First Aid Training for Village Health Volunteers

A training program organized through cooperation of the National Rehabilitation Center of the Lao Ministry of Public Health, Departments of Health in Khammouane and Sekong Provinces and World Education Funded by the United States Department of State,

Table of Contents

“What is UXO?”…………………………………………………….3 “Where is UXO found in Lao PDR?”……………………………….4 High-Risk Behaviors…………………………………………………6 Protecting ourselves from UXO accidents…………………………7 Safety tips……………………………………………………………8 Being prepared for emergencies…………………………………….9 Helping UXO survivors immediately after an accident…………...10 The Story of Uncle Bounmmy……………………………………..11 Controlling the Bleeding…………………………………………...18 Broken Bones………………………………………………………20 Protecting the Neck and Spine…………………………………….21 Positioning the Head for CPR and Preparing for Transport……….22 Transportation of the Patient……………………………………...23 When the UXO Survivor Returns Home…………………………24 Always Be Prepared!...................................................................................25 First Aid Box Contents…………………………………………….26 Changes in a Peron’s Life After a UXO……………………………27 How Can We Help the UXO Survivor?.................................................28

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What is UXO? Where does it come from? How does it injure people? How can we protect ourselves from UXO accidents?

From 1964 through 1973, Laos suffered war on the ground and bombing from the air. More than 2 million tons of bombs were used during the war.

More than 2 million tons of ordnance were used in Lao PDR. Many unexploded cluster bomblets, big bombs, mortar shells, artillery shells are still buried in the ground and can be dangerous if moved. About 300 people are injured or killed every year. Types of UXO found in Lao PDR

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Where is UXO found in Lao PDR? Some provinces have more UXO than other provinces.

Activity: The map above shows places where there are many unexploded bombs. Look for your province on the map and answer the following questions: 1.) Is your province heavily affected by unexploded bombs?

2.) What do you think is the UXO risk in your district?

3.) UXO can be found in many places. Can you think of some places near your villages where there is UXO? 4

UXO can be found in common places, such as... ...in the village...

...in places where children play...

...on the surface of the ground...

…or under the ground.

UXO can also be found in the forests, rice fields and under water in lakes in streams. It is important to be cautions of our environment because of all the common places that UXO can be. 5

High-risk behaviors: Maybe you have seen some examples in your villages! 1.) Building a fire directly on the ground can ignite UXO if buried under the ground. Also burning fields can be dangerous.

2.) Using a regular hoe can be dangerous because it hits the ground with a strong force which can make a bombie explode .

3.) UXO can be hidden under the ground in UXO contaminated areas, even in places that we think are safe.

What are some place you think could be UXO contaminated areas? 6

How can we protect ourselves from UXO accidents? 1.) Do not build a fire directly on the ground; make a fire pit. If clearing land or burning trash, stay far away from the fire.

2.) Use a spade to dig in the earth; loosen the dirt up with water first. Use a spade or ‘siiam’ carefully and don’t use a lot of force to hit the ground.

3.) Do not dismantle UXO or watch trained individuals dismantle UXO. It is important to tell your children to report any UXO they find. Children should never handle or play with UXO.

What safety messages do you get from UXO Lao or other organizations? Do you discuss UXO in village meetings? 7

How to make a safe fire pit Step #1 Decide where you would like the pit for cooking and burning trash. Step #2 Use a spade to dig in the earth; loosen the dirt up with water first. Step #3 If you see a UXO, stop digging and tell the village authorities. Step #4 Mark the pit and tell people it is for cooking or burning trash. Step #5 Mark the pit and tell people it is for cooking or burning trash

Remind people in your village about the danger of UXO! 1. ) Review the lessons that your children are learning in the UXO Education and Curriculum in the primary schools! 2.) Remind people in the village about UXO danger and to report any UXO they see to the village chief. 3.) Talk to people who dismantle UXO and advise them about how dangerous it is.

Don’t Forget To... 1.) Mark UXO you see in the village and tell people to avoid that area and... 2.) Put up UXO safety posters!

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How can we help UXO survivors after the accident? Provide immediate medical care and organize villagers to help transport UXO survivors to the hospital.

Check the most important injuries first! 1. Check the airway 2. Check if the person is breathing and if he is not breathing, provide mouth-to-mouth breathing

UXO injuries affect many parts of the body: 

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Head injuries can be open injuries, exposing the brain or they can be closed with bleeding occurring inside the head Eye injuries can involve just the eye lid or shrapnel can severely injure the eye Chest and abdominal injuries are very common injuries Severe bleeding occurs in most UXO injuries and can threaten the person’s life People often lose part of their hand or arm as well as part of their legs from the explosion. These injuries have a lot of bleeding! People injured by UXO may have only minor injuries or they may have injuries of many different parts of the body. 9

The Story of Uncle Bounmmy...

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When you see someone get in an accident, what should you do first?

Whey you someone who has just had an accident, you should: 1.) Check to see if they are unconscious—shake them and call their name. 2.) Send for help. 3.) Check for breathing. 11

Oxygen is very important for life. If a person does not breath for 5 minutes, the brain will start to die. Check for breathing by: 1. Placing your ear by the person’s nose. 2. Put your finger under the person’s nose to feel for breath. 3. Watch the person’s chest. Is it rising or is it still?

Sometimes, when a person is knocked out, the head and neck are in a bad position so the ‘breathing tube’ is blocked. The head has to be positioned so the airway is open.

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Very often, a victim of a UXO accident will have mud, stones, or part of teeth in their mouth. Each of these can prevent proper breathing. Usually, by opening the airway and removing these things from the mouth the person will begin breathing.

