First Aid Handbook Guide

First aid is an essential skill that everyone should have, as any of us can face life-threatening emergencies. However, not everyone knows how to respond in such situations. This handbook provides the latest knowledge on first aid, helping you stay updated and improve your skills.

Therefore, this article serves as an important and useful resource for anyone who wants to learn and equip themselves with first aid knowledge. It contains detailed, specific, and easy-to-understand instructions on first aid skills, enabling you to quickly and effectively master these abilities.

I. Purpose of the First Aid Handbook

The first aid handbook is a vital resource that helps everyone confidently and promptly apply correct and effective first aid measures in emergency situations. Its purpose is to provide readers with basic knowledge and skills to help patients receive care as quickly as possible, minimizing mortality and complications related to health incidents.

The first aid handbook is a useful tool not only for medical professionals or those working in the healthcare sector but also for ordinary people, enabling them to handle emergencies and assist others around them when needed.

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II. First Aid Cases

1. Controlling Bleeding

When a wound is bleeding, you should:

• Elevate the injured area.
• Press directly on the wound with a clean cloth (or your hand if none is available). Maintain pressure until the bleeding stops.

If the bleeding cannot be controlled with direct pressure or if the victim is losing a lot of blood:

• • Continue pressing firmly on the wound
  • Keep the injured area elevated as high as possible

• Apply a tourniquet to the arm or leg as close to the wound as possible. Tighten just enough to stop the bleeding. Use a folded cloth or wide belt; never use thin rope or wire.
• Immediately transport the victim to a medical facility.

A. Traffic Accidents

SUMMARY OF FIRST AID STEPS FOR TRAFFIC ACCIDENTS

The steps for first aid in traffic accidents outline the actions rescuers should take.

Things to do:

• Protect the victim and call emergency services
• Assess injuries and provide first aid
• Transport the victim to a medical facility if necessary

Cardiac arrest in traffic accidents is a result of trauma. Since blood cannot flow through the heart and vessels, external chest compressions are ineffective. This skill is beyond the scope of traffic accident first aid.

Protecting the victim and calling for help:

• Every accident situation can create new hazards. Without intervention, the lives of the victim and bystanders may be at risk. All hazards must be removed or isolated.
• If hazards cannot be immediately removed, the victim should be urgently moved away from danger.
• The first step in first aid is to call for help immediately after assessing the situation. This allows proper emergency care or transportation to the nearest hospital.

Steps to follow:

• Observe the scene and gather information
• Assess the victim and call 115 or the nearest medical facility
• Move the victim away from danger if necessary

Victim is conscious

Controlling bleeding:

• If the victim is bleeding heavily, immediate intervention is necessary to prevent life-threatening loss of blood. Apply direct pressure with a hand, wearing gloves if possible.
• If bleeding continues despite direct pressure, or if direct pressure is not possible due to foreign objects, use pressure points to control bleeding.
• If a rescuer is alone or there are multiple victims, and pressure points are ineffective, use a tourniquet with a wide cloth for the arm or leg.

Guidelines:

• Apply direct pressure with gauze or clean cloth (avoid direct contact with blood)
• Use indirect pressure points if the wound contains foreign objects
• Apply a tourniquet if other methods fail
• Monitor the tourniquet
• Note: record the time of application and loosen hourly

Complete airway obstruction:

• The victim is conscious but cannot breathe due to a foreign object in the airway. Immediate first aid is critical to save their life.

Actions to take:

• Perform airway clearance immediately: back blows and Heimlich maneuver

Difficulty breathing:

• The victim shows poor lung function: rapid breathing, wheezing, blue lips and nails, sweating.

Actions to take:

• Place the victim in a semi-reclining or seated position.

Shock:

• The victim shows poor heart function: pale, thirsty, sweating.

Actions to take:

• Place the victim lying down with legs elevated to increase blood flow to the head.

Trauma:

• Severe wounds:
  • If the victim has a severe wound that may cause internal bleeding, breathing difficulties, or infection, place them in a recovery position and call for emergency help.
• Chest wounds:
  • If the victim has a severe chest wound, place them in a semi-reclining or seated position to ease breathing.

Actions to take:

• Place the victim in a semi-reclining position.
• If the wound is open: seal and bandage it.

Abdominal wounds:

• If the victim has a severe abdominal wound, lay them on their back with knees bent to relax abdominal muscles and reduce pain.

Actions to take:

• Do not disturb the wound, cover it with a bowl or rigid container, and bandage it.
• Lay the victim on their back with knees bent.
• Elevate the legs while maintaining this position.

Open cranial wounds:

• Actions to take:
  • Do not disturb the wound, cover with a bowl and bandage.
  • Wound dressing skills
• Bone fractures:
  • If the victim has skeletal or joint injuries, improper handling can worsen pain and complications. Immobilize the injured area.
  • Immobilize suspected fractures by securing joints above and below the injury.
  • If the victim has injuries to the back, neck, or head, improper handling can cause severe consequences, including paralysis. Avoid movement and support the head.
  • Move the victim only if necessary, keeping the head, neck, and upper back stable.
• Fracture immobilization skills:
  • Forearm

• • Lower leg

• • Thigh

• • Immobilizing femur fractures without a splint

Actions to take:

• Use a splint and bandage to secure the upper and lower parts of the fracture.
• If no splint is available, use improvised items or tie the injured arm to the body, or bind the fractured leg to the healthy leg.
• Spinal injuries: immobilize the neck and back, then place on a rigid stretcher.

