General principles of management
After ensuring safety for the person in need, rescuers and bystanders and sending for help is a must, the management of the collapsed or injured person involves:
• prevention of further harm or injury
• checking response to verbal and tactile stimuli (“talk and touch”)
• care of airway, and breathing
• control of bleeding (Guideline 9.1.1)
• checking for physical (eg. alert jewellery) or electronic alert devices (eg. smartphone application) that may be relevant to assessment or management
• protection from the weather
• other first aid measures depending on the circumstances
• gentle handling
• continued observation.
The condition of a collapsed or injured person may be made worse by movement, increasing pain, injury, blood loss and shock. However, a person lying in a hazardous area, for example on a road or railway, may need to be moved to ensure safety. A rescuer should move a person when needed to:
• ensure the safety of both rescuer and the person in need
• protect from extreme weather conditions
• enable evacuation from difficult terrain
• enable the care of airway and breathing (e.g. turning the unconscious breathing person onto the side or turning a collapsed person onto their back to perform cardiopulmonary resuscitation)
• enable the control of severe bleeding.
ANZCOR Guideline 2 August 2016 Page 3 of 4 ANZCOR suggests that an unresponsive person who is breathing normally is positioned into a lateral, side-lying recovery (lateral recumbent) position as opposed to leaving them supine. It is reasonable to roll a face-down unresponsive person onto their back to assess airway and breathing and initiate resuscitation. Concern for protecting the neck should not hinder the evaluation process or lifesaving procedures.
Ideally, the most experienced rescuer should take charge and stay with the person in need while another rescuer is sent to seek help. If movement is necessary and help is available, the rescuer in charge should explain clearly and simply the method of movement to the assistants, and to the person in need if they are conscious. When ready to move the person in need:
• avoid bending or twisting the person's neck and back: a spinal injury (Guideline 9.1.6) can be aggravated by rough handling
• try to have three or more people to assist in the support of the head and neck, the chest, the pelvis and limbs while moving the person. A spine board may be used if available
• a single rescuer may need to drag the person. Either an ankle drag or arm-shoulder drag is acceptable
• make prompt arrangements for transport by ambulance to hospital.
AUSTRALIAN RESUSCITATION GUIDELINES