The unit, the scope, the currency

HLTAID011 is the broadest of the three workplace first-aid units. It supersedes HLTAID003 (2011-2020) and is the unit referenced in most Australian workplace WHS first-aid requirements.

Four elements

Currency

• HLTAID011 Statement of Attainment is typically refreshed every 3 years
• The CPR component is refreshed annually (ARC recommendation)
• WHS requirements for workplace first aiders may impose stricter currency — check your jurisdiction

Scope of practice

• HLTAID011 is workplace first-aid scope — not clinical scope
• First aiders provide initial care until medical or paramedical assistance arrives
• No invasive procedures (no IM injections outside of casualty's own auto-injector, no IV access, no advanced airway adjuncts)
• Where a first aider holds higher clinical qualifications (e.g. Diploma EHC), the wider scope applies in that role — not as a first aider

The legal framework — what a first aider can and cannot do

Duty of care

• A nominated workplace first aider has a defined duty to respond to incidents in the workplace
• Outside the workplace, there is generally no legal duty to act unless one has been created (parent-child, healthcare professional, contractual)
• Once first aid has commenced, the first aider has a duty to continue until: paramedics take over, the casualty no longer needs assistance, the first aider becomes exhausted, or the scene becomes unsafe

Good Samaritan laws

• Each Australian state and territory has Good Samaritan legislation providing some protection from liability for assistance rendered in good faith
• Protection extends to assistance given without expectation of reward, in line with one's training and ability, and not under the influence of alcohol or drugs
• The protection does not extend to grossly negligent or reckless conduct

Consent

• A conscious adult has the right to refuse first aid — even if refusal is unwise
• If refused — withdraw, call emergency services, monitor from a distance, document the refusal
• An unconscious casualty is presumed to consent (implied consent / doctrine of necessity)
• For a minor — parental consent where possible, implied consent where not

Privacy and confidentiality

• Personal health information is confidential — Australian Privacy Principles apply
• Do not discuss casualty's details with people not involved in the response
• Do not post on social media regardless of identification
• Workplace report is shared per organisational procedure — to those with a need to know

Documentation

• Workplace incident report — facts only (what was observed, what was done, by whom, what time)
• Not opinions about cause or fault
• Records are legal documents — sign, date, retain per workplace policy

The primary survey — DRSABCD applied to first aid

DRSABCD is the framework for every first aid encounter — not only cardiac arrest. The sequence prioritises preserving life, then preventing further injury.

The sequence

AVPU — assessing level of consciousness

• A — Alert and responding spontaneously
• V — Responds to Voice
• P — Responds to Pain (e.g. trapezius pinch)
• U — Unresponsive to any stimulus
• Document the level — V/P/U responses require 000 if not already called

Conscious casualty — secondary survey

• Casualty responsive: SAMPLE history — Signs/Symptoms, Allergies, Medications, Past medical, Last meal, Events leading up
• Head-to-toe check for obvious injury where appropriate
• Pain assessment — OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time)
• Don't waste time on secondary survey if life-threatening problem is present — manage it first

CPR and AED — the foundation skills

Covered in depth in HLTAID009. Key reminders for HLTAID011 context.

Adult CPR essentials

• 30 compressions to 2 breaths; rate 100-120/min; depth at least one-third chest depth (~5 cm)
• Hands lower half sternum; arms straight; full chest recoil between compressions
• 2 minutes uninterrupted required for PE — assessed on a manikin on the floor
• Compression-only CPR acceptable if rescuer unable or unwilling to ventilate

Infant and child CPR differences

• Infant: 2 fingers, ~4 cm depth, neutral head, cover mouth+nose
• Child: similar to adult, modified depth and force for size
• Ventilation matters more for paediatric (most paeds arrests are respiratory)

AED

• Apply as soon as available; follow voice prompts
• Stand clear during analysis; "all clear" before shock
• Resume CPR immediately after shock — do not check response
• If "no shock advised" — continue CPR; non-shockable rhythms still need compressions
• Pad placement: standard anterior-lateral; alternative anterior-posterior for small/large casualties
• Pacemaker — 8 cm clearance; pregnancy not a contraindication

Recovery position

• For unresponsive but breathing casualties
• Maintains airway, allows drainage if vomits, stable for monitoring
• Pregnant — left side; suspected spinal — log-roll with in-line stabilisation but airway wins

Anaphylaxis — recognition and adrenaline

Anaphylaxis kills quickly if untreated. Adrenaline (IM via auto-injector) is the only first-line treatment. Any delay or substitution is dangerous.

Recognition — anaphylaxis vs allergic reaction

Any ONE of the right-column features = anaphylaxis = adrenaline NOW.

