a. Sanitary, ballast, bilge or general service pumps may be acceptable as fire pumps, provided that they are not normally used for pumping oil.
b. An oil tanker of 1000 GRT and above must have at least 2 fire pumps so located that fire in any one compartment will not put all the fire pumps out of action.
c. Each of the fire pump a minimum capable of delivering at least 2 jets of water with sufficient pressure and will have a minimum capacity of 25 cm/hr.
d. Total required capacity of the fire pumps need not exceed 180 cm/hr.
e. In case all fire pumps onboard are so located that fire in any one compartment may put all of them out of action, there shall be an alternative means consisting of an emergency fire pump with its source of power and sea connection located outside the space where the main fire pumps or their sources of power are located.
f. No direct access is permitted between the machinery space and the space containing the emergency fire pump and it’s source of power. However an arrangement is accepted where the access is by means of an airlock, with the machinery space door being a-60 class standard and other door made of steel. Both doors must be reasonably gas tight, self-closing and without any hold back arrangement.
Every member of ship’s staff must be well versed with the following procedure of Emergency fire Pump.
ONBOARD EMERGENCY FIRE PUMP STARTING PROCEDURE IS AS FOLLOWS
a. Open main sea suction valve
b. Open delivery valve from pump.
c. Open isolating valve on main fire line
d. Start fire pump procedure laid down and posted.
EMERGENCY FIRE PUMP IS LOCATED IN ____________________.
10.2 Fire Hoses
Use of either rubber or plastic lined hose or a hose with PVC lining is strongly recommended for shipboard use.
A fire hose must stand up to high pressure, be flexible, should be unaffected by oils, acids, alkali, sunlight, mildew and seawater
COUPLING FOR FIRE HOSES
10.3 Fire Nozzles
Jet type, Spray type or Dual purpose type (jet and spray)
A jet nozzle will direct a solid stream of water directly at seat of fire. Only a small portion of this water (about 10% by volume) comes in actual contact with fire.
Comparatively, a fog or a spray nozzle breaks the water stream into extremely fine water droplets. These droplets have a much larger total surface area as compared to water jet thus can absorb much more amount of heat. Also most of the amount of water easily turns to steam once it hits the seat of fire.
Disadvantage of water spray is it lacks accuracy or reach of jet stream.
A dual purpose jet and spray nozzle combines advantages of a nozzle and a fog nozzle water stream may be turned into jet form or spray form as required by simply moving a lever.
TYPICAL HIGH PRESSURE JET AND SPRAY NOZZLE
Fire Hoses and Nozzles are Located at
a. Engine room floor___________
b. Engine room floor___________
c. Deck A (PORT) ___________
d. Deck A (STBD) ___________
e. Deck B___________
f. Deck B___________
g. Deck B___________
h. Main Deck C___________
i. On adjacent side of the pump room___________
j. The Alleyways___________
k. Deck F ___________
l. Deck F ___________
m. Deck E ___________
n. Deck E ___________
o. Deck E ___________
p. Deck D ___________
q. Deck D ___________
r. Deck B ___________
10.4 International Shore Coupling
Each vessel must carry at least one portable international shore connection, which can be connected matching fittings that are available at most ports and terminals throughout the world.
Thus in case of a fire onboard while in port, a vessel can take advantage of water pumping capability of the shore installation.
Location of international shore coupling onboard must be easily accessible and conspicuously marked.
A suitable gasket, four nos nuts and blots 16 mm dia x 50 mm long and 8 nos washers must be kept ready with each international shore coupling.
OPERATION OF FIXED FOAM FIRE EXTINGUISHING SYSTEM
In case of Fire Engine Room
a. Start emergency fire pump from safety station or in foam room.
b. Open valve ‘A’ from emergency fire pump to engine room fire extinguishing with water.
c. Open valve ‘B’ seawater to engine room.
d. Open valve ‘C’ from fire pump to foam proportionate.
e. Adjust 3.5% for normal expansion of foam.
f. Open suction valve of foam and start pump.
g. Open one of valve ‘E’, ‘F’ or ‘G’. To area which need protection.
In case of Fire on Main Deck
a. Start fire pump in engine room; Bridge or from safety station.
b. Open valve ‘B’ seawater from fire pump.
c. Open valve ‘A’ water from fire pump to deck.
d. Open valve ‘C’ from fire pump to from proportionator adjust pressure max to 8.5 kg / cm3.
e. Adjust proportionator to 3.5% for normal expansion of foam.
f. Open valve ‘D’ foam to deck.
The foam system is connected to main fire line and foam fire extinguishing is possible to use on all ship’s location as: Accommodation pump room: Bosun’s stories: Paint stories.
Note:
After using of foam system close valve on foam tank. Adjust the proportionate to 5% and clear the foam line with water.
10.5 Fire Control Plans
Must be approved by administration. Fire plans will be checked periodically to ensure they are legible and up to date.
Copy of an updated fire control plan will be located in a weather tight enclosure outside each accommodation entrance from main deck.
