Model Course 1.13 Elementary First Aid First published as Medical Emergency - Basic Training in 1989 by the INTERNATIONAL MARITIME ORGANIZATION Albert Embankment, London SE1 7SR Revised edition 2000 Printed in the United Kingdom by CPC The Printers, Portsmouth 10 ISBN 92-801-6117-2 IMO PUBLICATION Sales number: T113E • ACKNOWLEDGEMENTS IMO wishes to express its sincere appreciation to the International Labour Organization and the World Health Organization for its valuable assistance and co-operation in the production of this course In particular, IMO wishes to thank the World Health Organization for permission to utilize relevant parts of the International Medical Guide for Ships as the course compendium Copyright©WHO 1988, IMO 2001 All rights reserved No Rart of this publication may, for sales purposes, be produced, stored in a retrieval system or transmitted in any form or by any means, electronic, electrostatic, magnetic tape, mechanical, photocopying or otherwise, without prior permission in writing from the International Maritime Organization Contents Page ~rewo~ v Introduction Part A: Course Framework Part B: Course Outline and Timetable Part C: Detailed Teaching Syllabus Part D: Instructor Manual • Attachment: Guidanceon the implementationof modelcourses 15 19 Foreword Since its inception the International Maritime Organization has recognized the importance of human resources to the development of the maritime industry and has given the highest priority to assisting developing countries in enhancing their maritime training capabilities through the provision or improvement of maritime training facilities at national and regional levels IMO has also responded to the needs of developing countries for postgraduate training for senior personnel in administration, ports, shipping companies and maritime training institutes by establishing the World Maritime University in Malmo, Sweden, in 1983 Following the earlier adoption of the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, a number of IMO Member Governments had suggested that IMO should develop model training courses to assist in the implementation of the Convention and in achieving a more rapid transfer of information and skills regarding new developments in maritime technology IMO training advisers and consultants also subsequently determined from their visits to training establishments in developing countries that the provision of model courses could help instructors improve the quality of their existing courses and enhance their effectiveness in meeting the requirements of the Convention and implementing the associated Conference and IMO Assembly resolutions In addition, it was appreciated that a comprehensive set of short model courses in various fields of maritime training would supplement the instruction provided by maritime academies and allow administrators and technical specialists already employed in maritime administrations, ports and shipping companies to improve their knowledge and skills in certain specialized fields IMO has therefore developed the current series of model courses in response to these generally identified needs and with the generous assistance of Norway These model courses may be used by any training institution and the Organization is prepared to assist developing countries in implementing any course when the requisite financing is available W A O'NEIL Secretary-General Introduction • Purpose of the model courses The purpose of the IMO model courses is to assist maritime training institutes and their teaching staff in organizing and introducing new training courses, or in enhancing, updating or supplementing existing training material where the quality and effectiveness of the training courses may thereby be improved It is not the intention of the model course programme to present instructors with a rigid "teaching package" which they are expected to "follow blindly" Nor is it the intention to substitute audiovisual or "programmed" material for the instructor's presence As in all training endeavours, the knowledge, skills and dedication of the instructor are the key components in the transfer of knowledge and skills to those being trained through IMO model course material Because educational systems and the cultural backgrounds of trainees in maritime subjects vary considerably from country to country, the model course material has been designed to identify the basic entry requirements and trainee target group for each course in universally applicable terms, and the skill necessary to meet the technical intent of IMO conventions and related recommendations • • Use of the model course To use the model course the instructor should review the course plan and detailed syllabus, taking into account the information provided under the entry standards specified in the course framework The actual level of knowledge and skills and prior technical education of the trainees should be kept in mind during this review, and any areas within the detailed syllabus which may cause difficulties because of differences between the actual trainee entry level and that assumed by the course designer should be identified To compensate for such differences, the instructor is expected to delete