Unconscious victim:

• The victim is unresponsive but still breathing. Lying on their back may cause the tongue to block the airway or vomit to obstruct breathing. Perform airway clearance and place in a recovery position.
• Pregnant women should be placed on their left side for optimal blood flow.

Guidelines:

• Place the victim in a safe lateral position, with the injured side down.
• Pregnant women should be positioned on the left side.

Head tilted back:

Transporting the victim:

• With assistance (from 115 emergency services, bystanders, or relatives), move the victim onto a stretcher while ensuring spinal safety with 3-4 people. This minimizes movement and trauma to the back.
• Techniques for moving the victim depend on their injuries.

Bridge method:

B. Burns

Causes of burns include:

• Thermal burns, most common, divided into dry heat (fire, electric sparks, molten metal) and wet heat (boiling water, hot food, hot oil, steam)
• Electrical burns: low voltage (<1000V) and high voltage (>1000V). Lightning can also cause electrical burns.
• Chemical burns: oxidizers, reducers, corrosives, cytotoxic chemicals, drying agents, blistering agents. Clinically divided into acids and alkalis. Burns from quicklime involve both heat and alkali.
• Radiation burns: infrared, ultraviolet, X-ray, laser, subatomic particles

Clinical classification:

• Acute skin inflammation from burns (sterile acute inflammation)
• Epidermal burns: second-degree burns
• Dermal burns (intermediate, deep second-degree, third-degree, IIIA, superficial III)
• Full-thickness skin burns: third-degree, IIIB, deep III, fourth-degree. Wet or dry necrosis.
• Deep burns involving subcutaneous layers: third-degree, deep III, fourth-degree under fascia, fourth, fifth, sixth degree. Various methods exist for estimating burn area:
• Rule of nines: head/neck 9%, each upper limb 9%, front and back torso 18% each, each lower limb 18%, genital/perineum 1%
• Using the patient’s hand: ~1% of body surface
• Percentage method 1, 3, 6, 9, 18: 1% = palm, neck, nape, perineum; 3% = foot, facial skin, head, forearm, arm, one buttock; 6% = lower leg, 2 buttocks; 9% = thigh, upper limb; 18% = lower limb, back-buttock, chest-abdomen

Management:

• Immediately remove the burn cause (extinguish flames, cut off electricity). Immerse the burn in cold water (16-20°C or running water for 20-30 minutes). Delay reduces effectiveness. For chemical burns, wash chemicals and neutralize. Apply moderate bandage to limit swelling and plasma loss. Provide warm drinks, pain relief, keep warm if cold. Transport gently to avoid further pain.
• For eye burns, rinse thoroughly with sterile cold water and refer to ophthalmology.
• Assess burn area and depth early for proper treatment. Use Frank index: 1% superficial = 1 unit, 1% deep = 3 units. Frank 30-70: mild shock, 70-100: moderate, >110: severe. Children and elderly may develop complications even with <10% burn. Pregnant women require fetal monitoring and immediate referral.
• Burn shock treatment at the hospital: intensive care, restore effective circulating blood via IV fluids (colloids, electrolytes, isotonic glucose). Example: isotonic saline 1ml x kg x % burn; colloid 1ml x kg x % burn + 2000ml 5% glucose.
• Clinical guideline: first 24 hours fluid volume ≤10% body weight; 8-hour dose 1/2-1/3, next 16 hours 1/3-1/2. Days 2-3 ≤5% if shock persists.
• If anuria: use diuretics (lasix, mannitol); metabolic acidosis: sodium bicarbonate solution.
• After shock, provide systemic care, prevent burn toxicity, treat infections locally and systemically, support with blood transfusion, antibiotics, nutrition, and manage complications.
• Local care: superficial burns: apply membrane-forming medicines (herbal ointments) after sterilization. Deep burns: from week 2 use necrotic tissue removal, antibacterial solutions, grafting when granulation occurs; use bio-bandages or artificial skin for extensive deep burns. For small deep burns in stable patients, early excision and grafting in specialized centers.
• Burn sequelae (scars, adhesions, keloids, contractures, chronic ulcers) require early plastic surgery for functional and cosmetic recovery. Cracked or infected burn scars may need grafting to prevent skin cancer.

Common mistakes in burn care:

Would you apply toothpaste or fish sauce to a burn? Folk remedies like these worsen burns.

Immediate action for burns: Applying toothpaste is incorrect.

• Rubbing salt
• Pouring fish sauce
• Applying toothpaste
• Applying lard
• Chewing and applying certain leaves (e.g., sweet potato, guava)
• Applying fermented rice

Choosing any of these methods is wrong. According to Dr. Nguyen Van Hue, Deputy Director of the National Burn Institute, the only correct approach is to immerse the burn in clean cold water for 30 minutes. In winter, use a wet cloth. Then, lightly compress with dry gauze and go to a medical facility. Do not apply anything else.