FIRE CONTROL PLANS POSTED AT
Boat Deck, Accommodation Alleyway STBD
Naval Bridge Deck
Fire control plan located in watertight enclosure outside accommodation at
Main deck accommodation PORT side.
Main deck accommodation STBD side.
10.6 Portable Fire Extinguishers
IMO resolution a.602 (15), “revised guidelines for marine portable fire extinguishers”, recommends standards for the construction, performance, test specifications, markings, periodical inspections and maintenance of portable fire extinguishers.
A portable fire extinguisher because of its limited capacity and duration must only be used in the early stage of a fire.
According to the fire extinguishing agent they contain, portable fire extinguishers are divided into 4 categories.
a. Water
b. Foam
c. Dry chemical powder
d. Carbon dioxide
Capacity of a portable fire extinguisher will be between 9.5 litres to 13 litres.
A portable extinguisher will be placed next 7to locations with major fire risks (e.g. galley, radio console) and also near exit points of escape routes.
So that they can be readily seen and used by crew following an escape route.
Each portable extinguisher is to be clearly marked as under:
a. Manufacturer
b. Type of fire on which the extinguisher is suitable
c. Type and quantity of extinguishing medium
d. Approval details
e. Operating instructions in pictorial form
f. Recharging instructions
g. Year of manufacture
h. Test pressure
i. Temperature over which the extinguisher will operate satisfactory
DRY CHEMICAL FOAM EXTINGUISHER:
Operation:
Suitable for use on B Class and C Class fires.
Extinguisher with Monoammonium phosphates can be used on Class A fires as well.
They have little or no cooling effect.
DC extinguishers vary in sizes ranging from 0.9 kg to 13.6 kgs.
Range is between 3-9 meters with 8-30 seconds discharge time as to capacity.
Chemicals used are sodium bicarbonate, potassium bicarbonate, urea potassium bicarbonate, potassium chloride and monoammonium phosphate.
Dry chemical extinguishers are available in two types.
a. Gas Cartridge Type:
Insert gas is stored under high pressure in the cartridge. Once the cartridge is punctured, this gas will propel the dry chemical out of the extinguisher.
b. Stored Pressure Type:
Propellant gas is mixed in with the dry chemical in the stored pressure type. The powder outflow. Can be controlled with a squeeze grip trigger on top of the container. A pressure guage indicates condition of the charge.
For effective results, stand upwind of the seat of fire about 1.5 to 2.5 meters away and direct the stream near the seat of the fire progress forward, moving the nozzle rapidly with to side in a sweeping motion.
Once the fire is extinguished, fire fighting should move closer to burning debris and coat at fuel surfaces thoroughly with short intermittent bursts.
Maintenance:
a. Dry Chemical Extinguishers are unaffected by temperature variations and thus can be stowed anywhere on the vessel.
b. They do not deteriorate or evaporate and thus need not be recharged periodically.
c. Recharge immediately after use.
d. Ensure hose and nozzle are not clogged.
e. Examine cartridges every 6 months, in case punctured or weighing 14.2 Gms lesser than the indicated weight, it must be renewed.
f. Inspect stored pressure type extinguisher gauge every month to ensure internal pressure is within operating range.
DRY CHEMICAL EXTINGUISHER
IMPORTANT: HOLD THE NOZZLE FIRMILY PRIOR FIRING THE EXTINGUISHER
10.7 Carbon Dioxide Type Fire Extinguishers:
Operation:
Suitable on Class B and Class C Fires.
When using on fire involving electrical equipment, de-energise equipment on fire to avoid shock and source of ignition.
Grasp the insulated handle of the hose horn. Do not hold the hose as the co2 being released will expand and thus cool down very quickly as it leaves the extinguisher. The horn gets cold enough to frost over and this may cause extinguisher capacity ranges between 2.3 to 9.1 kg of co2.
The extinguisher shell retains carbon dioxide in liquefied form under pressure (850 psi @ 21 c). The cylinder is filled with this charge to about two-thirds by weight of its total water capacity.
Carbon dioxide fire extinguishers are used for putting out fires in oils, petroleum fires, gaseous substances under pressure, and on sophisticated electrical and electronic apparatus.
This extinguisher must not be used on:
Fires involving chemicals that contain their own oxygen supply e.g. cellulose nitrate
CARBON DIOXIDE EXTINGUISHER
Fire fighting training reactive like sodium potassium and magnesium.
The extinguisher is carried to the seat of fire in an upright position.
Removing the locking pin and release CO2.
Operation should stand upwind, direct the jet at the fire, starting at one edge and sweeping the discharge horn across the surface of the burning material.
The range varies between 1.8 to 2.4 met and the duration between 8-30 seconds as per capacity.
Release of carbon dioxide makes quite a noise and the operation must be aware of it distracted, he may misdirect the gas jet for few vital seconds.