from the course, or reduce the emphasis on, items dealing with knowledge or skills already attained by the trainees He should also identify any academic knowledge, skills or technical training which they may not have acquired By analyzing the detailed syllabus and the academic knowledge required to allow training in the technical area to proceed, the instructor can design an appropriate pre-entry course or, alternatively, insert the elements of academic knowledge required to support the technical training elements concerned at appropriate points within the technical course Adjustment of the course objectives, scope and content may also be necessary if in your maritime industry the trainees completing the course are to undertake duties which differ from the cour~e objectives specified in the model course Within the course plan the course designers have indicated their assessment of the time which should "be allotted to each learning area However, it must be appreciated that these allocations are arbitrary and assume that the trainees have fully met all the entry requirements of the course The instructor should therefore review these assessments and may need to reallocate the time required to achieve each specific learning objective ELEMENTARY FIRST AID • Lesson plans Having adjusted the course content to suit the trainee intake and any revision of the cours objectives, the instructor should draw up lesson plans based on the detailed syllabus Th detailed syllabus contains specific references to the textbooks or teaching material proposel to be used in the course An example of a lesson plan is shown in the instructor manual 01 page 18 Where no adjustment has been found necessary in the learning objectives of thl detailed syllabus, the lesson plans may simply consist of the detailed syllabus with keyword: or other reminders added to assist the instructor in making his presentation of the material • Presentation The presentation of concepts and methodologies must be repeated in various ways until thE instructor is satisfied, by testing and evaluating the trainee's performance and achievements that the trainee has attained each specific learning objective or training outcome The syllabw is laid out in learning objective format and each objective specifies a required performance or what the trainee must be able to as the learning or training outcome Taken as a whole these objectives aim to meet the knowledge, understanding and proficiency specified in thE appropriate taQles of the STCW Code • Implementation For the course to run smoothly and to be effective, considerable attention must be paid to the availability and use of: • • • • • • properly qualified instructors support staff rooms and other spaces equipment textbooks, technical papers other reference material Thorough preparation is the key to successful implementation of the course IMO has produced "Guidance on the implementation of model courses", which deals with this aspect in greater detail and is included as an attachment to this course • Training and the STCW 1995 Convention The standards of competence that have to be met by seafarers are defined in Part A of the STew Code in the Standards of Training, Certification and Watch keeping for Seafarers Convention, as amended in 1995 This IMO model course has been revised and updated to cover the competenc~s in STCW 1995 It sets out the education and training to achieve those standards set out in Chapter VI Table A-VI/1-3 Part A provides the framework for the course with its aims and objectives and notes on the suggested teaching facilities and equipment A list of useful teaching aids, IMO references and textbooks is also included INTRODUCTION Part B provides an outline of lectures, demonstrations and exercises for the course A suggested timetable is included but from the teaching and learning point of view, it is more important that the trainee achieves the minimum standard of competence defined in the STCW Code than that a strict timetable is followed Depending on their experience and ability, some students will naturally take longer to become proficient in some topics than in others Also included in this section are guidance notes and additional explanations A separate IMO model course addresses Assessment of Competence This course explains the use of various methods for demonstrating competence and criteria for evaluating competence as tabulated in the STCW Code Part C gives the Detailed Teaching Syllabus This is based on the theoretical and practical knowledge specified in the STCW Code It is written as a series of learning objectives, in other words what the trainee is expected to be able to as a result of the teaching and training Each of the objectives is expanded to define a required performance of knowledge, understanding and proficiency IMO references, textbook references and suggested teaching aids are included to assist the teacher in designing lessons The new training requirements for these competences are addressed in the appropriate parts of the detailed teaching syllabus The Convention defines the minimum standards to be maintained in Part A of the STCW Code Mandatory provisions concerning Training and Assessment are given in Section A-I/G of