Dr. Hue notes that folk beliefs discourage contact with water to prevent blistering, which is incorrect: water cools the burn, limits deeper tissue damage, reduces pain, and prevents shock. For acid or lime burns, water dilutes the chemicals. Without water, heat penetrates deeper, increasing tissue damage and necrosis risk.

Very few people do it correctly

• Dr. Nguyễn Viết Lượng, Head of the General Planning Department at the National Burn Institute, stated that only about 20–30% of patients receive proper first aid before arriving at the hospital. The remaining patients often receive incorrect care or none at all. Consequently, approximately one-third of burn cases worsen during transfer.
• According to Dr. Lượng, even city dwellers, including highly educated individuals, often do not know how to properly administer first aid for burns. He once treated a child whose parents were both PhDs. When the child was burned, they poured fish sauce onto the wound before taking the child to the hospital. Many other parents, including teachers, journalists, and scientists, are also surprised to learn that applying toothpaste, elephant oil, or fish sauce is not the correct solution.
• Dr. Nguyễn Văn Huệ explained that applying fish sauce or rubbing salt on burns causes more pain, increases the risk of shock, and can lead to infection. Toothpaste applied to a burn can turn a thermal burn into a chemical burn, causing deeper tissue damage and necrosis.
• Regarding elephant oil, which is considered effective in traditional medicine for treating burns, Dr. Huệ noted that it does have a slight cooling effect, but it is much less effective than water. Using only elephant oil causes patients to miss the opportunity to prevent the burn from spreading by immersing it in cool water. Additionally, applying any substance on damaged skin can increase the risk of infection.
• Experts also warn that many traditional medicine practitioners treat burns using film-forming medications. This method is effective only for minor burns and must be applied correctly (cleaning and removing necrotic tissue beforehand). Otherwise, the injury may worsen. The National Burn Institute has treated numerous serious complications from improper use of these medications.

2. Alcohol Poisoning

Clinical manifestations include initial excitatory symptoms, followed by depressive symptoms and coma, with breath smelling of alcohol, rapid shallow breathing, fast heartbeat, and low blood pressure.

Management:

• Treat consciousness disorders, as severe disturbances can cause respiratory paralysis.
• Correct metabolic acidosis.
• Prevent secondary hypoglycemia.
• Gastric lavage with sodium bicarbonate solution; do not use apomorphine.
• Give 1–2 drops of ammonia in a glass of saline (or coffee) or allow the patient to inhale it.
• Support cardiac function.
• Diuretics: intravenous Lasix.
• If agitated: administer sedatives carefully.
• For severe cases: provide oxygen, assisted ventilation, and hyperventilation to rapidly eliminate alcohol.
• Infuse 500 ml of 10% glucose, alternating with 14‰ bicarbonate solution every 2 hours.
• Prevent pneumonia in comatose patients (antibiotics).

3. Electric Shock

Electric shock can cause cardiac and respiratory arrest, leading to sudden death. Immediate on-site first aid within the first 5 minutes is crucial and considered the golden time.

Upon discovering an electric shock victim, quickly separate them from the power source. Determine if cardiac or respiratory arrest has occurred for timely intervention. Protect burns and call an ambulance.

If the victim is not breathing (chest not rising), perform artificial respiration until spontaneous breathing resumes or death is confirmed.

Artificial respiration: lay the victim on a flat surface in a ventilated area, loosen clothing and belt, place a cushion under the neck with the head slightly tilted back to ensure airway patency, remove any foreign objects from the mouth. Pinch the nose with one hand, pull the jaw downward with the other to open the mouth, seal your mouth over theirs, and blow two breaths for adults, one for children under 8. Allow the chest to deflate before the next breath. For adults and children over 8, blow 20 times per minute; for children under 8, 20–30 times per minute.

If cardiac arrest occurs (no heartbeat or pulse detected), immediately perform external chest compressions.

External chest compressions: place the victim on a hard surface, kneel on their left side, interlock hands, place them over the center of the chest (between nipples or 4th–5th intercostal space on the left), compress 1/3–1/2 of chest depth, then release. Adults and children over 1 year: ~100 compressions per minute. Infants: up to 120 compressions per minute.

If both cardiac and respiratory arrest occur: combine chest compressions and rescue breaths, 15 compressions to 2 breaths, for infants: 3 compressions to 1 breath.

4. Heat Exhaustion and Heatstroke

Heat exhaustion and heatstroke are disorders of body temperature caused by prolonged exposure to sunlight or extremely hot environments.

Heat exhaustion develops gradually, with body temperature not exceeding 40°C, while heatstroke occurs suddenly, often with neurological damage and possible fatality.

Signs and symptoms

Heat exhaustion:

• Cold, clammy, pale skin;
• Excessive sweating;
• Dry mouth;
• Fatigue;
• Dizziness;
• Headache;
• Nausea, occasional vomiting;
• Muscle cramps;
• Rapid, weak pulse.

Heatstroke:

• High fever (≥39.8°C);
• Hot, dry, red skin;
• No sweating;
• Deep breathing, then shallow breathing and weak pulse;
• Dilated pupils;
• Confusion, delirium, hallucinations;
• Seizures;
• Unconsciousness.