Maintenance:
a. Need not be protected against freezing.
b. Stow at temperatures below 54o c to keep internal pressure at safe level
c. Safety v/v built into CO2 extinguisher will activate at 2700 psi.
d. Every month, examine for damage and ensure extinguisher not empty.
e. Weigh the extinguisher annually, If any extinguisher has lost more 10% of its CO2 weight. The manufacture must recharge it. Also recharge after each full or partial use.
10.8 Fireman’s Outfit
A fireman’s outfit will consist of following.
a. Protective clothing material for shielding skin against heat radiation and burns and scalding by steam. The outer surface must be water resistance.
b. Boot and Gloves made from electrically non conductive material.
c. A rigid helmet providing effective protection against impact.
d. An electric safety lantern of electric battery type with a minimum burning period of 3 hours. Means must be provided for the lamps to be attached to the wearer at waist level.
e. A fire axe with a spike as well as a cutting edge, wooden or insulated handle and a belt and pouch.
f. A self-contained breathing apparatus.
For each breathing apparatus, a fireproof lifeline of sufficient length and strength with a snap hock will be provided.
10.9 Self Contained Berthing Apparatus
A human being requires oxygen and this will be absorbed in boold stream at a rate depending on amount of work body is performing. Once we breath in 4% of oxygen inhaled is attached into the blood stream.
Any self-contained breathing apparatus must be able to supply air at the rate of 4G liters / minute.
Compressed air breathing apparatus sets are popular on vessels due to following
a. Simple Design
b. Need less maintenance
c. Possible recharge onboard.
d. Staff can be trained easily as donning and use.
A typical set consists of a single steel cylinder mounted on a stainless steel back plate secured by two quick release cylinder straps and. This is supported on a wearer’s back an adjustable shoulder harness and a waist belt.
Each cylinder will have 1200 liters of air stored at a pressure of 200 bars.
Upon opening the air valve on the cylinder, high pressure air is routed thro a reducing valve that reduce the air pressure to the region of 4 bars. This air is then fed to a whistle warning unit and facemask with a demand valve incorporating a positive pressure mode.
Once air amount is reduced to 10 minutes of use, a whistle sound continuously warning user.
The demand valve will supply fresh air to the facemask only upon inhalation and will pass this air along visor to prevent misting.
Upon exhalation, expended air is passed out to atmosphere thro positively closed extinguisher valve.
It is important to note that the facemaske is designed to snug fit human face and prevent toxic gases from entering respiratory system. This facemask will only snug fit if the mask rubber seal makes close contact with skin.
There must not be any facial hair, side burns and stubble in this area.
The endurance of the set depends upon the work being carried out.
Predonning Checks:
a. Open cylinder air valve slowly and fully. Check the pressure gauge reads 200 bars
b. Shut cylinder air valve and listen for any air leak. The pressure drop if any must not exceed 10 bars within a minute.
c. Vent face mask slowly and confirm that the warning whistle at appropriate pressure
After Donning Checks:
a. Open cylinder air valve and don the facemask.
b. Breathe in slowly and deeply several times. Confirm that the demand valve and the exhalation v/v are in good working order.
c. Close cylinder air valve and continue breathing as usual. Once the air in the system is exhausted. The visor should pull on the face. If this does not happen, the facemask seal is not complete the head harness will have to be readjusted and this test to be repeated.
A Self-Contained Breathing Apparatus must always be donned completely and put to use while the users are still in fresh air.
10.10 Emergency Escape Breathing Device (E E B D )
Never use an E E B D for fire fighting purposes.
A self- contained breathing apparatus must be used for fire fighting purposes.
An Emergency escape breathing device is a compressed air, constant flow. Short duration emergency life saving apparatus used for making good an escape from a toxic or oxygen deficient atmosphere.
a. Emergency escape breathing device must be approved.
b. Must be stored at locations that can be reached quickly and easily in the event of fire.
c. Lightweight, to be donned quickly and carried hands free.
d. Made from fire retardant material.
e. Hood must cover mouth, nose and eyes and to have clear window for viewing.
f. Must provide a breathing air supply for minimum ten minutes upon activation.
g. Can be recharges on board with shipboard cabal compressor.
h. Air cylinder may require a 5-year hydro test.
10.11 Onboard Locations of Fireman’s Outfits
a. NAVIGATION BRIDGE.
b. OFFICER DECK OUT SIDE ACCOMODATION STBD SIDE ( SAFETY LOCKER)
c. .
d.
10.12 Onboard Locations of E E B D
a.
b.
c.
d.
e.
f.
g.
h.
i.
10.13 Types of Fire Drills
a. Evacuation of machinery space using emergency escape in event if power failure.
b. Evacuation of a casualty from cargo tank or pump room or crew cabin.
c. Fire in the purifier room.
d. Fire in the purifier room.
e. Fire in the machinery space bilges.
f. Boiler uptake fire.
g. Fire in galley ducts.
h. Fire in the paint locker.
i. Mast riser fire.
j. Fire at ship’s manifold and cargo spill.
k. Fire in cargo tank.
