Day 3: Injuries, environment and psychological first aid…

1Burns, wounds and fractures

Burn: cool immediately with clean, cool water for at least 20 minutes; remove rings and clothing that is not stuck; cover with cling film or a clean non-stick dressing. Never butter, oil, toothpaste or ice; do not burst blisters. Large burns, burns to the face, hands or genitals, or burns in a child: medical advice.

Simple wound: wash with clean water and soap, cover with a clean dressing; check tetanus vaccination. Embedded object: do not remove it; hold it in place with dressings around it.

Fracture or sprain: do not try to put the bone back in place; immobilise in the position found (improvised splint, sling) and check the colour and feeling of the fingers or toes. Open fracture: cover the wound with a clean dressing.

Head and spine: after a fall or road accident, limit head and neck movement in a conscious casualty. Loss of consciousness, repeated vomiting, confusion or drowsiness after a blow to the head: medical evacuation.

2Heat, cold and dehydration

Heatstroke (very high temperature, confusion, hot skin, sometimes seizures) is life-threatening. Cool immediately, preferably by immersion in cold water up to the neck if possible; otherwise, soak the person and fan them, in the shade. Heat exhaustion (fatigue, cramps, sweating): rest in the shade and a rehydration solution.

Hypothermia: get the person to shelter, remove wet clothing, insulate from the ground, cover (survival blanket), rewarm gradually and handle gently.

Diarrhoea and dehydration: give oral rehydration salts (ORS) in small, frequent sips; continue breastfeeding infants. Danger signs requiring medical care: a child who is lethargic or unable to drink, sunken eyes, blood in the stool, profuse watery diarrhoea (think of cholera).

3Bites, stings, seizures and sudden illness

Snakebite: calm the casualty and lay them down, immobilise the limb, remove rings and bracelets, and transport them to a facility with antivenom. No tourniquet, no cutting, no suction, no ice.
Animal bite (dog, monkey, bat): wash the wound for 15 minutes with soap and water, then seek care quickly for rabies prevention.
Seizures: protect from surrounding objects, put nothing in the mouth, do not restrain movements; note the duration; afterwards, recovery position. Call for help if the seizure lasts more than 5 minutes or recurs.
Low blood sugar in a person with diabetes who is conscious and able to swallow: sugar, juice or a sweet drink.
Severe allergic reaction (swelling of the face, difficulty breathing): help the person use their adrenaline auto-injector if they have one, and call for help.

4Psychological first aid

After a violent event, most people have normal reactions (fear, tears, shock, anger). Psychological first aid (WHO, 2011) offers humane, practical support without forcing anyone to talk.

Look: safety, urgent needs, people in serious distress.
Listen: introduce yourself, offer help, listen without judging, help the person calm down.
Link: to basic needs (water, shelter, news of loved ones), information and services (health, mental health, protection).

Avoid promising what you cannot deliver, forcing someone to talk or giving your own interpretation. Look after yourself too: after a difficult intervention, talk to a colleague or to your organisation's psychological support.

In-depth course

Detailed methods, a complete worked example, tools, common mistakes and interview questions.

5Trauma in detail: burns, wounds, head, spine and limbs

This online course does not replace certified hands-on first aid training. Immobilisation, dressing and casualty-handling techniques require practical learning, supervised by a qualified instructor, and regular refreshers.

Thermal burns: the complete method

Stop the burning process: move the person away from the source; if clothing is on fire, roll the person on the ground or smother the flames with a blanket.
Cool immediately with clean, cool water, preferably running, for at least 20 minutes, as recommended by the IFRC and ERC guidelines. Cooling remains useful even if it starts a little late. No ice or iced water.
Remove rings, watches, bracelets and clothing that is not stuck to the skin during cooling, before swelling develops.
Protect against hypothermia: in children and when the burn is extensive, cool the burned area while keeping the rest of the body warm. This is an important point of vigilance in displacement sites, where water may be cold and shelters poorly insulated.
Cover loosely with cling film laid in strips, or a clean non-adherent dressing. Do not burst blisters, and do not apply anything else (no paste, oil, butter, toothpaste or traditional remedy).
Assess severity in order to decide on referral.