Management — ASCIA Action Plan

1. Lay flat — do NOT stand or walk; if difficulty breathing, allow to sit but with legs out flat; DO NOT stand
2. Give adrenaline auto-injector — IM into outer mid-thigh (through clothing if needed); hold for 3 seconds; massage briefly
3. Call 000 — paramedic ambulance
4. Further adrenaline after 5 minutes if no response — second dose if available
5. Asthma puffer after adrenaline if also wheezing
6. If unresponsive and not breathing — commence CPR

Auto-injector use — EpiPen and Anapen

• EpiPen: blue to the sky, orange to the thigh — remove blue cap, push orange tip firmly into outer mid-thigh, hold 3 seconds, massage
• Anapen: remove BOTH black caps; push black needle end firmly into outer mid-thigh; press grey button to fire; hold 3 seconds
• Both deliver IM adrenaline 300 mcg adult / 150 mcg junior (paediatric)
• Through clothing OK in emergency — do not delay to expose skin

Asthma — emergency response

Recognition

• Difficulty breathing — shortness of breath, wheeze, persistent cough, chest tightness
• Anxiety, distress, sitting upright leaning forward (tripod position)
• Severity: mild/moderate — can speak in sentences; severe — only short phrases; life-threatening — single words or silent chest

Management — Asthma First Aid (4-4-4-4)

1. Sit upright — comfortable, leaning slightly forward; reassure
2. 4 puffs of reliever (blue/grey puffer — salbutamol or terbutaline), one puff at a time, into a spacer if available, 4 breaths after each puff
3. Wait 4 minutes
4. Repeat — another 4 puffs if no improvement
5. Call 000 immediately if no improvement after second round, OR if life-threatening from start, OR if first-ever attack
6. Continue 4 puffs every 4 minutes until paramedics arrive

Severe / life-threatening asthma

• Call 000 immediately — do not wait the full 4-4-4-4 cycle
• Continue reliever — up to 8 puffs every 5 minutes
• If anaphylaxis is also possible (allergen trigger) — adrenaline first, then asthma reliever
• If unresponsive and not breathing — commence CPR

Spacer technique

• Shake puffer, attach to spacer
• Place mouthpiece in casualty's mouth — seal with lips
• Press puffer once, casualty takes 4 slow breaths through the spacer
• Spacers improve drug delivery — use one whenever available

Bleeding — life-threatening and non-life-threatening

Severe / life-threatening bleeding

• Spurting bright red arterial blood, large pool of blood, blood through clothing within seconds, signs of shock
• This is a time-critical emergency — minutes matter

Management — direct pressure first

1. Direct pressure on the wound — gloved hand, gauze, or bare hand if no PPE
2. Lay casualty flat — manage for shock
3. Apply pressure dressing if available — pad and bandage firmly over the wound
4. Do not remove a soaked dressing — add more on top
5. Elevate the limb if a limb wound and no suspected fracture
6. Call 000 immediately for severe bleeding

Catastrophic limb bleeding — tourniquet

• If direct pressure fails to control catastrophic limb bleeding (arterial, life-threatening)
• Apply commercial tourniquet (CAT or similar) 5-7 cm above the wound, not over a joint
• Tighten until bleeding stops
• Note time of application; do not loosen
• Improvised tourniquets are inferior — use commercial where available
• For wounds at junctional sites (groin, axilla, neck) — direct pressure / haemostatic gauze packing — tourniquet not possible

Non-life-threatening bleeding

• Wash hands; apply gloves
• Apply direct pressure with a dressing
• Clean the wound — running water, mild soap, gentle
• Cover with a sterile dressing or bandaid
• Seek medical attention if: deep, contaminated, on the face/hand, signs of infection later, tetanus status uncertain, animal bite

Internal bleeding — suspect when

• Mechanism (significant trauma — fall, crash, blow)
• Signs of shock without visible external bleeding
• Abdominal pain/rigidity; bruising flank or umbilicus
• Coughing or vomiting blood; blood from rectum/urine
• Management: 000 immediately, lay flat, monitor, do not give food or fluids

Shock — recognition and management

Shock is inadequate tissue perfusion — the body can't move enough oxygenated blood to vital organs. Different causes, similar signs, similar first-aid management.

Causes of shock

• Hypovolaemic — bleeding (internal or external), severe fluid loss (burns, vomiting, diarrhoea)
• Cardiogenic — heart pump failure (MI, arrhythmia, cardiac tamponade)
• Distributive — anaphylactic, septic, neurogenic (spinal injury)
• Obstructive — tension pneumothorax, massive PE

Recognition — early signs

• Pale, cool, clammy skin
• Rapid weak pulse (tachycardia)
• Rapid breathing (tachypnoea)
• Anxiety, restlessness, confusion
• Thirst

Recognition — late signs (decompensated)

• Drowsiness, decreased level of consciousness
• Mottled skin, cyanosis
• Falling blood pressure
• Urine output drops to nil
• Eventually — cardiac arrest

