Could you offer advice on how to prevent and treat minor injuries? Here is a look at the best recommendations for these common first aid scenarios

Accidents happen, particularly to children. Each year more than one million children younger than 15 are taken to A&E after being injured in or around their home, according to the The Royal Society for the Prevention of Accidents (RoSPA). Yet research suggests that many of us are unaware of how to react in a first aid emergency. According to St John Ambulance, one in three dads and one in five mums are unsure what to do in an emergency situation; 59 per cent of people are unsure how to treat a nosebleed, and 57 per cent don’t know the correct response when somebody faints.

Joe Mulligan, head of first aid education at The Red Cross, said: “Pharmacies have the opportunity not only to demonstrate how easy first aid is, but also to advocate for the public to learn more themselves. We know that the actions of the first aid person on the scene of an accident are absolutely critical in increasing the likelihood of a positive outcome for the casualty.”

Scenario 1

A mother is concerned about a burn on her daughter’s arm. She cooled Mary’s arm straight away but wonders if she should do anything else. The skin looks red and slightly swollen.

Best advice

The symptoms of a burn will vary depending on how serious it is. Symptoms include pain, red and peeling skin, blisters, swelling, and white or charred skin. Mary’s symptoms suggest a mild superficial epidermal burn, which will normally heal, without the need for further treatment, in about a week. Advise Mary’s mum to keep the area clean and not to apply any greasy creams You could also offer appropriate painkillers to ease any pain.

Immediate first aid advice to treat burns and scalds includes:

• Remove any clothing or jewellery, unless it’s stuck on
• Cool the burn with cool or lukewarm water for 10 to 30 minutes, ideally within 20 minutes of the injury occurring
• Keep the person warm
• Cover the burn lengthways with cling film or a clean plastic bag to prevent infection. More serious burns can cause blisters and partial thickness of the skin. Anyone who is suffering from this type of burn, or from a deep burn that is larger than their hand, should be referred to the pharmacist.

Scenario 2

Luke comes to the pharmacy with sunburn after being outside without wearing sun protection. His skin is red, swollen, warm to the touch and peeling in places.

Best advice

Sunburn usually appears within a few hours of sun exposure, and is caused by damage from the sun’s UV rays. Having a cool bath or shower, or applying a clean towel dampened with cool water, will help to relieve pain and reduce swelling. Applying an after sun lotion or cream will help to cool and moisturise peeling skin and relieve the feeling of tightness. Mild sunburn should heal within a week, during which time Luke should keep hydrated and stay out of the sun.

Advise all customers to wear hats and light clothing during warm weather, as well as covering exposed areas of the skin with a broad-spectrum sunscreen of at least SPF30, and reapplying it regularly. Direct sunlight should also be avoided between 11am and 3pm.

Refer to the pharmacist anyone who:

• Is sunburnt and suffering from a rash, itching or fever
• Has skin that is white or numb
• Has skin that has blistered
• Is a young child l Is feeling faint or dehydrated, as this may be a sign of heat exhaustion.

Scenario 3

Rachel comes to the pharmacy after being stung by a wasp on the back of her leg. The area looks red, and Rachel complains that it’s itchy and painful.

Best advice

When an insect bites or stings, it releases saliva and, in the case of stings, venom. This makes the skin red, swollen, itchy and sometimes painful. In some people, it can also trigger a serious allergic reaction (anaphylaxis). Advise customers to wash the affected area with soap and water before placing a cold compress over the sting for at least 10 minutes to reduce swelling.

If the sting is visible, scrape it off using a clean fingernail or credit card; do not use tweezers as they can puncture the venom sac. Rachel could use a spray or cream containing an anaesthetic, antihistamine or hydrocortisone to reduce swelling, pain and itching, or take an antihistamine tablet. Anyone who has nausea, facial swelling, breathing difficulties or abdominal pain may be suffering from anaphylaxis, and should be referred to the pharmacist.

Wearing insect repellent and keeping skin covered reduces the risk of being bitten or stung while outdoors. Customers shouldn’t panic when encountering such insects, but back away slowly and avoid eating sweet food outside as it attracts stinging insects such as wasps.

Scenario 4

Nick, 10, is brought to the pharmacy after falling over while playing football on the school playground. He’s grazed his knee and cut his elbow, which is bleeding steadily.

Best advice

Before a dressing is applied, any bleeding should be stopped by applying pressure to the wound, using a bandage or clean towel. If, as in Nick’s case, the injury is to the arm, the arm should be raised above the head to stop the bleeding.