the STCW Code These provisions cover: qualification of instructors; supervisors as assessors; in-service training; assessment of competence; and training and assessment within an institution The corresponding Part B of the STCW Code contains non-mandatory guidance on training and assessment As previously mentioned a separate model course addresses Assessment of Competence and use of the criteria for evaluating competence tabulated in the STCW Code • Responsibilities of Administrations Administrations should ensure that training courses delivered by colleges and academies are such as to ensure those completing training meet the standards of competence required by STCW Regulation VI/1 • Validation The inforn;tation contained in this document has been validated by the Sub-Committee on Standards of Training and Watchkeeping for use by technical advisors, consultants and experts for the training and certification of seafarers so that the minimum standards implemeoted may be as unik)rm as possible Validation in the context of this document means that the Sub-Committee has found no grounds to object to its content The Sub-Committee has not granted its approval to the documents, as it considers that this work must not be regarded as an official interpretation of the Convention In reaching a decision in this regard, the Sub-Committee was guided by the advice of a Validation Group comprised of representatives designated by ILO and IMO ELEMENTARY FIRST AID Part A: Course Framework Aims This model course aims to provide the training for candidates to provide elementary first aid on board ship, in accordance with Section A-VI/1 of the STCW Code Objective This syllabus covers the requirements of the 1995 STCW Convention Chapter VI, Section AV/!1, Table A-VI/1-3 On meeting the minimum standard of competence in elementary first aid, a trainee will be competent to take immediate action upon encountering an accident or medical emergency until the arrival of a person with medical first aid skills or the person in charge of medical care on board Entry standards The course is open to all seafarers who are to serve on board sea-going merchant ships There are no particular educational requirements Course certijicate On successful completion of the course and demonstration of competence, a document may be issued certifying that the holder has met the standard of competence specified in Table AVI/1-3 of STCW 1995 A certificate may be issued only by centres approved by the Administration Course intake limitations The maximum number of trainees attending each session will depend on the availability of instructors, equipment and facilities available for conducting the training It should not exceed six trainees per instructor Staff requirements The course should preferably be under the control of a qualified first aider assisted by other appropriately trained staff Training facilities and equipment Ordinary classroom facilities and an overhead projector are required for the lectures When making use of audiovisual material such as videos or slides, make sure the appropriate equipment is available Smaller rooms for practical instruction, demonstration and application should be available rhe following equipme.nt should be available: ship's medical chest with contents (no drugs) various splints, braces, etc dressings, bandages life-size dummy for practical resuscitation training stretcher PART A: COURSE FRAMEWORK Teaching aids (A) A1 Instructor Manual (Part D of the course) A2 Videos First Aid Series: V1 A Matter of Life and Death (Code No 564) V2 Dealing with Shock (Code No 565) V3 Bone and Muscle Injuries (Code No 566) V4 Dealing with the Unexpected (Code No 567) V5 Well Travelled? - Staying Healthy on Working Trips (Code No 599) V6 Entering into Enclosed Spaces (Edition 2) (Code No 534) Available from: • Videotel Marine International Ltd 84 Newman Street London W1 P 3LD, UK Tel: +44 (0)20 7299 1800 Fax: +44 (0)20 7299 1818 E-mail: mail@videotelmail.com URL: www.videotel.co.uk All reference material necessary for the course has been incorporated Compendium (T1) in the Course IMO and other references (R) R1 R2 R3 R4 R5 R6 The International Convention on Standards of Training, Certification and Watch keeping for Seafarers, 1995 (STCW 1995), 1998 edition (IMO Sales No 938E) Medical section (pages 111 to 148) of International Code of Signals, 1987 edition (IMO Sales No 994E) Assembly Resolution A.438(XI) - Training and qualification of persons in charge of medical care aboard ship IMO/ILO Document for Guidance, 1985 (IMO Sales No 935E) ILO/IMO/WHO International Medical Guide for Ships (IMGS), 2nd ed., (Geneva, World Health Organization, 1988) (ISBN 924 154231 4) Medical First Aid Guide for use in Accidents Involving Dangerous Goods (MFAG) (IMO Sales No 251 E) Details of distributors of IMO publications that maintain a permanent publications may be found on the IMO website at http://www.imo.org stock of all IMO Textbobks (T) T1 A Course Compendium is provided for use as a textbook This contains selected extracts from ILO/IMO/WHO International Medical Guide for Ships (Ref R5) ELEMENTARY FIRST AID Part B: Course Outline and Timetable Lectures As far as possible, lectures should be presented within