First aid is the provision of initial care for an illness or injury. It is usually performed by a non-expert person to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. It generally consists of a series of simple and in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment. While first aid can also be performed on animals, the term generally refers to care of human patients. The instances of recorded first aid were provided by religious knights, such as the Knights Hospitaller, formed in the 11th century, providing care to pilgrims and knights, and training other knights in how to treat common battlefield injuries. The practice of first aid fell largely in to disuse during the High Middle Ages, and organized societies were not seen again until in 1859 Henry Dunant organized local villagers to help victims of the Battle of Solferino, including the provision of first aid. Four years later, four nations met in Geneva and formed the organization which has grown into the Red Cross, with a key stated aim of “aid to sick and wounded soldiers in the field”. This was followed by the formation of St. John Ambulance in 1877, based on the principles of the Knights Hospitaller, to teach first aid, and numerous other organization joined them with the term first aid first coined in 1878 as civilian ambulance services spread as a combination of ‘first treatment’ and ‘national aid’ in large railway centres and mining districts as well as with police forces. First aid training began to spread through the empire through organisations such as St John, often starting, as in the UK, with high risk activities such as ports and railways. Many developments in first aid and many other medical techniques have been driven by wars, such as in the case of the American Civil War, which prompted Clara Barton to organize the American Red Cross. Today, there are several groups that promote first aid, such as the military and the Scouting movement. New techniques and equipment have helped make today’s first aid simple and effective. The key aims of first aid can be summarized in three key points:  * Preserve life – the overriding aim of all medical care, including first aid, is to save lives* Prevent further harm – also sometimes called prevent the condition from worsening, this covers both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent worsening of the condition, such as applying pressure to stop a bleed becoming dangerous. * Promote recovery – first aid also involves trying to start the recovery process from the illness or injury, and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound First aid training also involves the prevention of initial injury and responder safety, and the treatment phases.  Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2010) In case of tongue fallen backwards, blocking the airway, it is necessary to hyperextend the head and pull up the chin, so that the tongue lifts and clears the airway. skills are considered essential to the provision of first aid and are taught ubiquitously. Particularly the “ABC”s of first aid, which focus on critical life-saving intervention, must be rendered before treatment of less serious injuries. ABC stands for Airway, Breathing, and Circulation. The same mnemonic is used by all emergency health professionals. Attention must first be brought to the airway to ensure it is clear. Obstruction (choking) is a life-threatening emergency. Following evaluation of the airway, a first aid attendant would determine adequacy of breathing and provide rescue breathing if necessary. Assessment of circulation is now not usually carried out for patients who are not breathing, with first aiders now trained to go straight to chest compressions (and thus providing artificial circulation) but pulse checks may be done on less serious patients. Some organizations add a fourth step of “D” for Deadly bleeding or Defibrillation, while others consider this as part of the Circulation step. Variations on techniques to evaluate and maintain the ABCs depend on the skill level of the first aider. Once the ABCs are secured, first aiders can begin additional treatments, as required. Some organizations teach the same order of priority using the “3Bs”: Breathing, Bleeding, and Bones (or “4Bs”: Breathing, Bleeding, Brain, and Bones). While the ABCs and 3Bs are taught to be performed sequentially, certain conditions may require the consideration of two steps simultaneously. This includes the provision of both artificial respiration and chest compressions to someone who is not breathing and has no pulse, and the consideration of cervical spine injuries when ensuring an open airway. In order to stay alive, all persons need to have an open airway – a clear passage where air can move in through the mouth or nose through the pharynx and down in to the lungs, without obstruction. Conscious people will maintain their own airway automatically, but those who are unconscious (with a GCS of less than may be unable to maintain a patent airway, as the part of the brain which automatically controls breathing in normal situations may not be functioning. If the patient was breathing, a first aider would normally then place them in the recovery position, with the patient leant over on their side, which also has the effect of clearing the tongue from the pharynx. It also avoids a common cause of death in unconscious patients, which is choking on regurgitated stomach contents. The airway can also become blocked through a foreign object becoming lodged in the pharynx or larynx, commonly called choking. The first aider will be taught to deal with this through a combination of ‘back slaps’ and ‘abdominal thrusts’. Once the airway has been opened, the first aider would assess to see if the patient is breathing. If there is no breathing, or the patient is not breathing normally, such as agonal breathing, the first aider would undertake what is probably the most recognized first aid procedure – Cardiopulmonary resuscitation or CPR, which involves breathing for the patient, and manually massaging the heart to promote blood flow around the body. The first aider is also likely to be trained in dealing with injuries such as cuts, grazes or bone fracture. They may be able to deal with the situation in its entirety (a small adhesive bandage on a paper cut), or may be required to maintain the condition of something like a