Ready Hands

A Step-by-Step First Aid Guide for Care Workers, from Heatstroke to the Roadside

Before You Begin

This book is for care workers: the people who support older people and people with disabilities in their own homes, in day centres and care homes, and on the way between them, on walks, at the shops, at appointments and in the car. Because you are close to the people you support every day, you are often the first person there when someone collapses, falls, chokes or becomes ill in the heat. You are not expected to be a doctor or a nurse. You are expected to stay calm, to call for help and to give the first help that keeps the person safe until professional help arrives, and that is what this book is about. Anyone else who wants the same knowledge is welcome to read it too.

Each chapter begins with a short moment from a care worker's day, the kind of moment that can happen on any shift. The chapter then explains what is happening and what to do, and at least two sections in every chapter are written as steps, one step to each paragraph, so that you can follow them in order. Every chapter ends with things to check at work or before an outing. Heat runs through the book, because older people and many people who receive care are at special risk in hot weather, and so do roads, because so much of your work happens on pavements, at stops and in vehicles.

The same basic order of first aid runs through every chapter, as it does through first aid courses. Make the scene safe, starting with your own safety. Check the person. Call for help. Give the first aid that the situation needs and that you have learned. Stay with the person until help arrives and takes over. Whenever you are unsure what to do next, come back to this order, and it will guide you through the first minutes.

In any serious emergency, calling the emergency number early is one of the most important things you can do, and if someone else is with you, one of you can call while the other helps. Learn the emergency number of the country where you work from official information, and the number of any country you travel to with the people you support. Save it in your phone and write it in the places your workplace uses. In some countries one number covers the ambulance, the fire service and the police; in others there are several. Chapter 2 explains how to make the call and how to describe where you are, even from the side of a road.

Reading this book is a good start. A practical first aid course with hands-on practice is the way to be ready, because it lets you press on a training manikin, roll a colleague into the recovery position and hear a training defibrillator speak before the day you need one. Refresher courses keep your skills fresh and teach you any changes in the methods. If you have not taken a course yet, or if your last one was some time ago, booking one is the best next step after this book.

You also work as part of a team. Your workplace has its own emergency procedures, and each person you support has a care plan that may say important things about their health, their wishes and what to do in an emergency. Follow those procedures and that care plan, report every emergency as your workplace asks, and use this book to understand the reasons behind the steps. With knowledge, practice and a steady mind, your hands can be ready when they are needed.

Chapter 1: Ready Before It Happens

What Can Happen

A care worker arrives for a morning visit at the home of a man in his eighties. Usually he opens the door with a smile, but today there is no answer, so the care worker lets herself in with the key that her workplace holds for visits. She finds the man sitting on the kitchen floor, pale and confused, with a broken cup beside him. For a moment her mind goes blank. Then she remembers the order she learned on her first aid course: make it safe, check the person, call for help, give first aid, and stay. She steps around the broken cup, kneels beside the man, and says his name in a calm, clear voice.

Moments like this one are part of the job for many care workers. You spend more time with the people you support than almost anyone else does, so you are often the first person to notice that something is wrong. This chapter explains what first aid is, why your role matters so much, and the basic order of first aid that courses teach. It also explains respect and consent in an emergency, the place of your workplace's procedures and the care plan, and how to get ready before anything happens. The rest of the book builds on this chapter, one situation at a time.

Why Care Workers Are Often First

First aid is the help that you give to a person who is injured or suddenly ill, before professional help arrives. It does not need a hospital or special equipment. It needs a clear head, a few practised steps and the willingness to start. Good first aid can keep a person alive, stop an injury from getting worse, and help the person feel less afraid. Even when there is little you can do with your hands, calling the emergency number quickly and staying with the person is first aid too.

Care workers are often the first on the scene for simple reasons. You visit people in their homes, sometimes when nobody else is there. You help them wash, dress, eat and move, and these are the very moments when falls, choking and dizziness often happen. You go with them on walks, to the shops and to appointments, so you are beside them on pavements, at bus stops and in cars. Many of the people you support are older or live with long-term health conditions, and they are more likely to become unwell suddenly, especially in hot weather.