• To dress the wounds, advise the following:
• Wash and dry hands thoroughly
• Clean the wounds under running water and wash out any loose objects
• Pat the area dry with a clean towel
• Apply a sterile, adhesive waterproof dressing
• Change the dressing regularly

Any wound that appears infected, is at increased risk of infection or contains embedded objects should be referred to the pharmacist. Wounds at increased risk of infection include those with a jagged edge; those that were contaminated before being cleaned, and those that are longer than 5cm or were caused by an animal bite. Signs of infection include swelling of the affected area, pus, redness, increasing pain and a raised temperature over 38°C.

Scenario 5

George comes to the pharmacy saying he’s strained his ankle. The ankle appears swollen and bruised, with limited movement and he mentions he is unable to put weight on it. George is keen to be able to play sport again in the next few weeks.

Best advice

It would appear that George is actually suffering from a sprain rather than a strain. Sprains occur when one or more ligaments are stretched, twisted or torn due to excessive force being applied to a joint. Common symptoms include pain around the joint, bruising, tenderness and inflammation. Strains, however, happen when muscle fibres stretch or tear, usually when stretched beyond their limits or when forced to contract too quickly. Symptoms depend on the severity of the injury, but usually include swelling, bruising, muscle spasms and loss of function.

Sprains and strains can both be self-treated with PRICE:

• Protection – use a support to enclose and protect the injured area
• Rest – avoid activity for 48 to 72 hours
• Ice – for the first 48 to 72 hours, apply ice wrapped in a damp towel to the area for 15 to 20 minutes every two to three hours. Do not leave on while sleeping
• Compression – wrap the joint to limit swelling but don’t restrict blood flow. Remove before sleep
• Elevation – keep the area raised and supported to reduce swelling

Patients should also avoid HARM – heat, alcohol, running and massage – for 72 hours after the injury. Also advise George that to avoid sprains and strains in the future he should warm up before exercise, stretch or ‘warm down’ after exercise, and regularly perform strengthening or conditioning exercises. Recovery time depends on the severity of the injury.

George should be walking normally in one to two weeks, but may not be able to do sport for eight to 12 weeks. Muscle strains vary and can take two weeks to six months to heal fully. Refer anyone with constant or worsening pain to the pharmacist.

Scenario 6 

Joanna comes to the pharmacy complaining of blisters on her feet after spending the previous day in her new high-heel shoes.

Best advice

A blister occurs when the upper layer of skin separates from the lower layers because of continuous rubbing or pressure. It then fills with liquid, creating a fluid-filled sac to cushion the wound. Blisters act as a natural barrier to bacteria and reduce the risk of infection. Advise Joanna to allow her blisters to remain intact unless they are painful or preventing her from walking. She should allow 24 hours for the liquid to be reabsorbed by the skin and then cover the area with an adhesive bandage to protect it from breaking. If it is necessary to drain a blister, recommend the following tips:

• Wash hands and the blister with soap and warm water
• Swab the blister with iodine and rubbing alcohol
• Sterilise a clean, sharp needle by rubbing it with alcohol, burning until it turns red in a flame or placing in boiling water
• Puncture the blister around the edge, let the fluid drain but leave the overlying skin in place. Only remove the skin with sterile scissors if it has a large tear in it
• Apply an antiseptic solution and cover with a bandage.
• Wearing comfortable, well fitting shoes can prevent blisters, as can regularly applying foot cream so feet are hydrated and supple. Anyone with infected blisters, or blisters that recur or come up in unusual places should be referred to the pharmacist.

First aid kit essentials

“It’s important to have an appointed person in the pharmacy who oversees the provision of first aid arrangements and the provision of a first aid box,” says Leyla Hannbeck, head of pharmacy services, NPA. “There is no mandatory list of items that should be included in this – it is left to the employers to decide what is needed in the workplace.” The following items may be useful in the pharmacy and to recommend to customers too:

• Various sized waterproof plasters
• Various sized sterile gauze dressings
• Antiseptic solution
• Disposable gloves
• Tweezers and scissors
• Instant cold compress
• Thermometer
• First aid handbook

Kits should be checked regularly to ensure items are within their expiry date. Medication should not be in the kit but sold OTC if required.

Up your knowledge

There are various first aid training courses suitable for pharmacies. The British Red Cross offers a ‘first aid for pharmacists’ course, while the NPA provides training in the management of anaphylaxis through the ‘consult and treat’ patient group direction service.

St John Ambulance’s ‘first aid at work’ offers practical first aid skills that comply with health and safety first aid regulations.

• NPA: Patient Group Directions
• Red Cross First Aid training courses
• St John's Ambulance: First aid and health and safety training courses