a familiar context and should make use of practical examples They should be well illustrated with diagrams, photographs and charts where appropriate, and be related to life at sea An effective manner of presentation is to develop a technique of giving information and then reinforcing it For example, first tell the trainees briefly what you are going to present to them; then cover the topic in detail; and, finally, summarize what you have told them The use of an overhead projector and the distribution of copies of the transparencies as trainees' handouts contribute to the learning process Course Outline The tables that follow list the competencies and areas of knowledge, understanding and proficiency, together with the estimated total hours required for lectures and practical exercises Teaching staff should note that timings are suggestions only and should be adapted to suit individual groups of trainees depending on their experience, ability, equipment and staff available for training the initial rescue, two men may be able to undertake further movement through a narrow space The method is demonstrated in Fig 53 and Fig 54 Ensure that the tied wrists not interfere with any breathing apparatus the rescuer may be wearing Neil-Robertson stretcher (Fig 56) A number of modifications of this type of stretcher exist under various names A good general-purpose stretcher for use on board ship, it is easily carried, gives firm support to the patient, and is partictdarly useful in narrow spaces, when difficult comers have to be negotiated, or when the patient has to be hoisted 46 The stretcher is made of stout canvas stiffened by sewn-on bamboo slats The upper portion takes the head and neck, which are steadied by a canvas strap passing over the forehead The middle portion is wrapped round the chest and has notches on which the armpits rest This part has three canvas straps which are used for fastening the stretcher round the chest The lower portion folds round the hips and legs down to the ankles If the patient is unconscious, place him on his back and tie his ankles and feet together with a figure-of-eight bandage, and his knees with a broad-fold bandage; also his wrists (Fig 57) A7 ELEMENTARY FIRST AID: COMPENDIUM with one hand and, with the other, slides the stretcher under the patient, at the same time opening out the flaps When the stretcher is in position, No I gives the order to lower and all lower together Three persons are required to carry out the lift No I takes charge; he stands astride the patient's legs, with his right hand under the left calf and his left hand under the right thigh (Fig 57) No.2 stands astride the chest and clasps his hands underneath the patient No.3 places the patient's wrists (tied together) round No 2's neck If the patient is conscious he may himself be able to clasp his hands round the neck of No.,2 The stretcher, with all straps unfastened, should be positioned close to the head of the patient If spinal injury is suspected, extreme care s}1ould be exercised in moving the casualty (see page 28) No I now gives the order to lift, while No.3 supports the head of the unconscious patient 48 The stretcher is now strapped up and the patient is ready for removal (Fig 59); this can be done most conveniently with four bearers (Fig 60) The Neil-Robertson stretcher can also be used to remove casualties vertically (Fig 61) First aid satchels or boxes These should contain iodine solution, a large standard dressing, medium standard dressings, small standard dressings, triangular bandages, some cotton wool, safety pins, sticking plaster, scissors, and a pencil and paper One box should be included in the ship's medicine locker for swift transfer to the site of an accident Others placed at strategic positions, particularly in a large ship, can be an aid to prompt action if the crew are made aware of CHAPTER 1: FIRST AID their location and contents These extra boxes are, however, liable to be thoughtlessly used for minor unreported casualties and, in some instances, are subject to pilfering Routine checking of their contents is therefore essential Emergency medical outfits There is a special need on merchant vessels, and on medium-sized and large fishing vessels with crews numbering over 20, for an emergency medical outfit readily accessible for use if the medical cabinet should be destroyed or made inaccessible by fire The emergency outfit should be sited well away from the ship's medical cabinet or the ship's hospital Oxygen administration (oxygen therapy) Oxygen is essential to life It is given for treatment when the body is unable to get enough oxygen from the air because of damage to the lungs or for other reasons, such as suffocation (see page 43) or carbon monoxide poisoning (page 58) Oxygen must be given with care since it can be dangerous to patients who have had breathing difficulties for a number of years due to lung disease, particularly chronic bronchitis Oxygen should be given only where advised in this guide Usually, it is given to a patient who is breathing without assistance but is unconscious or cyanotic (has bluish skin); also, oxygen should be given to all patients suffering from carbon monoxide or other toxic gas poisoning even when