Immediate actions:

• Move the victim to a cool, ventilated area, use fans;
• Lay the victim on their back, elevate legs;
• Loosen or remove clothing;
• Give cold water with salt to drink;
• Apply ice packs or cold water to the body (especially neck, armpits, groin), or spray cold water (avoid nose and mouth).

Call for emergency help or hospital transfer if:

• Cannot drink;
• Persistent vomiting;
• Rising fever;
• Unconsciousness;
• Other symptoms like chest pain, difficulty breathing, abdominal pain;

Prevention:

• Avoid prolonged exposure or overexertion in hot or sunny environments;
• Children, elderly, chronically ill, or alcohol consumers should avoid heat exposure;
• During hot seasons: drink plenty of water, wear loose, breathable clothing.

5. Sleeping Pill Poisoning

The lethal dose of Gacdénal is 5 g, but 1 g may be fatal; the lethal dose of chloral hydrate is 10 g.

Main symptoms:

• Mild poisoning: deep sleep, normal breathing and pulse, response to pinching or stimulation preserved, tendon and pupillary reflexes normal or slightly reduced.
• Severe poisoning: deep coma, slow shallow breathing, wheezing, rapid pulse, low or undetectable blood pressure, pupillary constriction with decreased light reflex, absent tendon reflexes.
• Barbiturates detected in urine (+).

If prolonged or poorly managed, respiratory center paralysis, acute pulmonary edema, pneumonia may occur.

Management:

• Monitor pulse, temperature, blood pressure, and respiration.
• Test urine and vomitus for barbiturates (50 ml urine needed).
• Check blood glucose, blood urea, ammonia, bicarbonate reserve, urine glucose, and ketones to rule out other causes of coma.
• Gastric lavage if ingestion <6 hours and patient conscious; use 30–40 g activated charcoal in 500 ml water. If deeply comatose: insert a small tube into stomach and repeatedly flush with sweet or alkaline solution until clean.
• Eliminate toxins via diuresis, according to barbiturate type:
• Slow or very slow-acting barbiturates (Phenobarbital, Verian): renal excretion; prolonged coma. Administer osmotic diuretics and alkalinization via IV fluids, adjust dose for women or small patients.
• Contraindications to osmotic diuretics: use dialysis if necessary.
• Fast or intermediate barbiturates: rapid hepatic metabolism; short but dangerous coma. Maintain hydration and electrolytes; provide assisted ventilation if needed.
• If unknown or mixed barbiturates: use osmotic diuretics.
• Support circulation: Ouabain, Noradrenaline as needed.
• Intermittent oxygen, maintain airway, suction secretions, position patient properly, prepare for intubation and assisted ventilation.
• Prevent respiratory infection: antibiotics.
• Administer lobeline as appropriate.
• Monitor bicarbonate reserve and electrolytes during treatment.
• Provide nutrition, prevent bedsores, keep warm if hypothermic.

6. Insect Bites

Bee stings often cause more panic than danger. Initially, pain and mild swelling occur. Some individuals allergic to these toxins may develop anaphylactic shock. Do not ignore stings in the mouth or throat due to potential airway obstruction.

Recommended actions:

• Relieve pain and reduce swelling.
• Arrange hospital transfer if needed. For skin stings, remove stinger with tweezers if present.
• Apply cold compress to reduce pain and swelling.
• If swelling persists or worsens after 1–2 days, see a doctor.

Oral stings:

• Have the victim hold ice to reduce swelling and seek immediate medical attention.

Tick bites:

• Ticks are small spider-like creatures found in grass or forest. They attach to animals or humans to suck blood, often without pain. The bite area may swell, resemble a pea, and risk infection.

Tick removal:

• Use fine-tipped tweezers to lift the tick out rather than pulling, to avoid leaving the head embedded.

7. Drowning and Strangulation

Drowning causes acute suffocation from water entering alveoli, leading to pulmonary edema and hypoxia.

Immediate on-site response:

• Lift the victim onto your shoulder, support the abdomen against your shoulder, tilt the head back, take 20–30 steps in place to expel water from stomach, lungs, and airway, acting like artificial respiration. Then lay the victim with head down, clear secretions urgently.

Principles:

• Keep airway open
• Persist in resuscitation
• If breathing and pulse present but unconscious: oxygen, cardiac support, rub to warm, antibiotics to prevent pneumonia.
• If breathing stops but heart beats:
  • Provide rescue breaths
  • Intubate and provide oxygen via ventilator ≥10 L/min, 16–20 breaths/min; suction secretions; use cardiac drugs and antibiotics as above.
• If both breathing and heart stop: follow CPR guidelines
• Inject 1/4 mg Ouabain into the heart

Once conscious: administer cardiac support, bronchodilators, maintain hydration and electrolytes, monitor for pulmonary edema, correct acidosis, provide antibiotics.

8. Choking on Food

Eating too quickly can cause food to enter the airway, leading to acute respiratory failure, circulatory collapse, and death.

Choking can occur in anyone but is most common in elderly and children due to limited self-feeding ability. Prompt intervention at the scene is critical.

