock

In the case of a serious injury or illness, it's important to look out for signs of shock (see below).

Shock is a life-threatening condition that occurs when the circulatory system fails to provide enough oxygenated blood to the body and, as a result, deprives the vital organs of oxygen.

This is usually due to severe blood loss, but it can also occur after severe burns, severe vomiting, a heart attack, bacterial infection or a severe allergic reaction (anaphylaxis).

The type of shock described here isn't the same as the emotional response of feeling shocked, which can also occur after an accident.

Signs of shock include:

• pale, cold, clammy skin
• sweating
• rapid, shallow breathing
• weakness and dizziness
• feeling sick and possibly vomiting
• thirst
• yawning
• sighing

Seek medical help immediately if you notice that someone has any of the above signs of shock. If they do, you should:

• phone 999 or 112 as soon as possible and ask for an ambulance
• treat any obvious injuries
• lie the person down if their injuries allow you to and, if possible, raise and support their legs
• use a coat or blanket to keep them warm
• don't give them anything to eat or drink
• give them lots of comfort and reassurance
• monitor the person – if they stop breathing, start CPR and re-alert the emergency services

Stroke

The FAST guide is the most important thing to remember when dealing with people who have had a stroke. The earlier they receive treatment, the better. Phone for emergency medical help straight away.

If you think a person has had a stroke, use the FAST guide:

• Facial weakness – is the person unable to smile evenly, or are their eyes or mouth droopy?
• Arm weakness – is the person only able to raise one arm?
• Speech problems – is the person unable to speak clearly or understand you?
• Time to phone 999 or 112 – for emergency help if a person has any of these symptoms

Read more about the symptoms of a stroke.

If someone is injured in an incident, first check that you and the casualty aren't in any danger. If you are, make the situation safe.

When it's safe to do so, assess the casualty and, if necessary, phone 999 or 112 for an ambulance. You can then carry out basic first aid.

Assessing a casualty

The 3 priorities when dealing with a casualty are commonly referred to as ABC, which stands for:

• Airway
• Breathing
• Circulation

Airway

If the casualty appears unresponsive, ask them loudly if they're OK and if they can open their eyes. If they respond, you can leave them in the position they're in until help arrives. While you wait, keep checking their breathing, pulse and level of response:

• are they alert?
• do they respond to your voice?
• do they respond to pain?
• is there no response to any stimulus (are they unconscious)?

If there's no response, leave the casualty in the position they're in and open their airway. If this isn't possible in the position they're in, gently lay them on their back and open their airway.

To open the airway, place one hand on the casualty’s forehead and gently tilt their head back, lifting the tip of the chin using two fingers. This moves the tongue away from the back of the throat. Don't push on the floor of the mouth, as this will push the tongue upwards and obstruct the airway.

If you think the person may have a spinal injury, place your hands on either side of their head and use your fingertips to gently lift the angle of the jaw forward and upwards, without moving the head, to open the airway. Take care not to move the casualty’s neck. However, opening the airway takes priority over a neck injury. This is known as the jaw thrust technique.

Breathing

To check if a person is still breathing:

• look to see if their chest is rising and falling
• listen over their mouth and nose for breathing sounds 
• feel their breath against your cheek for 10 seconds

If they're breathing normally, place them in the recovery position so their airway remains clear of obstructions and continue to monitor normal breathing. Gasping or irregular breathing is not normal breathing.

If the casualty isn't breathing, phone 999 or 112 for an ambulance and then begin CPR.

Circulation

If the casualty isn't breathing normally, then you must start chest compressions immediately.

Agonal breathing is common in the first few minutes after a sudden cardiac arrest (when the heart stops beating). Agonal breathing is sudden, irregular gasps of breath. This shouldn't be mistaken for normal breathing and CPR should be given straight away.

This page provides information and guidance about hands-only cardiopulmonary resuscitation (CPR) and CPR with rescue breaths.

Hands-only CPR

To carry out a chest compression:

1. Place the heel of your hand on the breastbone at the centre of the person’s chest. Place your other hand on top of your first hand and interlock your fingers
2. Position yourself with your shoulders above your hands
3. Using your body weight (not just your arms), press straight down by 5-6cm (2-2.5 inches) on their chest
4. Keeping your hands on their chest, release the compression and allow the chest to return to its original position
5. Repeat these compressions at a rate of 100 to 120 times per minute until an ambulance arrives or you become exhausted

When you phone for an ambulance, telephone systems now exist that can give basic life-saving instructions, including advice about CPR. These are now common and are easily accessible with mobile phones.

CPR with rescue breaths

If you’ve been trained in CPR, including rescue breaths, and feel confident using your skills, you should give chest compressions with rescue breaths. If you're not completely confident, attempt hands-only CPR instead (see above).

Adults

1. Place the heel of your hand on the centre of the person's chest, then place the other hand on top and press down by 5-6cm (2-2.5 inches) at a steady rate of 100 to 120 compressions per minute
2. After every 30 chest compressions, give two rescue breaths
3. Tilt the casualty's head gently and lift the chin up with two fingers. Pinch the person’s nose. Seal your mouth over their mouth and blow steadily and firmly into their mouth for about one second. Check that their chest rises. Give two rescue breaths
4. Continue with cycles of 30 chest compressions and two rescue breaths until they begin to recover or emergency help arrives

Children over one year old

1. Open the child's airway by placing one hand on the child’s forehead and gently tilting their head back and lifting the chin. Remove any visible obstructions from the mouth and nose
2. Pinch their nose. Seal your mouth over their mouth and blow steadily and firmly into their mouth, checking that their chest rises. Give five initial rescue breaths
3. Place the heel of one hand on the centre of their chest and push down by 5cm (about two inches), which is approximately one-third of the chest diameter. The quality (depth) of chest compressions is very important. Use two hands if you can't achieve a depth of 5cm using one hand
4. After every 30 chest compressions at a rate of 100 to 120 per minute, give two breaths
5. Continue with cycles of 30 chest compressions and two rescue breaths until they begin to recover or emergency help arrives

Infants under one year old

1. Open the infant's airway by placing one hand on their forehead and gently tilting the head back and lifting the chin. Remove any visible obstructions from the mouth and nose
2. Place your mouth over the mouth and nose of the infant and blow steadily and firmly into their mouth, checking that their chest rises. Give five initial rescue breaths
3. Place two fingers in the middle of the chest and push down by 4cm (about 1.5 inches), which is approximately one-third of the chest diameter. The quality (depth) of chest compressions is very important. Use the heel of one hand if you can't achieve a depth of 4cm using the tips of two fingers
4. After 30 chest compressions at a rate of 100 to 120 per minute, give two rescue breaths
5. Continue with cycles of 30 chest compressions and two rescue breaths until they begin to recover or emergency help arrives

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

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

You can follow these steps:

• with the person lying on their back, kneel on the floor at their side
• place the arm nearest you at a right angle to their body with their hand upwards, towards the head
• tuck their other hand under the side of their head, so that the back of their hand is touching their cheek
• bend the knee farthest from you to a right angle
• carefully roll the person onto their side by pulling on the bent knee
• the top arm should be supporting the head and the bottom arm will stop you rolling them too far
• open their airway by gently tilting their head back and lifting their chin, and check that nothing is blocking their airway
• stay with the person and monitor their condition until help arrives

Spinal injury

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

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

You should suspect a spinal injury if the person:

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