Two settings appear again and again in this book, because they are part of daily care work. The first is hot weather. Older people and many people who receive care feel heat less clearly and cool down less easily, so heat illness can come on quietly and become serious quickly; Chapters 6, 7 and 8 are about heat. The second is the road. Care workers walk, push wheelchairs, wait at stops and drive with the people they support, and they sometimes pass an accident on the way. Several chapters explain how to act safely beside a road and how to tell the emergency service exactly where you are.

You also know the person. You know how the woman you support usually speaks, how the man you visit usually walks, and what is normal for each of them on a good day. This knowledge is valuable in an emergency. A small change that a stranger would miss, such as new confusion or a face that looks different on one side, may be the first sign of something serious. When you notice a change and act on it, you give the person the best chance of getting help in time.

At the same time, nobody expects you to be a doctor or a nurse. First aid has clear limits, and those limits protect both you and the person. You give the help that a first aid course teaches, you call the people whose job is to give medical care, and you hand over to them when they arrive. Knowing where your role ends is part of doing it well. It lets you act quickly and with confidence, without feeling that everything depends on you alone.

This book follows the general content of first aid courses as they are taught today. These courses are based on public first aid guidelines, such as those of the Red Cross and Red Crescent societies, which experts review and update from time to time. Reading is a good start. A practical first aid course with hands-on practice, followed by refresher courses, is the way to be truly ready, because your hands learn the steps in a way that reading alone cannot give them.

Step by Step: The Basic Order of First Aid

Step 1. Stop for a moment and take a breath before you move. A few seconds to look and think will help you act more calmly and more safely. Tell yourself what you can see: who needs help, what may have happened, and what is around you. A calm voice and slow movements will also help the person, who may be frightened.

Step 2. Make the scene safe, starting with your own safety. Look for danger such as traffic, fire, smoke, electricity, water on the floor or broken glass. If you can remove the danger without risk, do so, for example by switching off an appliance at the wall or moving a fallen chair out of the way. If you cannot make the scene safe, do not go closer; stay back and call the emergency number. You cannot help anyone if you are hurt yourself.

Step 3. Check the person. Speak to the person loudly and clearly, using their name if you know it, and gently tap their shoulders. Notice whether the person answers, opens their eyes or moves, and look for breathing and for any heavy bleeding. Chapter 3 explains how to check a person who has collapsed, step by step.

Step 4. Call for help. Shout for anyone nearby, and call the emergency number yourself or ask another person to call it while you stay with the person. Put the phone on speaker so that your hands are free. When it is safe to do so, follow your workplace's procedure for telling your supervisor or office. Chapter 2 explains the emergency call in detail.

Step 5. Give the first aid that the situation needs and that you have learned. This may mean placing the person in the recovery position, pressing firmly on a bleeding wound, cooling a person who is overheated, or starting CPR. Follow the instructions of the emergency operator, who can guide you through each action. Wear disposable gloves if they are available and there is blood or other body fluid.

Step 6. Leave an injured person where they are unless there is danger, such as fire or traffic, that makes staying there more harmful. Moving a person with a hidden injury can make that injury worse. Keep the person still and as comfortable as possible, and protect them from heat, cold and rain where you can.

Step 7. Stay with the person until help arrives and takes over. Talk to the person calmly, tell them what is happening, and keep watching their breathing and how they respond. If anything changes, call the emergency number again or tell the operator if you are still on the line. Simple words such as "Help is on the way, and I am staying with you" can comfort a person who is frightened, even one who seems not to hear. When the ambulance crew arrives, tell them what happened and what you did.

Respect, Consent and Your Workplace's Procedures

The people you support have the right to decide what happens to their own bodies, even in an emergency. Whenever the person is awake and able to understand, tell them who you are, explain what you would like to do, and ask whether that is all right. A simple question such as "May I help you lie on your side?" shows respect and gives the person a sense of control. If the person says no, do not force your help on them, but stay nearby, keep watching, and call the emergency number if you are worried. When a person is unresponsive and cannot answer, first aid courses teach that you may give the help they need.