Prevention:
Elderly: avoid hard foods, eat while seated, prefer pureed foods, drink slowly with head down. Caregivers should supervise swallowing.

Children: feed small portions, choose appropriate foods, avoid eating while crying or playing. Avoid hard foods before teeth are fully grown.

Emergency response:
Elderly: conscious: Heimlich maneuver standing; unconscious: Heimlich maneuver lying down.

Children: infants <12 months: back blows and chest thrusts; older children: Heimlich maneuver. If respiratory arrest occurs, provide rescue breaths and chest compressions; do not use fingers to remove objects. After initial aid, transfer victim to hospital for comprehensive treatment. Heimlich maneuver standing: stand behind, wrap arms around waist, place left fist just below sternum, right hand over fist, thrust sharply inward and upward five times. Heimlich maneuver lying: kneel, place hands under sternum, thrust sharply five times. Back blows and chest thrusts: place victim prone, head down on rescuer’s arm, deliver five strong back blows between shoulder blades, then flip and deliver five chest compressions. Repeat 5–6 cycles until breathing resumes.

9. Pesticide Poisoning

Four commonly used organophosphates in Vietnam:

• Parathion (Thiophốt), yellow, foul-smelling, emulsion form.
• Methyl parathion (Vôfatốc), dark brown emulsion or bright brown powder, foul odor.
• Dipterex, white crystalline form.
• DDVP (dichloro diphenyl vinyl phosphate), light yellow.

Organophosphates enter the body via inhalation, skin, mucous membranes (especially eyes), and mainly ingestion (contaminated hands, accidental ingestion, suicide, poisoning).

Symptoms: two main types:

• Muscarinic: stimulates parasympathetic system, causing:
• Pupil constriction (sometimes pinpoint);
• Increased secretions (sweat, saliva);
• Increased intestinal motility: abdominal pain, vomiting;
• Bronchospasm: cyanosis, pulmonary edema, possible respiratory paralysis;
• Hypotension.
• Nicotinic: stimulates autonomic ganglia and CNS;
• Muscle twitching, spasms: eyelid, facial, tongue, generalized rigidity;
• Impaired coordination;
• Dizziness, tremor, slurred speech, visual disturbances, severe: coma.

Diagnosis is usually straightforward; hallmark signs include miosis, sweating, and excessive salivation.

Tests:

• Blood: normal cholinesterase activity: men 2.54 ± 0.53 µmol, women 2.18 ± 0.51 µmol. Reduction 30%: mild, 50%: moderate, >70%: severe poisoning.
• Urine: paranitrophenol quantification—positive only for Parathion and Methyl parathion poisoning.

Management:

• Immediate action is critical.
• If ingested and conscious: induce vomiting, give water to dilute toxin. Gastric lavage within 6 hours: 20–30 liters warm water with 1 tsp salt and 20 g activated charcoal per liter; after each wash, give 200 ml paraffin oil (adults) or 3 ml/kg (children).
• If absorbed through skin: remove contaminated clothing, wash skin with soap and water.
• If in eyes: rinse for 10 minutes.
• Resuscitation: high-dose atropine sulfate for muscarinic symptoms; administer immediately after airway secured and ventilation started.
• Severe poisoning: IV 2–3 mg atropine every 10 min until pupils dilate, then subcutaneous 1–2 mg every 30 min until recovery. Total dose 20–60 mg; typical 24 mg/24 h.
• Moderate poisoning: subcutaneous 1–2 mg every 15–30 min, total 10–30 mg.
• Mild poisoning: subcutaneous 0.5–1 mg every 2 hours, total 3–9 mg.
• Monitor for atropine toxicity: dry mucous membranes, dry skin, dilated pupils, tachycardia, agitation, delirium; stop if severe.
• PAM 2.5% (Pralidoxime, Contrathion) restores cholinesterase; use within 36 hours, otherwise less effective. Initial IV 1–2 g, then 0.5 g/hour or 0.5–1 g every 2–3 hours. Max dose 3 g; inject slowly over 5–10 minutes. Effective if used correctly.
• Provide glucose, oxygen, assisted ventilation, seizure control, antibiotics.
• Contraindicated: morphine
• Nutritional support: low-fat, no milk; parenteral feeding initially, then oral carbohydrates and protein when stable.

10. Dog Bites

Rabies is not only a fear for victims bitten by animals suspected of having rabies but also a concern for those working in rabies prevention. Why does such a serious problem still exist when a rabies vaccine has been available for over 100 years? Part of the reason is public awareness regarding post-exposure treatment after being bitten by an animal suspected of having rabies.

Even the most effective vaccine cannot save a patient if administered too late, if the wound is not properly treated, if the bite is too close to the central nervous system, or if rabies immunoglobulin is not properly combined with the vaccine. Additionally, general immune suppression due to chronic illnesses such as hepatitis, cirrhosis, or prolonged corticosteroid therapy can reduce the vaccine’s effectiveness.