To estimate the extent, a simple rule is that the palm of the casualty's hand, including the fingers, represents about 1% of his or her body surface area. Burns must be seen by a professional when they are extensive or deep (white, leathery or blackened skin, with little pain), when they affect the face, hands, feet, joints, perineum or genitals, when they go all the way round a limb, when they involve a young child or an older person, or when there is a risk of airway involvement (burn in an enclosed space, soot around the mouth or nose, hoarse voice, cough).

Chemical and electrical burns

Chemicals: protect yourself (gloves, goggles), remove contaminated clothing, brush off any dry powder before rinsing, then rinse with plenty of water for a long time. Identify the product (label, safety data sheet) and pass on the information.
Chemical in the eye: immediate, copious and prolonged irrigation with clean water, eyelids held open, directing the water so as not to contaminate the other eye; urgent medical referral.
Electricity: cut off the power before any contact. The visible burn may be small while internal injuries and the risk of cardiac arrhythmia are significant: every casualty of an electrical injury must be medically assessed. Be ready to perform CPR.

Wounds: clean, cover, refer

The guidelines recommend cleaning superficial wounds with plenty of clean water, running if possible. Then cover with a clean dressing. Referral to a health worker is required for a deep or large wound, a wound contaminated with soil, a bite wound, a wound to the hand or face, or a wound in a person whose tetanus vaccination is not up to date or is unknown. An embedded object is not removed: it is stabilised with dressings placed around it.

Head injury

After a blow to the head, the first aider looks for red flags requiring urgent medical assessment: loss of consciousness, even brief; confusion; increasing drowsiness; repeated vomiting; worsening headache; seizures; weakness or numbness in a limb; speech or vision disturbance; blood or clear fluid leaking from the nose or ears; unusual behaviour. The European guidelines advise against a first aider using a simplified scale alone to decide that a concussion is minor: if in doubt, professional advice is needed. The casualty should not be left alone or drive in the hours that follow.

Suspected spinal injury

Current guidelines do not recommend the application of a cervical collar by a first aider, because of possible adverse effects and the absence of proven benefit. A conscious casualty is asked not to move and head and neck movement is limited; if necessary, the head is held manually in the position in which it was found. In an unresponsive casualty who is breathing, protecting the airway takes priority: if the casualty must be turned onto his or her side, this is done while keeping movement of the head-neck-trunk axis to a minimum, with several people if possible.

Limbs: fractures, sprains, dislocations

Do not try to realign a deformed limb; immobilise it in the position found or the least painful position, including the joints above and below.
Check the colour, warmth and sensation of the extremities before and after immobilisation.
Open fracture: cover the wound with a clean dressing, control any bleeding, do not push the bone back in.
Sprains and closed bruising: cold (ice wrapped in a cloth or a cold pack) can relieve pain, for limited periods and without direct contact with the skin.
Severe pain in the thigh or pelvis after violent trauma: risk of internal bleeding; monitor for signs of shock and arrange evacuation.

6Environmental and medical emergencies: heat, cold, dehydration, bites, poisoning

Heat-related illness

Form	Signs	What to do
Heat cramps	Muscle pain during or after exertion in the heat	Rest in the shade, gentle stretching, a drink containing electrolytes (rehydration solution)
Heat exhaustion	Fatigue, weakness, heavy sweating, nausea, headache, dizziness, normal consciousness	Rest in the shade or somewhere cool, lie down, cool (wet the skin, fan), give a rehydration solution or a drink containing electrolytes; if no rapid improvement, seek medical advice
Heat stroke	Behavioural changes, confusion, seizures, loss of consciousness; hot skin, dry or sweating; very high temperature	Life-threatening emergency. Immediate active cooling, preferably by immersing the body up to the neck in cold water; failing that, any available cooling method (dousing with water, fanning, wet cloths). Raise the alarm. Give nothing to drink if consciousness is impaired.

The ERC and IFRC guidelines stress early cooling: it must start on site, before transport, and must not wait for a temperature reading. The decision to stop it rests with the protocol and, if possible, medical advice.