Dignity matters at every step. Cover the person with a blanket or a coat when clothing has been loosened or moved. Ask onlookers to step back, and speak to the person, not over their head to others. Many people who receive care already feel that they have lost some privacy and independence, and an emergency can make this feeling stronger. Small acts, such as using the name the person prefers and explaining each action before you do it, help the person keep their dignity on a very difficult day.

Some of the people you support cannot easily understand or answer you, because of dementia, a hearing or sight loss, a stroke or a learning disability. Speak slowly, face the person, and use short sentences and gentle gestures. Watch the person's face and body for signs of pain, fear or refusal, such as pulling away or crying out. The care plan often explains how each person communicates best, and reading it before an emergency helps you to understand the person when it matters.

Every workplace has its own emergency procedures, and you should know them well before you need them. They say whom to contact after the emergency number, how to report, where the first aid kit and any defibrillator are kept, and what to do when you work alone. The care plan of each person you support adds important details: their health conditions, how they move, how they eat and drink, whom to contact, and any wishes they have expressed about their care. When this book says "follow your workplace's procedures", it means these documents and the training that goes with them.

Learn the emergency number of the country where you work from official information, and learn the number of any country you travel to with the person you support. In some countries one number covers ambulance, fire and police, while in others there are several numbers. Save the number in your phone and write it in the places your workplace uses, such as the file kept in the person's home or the notice board at the office. The right number is always the one that official information gives for the place where you are, so check it again whenever you start work in a new area or plan a trip.

Your own safety stays important after the first moment. If a person becomes aggressive because they are confused or frightened, step back and keep a safe distance while you call for help. If you are working alone in a home and something feels dangerous, leave the room and call from a safe place. Taking care of yourself is not selfish; it keeps one more helper able to act, and the person you support needs you to be able to act.

Step by Step: Getting Ready at Work

Step 1. Find the emergency number from official information and save it in your phone today. If you work in more than one area or travel with the people you support, check the numbers for those places too. Make sure that you know where the number is written in each home you visit.

Step 2. Book a practical first aid course if you have not done one, and plan a refresher course before your skills begin to fade. Ask your workplace which course it recommends, because many workplaces arrange courses for their staff. On a course you practise each step with a trainer who can guide your hands and answer your questions.

Step 3. Learn where the first aid kit is kept at your workplace and in each home you visit, and check that it is complete. A basic kit holds disposable gloves, sterile dressings, bandages, small adhesive dressings, a foil blanket and scissors, as your course and your workplace recommend. Gloves protect both you and the person from infection, and you should wash your hands well after you take them off. Carry a small kit and spare gloves in your bag or your car for outings.

Step 4. Read the care plan of each person you support with emergencies in mind. Note their health conditions, how they usually move and speak, and whom to contact. If the care plan mentions the person's own prescribed emergency medicine or their wishes about resuscitation, ask your supervisor how your workplace handles these. In an emergency, the care plan, your training at work and the emergency operator tell you what to do.

Step 5. Find out where the nearest automated external defibrillator is, both at your workplace and along the routes you often use with the people you support. These devices are often kept in public buildings, shops, stations and sports centres, usually in a clearly marked box on the wall. Chapter 4 explains how to use one; for now, it is enough to know where to find it.

Step 6. Picture the first minutes of an emergency in each place where you work. Ask yourself where you would stand, how you would describe the address, who could help you, and how an ambulance crew would get in. A few quiet minutes of planning now can save precious time on a day when you are shocked and in a hurry.

Things to Check

Check that the emergency number, learned from official information, is saved in your phone and written where your workplace keeps it. In a sudden emergency, you should not have to search for it.

Check the date of your last first aid course. If some time has passed, ask about a refresher course so that your skills stay fresh.

Check that you know your workplace's emergency procedures, including what to do when you work alone. If any part is unclear, ask your supervisor now rather than during an emergency.

Check that disposable gloves and a basic first aid kit are where they should be, both at work and in your bag for outings. Replace anything that has been used or has passed its use-by date.

Check the care plan of each person you support for health conditions, contacts and wishes that matter in an emergency. These details help you and the ambulance crew act quickly and with respect.

Check that your phone is charged before every visit and every outing. A phone with a flat battery cannot make an emergency call.

Check that you could describe the address of each home you visit and the places you go to on outings. A clear description helps the ambulance reach you sooner.