broken bone, until the next stage of definitive care (usually an ambulance) arrives. First aid scenario training in progress Basic principles, such as knowing to use an adhesive bandage or applying direct pressure on a bleed, are often acquired passively through life experiences. However, to provide effective, life-saving first aid interventions requires instruction and practical training. This is especially true where it relates to potentially fatal illnesses and injuries, such as those that require cardiopulmonary resuscitation (CPR); these procedures may be invasive, and carry a risk of further injury to the patient and the provider. As with any training, it is more useful if it occurs before an actual emergency, and in many countries, emergency ambulance dispatchers may give basic first aid instructions over the phone while the ambulance is on the way. Training is generally provided by attending a course, typically leading to certification. Due to regular changes in procedures and protocols, based on updated clinical knowledge, and to maintain skill, attendance at regular refresher courses or re-certification is often necessary. First aid training is often available through community organizations such as the Red Cross and St. John Ambulance, or through commercial providers, who will train people for a fee. This commercial training is most common for training of employees to perform first aid in their workplace. Many community organizations also provide a commercial service, which complements their community programmes. In Australia, Nationally recognized First Aid certificates may only be issued by Registered training organisations who are accredited on the National Training Information System (NTIS). Most First Aid certificates are issued at one of 3 levels:* Level 1 (or “Basic First Aid”, or “Basic Life Support”): is a 1-day course covering primarily life-threatening emergencies: CPR, bleeding, choking and other life-threatening medical emergencies.* Level 2 (“Senior First Aid”) is a 2 day course that covers all the aspects of training in Level 1, as well as specialized training for treatment of burns, bites, stings, electric shock and poisons. Level 2 reaccreditation is a 1 day course which must be taken every three years, but CPR reaccrediation may be required more frequently (typically yearly). * Level 3 (“Occupational First Aid”) is a 4-day course covering advanced first aid, use of oxygen and automated external defibrillators and documentation. It is suitable for workplace First Aiders and those who manage First Aid facilities. Other courses outside these levels are commonly taught, including CPR-only courses, Advanced Resuscitation, Remote Area or Wilderness First Aid, Administering Medications (such as salbutamol or the Epi-Pen) and specialized courses for parents, school teachers, community first responders or hazardous workplace first aiders. CPR Re-accreditation courses are sometimes required yearly, regardless of the length of the overall certification. In Canada, first aid certificates are awarded by one of several national organizations including the Red Cross, the Lifesaving Society and St. John Ambulance. Or they can also be issued by sub-national organizations. The terms “Emergency First Aid” and “Standard First Aid” are generic and based on a Health Canada (a federal department of the Government of Canada) review and approval of a training organization’s curriculum / syllabus (training content), standards and other factors. Workplace safety regulations and standards for first aid vary by province depending on occupation. However, as some occupations are governed by federal, not provincial, workplace safety regulations, such as the transportation industry (marine, aviation, rail), trainees need to confirm with their employer as to exactly what specific training and certification standards comply with the applicable regulatory agencies, federal or provincial. Emergency First Aid: is an 8-hour course covering primarily life-threatening emergencies: CPR, bleeding, choking and other life-threatening medical emergencies. Standard First Aid: is a 16-hour course that covers the same material as Emergency First Aid and will include training for some, but not all, of the following: breaks; burns; poisons, bites and stings; eye injuries; head and neck injuries; chest injuries; wound care; emergency child birth; and multiple casualty management. Medical First Responder (BTLS – known by different names among different Canadian organizations): is a 40 hour course. It requires Standard First Aid certification as a prerequisite. Candidates are trained in the use of oxygen, automated external defibrillators, airway management, and the use of additional emergency equipment. CPR certification in Canada is broken into several levels. Depending on the level, the lay person will learn the basic one-person CPR and choking procedures for adults, and perhaps children, and infants. Higher-level designations also require two-person CPR to be learned. Depending on provincial laws, trainees may also learn the basics of automated external defibrillation (AED).* Level A is the lowest level of CPR training. Trainees learn how to perform the standard one-rescuer CPR and choking procedures on adults. Level B requires the same procedures as Level A, but trainees learn to perform these maneuvers on children and infants in addition to adults.* Level C requires the same maneuvers as Level B, and trainees are also taught how to perform two-person CPR.