For prevention, organisations can use the wet bulb globe temperature (WBGT) index to adjust physical work, schedule distributions at cooler times of day, provide shade, water and breaks, and pay particular attention to older people, young children, pregnant women, people who are ill and workers wearing heavy equipment.

Cold

Hypothermia: shivering, cold skin, clumsiness, then confusion, drowsiness and cessation of shivering in severe forms. Shelter the person from wind and moisture, remove wet clothing, insulate from the ground, cover including the head, handle gently (sudden movements can trigger a cardiac arrhythmia), and give a warm sweet drink only if the person is conscious and swallowing normally. Frostbite: do not rub, and do not rewarm if refreezing is possible before reaching a safe place; protect and refer.

Diarrhoea and dehydration

The reduced-osmolarity oral rehydration salts (ORS) recommended by WHO and UNICEF must be prepared strictly according to the instructions on the sachet, with safe drinking water or treated water, and the solution keeps for a limited time only. An over-concentrated solution is dangerous, especially for infants. In children, IMCI recommends continuing breastfeeding and feeding; zinc treatment is the responsibility of a health worker.

Signs of severe dehydration according to IMCI, which require management in a health facility: lethargy or unconsciousness, inability to drink or drinking poorly, sunken eyes, skin pinch that goes back very slowly. Profuse watery diarrhoea of sudden onset, especially in adults and in an epidemic context, should raise suspicion of cholera and trigger an alert to the disease surveillance system.

Bites and stings

Snakebite: in line with the WHO guidelines for the management of snakebites, reassure, lay the person down and immobilise the limb and if possible the whole body, remove rings and tight clothing, and transport without delay to a facility that has antivenom and can monitor the patient. No tourniquet, no incision, no suction, no ice, nothing applied to the wound, no traditional remedy. Some regional protocols provide for a pressure immobilisation bandage for certain species: it is applied only if the local protocol provides for it and the first aider has been trained in it. Note the time of the bite and the progression of signs (swelling, bleeding, drooping eyelids, difficulty swallowing or breathing).
Animal that may transmit rabies (dog, cat, monkey, bat): WHO recommends immediate and thorough washing of the wound with soap and water for about fifteen minutes, followed by prompt consultation for rabies post-exposure prophylaxis, which is a medical emergency. Check tetanus vaccination status.
Scorpion: reassure, immobilise, apply cold to the sting site, refer quickly, particularly young children, who are more at risk of severe forms.
Severe allergic reaction (anaphylaxis): breathing difficulty, swelling of the face or throat, feeling faint, rash. Help the person use their adrenaline auto-injector (outer thigh), raise the alarm; the European guidelines provide for a second dose after 5 minutes if signs persist and a second injector is available. Sitting position if breathing difficulty predominates, lying down if the person feels faint.

Other medical emergencies

Hypoglycaemia in a person with diabetes who is conscious and able to swallow: the European guidelines recommend 15 to 20 grams of glucose (tablets), or failing that another fast-acting sugar (sweet drink, sugar), then reassessment after about fifteen minutes; if the person does not improve or loses consciousness, raise the alarm and give nothing by mouth.
Seizures: protect the person, put nothing in the mouth, do not restrain movements, time the seizure; raise the alarm if the seizure lasts more than 5 minutes, recurs, or occurs in a pregnant woman, an injured person or a person with no known history; afterwards, recovery position and monitoring.
Poisoning (pesticide, household product, medication, fuel): protect yourself, move the person away from the source, remove contaminated clothing, do not induce vomiting, identify the product and quantity, contact the poison centre if there is one or the health facility. Organophosphate pesticide poisoning is common in rural areas: contamination of first aiders through the skin or vomit is a real risk.

7Psychological first aid in practice: method, communication and limits

Psychological first aid (PFA), as described in the guide by WHO, War Trauma Foundation and World Vision International (2011) and taken up by the IFRC Reference Centre for Psychosocial Support, is neither therapy nor debriefing. It is a humane, supportive and practical response to a person who is suffering and may need help, respecting his or her dignity, culture and abilities. It sits at the first level of the intervention pyramid in the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007).