Management

1. Address the underlying cause — control bleeding, treat anaphylaxis, CPR if needed
2. Lay flat; elevate legs ~30 cm (if no spinal/leg injury and no breathing difficulty)
3. Reassure and keep calm
4. Keep warm — blanket over and under
5. Do NOT give food or drink — even if requesting
6. Monitor breathing, level of consciousness, skin colour
7. Call 000 — shock is always a 000 situation
8. Be ready to commence CPR if breathing stops

Choking — adult, child, infant

Recognition

• Partial obstruction — coughing forcefully, can speak, breathing noisy but moving air
• Full obstruction — cannot speak, cannot cough effectively, silent or absent breathing, clutching throat (universal choking sign), cyanotic

Conscious adult/child — management

1. Encourage cough — if effective coughing, do not interfere
2. 5 back blows — between shoulder blades, with heel of hand, sharp upward angle
3. Check the mouth after each back blow; remove visible object
4. 5 chest thrusts if back blows fail — similar to CPR compression site but slower, sharper thrusts
5. Alternate 5 back blows and 5 chest thrusts until object dislodged or casualty becomes unconscious
6. Call 000 — early

Unconscious choking — management

• Lay casualty supine; commence CPR (30:2)
• Compressions may dislodge object
• Before each set of 2 ventilations — look in the mouth; remove the object only if visible
• Continue CPR until breathing returns or paramedics arrive

Infant choking (under 1 year)

• 5 back blows with infant face-down along your forearm, head lower than chest
• 5 chest thrusts — two fingers on lower sternum (as for infant CPR but sharper and slower)
• Alternate; check mouth between sets
• Do NOT do abdominal thrusts (Heimlich) on infants — risk of internal injury

Burns — thermal, chemical, electrical, radiation

Severity classification

• Superficial (1st degree) — red, painful, no blisters (e.g. sunburn)
• Partial thickness (2nd degree) — blisters, painful, wet appearance
• Full thickness (3rd degree) — white/charred/leathery, may be painless (nerves destroyed)

Severe burn criteria — needs hospital

• Larger than the casualty's palm (~1% TBSA) and partial thickness or full thickness
• Face, hands, feet, genitals, joints — regardless of size
• Chemical, electrical, radiation burns
• Inhalation burns suspected (singed nasal hairs, soot in mouth, hoarse voice, smoke exposure)
• Burns in children or elderly
• Circumferential burns

Thermal burn management

1. Stop the burning — remove from heat source, smother flames, remove burning clothing if not stuck
2. Cool the burn — running cool (not iced) water for 20 minutes, regardless of when injury occurred (still beneficial within 3 hours)
3. Remove jewellery, watches, tight clothing from the affected area — swelling will follow
4. Do NOT — burst blisters, apply ice, butter, toothpaste, creams, ointments (other than per medical advice)
5. Cover with a clean, non-stick, non-fluffy dressing (cling film is acceptable as a temporary cover)
6. Manage shock — burns lose significant fluid
7. Call 000 for any severe burn

Chemical burns

• Irrigate with copious water for 20+ minutes — longer for alkali
• Wear gloves; protect yourself
• Identify the chemical (SDS) — pass to paramedics
• Eyes — flush with running water for at least 20 minutes, eye open, from inside corner outward

Electrical burns

• Power off before approaching — if not done, do not touch
• High voltage — stay back, call emergency services to isolate
• Burns may be deeper than appear (current travels through tissues)
• Cardiac arrest risk — be prepared for CPR + AED
• Look for entry and exit wounds

Cardiac chest pain and stroke — time-critical

Cardiac chest pain — recognition

• Central crushing chest pain or pressure (classic)
• Radiation — jaw, neck, left arm, back, epigastrium
• Sweating (diaphoresis), pale, clammy
• Nausea, vomiting
• Shortness of breath
• Sense of impending doom
• Atypical presentations more common in women, elderly, diabetics — fatigue, indigestion-like, back pain only

Cardiac chest pain — management

1. Sit comfortably, reassure — half-sitting position is often preferred
2. Call 000 — do not let the casualty walk or drive themselves
3. If prescribed and available, assist with GTN (glyceryl trinitrate spray/tablet) — one dose, repeat every 5 minutes up to 3 doses
4. If not contraindicated (no allergy, not bleeding, not <12 yrs), chew one 300 mg aspirin tablet
5. Continue to monitor — be ready for CPR if collapses
6. Apply AED early if collapse occurs

Stroke — FAST

Stroke — management

• Call 000 immediately — clot-busting treatment is time-critical (thrombolysis window typically 4.5 hours)
• Note the EXACT time of onset (last seen well)
• Lay flat or recovery position if reduced consciousness
• Do not give food, fluid, or medication — risk of aspiration
• Stay with the casualty; reassure; monitor breathing

Envenomation — Pressure Immobilisation Technique (PIT)

For Australian snake bites, funnel-web spider bites, blue-ringed octopus, and cone shell envenomation — PIT is the standard first aid. The principle is to slow venom movement through lymphatic vessels.