11 SHIP’S EMERGENCY ORGANIZATION.
Ship’s emergency organization of five teams.
a. COMMAND team led by ship’s master.
b. ROVING team led by chief engineer and will include Electrical Engineer.
c. EMERGENCY team led by either Chief officer or 2nd Engineer depending on the location of emergency.
d. BACKUP team led by 3RD Officer / Deck Officer.
e. SUPPORT team.
Each team will consist of 3 to 6 members but no more than 8 as far as possible.
Emergency team must include Chief Officer and 2nd Engineer and unto 6 additionally who should be selected on the basis of their knowledge, physical strength and agility as these people will actually deal with any kind of emergency on board.
11.1 Responsibilities of Command Team
a. Assume overall command of the emergency response.
b. To coordinate actions of all teams.
c. Maintain a detailed and complete time log of all events.
d. Establish and maintain contact with HO and external agencies to obtain any assistance if necessary.
11.2 Responsibilities of Roving Team
a. To maintain essential shipboard services to support emergency response.
b. To appraise the bridge control team in a timely manner status of vessel operating systems.
c. To implement any damage control measures as directed by bridge control team.
11.3 Responsibilities of Emergency Team
a. To initiate response procedures as per impending emergency
b. To keep the bridge control team informed about the effectiveness of action taken.
c. To request any further assistance as and when required.
Every member of emergency team must be familiar with location and use of:
a. Fire nozzles and fog applicators.
b. Fixed and portable fire extinguishing systems.
c. Fireman’s outfits.
d. Emergency escape breathing device.
e. Portable gas detectors.
f. Pump room rescue gear.
g. Quick closing valves.
h. Trips for forced draft fans, vents.
i. Fire dampers.
j. International shore coupling.
k. First aid equipment, stretchers.
All crewmembers must be aware of firefighting procedures for engine room, accommodation spaces, galley, paint lockers, cargo tanks and cargo manifolds.
11.4 Responsibilities of Backup Team
a. Ensure that emergency response team is supplied all equipment required without undue delay.
b. To replace emergency response team members in order to test them if required.
c. To prepare lifeboats for launching.
11.5 Responsibilities of Support Team
a. Stand by for medical assistance with first aid kit and a stretcher.
12 Hazardous Products of Combustion
A firefighter must wear protective clothing and self- contained breathing apparatus.
Any fire will produce flames, heat, gases and smoke,
A human being exposed to any of the above is prone to serious injuries and even death.
Direct contact with flames can result in serious skin burns and damage to respiratory tract.
Temperatures above 50o c are hazardous to human beings even after wearing protective clothing and self- contained breathing apparatus.
It is common to experience temperatures in the range or 93o c to 427o c in a enclosed area with fire raging inside.
This heat will cause dehydration, heat exhaustion, burns and blockage of the respiratory tract a firefighter exposed to excessive heat over a long period could develop hypothermia that can eventually damage his nerve centers.
Most common gases produced by any fire are carbon monoxide (CO) and carbon dioxide (CO2).
Carbon monoxide is extremely dangerous as when air with carbon monoxide is inhaled: human blood absorbs co gas before absorbing oxygen.
Thus even a low concentration of carbon monoxide in air (1.3 % by volume) will result in oxygen deficiency for body and brain and death in a few minutes.
Once carbon dioxide concentrations in air goes up, oxygen content in the air is reduced and human respiratory system is starved off oxygen.
Human body will respond to this by rapid and deep breathing
If oxygen content in the air drops to 15% by volume, human muscular control is reduced. With oxygen levels hovering between 10% and 14% judgment is impaired and fatigue sets in.
Once oxygen levels in airdrop below 10% rapid unconsciousness will set in.
Smoke consists of carbon and other unburned substances in the from of suspended particles. It may additionally carry vapours of water, acids and chemicals that may be poisonous or irritating if inhaled. Smoke reduces visibility around seat of fire to a great extent and irritates eyes, nose, throat and lungs
A firefighter must wear protective clothing and self-contained breathing apparatus.
13 DANGERS INVOLVED WHILE FIGHTING SHIPBOARD FIRES
13.1 Dry Distillation
It is a combustion process in which a flammable material burns with insufficient oxygen to achieve complete combustion of the material. e.g. Making of a charcoal.
Dry distillation would occur in the following sequence of events.
a. Fire is located in an enclosed space.
b. Heat builds up but there is incomplete burning.
c. The opening or access introduces fresh air.
d. The result is a flash of fire towards the access opening.
e. Persons in the process of entry will be injured or burned unless they are well protected.
Above dangers can be mitigated by:
a. Cooling the compartment externally with water.
b. Approach the access in a crouched position behind the water screen.
c. Direct water towards the ceiling of the space on fire.
13.2 Chemical Reaction
A chemical reaction will result from addition of one or more of the following substances to a chemical.
a. Water or steam
b. Heat
c. Oil
d. Carbon dioxide
e. Sand
Chemical reaction will result in:
a. Explosion.
b. Spontaneous combustion.
c. Generation of toxic fumes.
d. Generation of smoke.