they are conscious There are two stages at which a patient may require oxygen: (l) during rescue from the place of an accident, and (2) when the patient is in the ship's sick-bay During rescue from the place of an accident During this time the patient should be connected to the portable oxygen apparatus through a mask placed over his face The oxygen valve should be turned on and oxygen admjQistered until the patient is transferred to the ship's sickbay ELEMENTARY FIRST AID: COMPENDIUM When the patient is in the ship's sick-bay The procedure set out below should be followed The unconscious patient l Ensure that a clear airway has been established (see page 7) and an airway (see page 104) has been inserted Place over the nose and mouth a disposable mask designed to give 35% oxygen to the patient Ensure that it remains securely in place Check that the equipment is correctly assembled according to the manufacturer's instructions and that the cylinder contains sufficient oxygen Connect the mask to the flowmeter, using the tubing provided, and set the flowmeter to litres per minute Administration of oxyg~ should continue until the patient no longer has difficulty in breathing and has a healthy colour The conscious patient l 52 Ask the patient whether he usually suffers from severe difficulty in breathing and a chronic cough, i.e., chronic bronchitis (see page 178) If the patient has severe chronic bronchitis, then he should be given only 24% oxygen, using an appropriately designed mask, with the flowmeter set at 41itres per minute All other patients should be given 35% oxygen, using an appropriately designed mask, with the flowmeter set at 41itres per minute The mask should be placed over the patient's mouth and nose and secured in place The patient should be placed in the high sitting-up position (see Fig 31, page 33) Check that the equipment is correctly assembled according to the manufacturer's instructions and that the cylinder contains sufficient oxygen Turn on the oxygen flowmeter at litres per minute Oxygen therapy should be continued until the patient no longer has difficulty in breathing and has a healthy colour If the patient has difficulty in breathing, or the face, hands, and lips remain blue for longer than 15-20 miniItes, he probably has one of the following complications: bronchitis (see page 177), pneumonia (see page 221), circulatory collapse in congestive heart failure (see page 205), or pulmonary oedema In such a case, seek RADIO MEDICAL ADVICE WARNING Smoking, naked lights, or fires must not be allowed in a room where oxygen is being administered, because of the risk of fire Annex joined to one another except for the lower jaw, which moves at joints just in front of the ears Anatomy and The skull rests on the upper end of the back· bone, which is made up of a series of small bones PhYSIO Iogy placed on top of each other These bones are Treatment of illness on board ship requires some ca!led vertebrae a~d col.lec~ively compose the understanding of the anatomy and physiology spInal column, withIn which IShoused the spInal of the human body cord; nerves emerge from the cord at the level of each vertebra At the lower end of the backbone The pri~cip?l bones and ~usc1es of the b~y are is the pelvis, formed by the hip-bones, one on shown In Fig 147 and Fig 148, the positIOn of either side which together form a basin to supthe main arteries and veins in Fig 1~9, a~d the port the c~ntents of the abdomen On the outer conte~ts of the chest and abdomen In Fig 150 side of either hip is a cup-shaped socket into and Fig 151 which the rounded head of the femur (or thigh Th k I I I Ie bone) fits, forming a ball-and-socket joint The e see a sys m femur ends at the knee, where it forms a hingeThe skull forms a case that contains and protects likejoint with the strong tibia (shin-bone) which the brain It consists of many bones, firmly can easily be felt under the skin On the outer ELEMENTARY FIRST AID: COMPENDIUM side of the shin-bone is attached the slender fibula In front of the knee-joint lies the patella (kneecap), the shape of which can be easily felt At the ankle the foot is joined to the lower ends of both the tibia and fibula by another hinged joint The foot is made up of many small bones of different shapes There are two bones in the great toe and three in each of the other toes Twelve ribs are attached to the backbone on either side Each rib, with the exception of the two lowermost on either side, curves round the chest from the backbone to the sternum (breastbone) in front As can be seen from Fig 147, the lowermost ribs have no attachment to the sternum in front The ribs form the chest and protect the lungs, heart, and other internal organs When you take a deep breath, your ribs move slightly upwards and outwards so as to expand your chest 'the sternum, flat and dagger-shaped, lies just under the skin of the front of the chest, and to its upper end is attached the clavicle (collar-bone) On either side this bone goes out horizontally to the point of the shoulder and acts like an outrigger in keeping the shoulder in position The outer end of the collarbone joins with the scapula (shoulder-blade), which is a triangular bone lying at the upper and outer part