Snake bite — PIT

1. Keep the casualty calm and STILL — movement spreads venom; do not walk them anywhere
2. Apply a broad pressure bandage directly over the bite site, firmly (as firm as for a sprained ankle)
3. Extend the bandage up the entire limb, from extremity toward the trunk, then back down — covering as much limb as possible
4. Immobilise the limb with a splint — do not let the limb move
5. Mark the bite site through the bandage with a pen — paramedics need to know location
6. Call 000 — do not transport the casualty yourself if avoidable; ambulance comes to them
7. Do NOT: wash the wound (venom on skin helps hospital identification); cut/suck/incise; apply ice; use a tourniquet; give the casualty alcohol
8. Reassure — most Australian snake bites do not deliver envenomating dose; if they do, hospital treatment is highly effective

Funnel-web spider bite

• Same PIT as snake bite
• Highly aggressive and dangerous — confirmed kills are infrequent due to antivenom availability
• If spider is identified — capture if safe to confirm species

Other Australian envenomations

• Redback spider: NOT PIT — apply ice/cold pack, monitor pain, seek medical attention; antivenom available
• Blue-ringed octopus and cone shell: PIT (neurotoxic) + close monitoring of breathing; CPR may be needed
• Tropical jellyfish — box jellyfish (Chironex) AND Irukandji: liberally douse the sting with vinegar for at least 30 seconds to inhibit undischarged stinging cells; do NOT rinse with fresh water; remove tentacles; call 000; watch for collapse and be ready for CPR (antivenom available for box jellyfish)
• Bluebottle (Physalia) and other non-tropical stings: do NOT apply vinegar (it makes Physalia nematocysts fire). Do not rub. Pick off any tentacles, rinse the area well with seawater (never fresh water), then immerse the stung area in hot water — as hot as can be comfortably tolerated, around 45°C — for 20 minutes as first-line pain relief. If hot water is unavailable or pain is unrelieved, apply a cold pack/ice in a dry plastic bag.
• Vinegar rule: vinegar is for tropical jellyfish only (box jellyfish & Irukandji). Never use vinegar on a bluebottle. (ANZCOR Guideline 9.4.5)
• Ticks: kill in place with permethrin/ether-based spray rather than pulling out (allergic reaction risk if disturbed)

Musculoskeletal injuries — when in doubt, treat as fracture

Definitions

• Fracture — broken bone (closed: skin intact; open: bone or wound exposed)
• Dislocation — bone displaced from joint
• Sprain — ligament injury (joint)
• Strain — muscle/tendon injury

Recognition

• Pain, tenderness at the site
• Swelling, bruising
• Deformity, abnormal angulation, shortening of limb
• Loss of function, inability to bear weight
• Crepitus (grating) — felt or heard
• If uncertain — manage as fracture

General management — RICER and immobilisation

1. Rest — stop the activity; do not move the injured part
2. Ice — cold pack wrapped in cloth, 15-20 min on, 60 min off
3. Compression — bandage firmly (not tightly)
4. Elevation — above heart level if possible
5. Referral — medical assessment
6. Immobilise a suspected fracture — splint in the position found; do NOT attempt to realign
7. Open fracture — control bleeding with pressure beside (not on) protruding bone; cover with sterile dressing; immobilise; call 000

Specific considerations

• Suspected hip fracture in elderly — typically following a fall; one leg shortened and externally rotated; do not move; pad and support; 000
• Suspected spinal fracture — see slide 15
• Dislocations — do NOT attempt to relocate; splint as found; transport for medical reduction
• Compartment syndrome — severe disproportionate pain, pallor, paralysis — emergency; loosen any tight bandages; 000

No HARM in the first 48-72 hours

• Heat (vasodilation worsens swelling)
• Alcohol
• Running / exercise
• Massage

Head, neck, and spinal injuries

Suspect spinal injury when

• Significant mechanism — high fall, MVA, sports collision, diving, electrocution
• Casualty reports neck/back pain
• Neurological symptoms — numbness, tingling, weakness, paralysis
• Loss of bladder/bowel control
• Unconscious casualty after head trauma
• Multiple injuries / high-energy mechanism

Management — minimise movement

1. Do NOT move the casualty unless absolutely necessary (immediate danger, airway management)
2. Maintain head and neck in neutral alignment — manual in-line stabilisation
3. Allow casualty to find their own position of comfort if conscious — do not force movement
4. If unconscious but breathing — recovery position with log-roll technique and as much in-line stabilisation as possible
5. Airway management still wins — do not allow a casualty to aspirate to protect the spine
6. Call 000 — paramedics will provide appropriate immobilisation

Head injury — concussion and beyond

• Concussion signs: any loss of consciousness, confusion, memory loss, headache, nausea/vomiting, balance issues, sensitivity to light/sound
• Red flags (call 000): persistent LOC, deteriorating consciousness, repeated vomiting, seizure, unequal pupils, severe headache, weakness, blood/CSF from ears/nose
• Even minor head injury in someone on anticoagulants warrants medical review
• "Second impact syndrome" — repeat head injury before recovery from concussion can be fatal; remove from activity