Response procedures to fire on dangerous goods can be found in the emergency schedules procedures for ships carrying dangerous goods.
Response procedures to fire in bulk cargoes can be found in emergency schedules of the code of safe practice for solid bulk cargoes.
13.3 Boiler Uptake Fires
Fires occur in exhaust pipes, economizers and waste heat boilers of ships.
Cause of such a fire is accumulation of carbon deposits with or without oil, which become overheated and catch fire.
Difficulties faced are:
a. Inaccessibility of all sections of the uptake. ( Particularly in the upper section of the engine room).
b. The economizer tubes reaching a temperature of 700o c when the following can take place.
The iron in the tubes will start burning in steam. This reaction is self-sustaining and generates considerable heat. Thus burning of iron tubes in steam does not need oxygen supply and produces black iron oxides and hydrogen. In case air is introduced at this stage, hydrogen produced will burn and explode.
Procedures for containing and extinguishing boiler uptake fire.
a. Shut down boiler and/ or main engine.
b. Spray the external surfaces in way if the fire with water to keep the temperature down.
c. To exclude air from fire, close turbo charger air suction filters, all valves, all indicator cocks and all exhaust system drains.
d. Protect electrical equipment blow the fire zone against water damage.
Continue cooling till it is safe it opens the economizer for examination and thorough cleaning.
Effects of fire and combustion process on human health.
* Suffocation (asphyxiation)
* Poisoning
* Burns to skin and tissues
* Pain
* Shock
a. Suffocation
It is a condition in which the lungs do not get sufficient supply of air for breathing . In case continued, breathing and heart action stops and death will occur. Any casualty who cannot breathe normally or ceased to breathe should be immediately administered artificial respiration.
Suffocation may be caused as the result of.
* Fires causing oxygen shortage.
* Extinguishing gas like carbon dioxide replacing air.
b. Poisoning
A poison may enter the human body ingestion, injection, inhalation or absorption.
Airborne toxins resulting from fire will normally enter body by absorption or inhalation.
A casualty overcome by an airborne toxin should be immediately shifted to fresh air and resuscitated.
Poising may be caused by
* Carbon monoxide which is a product of most fires.
* Toxic combustion products of fire.
A casualty overcome by an airborne toxin should be immediately shifted to fresh air and resuscitated.
c. Burns and Scalds
Burns result from dry heat, flames, contact with wire carrying high-tension electrical current.
Scales are caused by moist heat due to boiling water, steam, oil, and hot tar etc.
Chemical burns are caused by storing acids or by strong alkalis.
Nuclear burn is caused by instant flash or intense heat from a nuclear explosion.
The degree of burn indicates the degree of damage to the tissues.
First degree: skin is reddened.
Second degree: presence of blisters on the skin.
Third degree: when tissues are destroyed and or charred.
Danger from burns depends on the area of the burns rather than the degree. It must be noted that in the same person, different parts of the body may show different degrees of burns.
Any casualty with burns over 30% irrespective of the degree of burns must be hospitalised at the earliest opportunity.
Damage to skin and tissues may lead to:
* Loss of body functions.
* Infections.
* Mutilations, scarring, disfigurement.
* Burnt skin may interface with breathing function, which may cause death.
* Secondary shock is a serious condition, caused by the collection of body fluids in blisters and must always be suspected expect with minor burns.
In order to determine the area affected by burns, human body is divided into several parts. Each part is allocated percentages as follows:
RULES OF NINE FOR AREAS OF BURN
Face: 9%
Each hand : 9%
Back and chest : 9 % each
Abdomen front and back: 9 % each
Each thigh : 9 %
Each calf and foot : 9 % each
Genitals : 1 %
d. Pain
Injury by fire will result in intense pain.
e. Shock
Results from excessive loss of body fluids. In case body loses large amount of blood due to internal or external injuries, blood circulation will fail and the person will go in a shock. Exposure, fear and pain will only make shock worse.
General symptoms of shock.
* Patient lies still talking scant notice of surrounding.
* Feels weak, thirsty and may vomit.
* Body is pale, cold and clammy.
* Lips and ears may turn blue.
* Rapid but shallow breathing.
* Rapid and weak pulse.
14 CLASSIFICATION OF BURNS ACCORDING TO SEVERITY
FIRST DEGREE SECOND DEGREE THIRD DEGREE
PARTIAL THICKNESS PARITIAL THICKNESS FULL THICKNESS
14.1 Medical Emergency as a result of Fire and / or Fire Fighting
Any medical emergency that results from fire fighting may not be restricted to burns and may range from small burns to life threatening problems.
During fire fighting, fire and smoke may cause thermal burns, poisoning of victims, falls and trips, respiratory arrests, heart attacks and also drowning in water filled compartment.
A shipboard rescuer must;
* Protect a casualty from additional harm
* Reverse life threatening problems
* Immobilize injured limbs
* Treat minor injuries
* Keep the casualty stable till medical help is available
14.2 Diagnostic Signs and their significance
Diagnostic signs are set of indicators that the rescuer should use in evaluating the patients condition.
a. Respiration
The normal-breathing rate is 12 to 15 breaths per minute.
