1. Emergency Lifesaver Course
Objectives of First Aid
Preserve Life ・ Prevent Worsening ・ Pain Relief
Necessity of First Aid
Importance of the first 5 minutes
Necessity of independent aiders - the courage to help
In saving others, society saves us
Casualty (person injured or taken ill)
Responder （passer-by)

2. Tokyo Ambulance Call-outs in 2001
606,695 calls (up 5.4％) One every 52 seconds. 204 teams responding to 3,018 calls each.
1 in 20 citizens used service. Average response time at scene 5-6min.

3. The Chain of Survival Early Access Early CPR Quick Emergency Measures
Calmly and quickly call 119 and explain the situation
Early CPR
Perform CPR or other first aid as necessary until ambulance arrives
Quick Emergency Measures
Ambulance team provides further expert care
Early Medical Care
Professional care at medical institution

4. Is Resuscitation Possible?
１００ １ ２ ３ ７５
Breathing Stops
Major Bleeding
Heart Stops
Death rate ５０ ２５ ０ ２ ３ ５ １０ １５ ３０
１hour
30s
１min
time
① 50% die within 3min after circulatory arrest
② 50% die within 10min after pulmonary arrest
③ 50% die within 30min of major bleeding
* Average ambulance arrival time is 6min from call

5. Preserve airway First Aid Emergency Aid Stop bleeding Other Aid
If unconscious
If not breathing
Artificially ventilate
If no heartbeat
Chest compressions
If airway blocked
Remove obstruction
If bleeding heavily
Stop bleeding
Make comfortable.
Treat fractures, wounds, injuries,
burns, drowning. Transportation.
Other Aid

6. Age Divisions for First Aid Treatment
Life Saving
CPR（observation, airway, breathing, circulation)
Bleeding
Age Divisions
　　Adult　　 8 years or over
　　Child　　 Between 1 and 8 years
　　Infant　　 Between 1 month and 1 year
　　Newborn Less than 1 month old

7. Observation and First Aid
Heavy bleeding? 　Stop bleeding
Impaired consciousness? 　Preserve airway
Breathing absent or impaired? 　Ventilate
No signs of circulation? 　CPR
Is casualty breathing?
Watch response
Signs of
circulation
When ventilating
Any coughing?
Give two breaths
Any movement?

8. Signs of Circulation: Checking the Pulse
Adults, children
　（carotid artery）
Infants, newborns
　（brachial or femoral
artery）

9. (breathing, coughing, movement) If breathing still insufficient
①Conscious? No
Yes
②Get help
④Breathing?
Insufficient
③Open airway
Sufficient
④Breathing?
Sufficient
Put in recovery
position and observe
⑤Ventilate (2 times)
Yes
⑥Circulation signs?
(breathing, coughing, movement)
If breathing still insufficient
continue ventilating (one breath
every 5 seconds)
⑦⑧ CPR (15 compressions: 2 breaths)
for 4 cycles
Yes
If breathing recovers or
casualty protests, stop
ventilating
⑥Circulation signs?
⑧ Continue CPR
(15 compressions: 2 breaths)

10. Observation: Consciousness
Call “Are you alright? Can you hear me?” into casualty’s ear while tapping their shoulder. See if they can talk or respond. If no response, get progressively louder/harder (no more than 3 times!) 　　　　　　　　　　　　　　　　　　　　　　　
Judge whether casualty is conscious or unconscious
Do not move or slide the casualty
For infant/newborn casualty, scrape the sole of the foot
Can you
hear me?

11. Choose someone and request their help.
Get Help
Choose someone and request their help.
Please call
119 for an
ambulance

12. The Airway
The airway is the path taken by air through the mouth and nose
to the lungs.
　（Consciousness problems/ not breathing/ airway obstruction）

13. Opening the Airway
　Lift the chin forwards with the index and middle fingers of one hand while pressing the forehead backwards with the heel of the other hand.
Do not put pressure on the soft parts of the chin or throat.
Do not do this if there is a risk of a neck injury.

14. Opening the Airway (2): neck injuries
Grasp the jawbone with both hands and gently ease upwards, applying pressure with all 4 fingers on both sides.