Helmets

• If casualty has a helmet (motorcycle, sports) and is conscious and breathing — leave helmet on; let paramedics manage
• If airway management requires it — careful 2-person removal with in-line stabilisation
• If breathing absent — remove to access airway and start CPR; needs of CPR override spinal precaution

Seizures — observe and protect

Generalised tonic-clonic seizure — recognition

• Sudden loss of consciousness
• Tonic phase — body rigid, may fall
• Clonic phase — rhythmic jerking of limbs and body
• May lose bladder/bowel control
• May bite tongue, foam at mouth
• Typically 1-3 minutes
• Post-ictal — confused, drowsy, gradually returning to awareness

Management during the seizure

• Note the start time
• Protect from injury — move dangerous objects away; do NOT restrain
• Cushion the head — pillow, jumper, anything soft
• Do NOT put anything in the mouth — they will NOT swallow their tongue
• Do NOT attempt to hold limbs or stop the movement
• Time the seizure

Management after the seizure

• Place in recovery position
• Reassure as consciousness returns — confusion is normal
• Stay with the casualty until fully oriented
• Allow rest — recovery may take hours

Call 000 if

• First-ever seizure
• Seizure lasts more than 5 minutes (status epilepticus)
• Repeated seizures without recovery in between
• Injury sustained during the seizure
• Difficulty breathing after seizure
• Seizure in water, in pregnancy, or in a diabetic
• Casualty does not return to normal consciousness

Causes to consider

• Epilepsy (most common cause of recurrent seizures)
• Febrile (children with high fever)
• Head injury
• Hypoglycaemia
• Stroke
• Alcohol withdrawal
• Drug overdose / poisoning

Diabetic emergencies — hypo and hyper

Hypoglycaemia (low blood sugar) — sudden onset

• Causes: too much insulin, missed meal, exertion, alcohol
• Signs: pale, sweaty, shaky, hungry, confused, aggressive or odd behaviour, slurred speech, loss of consciousness, seizure
• Sudden onset — minutes to develop
• This is the more immediate emergency

Hypoglycaemia — management

• Conscious and able to swallow: give 15g fast-acting glucose — jelly beans (6-7), regular (not diet) soft drink, glucose gel, sugar in water; wait 10-15 min; repeat if no improvement; then give complex carbohydrate (bread, biscuits)
• Unconscious or unable to swallow: do NOT give food/drink — risk of aspiration; recovery position; 000; if their own glucagon kit is available and you are trained — assist with IM glucagon
• Always call 000 if no rapid improvement, if unconscious, or if first-ever episode

Hyperglycaemia (high blood sugar) — gradual onset

• Causes: missed insulin, illness, dietary indiscretion
• Signs: thirst, frequent urination, hot dry skin, fruity (acetone) breath odour, deep rapid breathing (Kussmaul), abdominal pain, vomiting, drowsiness progressing to unconsciousness
• Gradual onset — hours to days

Hyperglycaemia — management

• Call 000 — needs hospital insulin and fluid management (DKA, HHS)
• Allow water if conscious and able to swallow
• Recovery position if reduced consciousness
• Monitor breathing

If in doubt — give sugar

• It is much harder to recognise hypo vs hyper without a glucometer
• If conscious and uncertain — give the sugar; the harm of giving glucose to a hyperglycaemic patient is minimal compared with the harm of not giving it to a hypoglycaemic patient

Poisoning — ingested, inhaled, absorbed, injected

Recognition

• History of exposure (medication, chemical, plant, alcohol, recreational drug)
• Empty containers nearby, suicide note, witnesses
• Symptoms vary widely by substance — nausea, vomiting, abdominal pain, confusion, drowsiness, breathing difficulty, seizures, unconsciousness

Initial management — all poisoning

1. Ensure scene safety — do not become a casualty (chemical exposure, gas)
2. Call Poisons Information Centre 13 11 26 (24 hr Australia-wide) — get specific advice
3. Call 000 for life-threatening symptoms
4. Identify the substance — bring container or remnants to hospital
5. Note the time and approximate quantity
6. DRSABCD as normal — manage airway, breathing, circulation
7. Recovery position if unconscious and breathing
8. Do NOT induce vomiting unless specifically advised by Poisons Info

Specific routes of exposure

• Ingested: per advice above; do NOT give milk/water/charcoal unless advised
• Inhaled: remove from source if safe to do so; fresh air; oxygen if available; CPR if needed
• Absorbed (skin contact): remove contaminated clothing; irrigate skin with copious water; protect yourself with PPE
• Injected (drugs, stings): do not attempt to remove what's already been delivered; manage symptoms; 000

Common poisonings

• Paracetamol overdose: often asymptomatic initially — delayed liver damage; always 000 + hospital, even if "feels fine"
• Carbon monoxide: headache, nausea, confusion, "cherry red" appearance unreliable; remove to fresh air; high-flow oxygen needed; 000
• Opioid overdose: pinpoint pupils, slow shallow breathing, unresponsive; if naloxone available and trained — administer; ventilate; CPR if needed
• Stimulant overdose: agitated, hot, hypertensive, possibly seizing; cool, calm, 000
• Plant ingestion in children: identify the plant if possible; Poisons Info; bring sample to hospital

Temperature emergencies

Hyperthermia — heat-related illness

Heat exhaustion — pale, sweating profusely, dizzy, nauseous, weak pulse, normal or slightly raised core temperature.