The step-by-step method

Prepare: learn about the event, the services available (health, protection, family tracing, distributions), safety and security issues, and cultural norms (who may speak to whom, how to approach a woman, an elder, a child).
Look: the safety of the area; urgent basic needs; people in acute distress (extreme agitation, complete shock, inability to care for themselves or their children, suicidal talk); people at particular risk (unaccompanied children, isolated older people, people with disabilities, survivors of violence).
Listen: introduce yourself (name, organisation), ask whether you can help, find a quiet and safe place, ask what the person needs and what worries them, listen without pressing them to talk, help them calm down (slow breathing, concrete reference points about place and time, presence).
Link: with basic needs and services, with reliable information (what is known, what is not known, when more will be known), with loved ones and social support. Physically accompany the person to a service when needed, rather than just pointing the way.
Close: say what will happen next, make sure the person is not left alone if vulnerable, and do not promise to come back unless it is certain.

What to say and what not to say

Do	Avoid
Be honest and trustworthy	Making promises you cannot keep
Respect the person's right to make their own decisions	Deciding for them, putting pressure on them
Speak calmly, in simple sentences, in their language if possible	Using technical jargon, speaking too fast
Acknowledge their losses and distress ("what you are going through is very hard")	Minimising ("it's nothing", "it could be worse"), offering religious or personal explanations
Allow silences, listen	Pressing them to tell their story, asking detailed questions about the event
Maintain confidentiality	Telling the person's story to others, photographing them
Refer to a professional when needed	Acting as a therapist, making a diagnosis

What PFA is not: psychological debriefing

The WHO guidelines for the management of conditions specifically related to stress (mhGAP programme) advise against single-session psychological debriefing, which consists of having people recount the event and the associated emotions in detail shortly afterwards, because it has shown no benefit and may be harmful for some people. This is one of the reasons why PFA never asks people to recount the event.

Children

Children's reactions depend on their age: regression (bedwetting, clinging to parents), sleep problems, repetitive play about the event, irritability. The priorities are to keep them with their parents or usual caregivers, to report an unaccompanied or separated child immediately to child protection actors, to speak to the child at his or her level in simple words, and to support the parents, who are the child's primary protective factor. Never photograph a child or record a child's identity outside the established child protection procedures.

When to refer immediately

Referral to a specialised service, urgently if necessary, is required when the person is injured or ill, is so distressed that he or she cannot care for themselves or their children, expresses thoughts of harming themselves or others, or is a survivor of sexual violence (referral to clinical management and psychosocial support services within the medical time frames, according to the person's choice and the established referral pathway).

8Worked example: a distribution day in extreme heat

Fictitious context: Bassa-Nord displacement site, 9,400 people, hot season. The NGO "Terres Communes" is organising a distribution of shelter kits and non-food items for 1,150 households over two days. The forecast temperature exceeds 40 °C in the afternoon. The site health post, run by a partner, is open from 8:00 to 16:00, with a nurse and two nursing assistants; the district hospital is 50 minutes away. The distribution team has 14 people, including 3 certified first aiders; a first aid post is set up in a tent, with a dedicated first aider who does not take part in the distribution.

Preparation: decisions taken the day before

Distribution from 6:30 to 11:30, resuming at 15:30, based on the heat index and the advice of the health partner.
Queues under stretched tarpaulins; water points every 50 metres; priority queue for older people, pregnant women, people with disabilities and people who are ill.
First aid post equipped with: plenty of water, ORS, basins and buckets for cooling, blankets, a complete kit, assessment forms, a radio.
Referral pathway agreed with the health post nurse, and a vehicle designated for transfer to the hospital.