Washing the wound thoroughly with plenty of water and soap, disinfecting with iodine alcohol, and receiving the vaccine within the first few hours are the most effective measures to prevent the rabies virus from entering the central nervous system. In a small survey, only 16/48 (33.33%) people received the vaccine within 24 hours; 5/48 (10.42%) after 48 hours, and 27/48 (56%) received it after 3 days. The Fuenzalida vaccine, according to its schedule and administration method, requires at least 15 days to achieve a protective antibody level above 0.5 IU/ml. Therefore, for deep wounds or bites on the upper body, receiving the vaccine immediately after being bitten is extremely important. Moreover, coordinated treatment with high-quality rabies immunoglobulin is essential to protect the patient’s life. Most deaths from rabies occur because patients either ignored vaccination (77–94.6%) or received it 2–3 days after the bite.

Rabies has a high mortality rate once symptoms appear, making prevention crucial. The most important step is ensuring domestic animals are fully vaccinated. It is also recommended that laboratory staff working with the rabies virus be vaccinated and have their antibody levels checked. High-risk individuals, such as veterinarians, livestock workers, forestry workers, and healthcare staff in infectious disease departments, should adopt preventive measures.

11. Dislocations

Dislocations can occur in any joint. If a dislocation is suspected, call emergency services immediately. While waiting for transport to the hospital, you can do the following:

• Do not move the joint.
• Keep the joint in its current position. For example, an elbow dislocation will have the elbow bent. Use a piece of cloth or a shirt to secure the elbow to the body. Generally, dislocations in the arms can be immobilized by tying the arm to the body, using the body itself as support for the arm.
• If the dislocation is in the leg, tie the two legs together, using the uninjured leg as a splint for the injured leg.
• Do not attempt to reposition the joint yourself. You may worsen the injury if you do not know the proper method.
• Apply a cold compress to the dislocated joint to reduce swelling. Do not place ice directly on the skin; instead, use a cloth or clothing that is securing the limb.
• Some dislocations, such as the knee, carry a high risk of vascular injury. Ask the victim if they feel cold, numbness, or notice a bluish color in the limb, as these may indicate vascular compromise.

12. Food Poisoning

What causes food poisoning?

• {mosimage}Food is easily contaminated by biological agents, harmful chemicals, and physical hazards, which can cause severe poisoning and affect consumer health.

The main biological contaminants include bacteria, molds, viruses, and parasites:

• Bacteria are everywhere around us. Wastewater, dust, and raw food are reservoirs of many pathogenic bacteria. Hundreds of bacteria reside in the air and on the human body, particularly on the skin (especially hands), mouth, respiratory and digestive tracts, genital, and urinary systems. Cooked food left at room temperature provides an ideal environment for bacteria in the air to multiply rapidly. Even leftovers can reach dangerous bacterial levels within a few hours, causing food poisoning.
• Molds are commonly found in living environments, especially in grains and oilseeds stored in hot, humid climates like Vietnam. Molds can spoil food, and some produce dangerous toxins. Aflatoxin, produced by Aspergillus flavus and Aspergillus parasiticus in moldy corn, peanuts, and other legumes, can cause liver cancer.
• Viruses causing food poisoning are often present in the human intestines. Shellfish from polluted waters, vegetables irrigated with fresh manure, or improperly prepared raw vegetables are commonly contaminated with poliovirus or hepatitis virus.
• Viruses can spread from feces to human hands or from contaminated water to food, and even a small amount of virus can infect humans. Infected individuals can transmit viruses to others before showing symptoms.
• Parasites commonly found in food include helminths. Consuming undercooked beef or pork containing tapeworm larvae can result in adult worms developing in the digestive tract, causing digestive disorders.
• Eating freshwater fish such as carp, crucian, or roach with immature liver fluke cysts that are not fully cooked can lead to parasites migrating to the bile ducts and liver, causing liver damage.
• Consuming shrimp or crab with lung fluke cysts, or drinking water with cysts, allows parasites to penetrate the intestinal wall, migrate through the diaphragm to the lungs, and develop into adult worms causing bronchitis, chest pain, and dangerous hemoptysis. Trichinosis can result from eating undercooked meat, raw fermented pork, or dishes containing larvae, causing poisoning, allergies, high fever, and respiratory muscle paralysis that may be fatal.

Chemical hazards that often contaminate food include:

• Industrial and environmental pollutants such as dioxins, radioactive substances, and heavy metals (lead, mercury, arsenic, cadmium…).
• Chemicals used in agriculture: pesticides, veterinary drugs, growth enhancers, fertilizers, anthelmintics, and smoking agents.
• Improperly used additives: colorants, flavorings, sweeteners, thickeners, stabilizers, preservatives, antioxidants, cleaning agents, and unwanted compounds from packaging materials.
• Toxins produced during processing: smoked meat, burnt oils, chemical reactions in food, toxins from mold-contaminated storage (mycotoxins), or spoiled food.
• Natural toxins present in food: potato sprouts, cassava, fava beans, bamboo shoots, poisonous mushrooms, pufferfish, toads, etc.
• Allergens in certain seafood, shrimp pupae, and physical hazards such as glass, wood, metal, stones, bones, nails, hair, and other foreign objects can cause significant harm, including broken teeth, choking, and injury to the stomach or mouth.