Heat stroke — flushed, hot, often DRY skin (sweating may have stopped), confused, irrational behaviour, core temp >40°C, may seize, may become unconscious. Life-threatening.

Heat exhaustion — management

• Move to a cool place — shade, air conditioning
• Lay flat with legs elevated
• Remove excess clothing
• Sips of cool water if conscious and able
• Cool with fan, damp cloth on skin, ice packs to neck/armpits/groin
• Improvement usually rapid — if not, treat as heat stroke

Heat stroke — management

• Call 000 immediately
• Aggressive cooling — cold water immersion if possible, or wet sheets with fan, ice packs to neck/armpits/groin
• Cool until core temp normalises or paramedics arrive
• Recovery position if unconscious
• Be prepared for seizures and CPR
• Do NOT give aspirin/paracetamol — these do not work for hyperthermia (different mechanism than fever)

Hypothermia — core temperature below 35°C

• Mild (32-35°C): shivering, confused, clumsy, slurred speech
• Moderate (28-32°C): shivering stops, drowsy, irrational, slow weak pulse
• Severe (<28°C): unconscious, no detectable signs of life, "appears dead"

Hypothermia — management

• Handle gently — rough movement can trigger cardiac arrhythmia in severe hypothermia
• Remove from cold environment
• Remove wet clothing; wrap in warm dry blankets, including head
• Skin-to-skin contact in life-threatening situations
• Warm sweet drinks if conscious — NOT alcohol or caffeine
• Do NOT apply direct heat (hot water bottle, electric blanket on direct skin) — can cause re-warming shock
• Call 000 for moderate or severe hypothermia
• "Not dead until warm and dead" — continue CPR for hypothermic cardiac arrest until hospital re-warming

Eye injuries, minor wounds, nosebleed, sharps

Foreign body in eye

• Do NOT rub the eye
• If small and superficial — flush with sterile saline or clean water; from inner to outer corner
• If embedded — DO NOT remove; cover both eyes (eye movement is synchronous) with sterile dressing; seek medical attention
• Penetrating eye injury — DO NOT remove; pad around the object; both eyes covered; lay flat; 000

Chemical eye injury

• Immediate irrigation with running water for at least 20 minutes
• Eye open, head tilted so water runs from inner to outer corner
• Continue while transporting if possible
• Identify chemical for medical staff

Minor wounds

• Hand hygiene + gloves before contact
• Control any bleeding with direct pressure
• Clean with running water; mild soap if dirt embedded
• Apply sterile non-stick dressing
• Refer for tetanus / wound assessment if: deep, dirty, animal bite, in elderly/immunocompromised, on face, joints, hand

Nosebleed (epistaxis)

• Sit upright, lean forward (NOT back — blood goes to stomach, causes nausea)
• Pinch the soft part of the nose firmly for 10-15 minutes continuous
• Cold pack on bridge of nose may help
• Spit out any blood — do not swallow
• Seek medical attention if: lasts more than 20-30 minutes, follows head injury, casualty on anticoagulants, recurrent or severe

Sharps injury (first aider's own injury)

• Encourage bleeding by gentle squeezing — do not suck
• Wash with soap and running water for several minutes
• Do not scrub
• Cover with sterile dressing
• Report to supervisor IMMEDIATELY — workplace post-exposure protocol
• Medical assessment within hours — possible post-exposure prophylaxis (HIV, hepatitis) if source patient at risk
• Complete incident report; serology baseline + follow-up testing typically required

Infection prevention & PPE for first aiders

Standard precautions — applied to ALL casualties

• Hand hygiene — before and after every casualty contact
• Gloves whenever contact with body fluids or non-intact skin is possible
• Eye protection / face shield when splash possible
• Resuscitation barrier device (pocket mask, face shield) for ventilation
• Wound dressings — clean, sterile where possible, single-use
• Safe disposal of contaminated materials in appropriate waste stream
• Avoid recapping needles; use sharps container

Casualty-related precautions

• Casualty with respiratory symptoms — surgical mask on the casualty if tolerated; first aider wears mask
• Suspected blood-borne virus exposure — gloves, eye protection, careful disposal
• Suspected infectious disease in workplace — follow workplace infection control plan

If exposed

• Wash exposed skin immediately with soap and water
• Flush mucous membranes with copious water
• Report to supervisor and seek medical assessment as soon as possible
• Workplace post-exposure protocol will determine testing and prophylaxis