of the back on either side Each scapula has a shallow socket into which fits the rounded upper end of the humerus (arm bone) At the elbow the arm bone forms another hingelike joint with the radius and ulna (the forearm bones) and these join with the hand at the wrist The wrist and hand, like the foot, are made up of many small bones There are two bones in the thumb and three in each finger The muscular system are found in the head neck, limbs, back and walls of the abdomen (Fig 148) They are attached to bones by fibrous tissue which is frequently'in the form of a cord and is then called a tendon or leader When a muscle contracts in response to an impulse sent to it through a nerve, it becomes shorter and thicker and draws the bones to which it is atVo/Lmttti'y Imlseles tached nearer to one another The brain controls such movements Involuntary muscles are found in the stomach and intestines, heart, blood vessels, and other internal organs of the body As the name indicates, they are not under the influence of the will, but function on their own, day and night The circulatory system (heart and blood vessels) The body contains about five litres of blood, which circulates to all the tissues of the body (Fig 149) It is kept moving round the body by the heart, a muscular pump about the size of a clenched fist situated in the chest behind the breastbone, lying 'between the lungs, rather more on the left than on the right The heart has two sides; the right side receives the venous blood coming back to it from the body in general and pumps it through the lungs, where it passes through minute tubes, gives up carbon dioxide, and takes up a supply of oxygen The oxygenated blood now passes to the left side of the heart, which pumps it to all parts of the body through the arteries This blood carries oxygen, food, water, and salts to the tissues; it is bright red in colour It also conveys heat to all parts of the body and contains various substances to counteract infections in the tissues The arteries are like thick-walled tubes and decrease in diameter away from the heart In the tissues the smallest blood vessels are very minute and are called capillaries The blood, having supplied the tissues with oxygen and other substances and removed the carbon dioxide that has accumulated, becomes darker in colour The capillaries take it into the veins, thin-walled tubes that carry the blood back to the right side of the heart Some of the blood passes to the stomach and intestines and, having taken up food products, carries them away to be stored in the liver Blood is also taken by arteries to the kidneys and there gets rid of waste products, which are passed in the urine ANNEX 1: ANATOMY As the blood passes along the arteries, they pulsate at the same rate as the heart is pumping The average normal pulse rate is about 70 per minut~, but it increases with exercise, nervousness fear, fever, and various illnesses The pulse is usually counted by feeling the artery at the front of the wrist just above the ball of the thumb AND PHYSIOLOGY The respiratory system Every time a breath is taken, the air (containing oxygen) passes through the nose or mouth and past the larynx or voice-box into the windpipe The windpipe divides into two main tubes called bronchi, each of which then divides up into ELEMENTARY FIRST AID: COMPENDIUM ANNEX 1: ANATOMY AND PHYSIOLOGY people think that it is the ribs moving in and out that produce the act of breathing Rib movement does in fact play quite a big part, but the main work is done by the diaphragm moving up and down The diaphragm is a large domeshaped muscle which separates the chest from the abdominal cavity When the diaphragm muscle contracts, its dome becomes flattened and draws down the lungs, causing air to enter them; when it relaxes, the lungs become smaller and the air in them is expelled The muscles of the abdomen also help in breathing When they tighten, they press the abdominal contents against the diaphragm and help in expelling air from the lungs, and when they relax, they assist the diaphragm in drawing down the lungs in breathing in The normal rate of breathing at rest is 16 to 18 times a minute, but it increases considerably with exertion and also with certain diseases, especially those affecting the heart and lungs The digestive system and abdomen many smaller bronchial tubes that pass into the lung tissue The air breathed in passes through these small tubes into minute air cells called alveoli, each of which is surrounded by capillaries, The blood in the capillaries gives up carbon dioxide and takes up oxygen In breathing out, the air passes back along the same respiratory passages and is breathed out through the nose or mouth Each lung is covered by a lubricated membrane called the pleura The inner side of the chest wall is lined with the same kind of membrane These two layers of pleura are in contact and slide smoothlY"'over one another dUrIng breathmg The lungs are rather like elastic sponges, ard the many air cells in them expand with breathing in and are compressed with breathing out Most Food in the mouth is broken up by chewing and tongue movements and mixed with saliva (spittle), which lubricates it and starts the digestive processes