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Sometimes the heart can stop after an accident which means the person does not have a pulse. What does the heat do? 

It pumps blood around the body so that air from the lungs can reach the brain and other cells in the body. If the heart does not pump blood, the body will die.

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Being Prepared for Emergencies After this class, you will know how to help someone after an accident. In order to help someone in an emergency, you should keep your equipment and emergency supplies prepared and practice with other people in the village.

What if an accident does happen? In seven provinces (Xieng Khouang, Huaphan, Savannakhet, Khammouane, Champasak, Sekong and Salavan), the Departments of Health and World Education have set up a treatment fund. This fund helps with the costs of medical care, transportation to the district and province hospitals, and a food allowance. If there is a UXO accident in the village, contact the Department of Health and refer the UXO survivor to the hospital.

It is very important to practice When practicing, you can use people instead of manikins but remember…

1.) Do not blow in the person’s mouth.

2.) Do not press on the person’s chest. You can cause damage. Instead, draw a “chest” on a piece of paper or in chalk on a desk

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Things to remember about CPR: 1. Check if the person is breathing when you get to the accident scene. 2. The person may be unconscious and can’t breath because of the head position. 3. In many accidents, the person may have fallen face first into mud or water. In these cases, make sure the person’s mouth clear. 4. They may be in shock so giving them a first breath will stimulate them to start breathing again. 5. When the heart stops, CPR becomes more difficult 6. Continue CPR for 10 minutes or until people become tired.

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Things to remember about the recovery position: 

By placing the person on the side, and positioning his mouth downwards, the airway is easier to keep open and he can breathe more easily

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If the person vomits, it doesn’t affect his airway. Don’t put the person on the stomach.

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Controlling the Bleeding

Pressure Points—press on them to help control bleeding

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Remember these 4 steps: 1. Direct pressure on the wound. 2. Place pressure on the artery that goes to that limb.

Here’s how to wrap an elastic bandage! Note: don’t wrap the elastic bandage only on the wound because then it will cut off the blood flow to the whole limb.

3. Lift the limb. 4. Put in more dressings and wrap the wound with elastic bandage. **When you use the dressings to apply pressure to the wound, they have to be packed in very tightly and then wrapped tightly with the elastic 4 bandages.

Broken Bones

How to make a splint: 1. Wrap the arm or leg in cloth. 2. Use two pieces of wood or bamboo to support the limb. 3. Wrap the two pieces of wood or bamboo on the outside to prevent the limb from moving. 4. Check if you feel a pulse or if the finger or toes move.

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Save the Life – but Protect the Spine and Neck too! 

If someone has a UXO accident or other trauma, the person might be unconscious and it is difficult to know if they have a spine injury. If the person is unconscious , always think he has a spine injury. In this lesson, there is information in these pages to move them carefully

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If the person is conscious, he may complain of numbness or no feeling in the arms or legs, even if he is able to stand. He might not be able to move; that's a definite sign of spinal cord injury.

**Before doing CPR, roll the person on his back and on to a board. Roll the person over carefully – one person to hold the head and direct the other helpers so they roll the patient in same way. Do not bend the neck or the body.

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The spinal bones protect the spinal cord, which brings messages from the brain to our body to control our movements.

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If the spine gets damaged, then these nerves can become damaged and the person can become paralyzed.

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Positioning the head for CPR and preparing to transport the patient

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After the person with a possible spinal cord injury is positioned on this back, and if he is not breathing, lift the jaw to open the airway but do not tilt the head. If a second person is available, he can hold the person's head to keep it as still as possible.

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If transportation is done by hammock, it’s essential to transport a person with a spinal cord injury so the back and neck of the person stay still. A stretcher can be made or positioned in a hammock. Fasten the patient on the stretcher with cloth so he does not move.

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If the patient is near a road, wait until there a vehicle and lift the patient on a stretcher or board.

**This information is useful not only for UXO survivors but for other types of accidents as well. Car and motorcycle collisions are becoming the major cause for spinal injuries and disabilities from paralysis. 7

Transportation of the Patient

Remember: 1. Give the basic emergency care before you transport the patient. 2. Work with the village chief to decide how many people will transport the person. 3. If you have a phone, call the suk-sala or district hospital to tell them you are bringing a patient. 4. A VHW should go with the patient to check their condition. Are they still breathing? Do they have good blood pressure? 5. Reassure the patient that you will take good care of them.

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When the UXO Survivor Returns Home

When the UXO survivor returns home, the VHV should check: 

What medicine do they have?

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Do they know how to take the medicine?

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Do they have any dressings?

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Do they have any pain?

Important: Always check with them and see how they are feeling.

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Changes in a person’s life after a UXO or other trauma

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How Can We Help the UXO Survivor?

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Always Be Prepared! Now that you have new knowledge about your first aid, here’s what you should do when you return to your village

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Educate everyone in the village, especially the village chief, about your first aid course.

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Use the first aid techniques you have learned and help teach other people.

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Always be sure that your first aid kit has the proper supplies.

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First Aid Box Contents 1. First aid bag

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2. Gauze squares in separate packets

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3. Hydrogen peroxide—clear liquid and be-

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tadine—brown liquid (in small bottles) 4. Tape for attaching gauze to skin

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5. Elastic bandages—4 inch size

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6. Thermometer

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7. Dressing set

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8. Cotton roll 9. Flashlight 10.Stethoscope

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11.Blood pressure device with dial for measurement 12.Rubber Gloves

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