Disposing of contaminated items

• Soiled dressings, gloves, masks — sealed biohazard or rubbish bag per workplace policy
• Sharps — rigid puncture-resistant container only; never in regular waste
• Spills — workplace spill kit; absorb, disinfect, dispose

Communication and incident reporting

To 000 emergency services

• Location — full address, landmarks, nearest cross-street, level of building
• What happened — brief description
• Casualty status — age, sex, conscious or not, breathing or not, injuries
• What you've done — what first aid in progress
• Number on scene
• Follow dispatcher instructions; remain on the line if possible

To arriving paramedics — ISBAR or MIST

Communicating with the casualty

• Introduce yourself — "Hi, I'm [name], I'm a first aider, I'm here to help"
• Stay calm, slow, clear — even if internally panicking
• Explain what you are about to do before you do it
• Ask permission for conscious casualties
• Listen as well as talk — the casualty often knows what's wrong
• Cultural and language considerations — use interpreter services if needed

Communicating with bystanders and family

• Give clear, specific roles — "YOU [name], call 000"; "YOU, hold the bandage here"
• Manage onlookers — keep them back to give space and dignity
• Family — keep informed of what's happening without overwhelming
• Witnesses — note who they are; paramedics or police may want to speak to them

Incident report

• Complete the workplace incident report form as soon as practical after the event
• Facts only — what was observed, what was done, by whom, what time
• Sign and date
• Submit per workplace policy — typically to WHS officer or manager
• The incident report is a legal document

Review the incident — and yourself

Reviewing the response

• Hot debrief immediately after the event — informal among those involved
• Formal debrief later — what went well, what could be improved, what to change
• Consider equipment — was the kit complete? Was the AED accessible? Did the response time meet expectations?
• Update workplace procedures based on lessons learned

Psychological impact on the first aider

• Common reactions — shakiness, emotional flooding, sleep disturbance, intrusive thoughts, hyper-vigilance, irritability
• Reactions are normal and not a sign of weakness
• Outcome of the casualty affects impact significantly (death, especially paediatric, is harder)
• Repeat exposures accumulate — long-term first aiders need ongoing support

Looking after yourself

• Acknowledge it happened — do not minimise
• Talk to colleagues, family, trusted friends
• Limit alcohol — common short-term coping, worsens long-term
• Maintain normal routine — sleep, food, exercise
• Engage formal debrief if offered
• EAP (Employee Assistance Program), GP, psychologist if symptoms persist beyond a few weeks

Looking out for others

• Other first aiders / colleagues / bystanders / family of casualty
• Check in with them in the days after
• Encourage professional support if symptoms persist
• Critical Incident Stress Management (CISM) for major events

The workplace first aid system

WHS first aid arrangements

• Each Australian jurisdiction has WHS legislation requiring workplaces to provide first aid
• Risk assessment determines first aid arrangements — number of first aiders, kit contents, location of AEDs
• Safe Work Australia Code of Practice "First aid in the workplace" provides national guidance
• State regulators may have additional requirements (e.g. high-risk industries)

The nominated first aider

• Holds current HLTAID011 (or higher)
• Listed on the workplace first aid roster
• Responds to incidents during their work shift
• Maintains the first aid kit (or works with whoever does)
• Refreshes training as required

First aid kit contents

• Per Safe Work Australia model code — adjusted to workplace risk profile
• Typically includes: dressings (various sizes), bandages (crepe, triangular, conforming), gloves, scissors, tweezers, eyewash, thermal blanket, pocket mask, instant ice pack, sterile saline, plasters, splints, sharps container, notepad/pen
• Inspect monthly; replace expired or used items
• Stocked in accessible, signed locations

The AED in the workplace

• Increasingly common — strongly recommended for workplaces with a higher risk profile
• Maintenance — battery, pads, self-test logs
• Signage — clearly marked location
• All staff should know location, not only nominated first aiders
• Some Australian states have AED registration programs (e.g. AED location databases)

Where this unit connects

Basic anatomy & physiology for first aiders

You don\'t need to be a clinician, but understanding why the body fails helps you act in the right order. DRSABCD follows the systems that keep us alive.

The systems that keep a casualty alive

Why the order matters

• The brain dies within minutes without oxygen — so Airway & Breathing come before everything except Danger
• An open airway is useless if the heart isn\'t circulating blood — hence CPR when not breathing normally
• You treat the biggest threat to life first: this is the logic behind the whole DRSABCD sequence

The ARC Basic Life Support flowchart & Chain of Survival

The Australian Resuscitation Council BLS flowchart is the backbone of HLTAID011. Every condition response loops back to it.

DRSABCD — the BLS flowchart

Chain of Survival

• Early recognition & call for help → Early CPR → Early defibrillation → Early advanced care
• Each link improves survival; bystander CPR and a prompt AED shock are the links a first aider owns
• Survival from cardiac arrest falls roughly 10% for every minute without CPR/defibrillation

Drowning and near-drowning

Drowning is primarily a breathing (hypoxic) emergency. Rescue breaths matter, and your own safety comes first.