Observe both the rate and depth of breathing.
* In case breathing is deep, gasping or laboured, airway may be obstructed.
* In case bright red frothy blood is observed with each exhalation, lung damage should be suspected.
* If there is no breathing, casualty has suffered a respiratory arrest.
b. Pulse
The pulse is an indication of heart action. The normal pulse rate in adults is 60 to 80 beats per minute.
* In case of rapid but weak pulse, casualty is in shock.
* In case of rapid but bounding pulse, casualty is suffering from fright or hypertension.
* In case of absent of pulse, casualty has suffered cardiac arrest or the person is dead.
c. Blood Pressure
It is the pressure that circulating blood exerts against the walls of the arteries.
Systolic pressure is the pressure exerted while the heart is contracted (when the heart contracts and blood is pumped thro the arteries) whereas the diastolic pressure is the pressure exerted while the heart is relaxed.
Normal systolic pressure for men is 100 plus the age of the man.
Normal diastolic pressure is between 65 to 90.
For women, both pressures are about 10 mm lesser than the men.
d. Skin Temperature and Skin Colour
As the skin regulates the body temperature, changes in skin temperature indicate changes occurring within the body.
To determine the skin temperature, feel the skin surface at several locations with back of your hand.
A hot dry skin indicates heat stroke or high fever.
Clod clammy skin indicates shock.
Cold moist skin indicates that body is losing heat.
Cool dry skin indicates exposure to cold.
Mainly the blood circulating in blood vessels just below the skin determines skin colour.Thus a change in colour reflects the increase or decrease in blood flow or changes in the blood chemistry.
Reddish skin indicates high blood pressure, carbon monoxide poisoning or heart attack.
White skin indicates patient suffering from shock fright.
Blue skin indicates poisoning, asphyxia, or heart attack.
g. Pupils of the Eyes
The pupils of the eyes are good indicators of the condition of the heart and central nervous system. When the body is in normal state, the pupils are the same size and they respond to light.
In death, pupils are dilated and do not respond to light.
* Dilated pupils indicate unconsciousness, cardiac arrest.
* Constricted pupils indicate drug use, central nervous system disorder.
* Unequal pupils indicate head injury, stock.
h. Level of Consciousness
* Brief unconsciousness indicates simple fainting.
* Confusion indicates alcohol use, sight blow to head.
* Stupor indicates severe blow to head.
* Deep coma indicates severe brain damage, poising.
Triage is the sorting of accident victims according to the severity of their injuries.
When confronted with several accident victims, sometimes rescuers tend to care first for those who scream the loudest or whose injuries appear to be serious.
Accident victims should be sorted into three groups and treated according to their injuries.
a. High Priority Injuries.
* Airway or breathing difficulties.
* Cardiac arrest.
* Uncontrolled breathing.
* Severe head injuries.
* Open chest or abdominal wounds.
* Heart attack or severe shock.
b. Second Priority Injuries
* Burns
* Major multiple fractures
* Back injuries
c. Low Priority Injuries.
* Minor fractures
* Minor injuries
* Obvious death
* Obviously mortal wounds is that death appears reasonably certain
15. FIRST AID MEASURES FOR FIRE RELATED CASUALITY
In case of suffocation poisoning
* Remove casualty away from the affected area
* In case casualty is unconsclous, place him in the recovery position
* In the absence of breathing, apply artificial respiration immediate
In the absence of pulse and breath, immediately start with cardio pulmonary resuscitation
Artificial respiration or resuscitation
Aim of artificial respiration is to supply much needed oxygen to blood.
In case the human brain cells are deprived of oxygenated blood for more than four minutes, irreversible brain damage would occur.
For this reason, a casualty not breathing normally or where breathing has ceased, it is of utmost importance to start artificial respiration without wasting any more time.
For an effective artificial respiration, the air passage from mouth to lungs should be open and clear so that air can flow unrestricted into the lungs and then out.
Three most effective methods for artificial respiration are as follows
* Mouth to mouth
* Hoiger nieison method
* Schafer’s method
Mouth to mouth resuscitation
* Does not need strength for application
* Chest movement can be watched and thus inflation of lungs can be assessed
* Can be applied easily and effectively
* Provides good amount of oxygen to the lungs and blood.
If a casualty is unconscious, the airway may be narrow or blocked making the breathing difficult.
Head may be tilting forward narrowing the passage.
Muscular control in the throat may be lost and as a result tongue may block the air passage. As the reflexes are impaired, saliva or vomit may lie at the back of the throat blocking the air passage.
Mouth to mouth resuscitation to be applied in the following sequence
Place the casualty on his side and strike three or four sharp blows between the shoulders to clear the windpipe.
* Place the casualty in natural position
* Confirm that the airway is clear.
* Take up a convenient posture by kneeling down by the side of the casualty.