Symptoms of food poisoning:

SUMMARY OF COMMON FOOD POISONING

CAUSE	FOOD	POISONING SYMPTOMS
Salmonella	Undercooked eggs, poultry.	Fever, diarrhea, abdominal pain, vomiting.
Campylobacter	Unpasteurized or unboiled milk, undercooked poultry	Nausea, abdominal pain, diarrhea, bloody stools.
V. cholerae (cholera)	Using contaminated water for ice, washing vegetables, or consuming raw/undercooked fish and shellfish from polluted water.	Profuse watery diarrhea accompanied by vomiting and abdominal pain.
Clostridium botulinum (anaerobic bacteria)	Contaminated canned foods: fish, meat, vegetables.	Muscle weakness, especially in eyes (blurred vision) and lungs (difficulty breathing).
Escherichia coli	Meat, fish, vegetables, milk, or water contaminated with human feces.	Diarrhea, sometimes resembling dysentery or cholera with bloody stools.
Staphylococcus aureus	Dairy products, undercooked poultry. Infection can spread from nose, hands, or skin to cooked food.	Nausea, vomiting, diarrhea, abdominal pain, no fever, severe dehydration.
Shigella (dysentery)	Moist dairy and foods contaminated with feces.	Diarrhea, bloody stools, fever in severe cases.
Bacillus cereus	Grains, vegetables, milk, roasted or fried meat.	Abdominal pain, diarrhea, nausea.
Pesticides	Fresh vegetables, tea	Central nervous system disorders, headaches, insomnia, memory loss. Brain damage can cause toxic encephalopathy from mercury, organic phosphorus, and chlorine. May also affect cardiovascular, respiratory, digestive, hematologic, urinary, endocrine, and thyroid systems and can be fatal.
Mycotoxins (Aflatoxin)	Peanuts, legumes, sesame, sunflower seeds, and cereals.	Liver dysfunction that may lead to cancer.
Cassava poisoning	Cassava	Headache, dizziness, nausea; severe poisoning can cause neurological disorders, muscle spasms resembling tetanus, and may result in death within about 30 minutes.
Mushroom poisoning	Yellow wax mushroom (Gyromitra)	Symptoms appear 8-10 hours after ingestion. Abdominal pain, vomiting, followed by jaundice, potentially leading to death.
	Pale mushroom (Amanita phalloides)	Symptoms occur 9-11 hours after ingestion, causing gastrointestinal disorders, abdominal pain, anuria, liver enlargement, coma, potentially leading to death.
	Red mushroom (Amanita muscaria)	Symptoms appear 1-6 hours after ingestion, causing sweating, salivation, vomiting, diarrhea, pupil constriction, and in severe cases, coma and seizures.

 

Some Common Measures for Handling Food Poisoning

In cases of contamination, food poisoning, or suspected poisoning, it is essential to stop consuming the suspected food and keep all leftover food, vomit, feces, urine, etc., for laboratory testing. Immediately notify the nearest medical authority for investigation and promptly organize emergency care for the affected person. The primary emergency treatment is to induce vomiting to expel all ingested substances, prevent intestinal absorption of the toxins, neutralize the toxicity, and protect the stomach lining.

Elimination of toxins from the body:

• Inducing vomiting: immediately done by inserting a finger into the throat to stimulate vomiting.
• Gastric lavage: perform as soon as possible, ideally within 6 hours. Warm water or saline solution can be used for lavage.
• Intestinal cleansing: if poisoning occurred over 6 hours ago, magnesium sulfate or sodium laxatives may be used.
• Diuresis: induced by intravenous fluids.

Detoxification:

• Use activated charcoal to absorb toxins.
• Neutralize the toxins.
• Specific antidotes according to the cause of poisoning.

In general, when symptoms of food poisoning appear, one should go to the nearest medical facility for timely treatment using these common measures.

13. Gasoline and Petroleum Poisoning

Symptoms

• Coughing, difficulty breathing, vomiting, respiratory disorders, pulmonary consolidation syndrome.
• Coughing, shortness of breath, and fever indicate the toxin has entered the bronchi.
• Dizziness, cyanosis, headache, convulsions, fainting…
• Gastrointestinal symptoms if ingested.

Management

• If inhaled: provide oxygen and appropriate treatment.
• If ingested: administer Ipecac 0.5–1.5g.

In general, gastric lavage is contraindicated if kerosene, gasoline, or their derivatives are ingested, except in cases of large amounts that may cause critical neurological complications.

• If the patient is unconscious: perform intubation and assisted ventilation; strong ventilation helps increase toxin elimination through the lungs.

For children:

• If there is cyanosis and difficulty breathing: administer oxygen, avoiding endotracheal oxygen to prevent pneumothorax.
• If blood pressure drops: give Metaraminol (Aramin) 1 ampoule 1ml (0.01g) intramuscularly.
• If severe respiratory disorders occur: provide appropriate intervention.
• Absolutely avoid fatty foods and milk.

14. Choking on Foreign Objects

A person who is choking will have a chest that does not rise, a pale face, cold hands and feet, dusky skin, and bulging eyes. The victim may be unable to speak, only making noises in the throat and clawing at the neck.

