First aid saves lives in accidents or medical emergencies. Taking care of the patient safely until professional help arrives or they are handed over to the hospital is a central part of the rescue chain on the road to recovery. The basic principle of first aid is simple skills that can be easily trained and applied in stressful situations. 
This programme is intended to serve as a first aid primer for Emergency Medical Technicians (EMTs).

A person providing first aid must protect themselves as much as possible from contact with bodily fluids - including vomit, urine and blood. Therefore, Personal Protective Equipment (PPE) is very important for any emergency responder (see Fig. 1). It covers a variety of apparel, helmets, gloves, boots, outerwear and other equipment needed for a safe and efficient emergency response. Essential components of PPE are disposable gloves, face shields/masks (to address risks associated with mouth-to-mouth resuscitation) and the usage of an alcohol-based disinfectant (or similar) (before and after treatment). Also hand washing remains central, as it reduces the risk of pathogen transmission or infection between first responders and patients. Ideally, hands should be washed with soap and warm running water before and after patient contact - or before and after activities where infection is possible. After washing, hands should be dried completely, preferably with disposable wipes. A disinfecting liquid or disinfectant may be used if soap and water are not available and hands are visibly clean (Johanniter International, 2019).

In an emergency, it is important to follow a clear plan, which will help prioritize actions and respond properly and effectively.
Next to establishing personal safety, as described in the chapter above, providing scene safety and developing an overview of the incident and the context in which it occurred is crucial as well.  This includes “determining whether there are immediate life threats to the patient, which need to be addressed; highlighting early, important decisions which need to be made; and, guiding the paramedic with extrication and transport considerations” (Colbeck et al., 2018).

Most incidents a first responder faces are of relatively minor severity. Patients may not require further medical attention, and if they do, at least no ambulance service is required. In most cases, patients are able to contact other medical professionals, or they may be transported by other means to a hospital. In this case the role of the first responder is to help the patient with regard to further care. 
If the accident is more severe, certain steps are essential, and the first responder must assess the hazard situation and secure the surrounding area. If necessary, call the international European emergency number 999/112.
When reporting an accident to the emergency operator, it is important to first state your name and telephone number. This information should be conveyed briefly and clearly.

After the call, it is important to do everything possible to care for the patient until help arrives. Additional support might be provided by the ambulance operator over the phone. In some cases one can do no more than support the patient and keep them company until help arrives. However, this is very valuable (Johanniter International, 2019).

If the emergency occurs in a larger facility or building and, if the situation requires it, it is important to make sure someone is waiting for additional emergency services to arrive and guide them to the scene of the emergency.
If possible and appropriate, the patient's medications can be gathered, free-roaming animals need to be kept at a safe distance, and if it is dark, the scene should be lighted to make it easier for people to find the accident site.
When rendering first aid, it is important to preserve the patient's dignity and privacy as much as possible, but without compromising one’s ability to help. Also, one should be aware of cultural sensitivities. 

The second step of the DRS-ABCD is ‘Responsive?’, which means checking to see if the person is conscious. Do they respond when you talk to them, touch their hands or squeeze their shoulder? If you do not get a response, the person is unconscious. Do not shake the patient (violently), because this can aggravate injuries. 
 

Next is stopping severe bleeding, if this is the case for the patient. Then sent for help. Don’t forget to answer the questions described in Figure 2. Ideally, stay with the patient and use the hands-free function of your cell phone. You may receive further instructions from the telephone operator of the rescue service. Bystanders should leave a clear path/ space around the patient so that emergency services can find their way quickly.
 
If the patient is unresponsive, check if their airway is clear. If a blockage is visible in the mouth, remove it carefully, if this is possible and safe. An unconscious patient is also at risk of airway obstruction due to the tongue falling back. Perform a head tilt-chin lift to open their airway. 
 
Now look, listen, feel for breathing and assess respiratory effort by looking for chest movements (up and down), listen by putting an ear near to their mouth and nose. Feel for breathing by putting a hand on the lower part of their chest. If you are undecided whether the patient is breathing normally, assume that they are not.

CPR stands for cardiopulmonary resuscitation and is a lifesaving technique that is useful in many emergencies, in which someone's breathing or heartbeat has stopped. Make sure the patient is flat on their back. Kneel beside their chest and then place the heel of one hand in the centre of their chest and your other hand on top (see Fig. 6). Press down firmly and smoothly 30 times. Give two breaths. To get the breath in, tilt their head back gently by lifting their chin. Pinch their nostrils closed, place your open mouth firmly over their open mouth and blow firmly into their mouth. Keep going with the 30 compressions and two breaths at the speed of approximately five repeats in two minutes. Performing chest compressions is tiring and ideally the provider should be changed every 2 minutes. CPR should only be stopped if the patient starts to show signs of life, when further medical help arrives, or the provider becomes exhausted (Johanniter International, 2019). 
  