* With one hand. Press the fore head of the casualty downwards and with other hand, pull jaw of the casualty. This will ensure that the air passage is unrestricted.
* Take a deep breath.
* Pinch the nose of the casualty.
* Seal your mouth on the lips of casualty and breath out in the casualty’s mouth
* Watch out for any chest movement of the casualty.
* The first 6 inflations should be given as quickly as possible and subsequently 10 per minute.
16. MANAGEMENT OF SERIOUS BURNS AND SCALDS.
* Keep the casualty quiet and reassure him.
* Do not remove adhering particles of charred clothing.
* Cover burnt areas with sterile dressing or bandage.
* It the hands are burnt, keep them above the level of victim’s heart.
* Keep burnt legs or feet elevated.
* If victim’s face is burnt, prop him up and keep him under continuous observation for any breathing difficulty.
* Do not open any blister.
* If the person has any items like ring, chain, bracelets, and belt on him, take them off quickly before limbs begin to swell.
Management of Minor Burns or Scalds
* Submerge or hold the affected part in running cold water.
* Cover with burn dressing.
* Do not apply any cotton directly onto a burn wound.
* Feed sweet warm drinks to casualty.
Management of Chemical Burns.
* Cut off contaminated clothing.
* Wash off the chemical with a large quantity of running cold water
* Do not use bare fingers to touch the burnt area.
* Treat as for burns.
* In case eyes have been affected by chemical, flush eyes thoroughly with large amount of cold water, avoid rubbing eyes.
Management of Electrical Burns
* Caused by an extremely high voltage/current passing thro human body.
* Human respiratory and cardiac canters are affected resulting in stoppage of breathing and heartbeat.
* Separate casualty from cause of injury
* Cover the burn and treat for shock.
* Resuscitate if breathing or heart has stopped.
17. RESUSCITATION.
Basic life support, Or
Artificial respiration and heart compression
Introduction
Basic life support as an emergency life saving procedure that consist of recognizing and correcting failure of the respiratory or cardiovascular systems. Any procedure that consist of recognizing and correcting failure of the respiratory or cardiovascular systems, any profound disturbance of the airway the breathing or the circulation can promptly produce brain death.
Basic life support comprises the ABC steps which concern the airway, breathing and circulation respectively. Its prompt application is indicated for.
a. Airway obstruction
b. Breathing or respiratory arrest
c. Circulatory or cardiac ( heart) arrest.
Basic life support requires 40 instruments or supplies and the correct application of the steps for dealing with the above three problems can maintain life until the patient recovers sufficiently to be transported to a hospital where he can be provided with advanced life support must be taken with the maximum sense of urgency and any inadequacy or absence of breathing or circulation must be determined immediately.
* If breathing alone is inadequate or absent all the as necessary as either to open the AIR WAY or to apply ARTIFICIAL RESPIRATION
* If circulation is also absent artificial circulation must be started.
* HEART COMPRESSION in combination with artificial respiration
* If breathing stops before the heart stops enough oxygen will be available in the lungs to maintain life for several minutes. However if the heart arrest occurs first, delivery of oxygen to the ceases immediately.
* Brain damage is possible if the brain is deprived of oxygen for 4-6 minutes beyond 6 minutes without oxygen brain damage is very likely.
* Once you have started basic life support do not interrupt if for more than 5 seconds for any reason except when it is necessary to move the patient even in that case interruption should not exceed 15 seconds each.
A, B and C of CPR- (Steps)
A for airway-clearance
B for Breathing-Assist in breathing
C for Circulation – Establish circulation
Step-A (Airway)
Establish an open airway
Place the person is a face up position on a hard surface
Put one hand under the patients neck and he other hand on the forehead
* Lift the neck with one hand and apply pressure to the forehead with the other to lift the head back ward.
* This extends the neck and moves the base of the tongue away from the back of the throat
* The head should be maintained in the position during the entire artificial respiration and heart compression procedure.
* If the airway as still obstructed with any foreign material in the mouth or throat should be removed immediately with the fingers.
ESTABLISHING AN OPEN AIRWAY.
* Once the airway has been opened the patient may or may not start to breath again.
* To assess whether breathing has retuned the person providing the basic life support must place his ear about 2-3 cm above the nose and mouth of the patient.
* If the rescuer can feel and hear the movement of air and can see the patient’s chest and abdomen move, breathing has retuned.
* With airway obstruction it is possible that there will be no air movement even though the chest and abdomen rise and fall with the patient’s attempt to breath, also observing chest and abdominal movement is difficult when the patient is full clothed.
Step-B (Breathing).
If the patient does not resume adequate, spontaneous breathing promptly after his bead has been tilted backward then artificial respiration should be given by the mouth to mouth or mouth to nose method or with other techniques regardless of the method used the preservation of an upon airway is essential.
Mouth to Mouth Respiration.
* Keep the patient’s head of a maximum backward tilt with one hand under neck.
* Place the heel of the other hand or the forehead with the thumb and index finger toward the nose.