• The cause is usually a foreign object lodged in the throat. Without timely first aid, the victim may die.
• Objects often enter the throat in accidents such as: food regurgitation from the stomach during vomiting, dislodged dentures, swallowing seeds, marbles, or while playing (in children)… First aid procedures vary depending on the situation and the victim.

Adult First Aid

Self-rescue when alone

If alone, you can perform abdominal thrusts to expel the object using both hands as follows:

• Stand with your back against a flat wall. Make a fist with one hand, placing the thumb side against the upper abdomen, just below the sternum (palm down).
• Use the other fist to strike the fist on the abdomen firmly from front to back and from bottom to top.
• If unsuccessful, use a chair back: press the upper abdomen above the navel onto the top edge of the chair back, then lean your body weight forward to create pressure and expel the object.

When assisted by another person: Heimlich maneuver:

• Step 1: The rescuer stands behind the victim, one leg forward, one leg back; the front leg between the victim’s legs.
• Step 2: Wrap both arms around the victim’s abdomen, grasp the fist of the other hand (palm down), pressing it against the upper abdomen, just below the sternum.
• Step 3: Thrust sharply and suddenly from front to back and bottom to top, 4–5 times. Perform firmly without pressing on the chest for effectiveness.

For pregnant or obese individuals, the best hand position is in the middle of the sternum, 2–3 cm from the xiphoid process. The victim may sit against a chair for easier operation.

Back slapping maneuver:

• Place the victim bending forward, head lower than chest. Rescuer places one hand on the middle of the chest above the sternum and the other hand to deliver 4–5 strong back blows between the shoulder blades (the victim may bend forward while standing for better access).

For unconscious victims:

• Lay the victim on their back on the ground or a firm surface. The rescuer kneels straddling the victim’s thighs, knees outside the victim’s knees.
• Place hands on top of each other, heel of lower hand on the upper abdomen, just below the sternum. Press from top down and from abdomen toward chest 4–5 times.

Once the object is expelled and lies at the victim’s mouth, remove it carefully. Incorrect handling may push it back into the throat.

Infant First Aid (under 1 year)

Prone position: Place the infant across the rescuer’s lap, chin on the rescuer’s knee, head lower than chest (not too low to avoid object entering the nose). Deliver 1–5 rapid back blows between the shoulder blades to expel the object.

Supine position: Place the infant along the rescuer’s forearm (hand supporting the head). Place two fingers of the other hand on the chest, between the nipples. Apply rapid forceful thrusts 4 times continuously. Repeat 4–5 times if needed. All actions must be quick, decisive, and not too forceful.

15. Infected Wounds

Any wound that penetrates the skin can cause infection. Infection occurs when pathogens enter the body, through the causing object (e.g., dirty knife) or from other sources after the wound is inflicted.

Preventing Infection

Several measures can reduce the risk of infection.

• If time allows (e.g., the wound is not life-threatening or minor), wash hands thoroughly before treating an open wound. Rinse under running water to reduce pathogen transmission.
• Wear gloves (if available). Plastic gloves provide a protective barrier against contamination. Keep a pair in your first aid kit to avoid direct contact with the wound.
• Minimize direct contact with the wound; for example, have the patient apply pressure with their own hand if possible.
• Dress the wound as soon as possible.

Managing Infected Wounds

Cover the wound with a sterile dressing and bandage it properly.

• Elevate the injured area if possible to reduce swelling and pain.
• Seek medical consultation and treat shock if necessary.

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III. Where to Attend First Aid Skills Training

An Toàn Nam Việt is a reputable and professional organization in Vietnam specializing in first aid skills training. With experienced instructors, modern equipment, and high-quality training programs, the An Toàn Nam Việt First Aid Training Center has become an ideal destination for anyone interested in protecting their own and the community’s life and health.

By participating in courses at An Toàn Nam Việt, you will learn basic and advanced first aid skills, from resuscitating individuals with cardiac or respiratory arrest, poisoning, injuries, to handling other emergency situations. Training programs are designed flexibly to suit various learners, including adults, children, medical staff, rescue personnel, and the general public.

The An Toàn Nam Việt First Aid Training Center not only equips you with essential skills to save lives in emergencies but also instills awareness to protect yourself and others. Training by experienced and highly qualified instructors ensures you gain confidence and readiness to face any emergency situation.

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IV. First Aid Training Capacity of An Toàn Nam Việt

An Toàn Nam Việt is a leading and reputable center for first aid skills training in Vietnam, conducting continuous training sessions at factories, workshops, and construction sites nationwide (all 63 provinces in Vietnam).

First Aid Training License

• An Toàn Nam Việt has been certified by the Department of Safety under the Ministry of Labor – Invalids and Social Affairs for meeting the conditions to conduct occupational safety training. In the Group 2 training program, first aid skills training is included, further reinforcing our first aid training capability.

Materials and Lectures

• Before being included in first aid training courses, materials are reviewed to ensure accuracy and effectiveness in application.
• Teaching methods of instructors are standardized according to An Toàn Nam Việt’s guidelines, developed by first aid training experts to maximize knowledge absorption for learners.

Facilities

• Controlling classroom factors that affect training increases teaching efficiency and learner comprehension.
• Our training facilities include spacious classrooms meeting standards for size, lighting, and training equipment, among others.