If CPR is not necessary, assess circulation by looking for signs of shock. 
The last point of the DRS-ABCD is ‘Defibrillator’, which is needed for an unconscious person who is not breathing. 
If cardiopulmonary resuscitation has been initiated, connect the patient to an automated external defibrillator (AED) as soon as possible and follow the device's visual and verbal instructions. An AED is a machine that delivers an electrical shock to cancel any irregular heartbeat, in an effort get the normal heart beating to re-establish itself. They are available in many public places, clubs and organizations (see Fig. 7). If the person responds to defibrillation, turn them onto their side and tilt their head to maintain their airway. Caution: Some AEDs may not be suitable for children.
  

Choking is a blockage of the upper airway by food or other objects, which prevents a person from breathing effectively. It is common, especially in the very young or elderly. “Unless the air passage is cleared, the person with choking can lose consciousness within 3-5 minutes. In worse cases, the lack of oxygen to the brain could cause brain damage or death” (Boada et al., 2020). As simple emergency measures can save lives, the DRS-ABCD approach described in lesson 2 should be followed. 

Signs and symptoms of choking include coughing or gasping, difficulty breathing, speaking, or swallowing, panic and/ or clutching of the throat, as well as making abnormal sounds like whistling when breathing or total unresponsiveness (Johanniter International, 2019). 

Most people who suffer from asthma are aware of their condition and should know how to use their own medication appropriately. Still, an asthma attack can be potentially be life-threatening, as the airways become swollen and inflamed. The muscles around the airways contract and the airways produce extra mucus, causing the breathing (bronchial) tubes to narrow.
  
An asthma attack may have symptoms such as difficulty breathing, wheezing and/ or coughing. Without treatment, the symptoms can quickly worsen and lead to severe shortness of breath up to anxiety or panic. 
  
It is advisable Always follow the DRS-ABCD approach. Help the patient to sit upright in a comfortable position and reassure them. Guide the patient to self-administer the soothing medication via an inhaler (see Fig. 10). If necessary, assist the patient in administering their medication, and encourage them to use a "spacer" if the patient has one. Make sure help is on the way. 

“An allergic reaction results from an acquired hypersensitivity to a substance that causes no reaction in the great majority of people. The allergy-causing substance is called an allergen” (Tilton, 2010). Mild allergic reactions are very common, and often it is enough to treat the symptoms. In many cases, the patient knows what caused the problem. Common triggers include peanuts, antibiotics, and seafood (see Fig. 11). In other cases, it is unclear what the trigger is. The relief measures depend on how severe the allergic reaction is.

Features of mild to moderate allergies include swelling around the skin, face and eyes, as well as increased/raised rash that is usually itchy (also called hives)(see Fig. 12). In this case, you should eliminate the potential cause and seek further medical help. Also, ask the patient to take their own medication for a known allergy. If swelling of the airways and respiratory problems develop, examine the patient for signs of severe allergy.

A severe allergic reaction, also called anaphylaxis, is potentially life-threatening and must always be treated as a medical emergency. An anaphylaxis can occur just minutes after exposure to a specific allergy-causing substance (allergen). The patient may show signs of shock, be unresponsive, or go into cardiac arrest. Features include breathing problems and/or noisy breathing, swelling of the tongue and/or constriction in the throat, as well as abdominal pain/cramping and rash and/or excessive sweating.
  
What can be done in this case is to follow the DRS-ABCD approach, help the patient into a comfortable lying position and, if available, assist the patient with the self-application of his epinephrine auto-injector. If the patient is unable to do so, perform the injection.  If there is no improvement after five minutes, another epinephrine auto-injector can be applied, if available. Ensure that the patient is treated as soon as possible. 

A stroke is a serious life-threatening medical condition that happens when the blood supply to part of the brain is cut off. Strokes are a common medical emergency and urgent treatment is essential. Nowadays, there are measures that can improve treatment outcomes for many patients, and early detection by a first responder can make a big difference. The sooner a person receives treatment for a stroke, the less damage is likely to happen.
  
The main symptoms of stroke can be remembered with the word FAST (see Fig. 13), which stands for Face, Arm, Speech and Time.  

In detail this means, 1) the face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have dropped. 2) the person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in one arm. 3) their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake. They may also have problems understanding what you're saying to them. 4) it's time to call for help immediately if you see any of these signs or symptoms.
  
What should be done in this case is to follow DRS-ABCD, offer reassurance and keep the patient comfortable. If the patient has a reduced level of response, put them in the recovery position (Johanniter International, 2019).

Seizures are the result of abnormal brain activity that can lead to involuntary muscle contractions. Seizures can be caused by head injury, brain disease, lack of oxygen, or even hypoglycemia, as well as alcohol or drug abuse.
  
Features may include the patient suddenly falling to the floor, biting the tongue, the body becoming stiff and rigid, twitching or convulsive movements or even involuntary emptying of the urinary bladder (see Fig. 14). After the seizure subsides, the patient may appear confused and sleepy (Johanniter International, 2019). 

Seizures associated with elevated body temperature also exist. Here, a rapid rise in body temperature in an infant or younger child can lead to seizures. Although it is a frightening experience for parents, such seizures are common and do not cause long-term problems if the seizure is brief.