* Pinch together the patient’s nostrils with the thumb and index finger to prevent air from escaping.
* Backward tilt of the head.
* Take a deep breath then from a tight deal with your mouth over and around the patient’s mouth.
* Blow four quick full breaths in first without allowing the lunge to deflate fully.
* Watch the patient’s chest while inflating the lungs. If adequate respiration is taking place the chest should rise and fall.
* Remove your mouth and allow the patient to exhale passively. If you are in the right position, the patient’s exhalation will be felt on your check.
MOUTH TO MOUTH RESPIRATION
* Take another deep breath, form a seal around the patient’s mouth and blow into the mouth again.
* Repeat this procedure 10-12 times a minute (one every five seconds) for adults and children over four years of age.
* If there is no air exchange and an airway obstruction exists that is to be removes with fingers then resume artificial respiration
Step - C (Heart Compression)
In attempting to bring back to life a non breathing person whose heart has stopped beating heart compression (external cardiac compression) should be applied along with artificial respiration
TECHNIQUES FOR HEART COMPRSSION
Compression of the sternum produces some artificial ventilation but not enough for adequate oxygenation of the blood. For this reason artificial respiration is a always required whenever heart compression is used.
* Effective heart compression requires sufficient pressure to depress the patient’s lower sternum about 4-5 cms (in an adult)
* For chest compression to be effective the patient must be on a firm surface. If he in a bed a board or improvised support should be placed under his back. However chest compression must not be delayed by a search for a firmer support.
* Kneel close to the side of the patient and place the heel of the sternum
* Avoid placing the hand over the tip of the breast bone which extends down over the upper abdomen as pressure on the lower and may tear the liver and lead to severe internal bleeding.
* Feel the tip of the sternum and place the heel of the hand about 4 cms. nearer the head of the patient.
* Your fingers must never rest on the patient’s ribs during compression since this increase the possibility of rib fracture.
* Place the heal of the other hand on top of the first one.
* Rock forward so that your shoulders are almost directly above the patient’s chest
TWO RESCURE HEART COMPRESSION AND ARTIFICAL RESPIRATION
* Keep your arms straight and exert adequate pressure almost directly downwards to depress an adult’s chest for 4-5 cms.
* Compress the chest 60 times per minute for an adult if helper is available as this is enough to maintain blow flow and slow enough to allow the heart to fill with blood.
* The compression should be regular. Smooth and uninterrupted. Compression and relaxation being of equal duration.
* Under no circumstances should compression be interrupted for more than five seconds.
* It is preferable to have two rescuers because artificial must be combined with artificial respiration.
* The most effective artificial respiration and heart compression are achieved by giving one lung inflation quickly after each five heart compression (5:1 ratio) the compression rate should be 60 per minute if two rescuers are operating
* One rescuer perfumes heart compression while the other remains at the patient’s head keeps it titled back and continue artificial respiration.
* A single rescuer have to perform both artificial respiration and artificial circulation using 15:2 ratio. Two very quick lung inflation should be delivered after each 15 chest compression without waiting for full exhalation of the patient’s breath
ONE RESCUER ARTIFICIAL RESPIRATION & HEART COMPRESSION
* A rate of 80 chest compressions per minute must be maintained by a single rescuer in order to achieve 50-60 actual compressions per minute because o f interruptions for the lung inflations.
CHECKING EFFECTIVENESS OF HEART COMPRESSIONS
* Check the reaction of the pupils. If the pupils contract when exposed to light this is a sign that the brain is receiving adequate oxygen and blood.
* Carotid (neck pulse) should be left after fist minute of heart compressions and artificial respiration and every five minutes there after. The pulse will indicate the effectiveness of the heart compression.
* Return of color of skin.
Silvester Method
The Sylvester method is an alternative method of artificial respiration it can be used in cases of swallowed poisons and if the mouth and nose are badly damaged.
The steps are as follows:
* Lay the patients on his back on a firm surface. Raise his shoulders on a cushion. or rolled clothing and the head is extended fully back.
* Kneel across the patients head. It required the head can be turned to one side to clear out the mouth. Grasp the wrists, cross them over the lower part of his chest.
* Rock your body forward and press down the patients chest. Release the pressure possible repeat this procedure twelve times per minute.
Repeat this procedure twelve times per minutes.
SUMMARY
RESUCITATION
a. Airway Clearance
Maintain Open Airway
b. Artificial Respiration.
Kneel beside patient, extend neck, pinch nostrils
Take a deep breath, blow onto the patients mouth, watch for chest expansion.
Feel carotid pulse.
If present continue artificial respiration at a rate of one breath every 4-5 sec.
If absent pulse – start chest compression
c. Chest Compression
Locate lower half of breastbone.
Give compression at center of the lower half of sternum. Depress sternum by 4-5 cms.
Complete 15 compression at a rate of 100% min. (less than compressions per second)
Signal operator - 15 chest compresses ions : 2 mouth to mouth breaths
Tow operators - 5 chest compressions : 1 mouth to mouth breath