* Level HCP (Health Care Professional) was introduced in Canada in response to new guidelines set by the International Liaison Committee on Resuscitation. In addition to the techniques taught in Level C, artificial resuscitation, AED use (to certification standards), and bag-valve-mask use is taught. Anyone with CPR-HCP certification is considered AED certified. In Ireland, the workplace qualification is the Occupational First Aid Certificate. The Health and Safety Authority issue the standards for first aid at work and hold a register of qualified instructors, examiners and organisations that can provide the course. A FETAC Level 5 certificate is awarded after passing a three day course and is valid for two years from date of issue. Occupational First Aiders are more qualified than Cardiac First Responders (Cardiac First Response and training on the AED is now part of the OFA course) but less qualified than Emergency First Responders but strangely Occupational First Aid is the only one of the three not certified by PHECC. Organisations offering the certificate include, Ireland’s largest first aid organisation, the Order of Malta Ambulance Corps, the St John Ambulance Brigade, and the Irish Red Cross. The Irish Red Cross also provides a Practical First Aid Course aimed at the general public dealing primarily with family members getting injured. Many other (purely commercially run) organisations offer training. In the Netherlands first aid training and certification for lay persons are provided mostly by specialised (commercial) first aid training companies or voluteers of the “Dutch Red Cross” and the foundations “Het Oranje Kruis” and “LPEV”. They offer a variety of levels in first aid training, from basic CPR to First Responder. Medical first aid must be provided by certified ambulance crews, physicians and in hospitals. In the U.K., there are two main types of first aid courses offered. An “Emergency First Aid at Work” course typically lasts one day, and covers the basics, focusing on critical interventions for conditions such as cardiac arrest and severe bleeding, and is usually not formally assessed. A “First Aid at Work” course is usually a three-day course (two days for a re-qualification) that covers the full spectrum of first aid, and is formally assessed by recognized Health and Safety Executive assessors. Certificates for the “First Aid at Work” course are issued by the training organization and are valid for a period of three years from the date the delegate passes the course. Other courses offered by training organizations such as St. John Ambulance, St Andrew’s First Aid or the British Red Cross include Baby and Child Courses, manual handling, people moving, and courses geared towards more advanced life support, such as defibrillation and administration of medical gases such as oxygen and entonox. The British Forces use First Aid ranging from levels 1-3, to assist the medical staff on their Ship, Squadron, Section, Base or any other purpose required. They are trained in both Military and Civilian First Aid and often utilise their knowledge in aid stricken regions around the world. First Aid is vital on board HM Ships because of the number of people in a small area and the space given to perform their task, it is also vital for the Army and Royal Marines to know basic first aid to help the survival rate of the soldiers when in combat. In the United States, there is no universal schedule of First Aid levels that are applicable to all agencies that provide first aid training. Training is provided typically through the American Red Cross, but may also be completed by local fire departments and the American Heart Association (AHA) in terms of CPR. The American Red Cross, however, offers the following courses CPR- Red Cross training programs may vary by Chapter and season. Layman First Responders in the United States are subject to Good Samaritan law protections as long as their treatment does not extend beyond training or certification. First Aid training in the United States is limited to basic life support functions needed to sustain life, and training instills the importance of activating the Emergency Medical System before beginning assistance (through the Three C’s: Check, Call, Care). Training classes range from a few hours for a specific course, or several days for combination, specialty, and instructor courses. Red Cross volunteers are required to be Standard First Aid plus CPR/ACI certified (AED is encouraged but not required as of 2009), as well as passing the FEMA NIMS Introductory certification. There are certain factors which increase risk of sprains.  Fatigue of muscles generally leads to sprains. When one suddenly starts to exercise after a sedentary lifestyle, sprains are quite common. Not warming-up is the most common cause of sprains in athletes. Warming-up loosens the joint, increases blood flow and makes the joint more flexible. Poor conditioning of the body can also lead to sprains. Diagnosis of sprains is not difficult but in most cases x-rays are obtained to ensure that there is no fracture. In many cases, if the injury is prolonged, magnetic resonance imaging (MRI) is performed to look at surrounding soft tissues and the ligament first modality for a sprain can be remembered using the acronym RICE  The treatment of sprains depends on the extent of injury and the joint involved. Medications like non-steroidal anti-inflammatory drugs can relieve pain. Weight bearing should be gradual and advanced as tolerated.      * Rest: The sprain should be rested. No additional force should be applied on site of the sprain. If, for example, the sprain were an ankle sprain, then walking should be kept to a minimum. * Ice: Ice should be applied immediately to the sprain to minimize swelling and ease pain. It can be applied for 20-30 minutes at a time, 3-4 times a day. Ice can be combined with a wrapping to minimize swelling and provide support * Compression: Dressings, bandages, or ace-wraps should be used to immobilize the sprain and provide support.* Elevate Keeping the sprained joint elevated above heart level will also help to minimize swelling. Ice and compression (cold compression therapy) will not completely stop swelling and pain, but will help to minimize them as the sprain begins to heal itself. Careful management of swelling is critical to the healing process as additional fluid may pool in the sprained area. The joint should be exercised again fairly soon, in milder cases from 1 to 3 days after injury. Special exercises are sometimes needed in order to regain strength and help reduce the risk of ongoing problems. The joint may need to be supported by taping or bracing, helping protect it from re-injury. After any sprain, proper rehabilitation is a must; especially when the injury has been severe. After acute treatment, a rehabilitation program is critical in speeding recovery of the joint. Lack of rehabilitation can often delay return to normal function for months. The other error most people make is to use prolonged immobilization. This usually leads to muscle atrophy and stiff joint. The components of an effective rehabilitation for all sprain injuries include increasing range of motion and progressive muscle strengthening exercise.