COVID-19 is a new strain of Coronavirus with symptoms of a cough, difficulty in breathing and fever, which develops within 14 days of exposure.
Scientists are learning more about the virus every day, but it is thought that the main way spread of the virus is through droplets. If you stay 2 metres (6 feet) from an infected casualty it will be very difficult to catch the virus. If you need to get closer then use PPE (as described below), wash hands or use hand sanitizer regularly and avoid hand to eye contact.
There is now lots of ‘guidance’ which has appeared from a number of statutory organisations about how to do first aid now that Covid-19 has arrived. We have tried to pull this information together into one document based on the standard Casualty Assessment ‘ABCDE’ structure. Remember that this is guidance based on current best practice, and as the pandemic continues advice may change.
Ten things to remember when doing first aid to casualties in the Covid -19 era;
1. A- Assess
Remember the basics – look after yourself first – safety first. As part of your scene safety and personal protection you now need to think about Coivd-19. PPE (personal protective equipment) is normally means putting on your disposable non latex gloves. Now you should also include a disposable fluid repellent facemask and googles too. These should be added to your first aid kit.
If you don’t have these then use your judgement as to how close to the casualty you should get.
Ensure you do not cough or sneeze over the casualty.
2. A- Approach
When approaching a casualty there is always a risk of cross contamination – especially when you may have to get close to the casualty to talk to them or to check their breathing.
If the casualty appears unconscious kneel next to them and check for alertness by squeezing their shoulders and shouting a command, but do not place your face near their face and mouth.
If a casualty is conscious you may ask them to put on a face mask, ask them if they have a temperature or are feeling unwell. Do they have a cough, temperature of loss of smell? If you suspect Covid-19 maintain a 2 metres distance from the casualty if there is no need to approach closer.
If you should still first perform a primary survey and if the casualty is not alert open their airway normally, with a head tilt and chin lift. If you can lay a cloth or towel or piece of light clothing loosely over the casualty’s mouth. Do not place your face close to theirs.
Check for breathing by looking and feeling (by hand) for abdominal and chest movement. If you have used a cloth over their mouth you may see it move. Take your time and wait for up to 10 seconds to make sure the casualty is breathing effectively.
If you find that the casualty is unresponsive and not breathing, you should ask a bystander to call 999 or 112 for emergency help while you start CPR. Ask a helper to find and bring a defibrillator, if available. If there is no bystander you need to make the emergency services call.
5. C – CPR
CPR for Cardiac Arrest
Do not perform rescue breaths on the casualty.
If there is no history and the casualty is an adult it is assumed, they have collapsed because of a cardiac arrest. Pre Covid-19 first aiders were taught to do chest compressions and rescue breaths if possible. This has now changed and we have moved to ‘bystander CPR’ or ‘compression only CPR’ i.e. CPR without rescue breaths.
- If you are in any doubt about confirming cardiac arrest, the default position is to start chest compressions until help arrives.
- Make sure an ambulance is on its way. If COVID 19 is suspected, tell them when you call 999.
- Early use of an AED significantly increases the person’s chances of survival and does not increase risk of infection.
- If the rescuer has access to any form of personal protective equipment (PPE) this should be worn.
- All first aiders should wash their hands with soap and water after providing first aid. If soap and water are not available, an alcohol-based hand gel should be utilised.
- If possible, the bystander should keep a safe distance away – 2m.
CPR for drowning or children
Remember that this is a casualty who’s heart is running out of oxygen rather than one in cardiac arrest. This is why we would normally give the casualty 5 rescue breaths before starting CPR at a ratio of 30 compressions to 2 breaths.
If you have history which would indicate drowning or the casualty is a child we accept that doing rescue breaths will increase the risk of transmitting the COVID-19 virus, either to the rescuer or the casualty. If you decide to perform mouth-to-mouth ventilation use a resuscitation face shield where available.
Statistically it is likely that in the case of children or infants that the first aider knows the casualty. The first aider may choose to do breaths as the risk of spreading Covid-19 is small compared to the risk of taking no action, as this will result in certain cardiac arrest and the death of the child.
Whatever the outcome, if mouth-to-mouth breathing has been given there are no additional actions to be taken other than to monitor yourself for symptoms of possible COVID-19 over the following 14 days.
6. C- Circulation
Normally when we deal with bleeding, we are very cross contamination aware. Remember the basics. If the casualty has a friend or partner with them, they may be able to clean and dress a wound rather than the first aider who can remain socially distanced.
If the first aider is going to bandage a casualty make sure they are wearing first aid gloves, goggles and face mask. Ask the casualty to wear a face mask if they can.
7. After the incident
Wash your hands with soap and water or use hand sanitizer. Avoid touching your mouth, eyes and nose. This advice is applicable to all situations, regardless of whether there was close contact, or the minimum 2 metre social distancing was maintained.
8. Stress management
The COVID-19 outbreak has meant a lot of change over a short period of time. If you have performed first aid on a casualty take the time to look after your own needs. Talk to a trusted friend or councillor about any fears and concerns. Look after your own welfare as well as that of the casualty.
9. First Aid Equipment
In addition to your normal first aid kit, it would be advisable to add some new items – first aider face mask, goggles or clear visor, casualty face mask, and hand sanitizer.
Any equipment that has been used but is not disposable, must be thoroughly ‘Covid cleaned’ following the incident. Including the box or bag that contains it.
10. Keep informed and updated
As this is a new disease this is an ever-changing situation and the government and NHS are continually updating their advice. Make sure that you regularly review the NHS 111 or Gov.uk website which has a specific section on Coronavirus. Click here to visit Resuscitation Council
Remember if you can’t maintain social distancing, there are still simple things to do to help a casualty. Always stick to the basics. This Video from the European Resuscitation Council has some really pragmatic and relevant advice for first aiders.
Yes, if you feel comfortable doing so. Providing first aid can make a life saving difference, and with appropriate care as detailed above, shouldn’t put you at undue risk.
Extra gloves, face masks, goggles or visors, and hand sanitiser gel. It may be advisable to also include guidance information on providing first aid during the pandemic if your first aid kit is used by others in the workplace.
Yes. Providing CPR can be a life saving intervention, and is still effective in a lot of situations without providing breaths, especially where help is close to hand. Following the advice above will help you stay safe during the Covid-19 pandemic. Remember that the most important thing you can do in the case of a Cardiac Arrest is to call for the emergency services and ask for an AED (defibrillator), before attempting CPR.
In the case of Child CPR, the breaths are likely to be vital to their survival as they are very unlikely to have suffered from a Cardiac Arrest, and have more likely suffered a Respiratory Arrest.
It is very likely that the child is known by the rescuer and therefore history will be known. If not, the advice is to still give rescue breaths is you feel comfortable doing so as they are life saving, while the risk of contracting Covid-19 from the child is relatively very small.
If there is any doubt, the priority is to call for emergency help, this is essential.