When it is in a suitable state it passes to the back of the throat, where muscular action forces it down the oesophagus, or gullet, a muscular tube in the neck behind the windpipe The gullet runs down the back of the chest between the two lungs, then passes through the diaphragm into the stomach As ma~ be seen 10 Fig 151, the stomach lIes mal.nly 10 the left upper part of th~ abdo~mal cavIt.y, partly behmd the lower left rIb cartilages and Just und~r the, hea~t ~?en food ent~rs the stomach, varIOUSdigestive JUIcesact upon It, and the stomach muscles contract and relax, mixing it thoroughly The capacity of the adult stomach is about one litre ' · ~ ' St Ill on Iy par tl y d Igest e,d th e 100d passes m t ' · · · th e sma II m tes t me, were h more d Igest Ive JUIces, especially those from the liver and pancreas, mix' with it Nourishment and fluids are absorbed from this coiled-up tube, which is about six ELEMENTARY FIRST AID: COMPENDIUM metres long, and the residue of the food passes into the large intestine, or colon, at a point in the lower part of the right side of the abdomen, close to where the appendix is situated In the large intestine more moisture is extracted from the food residue At its far end, the large intestine joins the rectum, and here the unwanted food residue collects and is passed out of the body by the back passage or anus The liver secretes the important digestive juice called bile (a greenish/brownish fluid) and, on its surface, has a small reservoir called the gallbladder, where a supply of bile is kept available The liver also deals with, and stores, digested food materials The spleen (Fig 151) is a solid oval-shaped or- gan in the upper part of the left side of the abdominal cavity at the back of the stomach, just above the kidney Its functions are largely connected with the blood and it may be enlarged in certain diseases The urinary system (See Fig 140, page 236) The kidneys are at the back of the upper part of the abdominal cavity, one on either side of the spine They remove water and certain waste products from the blood and produce urine Urine leaves each kidney by a small tube called the ureter, the two ureters entering the back of the bladder, which is a muscular bag situated in the front part of the cavity of the pelvis Urine collects in the bladder and is expelled from it through a tube leaving its under-surface This tube is called the urethra and in the male is contained in the penis The nervous system The nervous system cORsists of the brain, the spinal cord, and the nerves that issue from them The brain, in the cavity of the skull, is a mass of nervous tissue The coordinating centre of the body, it acts like a computer, receiving messages through the incoming (sensory) nerves and the special nerves connected with sight, smell, hearing, etc., deciding on the action necessary, then sending out orders to the various parts of the body by the outgoing (motor) nerves The spinal cord is composed of similar tissue; it leaves the under-surface of the brain through an opening in the base of the skull and passes down a canal in the vertebral column To pursue the analogy with a computer, it contains the trunk lines running between the brain and the various parts of the body and also a number of local nerve centres At intervals down the spinal column, nerve trunks issue from the spinal cord containing both motor and sensory fibres; these nerves make contact with the muscles, which they cause to contract, and with the skin and other organs, where the sensory messages to the brain and spinal column start Autonomic nervous system This is a fine network of nerves which help control the functions of various organs in the body It, too, has local nerve centres, such as the solar plexus, which is situated in the upper part of the abdomen behind the stomach Although connected with certain parts of the brain, it is not controlled by the will but functions automatically day and night It regulates the rate at which the heart pumps, in accordance with the demands of the various bodily systems at any particular time It also helps control the muscles of the stomach and intestine and the rate and depth of breathing Skin The skin covers and protects the body It consists of two layers The outer layer is hard, contains no blood vessels or nerves, and protects the inner layer, where the very sensitive nerveendings lie The skin contains numerous sweat glands, the roots of the hair, and special glands that lubricate the skin and the hair Sweat consists of water, salt, and other substances Sweating cools the body and helps to regulate its temperature ... - no active rewarming f 12 Teaching Aid T1 - pp.6 14 V1 in Required performance: Textbooks, Bibliography R4Sect 17 App .1 R4Sect .17 , App .1 T1 pp .14 17,40-42 T1 - pp .17 18 V2 V2 PART C: DETAILED... Chapter 1, pages 6 -14 , Figs 4 -11 Bleeding Chapter 1, pages 14 -17 , 40-42, Figs 12 -15 , 41- 43 Management of shock Chapter 1, pages 17 -18 Burns and Scalds, and Accidents Caused by Electricity Chapter 1, ... Principles Chapter 1, pages 1- 3 Body Structure and Functions Annex 1, pages 3 41- 348, Figs 14 7 -15 1 Positioning of Casualty Chapter 1, page 6, Fig The Unconscious Casualty Chapter 1, pages 3-6, Figs