Log of cases managed during the day

Time	Person	Problem	Care given	Referral
8:10	Woman, about 70 years old	Dizziness, sweating, nausea, normal consciousness	Rest lying down in the shade, wet cloths, ORS in small sips	Improved within 30 minutes; her entitlement handed over via the priority queue, accompanied home by a neighbour
9:25	Man, kit porter, about 30 years old	Calf cramps	Rest, gentle stretching, drink with electrolytes	Returned to a light task after one hour; rotation of porters introduced
10:40	Woman, about 25 years old, pregnant	Felt faint in the queue, no loss of consciousness	Placed on her left side in the shade, water, monitoring	Referred to the health post for examination, accompanied
11:05	Man, about 45 years old, distribution volunteer	Incoherent speech, staggering, burning-hot skin, then a brief seizure	Radio alert; immediately placed in an improvised tub (tarpaulin raised at the edges and filled with water), head supported above the water by a first aider, continuous dousing, fanning; recovery position after the seizure	Nurse on site within 6 minutes; cooling continued; transfer to hospital after consciousness improved, with cooling during the journey
11:20	Boy, about 8 years old, with his mother	Burn to the forearm from an overturned cooking pot near the cooking area	Cooling with clean water for 20 minutes while keeping the child covered, bracelet removed, cling film laid in strips	Burn of about two palms, with blisters: referred to the health post, mother present and informed
11:30	Man, about 35 years old	Dog bite to the calf	Washing with soap and water for about 15 minutes, clean dressing	Referred to the health post for assessment for rabies post-exposure prophylaxis and tetanus; information passed to the site health focal point

Analysis of the most serious case

The volunteer who suffered heat stroke had refused a break at 10:00 in order to finish a row. What protected him: rapid recognition of the behavioural changes as a sign of severity (rather than fatigue or alcohol consumption), immediate cooling on site without waiting for transport, and the equipment prepared in advance (water, tarpaulin, basins). What was missing: a mandatory break rule for staff and volunteers, and monitoring of their water intake.

Decisions for the second day

Mandatory 15-minute breaks in the shade every hour for porters and volunteers; buddy pairs responsible for watching each other.
Distribution stopped from 10:30 and resumed at 16:00.
The staff cooking area moved away from the queues.
A short briefing for volunteers on the signs of heat stroke.
Incident report for the volunteer, submitted in line with procedure; follow-up of his condition by the volunteer manager.

The psychological dimension

The mother of the burned child was very agitated and blamed herself for the accident. The first aider introduced herself, had her sit next to her son during cooling, explained each step, acknowledged her fear without judging her, and accompanied her to the health post, telling her where she could collect her kit later. This is a direct application of PFA: look, listen, link, with no debriefing or questioning.

9Tools, common mistakes and contextual variations

Tool 1: burns decision tree

Question	If yes
Burn from a flame, liquid or hot object?	Cool for at least 20 minutes, remove jewellery, cover with cling film
Chemical?	Protect yourself, brush off powder, rinse with plenty of water for a long time, identify the product
Electrical?	Cut off the power, systematic medical assessment, be ready to perform CPR
Face, hands, feet, perineum, joints, circumferential burn?	Medical referral
Larger than one or two palms, deep burn, child or older person?	Medical referral
Respiratory signs (soot, hoarse voice, cough, enclosed space)?	Emergency: raise the alarm, monitor breathing

Tool 2: heat-illness prevention checklist for an activity

Weather forecast checked and timings adjusted.
Shade for queues and teams.
Safe drinking water accessible to all, ORS at the first aid post.
Priority queue for vulnerable people.
Mandatory breaks and rotation for physical work.
Cooling equipment ready (plenty of water, container, tarpaulin).
Dedicated first aider and known referral pathway.

Tool 3: PFA pocket card

Look: safety, urgent needs, severe distress, people at risk.
Listen: introduce myself, offer help, ask about needs, listen without pressing, help the person calm down.
Link: basic needs, reliable information, loved ones, services; accompany if necessary.
Refer urgently: injury, inability to care for oneself, thoughts of self-harm, sexual violence, unaccompanied child.
Look after myself: take a break, talk with a colleague, use the organisation's support.

Common mistakes

Cooling a burn for only a few seconds, or with ice; applying traditional remedies or toothpaste.
Cooling a child's burn without keeping the child warm, risking hypothermia.
Mistaking heat stroke for fatigue or drunkenness and delaying cooling until the hospital.
Preparing ORS with a different amount of water from that stated on the sachet.
Applying a tourniquet or making an incision after a snakebite; wasting time trying to catch or kill the snake.
Neglecting a dog bite because the wound is small.
Applying an improvised cervical collar or leaving a head-injured casualty alone.
Asking a person in shock to tell their story "to get it off their chest".