Response

1. Your safety first — reach or throw, don\'t go. Only enter the water if trained and it is safe
2. Remove from the water and check response and breathing (DRSABCD)
3. If not breathing normally — give 5 initial rescue breaths, then commence CPR 30:2
4. Expect vomiting/water — turn to clear the airway, then continue
5. Call 000 — keep them warm and minimise heat loss

Cold-water considerations

• Cold-water immersion can cause hypothermia — handle gently, warm gradually
• Do not abandon resuscitation early in a cold-water drowning — recovery can occur after prolonged submersion in cold water

Considerations for different casualties

First aid principles are universal, but technique and risk change with age, pregnancy and ability.

Infants (under 1) and children

• Most paediatric arrests are respiratory in origin — ventilations matter; give 5 initial rescue breaths before compressions
• Infant compressions: two fingers, ~one-third chest depth; child: one or two hands
• Children deteriorate quickly but also respond quickly — act early, reassess often
• Auto-injectors: junior 150 mcg for smaller children per the prescribed device

Older people

• Multiple medical conditions and medications (e.g. blood thinners increase bleeding)
• Atypical presentations — a heart attack or infection may show as confusion or a fall
• Fragile skin and bones — handle gently, higher fracture risk from minor falls

Pregnancy

• Position an unconscious breathing casualty on her left side to avoid compressing major blood vessels
• CPR is performed the same way; do not withhold compressions or defibrillation

Disability & communication needs

• Ask the person (or carer) how best to help; do not assume capacity or incapacity
• Allow for hearing, vision, cognitive or language needs — use interpreters/aids where possible

First aid resources, kits and support

A workplace first aid kit typically contains

• Dressings (assorted), wound & pressure (trauma) dressings, non-adherent pads
• Triangular bandages, crepe/conforming bandages, adhesive strips, tape
• Disposable gloves, resuscitation barrier device (pocket mask/face shield), eye pads
• Saline for irrigation, antiseptic, scissors, tweezers/forceps, safety pins
• Instant cold pack, emergency/space blanket, notepad & pen for records
• A current first aid guide; emergency contact numbers (000, Poisons 13 11 26)

Maintaining resources

• Check contents regularly; replace used and out-of-date items (note expiry dates)
• Kit contents and quantities should match the workplace risk assessment and WHS code of practice
• Know where the nearest kit, AED and trained first aiders are before an emergency happens

Information & support resources

• Emergency: 000  |  Poisons Information Centre: 13 11 26
• ARC / ANZCOR guidelines; ASCIA action plans (allergy/anaphylaxis); Asthma Australia
• Employee assistance / counselling services for psychological support after an incident

Common first aid errors

Recognition errors

• Mistaking anaphylaxis for "just hives" — missing the breathing/cardiovascular features
• Missing atypical cardiac presentation in women, elderly, diabetics
• Treating heat stroke as heat exhaustion (and vice versa)
• Mistaking hypoglycaemia for intoxication or aggression

Action errors

• Not calling 000 early enough — "let's see if it gets better"
• Standing or walking an anaphylaxis casualty before adrenaline
• Putting nosebleed casualty's head back instead of forward
• Removing an embedded object instead of stabilising it
• Inducing vomiting in poisoning without Poisons Info advice
• Applying ice directly to skin (frostbite risk)
• Giving food/drink to an unconscious casualty

Communication errors

• Talking around the casualty instead of to them
• Speculating about cause in the casualty's hearing
• Sharing identifiable details with people not involved
• Posting on social media
• Failing to complete the incident report

Self-care errors

• Minimising the event ("it was nothing")
• Not seeking support after a serious event
• Using alcohol to cope
• Failing to refresh training when due

How you will be assessed

Task 1 — Knowledge Questions (auto-marked)

A set of multiple-choice and true/false questions covering the full scope of the unit. Questions and answer options are randomised. Marked automatically online. Pass mark 100% (every question correct), with up to 3 attempts — review the materials between attempts. On passing, your Certificate of Completion (Theory) is generated.

Task 2 — Practical Skills Assessment (face-to-face)

• Adult CPR on manikin — at least 2 minutes uninterrupted, 30:2, on the floor
• Infant CPR on manikin — at least 2 minutes uninterrupted, 30:2, on a firm surface
• Child CPR on manikin — EMSET best practice. The unit (HLTAID011) mandates adult and infant CPR; EMSET also has you demonstrate child technique so you are prepared across all age groups
• AED use — follow voice prompts during simulated arrest
• Two simulated first-aid incidents — casualty's condition NOT disclosed beforehand; selected from anaphylaxis, asthma, bleeding, choking, shock, chest pain, stroke, fracture, envenomation, burns, seizure, etc.
• Incident report — written or demonstrated