15. Observe Breathing
Place your ear above the casualty’s mouth and nose. Look along the chest and abdomen. If she is breathing you will hear and feel the breath on your face and see movement.
Observe for no more than 10 seconds to judge whether or not casualty is breathing.
Count “ ”
“No breathing”
“Ventilate”

16. The Recovery Position
For the casualty who is breathing sufficiently but is not fully conscious. Use the casualty’s own hand under their jaw to keep the airway open.

17. Artificial Ventilation
Keeping the airway open, pinch the nostrils so that air cannot escape through the nose but is forced into the lungs.
Mouth-to-
-Mouth
-Nose
-Mouth & nose
-Mask
-Tracheostomy
etc.

18. Breathe for the Casualty
Open your mouth wide, take a deep breath, and seal your lips around the casualty’s mouth. Blow into the lungs, looking along the chest until you see the chest rise slightly.
Blow about 10cc per kg of casualty’s weight. (e.g cc)
Problems:
Open airway?
Nostrils?
Seal?
Airway obstructions?

19. Remove your mouth and watch the chest fall
Pros and cons of Mouth-to-Mouth Ventilation
Requires no special tools
Can be done by one person, even a child
Easy to see if it’s working
Risk of infection
Risk of secondary poisoning
May feel unpleasant

20. Preventing Infection
A non-return valve resuscitation mask can be used.
If you’re worried about infection you can perform chest compressions only.

21. Ventilating when circulation signs are present１ ２ １ ２ １ ２ ３ ４ ５ ６ ７ ８ ９ １０ １
Breathe gently for two seconds
Breathe gently for two seconds
Breathe gently for two seconds
“No breathing”
Ventilate
Ventilate
Ventilate
Check signs for no more than ten seconds.
Look for autonomous breathing, coughing or movement.
Breathing may still be insufficient.
“Circulation Signs present”

22. Mouth-to-mouth-and-nose
Breathing: Age groups
Frequency
Amount
Duration
Method
Adult
Every 5 sec. cc
（10cc/kg）
2 sec.
Mouth-to-mouth
Child
Every 3 sec.
Until chest
rises gently.
sec.
Infant
Mouth-to-nose
Mouth-to-mouth-and-nose
Newborn
Every sec.
1 sec.

23. Chest Compressions: Correct Hand Position
The heart is located within the ribcage, slightly to left of centre.
An incorrect hand position will make compressions less effective, and break the casualty’s ribs.
Heart
Hand position

24. Hand position: lower half of the sternum (breastbone)
For adults and children, the first hand should be placed on the sternum one finger-space from the lower end.
Hand
position
Sternum
One finger-space
Lower limit for
compression
Xiphoid
process

25. Finding the correct hand position
Trace the underside of the ribs with your index and middle fingers.
ribs

26. Place the middle finger in the sternal notch, and the index finger on the sternum
Using two fingers, trace the underside of the ribs to the notch where the sides join in the middle.
Leaving your middle finger in the notch, rest the index finger next to it on top of the sternum.
Index finger on
the sternum
Middle finger in
the notch

27. Now rest the heel of the other hand on the sternum next to the extended index finger. This is the correct hand position for compressions.

28. Cardiac Compressions - Essential Points
①　Sit level with the casualty’s chest
②　Correct hand position, with the heel of the hand
③　Lock your elbows
④　Position your shoulders over the chest
⑤　Using your body weight, compress straight down towards the ground
Adult casualty:
Compress 3.5〜5cm
Rhythm of 100 per min.

29. Compression technique
Avoiding pressure on the casualty’s ribs, compress only the narrow sternum. This maximises the safety and effectiveness of the compressions.
Use this part (the heel of the hand) to compress the chest

30. Compress Vertically
With elbows straight, push straight down. Release pressure promptly. Take care not to lose your position.