Contextual variations

Sudden-onset crisis: an influx of minor and moderate injuries (wounds, fractures, burns), scarce clean water, overwhelmed facilities. Community first aiders manage simple injuries and refer serious cases. PFA is a priority in the first days.

Protracted crisis: environment-related illness (diarrhoea, heat, cold in shelters) and household burns in overcrowded shelters predominate. Prevention (layout of cooking areas, shelter insulation, access to water) is the responsibility of the shelter, WASH and health sectors, and first aiders can report the risks they observe.

Camps: high density, open fires, fire risk; a fire evacuation plan and first aid for burns should be prepared with the site manager.

Urban settings: carbon monoxide poisoning (heating or a generator in an enclosed space), electrical injuries, falls. Ventilate and remove casualties from an enclosed space only without exposing yourself.

Remote management and partners: PFA can be delivered by trained non-specialists and is a priority skill for local partner teams and volunteers, provided that referral pathways to specialised services exist.

Insecurity: people may be exposed to repeated violence; do not create expectations of a return visit if access is not guaranteed; strictly protect the information collected.

What assessors look for

Integration of environmental health risks into activity planning (heat, cold, water).
PFA training for staff in contact with affected populations and the existence of a functioning referral pathway.
Log of cases managed at activity sites and follow-up of referrals.
Attention to the well-being of staff and volunteers (breaks, water, post-incident support).

10Interview questions and key references

1. "How do you organise a distribution in extreme heat to reduce health risks?"

A strong answer covers timings, shade, water, priority queues, mandatory breaks for staff and volunteers, a first aid post with a dedicated first aider and cooling equipment, a referral pathway agreed with the health partner, and the ability to suspend the activity.

2. "What is the difference between heat exhaustion and heat stroke, and why does it matter?"

The candidate cites altered consciousness or behaviour as the sign of heat stroke, explains that it is a life-threatening emergency requiring immediate active cooling on site, preferably by cold-water immersion, and that heat exhaustion is treated with rest, cooling and rehydration.

3. "A colleague is bitten by a snake in the field, three hours from the hospital. What do you do?"

The candidate describes rest, immobilisation, removal of jewellery, the prohibition of tourniquets, incisions, suction and ice, raising the alarm, choosing a facility with antivenom, monitoring for signs of severity, and mentions advance preparation (mapping the facilities with antivenom in the medical plan).

4. "What is psychological first aid, and how does it differ from debriefing?"

The candidate presents the look, listen, link principles, the absence of pressure to talk, the practical and humane nature of the support, and explains that WHO advises against single-session psychological debriefing. He or she cites the situations that require specialised referral.

5. "How would you train community volunteers in first aid in a camp?"

The candidate mentions a partnership with the Red Cross or Red Crescent National Society, content adapted to the common risks in the camp (burns, diarrhoea, heat, wounds), certified hands-on training, equipment, a referral pathway to health facilities, refresher training and supervision.

Key references

International First Aid, Resuscitation and Education Guidelines (2020): IFRC.
European Resuscitation Council Guidelines (2021), "First Aid" chapter: European Resuscitation Council.
Psychological First Aid: Guide for Field Workers (2011): WHO, War Trauma Foundation and World Vision International.
A Guide to Psychological First Aid: IFRC Reference Centre for Psychosocial Support.
IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007): Inter-Agency Standing Committee.
WHO Guidelines for the Management of Conditions Specifically Related to Stress (mhGAP programme, 2013).
WHO Guidelines for the Management of Snakebites, and WHO position paper on rabies vaccines.
Integrated Management of Childhood Illness (IMCI) strategy: WHO and UNICEF.
The Sphere Handbook (2018), Health and Water Supply, Sanitation and Hygiene Promotion chapters.

Reminder: this online course does not replace certified hands-on first aid training or specific training in psychological first aid. Both are learned through practice, with an instructor.