31. Compress 15 times at a rate of 100 compressions/minute.
Cardiac Compressions
Compressing the heart between the sternum and spine causes blood to circulate.
Compress 15 times at a rate of 100 compressions/minute.
heart
sternum
spine
downstroke
upstroke

32. How NOT to do it!
Don’t push at an angle
Don’t bend your elbows

33. Cardio-pulmonary Resuscitation(CPR)
Repeat cycles of 15 compressions to two breaths (ratio 15:2)
After the first four cycles, check again for signs of circulation - for no more than 10 seconds

34. One cycle 10 second check for signs of life 15 chest compressions
2 breaths
2 breaths
“No breathing. Ventilate.”
“Checking signs”
“No signs of life”
“Starting CPR”
One cycle
15 compressions : 2 breaths

35. Removing Obstructions (1)
Open the casualty’s mouth with the “crossed finger” technique.
Cross the thumb and index finger. Place the thumb on the upper teeth, the index finger on the lower teeth, and twist to open the mouth.
Don’t move the head when inspecting the mouth.
Do you need to remove dentures?

36. Removing Obstructions (2)
Turn casualty’s head to one side.
Wrap your finger with a handkerchief or cloth, and wipe out any obstructions.
Make sure to clean away all blood or body fluids.

37. Back Slaps
　Slap sharply and strongly 4 or 5 times between the casualty’s shoulder blades using the heel of your hand.

38. Heimlich Maneuver (Sitting)
Only on conscious casualties aged > 8 years
Put the ball of the thumb against the upper stomach area
Put your chest against the casualty’s back.
Put both arms under the casualty’s armpits.
Squeeze inward and upward.

39. Heimlich Maneuver (Astride)
With the heel of one hand on the upper stomach area, support with the other hand and push sharply upwards and inwards.

40. Compression from Behind
With one knee raised, put open hands on the lower trunk beneath the ribs on either side of the spine. Squeeze strongly, inwards and upwards.

41. Breathing? Coughing? Moving?
① Conscious? No
Yes
② Call for help
④ Breathing?
Not enough
③ Open airway
Enough
④ Breathing?
Enough
Recovery position
(continue to monitor)
⑤ Two breaths
Yes
⑥ Check signs of life　　　　　　　
Breathing? Coughing? Moving?
If breathing sufficient, continue ventilations (1 every 2 to 3 sec.)
⑦⑧ Perform CPR (15:2) 　
Yes
If breathing recovers or casualty objects, stop ventilations
⑥ Check signs of life
⑧ Perform CPR (15:2)

42. CPR for Children, Babies and Newborns
Mouth-to-Mouth
Two breaths.
1～1.5 seconds apart.
Chest should rise gently.
Mouth-to-Nose & Mouth
Two breaths.
Breathe for 1 sec.
Baby &
Newborn
Child

43. Baby & Newborn Child Casualty Hand Position Technique Extent Rate
(1-8 yrs)
Lower half of sternum
Heel of one hand
About 1/3 depth of chest
100/minute
Baby
(1-12 month)
One finger width below line joining the nipples
Middle & ring fingers only
At least 100/minute
Newborn (less than 28 days)
About 120/minute
Baby & Newborn
Child

44. Removing Obstructions: Baby & Child
Back Slaps
　Turn over, facing downwards
Support chin with fingers
Slap 5 times with heel of hand
Thoracic Compressions
Face upward.
Compress lower sternum as for CPR, 5 times.
Cycle both techniques. If becomes unconscious start CPR!

45. Bleeding Control: Direct Pressure
Consider the cleanliness, thickness and position.
Apply direct pressure to the wound.
Use a plastic bag or rubber gloves to avoid infection.
Gauze pad
bone
wound

46. Bleeding Control: Tourniquet
Position between the wound and the heart.
Centered a few cm from the wound.
Using a wide (at least 3cm) triangular bandage or scarf.
Tighten using a stick.　　　　　　　　　　　
Release pressure every 30 mins.

47. 1. Prepare the tourniquet.
4. Turn the stick until bleeding stops.
2. Tie loosely. Insert a pad.
5. Secure the stick so it won’t move.
3. Insert the stick. Steady the pad.
6. Record the time.

48. Legal Protection for First Aiders
　USA: Good Samaritan Law. If emergency aid is given with sincere spirit there will be no retribution even in the event of a mistake.
JAPAN: “Regarding actions made in good faith, in the absence of malice or negligence, there shall be no civil or legal liability.”
(総務庁長官官房交通安全対策室・交通事故現場における市民による応急手当促進方策委員会報告書・平６．３)