FDA Food Security Guidance

TREATMENT FOR HEALTH EMERGENCIES
Abrasions
A minor break in the skin, such as one caused by scraping or rubbing against a rough surface, should be washed with soap and water and treated with mild antiseptic, such as hydrogen peroxide. Then cover the abrasion with sterile gauze dressing held in place with a bandage. If signs of infection appear, consult a doctor.

Animal Bites
Animal bites, whether from a pet or a wild animal, can cause a puncture wound, a laceration, or an avulsion, in which part of the flesh is torn away. First aid should be directed toward control of bleeding and protecting the wound from infection until a doctor can examine it. Unless the wound is extremely painful or bleeding profusely, clean it with soap and water and cover it with a sterile dressing before taking the victim to a doctor's office or hospital emergency room.

Many animal bites require a tetanus shot and, if the animal is identified as being rabid, additional protection against rabies. In most communities, local health authorities require notification of any serious animal bite.

Black Eyes and Bruises
Black eyes and bruises are actually a type of closed wound in which blood from a damaged vessel in the soft tissues has leaked into a space beneath the skin. Apply ice or a cold compress to reduce the swelling and control the further loss of blood under the skin. In most cases, the pool of blood will be reabsorbed and the skin color will return to normal.

Boils and Blisters
A boil is a tender, often painful, pus-filled swelling of the skin. A boil is also known as a furuncle, and a group of furuncles is a carbuncle. Boils should be treated quickly and carefully to prevent the spread of a more serious infection and the formation of a scar. A boil around the nose or face can be particularly serious and should be treated with antibiotics by a doctor. Most other boils should be treated with moist heat to cause spontaneous rupture and drainage. The pus contains staphylococcus bacteria and should not be allowed to spread the infection.

Blisters are fluid-filled skin eruptions that may be caused by allergy, injury, sunburn, insect bites, infection, friction, irritation, or drug reaction. Correcting the cause is important if the cause is an infection, allergy, or drug reaction. Most ordinary blisters can be treated with a mild antiseptic and a protective dressing. Do not puncture a blister. If the blister is accidentally broken, treat it as a wound.

Burns
Burns can be caused by contact with heat, chemicals, electricity, or radiation. One of the effects is "burn shock," in which body fluid is diverted from normal blood flow to the brain, heart, and other vital organs to the burned area of the body. Burn shock is the same as physical or psychological shock and can even follow sever sunburn. Small thermal burns, as those caused from fire, steam, or touching a hot object, usually result in pain, a reddened skin area, and blisters. In many cases, the burn can be treated with ice or cold water. Do not try to open a blister. It can be protected by a pad held in place with a loose bandage.

Never apply ointments or grease, including butter or margarine, baking soda, or other household substances, to a burned skin area.

A sever or extensive thermal burn requires professional care in a hospital. A doctor and/or emergency personnel should be summoned. While waiting for professional medical care, the victim should be made to lie down with the head and chest lower than the legs (shock position). Cover the burned area with a clean cloth to exclude air. Infection is a common complication if the skin is broken. If the victim is conscious and can swallow, provide adequate nonalcoholic liquids to drink. Because of burn shock, body tissues require fluid replacement. See "Lifesaving Procedures: Preventing Shock" earlier in this chapter.

First-and Second-Degree Burns
First-degree burns are marked by redness or other skin discoloration, pain, and swelling. An ordinary sunburn is typical of a first-degree burn. These burns generally are treated as small thermal burns and usually will heal with the application of cold water followed by a dry dressing.

Second-degree burns are often the result of exposure to flame, scalding liquids, or a very severe sunburn. The skin is usually reddish, mottled, and damaged, with signs of body fluid loss. These burns are treated as extensive thermal burns, requiring professional medical care.

Third-Degree Burns
Third-degree burns are marked by damage to tissues beneath the skin. The area may resemble a second-degree burn at first, but it quickly progresses to a whitish or charred coloration. Third-degree burns often result from contact with high-voltage electricity, steam, or boiling water, or from an accident in which the person is trapped in burning clothing. A third-degree burn is a true medical emergency. While ice or cold water may be used as a first-aid measure for first-or second-degree burns, nothing should be applied to a third-degree burn; nothing should be applied to a third-degree burn. Do not even remove clothing from burn areas. Burn areas can be covered temporarily, however, with sterile dressings, clean sheets, or even plastic garment bags. Do not put plastic materials over facial burns.

If the third-degree burn victim is conscious and not vomiting, small amounts of fluid should be offered. The recommended beverage is lukewarm water containing a teaspoon of salt and one-half teaspoon of baking soda per quart of liquid, to be sipped at a rate of one ounce every four or five minutes while waiting for professional medical help.

Chemical Burns
Chemical burns, either acid or alkali, are generally corrosive reactions that tend to affect the skin, eyes, and digestive tract. They usually result from spills, leaks, and splashes. A strong acid or alkali can cause permanent tissue damage. An alkali burn may be more serious than an acid burn because an acid usually is neutralized by contact with body tissues, whereas an alkali can continue causing damage until it is neutralized by another substance or washed away with copious amounts of water.

As a result, all chemical burns should be flooded-not merely rinsed-with water. It is usually important to remove contaminated clothing, which tends to absorb the chemical and hold it next to the skin, exacerbating the damage. Water flooding should continue while clothing is being removed. If possible, insert a hose under the clothing to inject water between the skin and the contaminated fabric.

Choking
Obstruction of the airways leading to the lungs can be caused by food, candy, chewing gum, or other objects accidentally inhaled. If air is unable to reach the lungs, the body's oxygen supply can become exhausted in a few minutes, resulting in death.

Note: A person whose windpipe (trachea) is blocked cannot talk but must make those around aware that he or she is choking, sing sign language or any other means so that first aid can be given immediately.

The Heimlich maneuver, which consists of a series of thrusts to the upper abdomen. Stand behind the victim and put your arms around his or her upper abdomen so that your hands can be clasped in a fist at the bottom of the victim's breastbone. Then quickly push your fist upward into the victim's chest, putting pressure on the lungs so that any air in them will be squeezed backward up into the windpipe, pushing the obstruction into the mouth. The Heimlich maneuver may have to be repeated six or more time to dislodge a foreign body in the throat. If the victim is pregnant or very obese, the rescue pressure should be directed through the chest rather than the abdomen.
Firm blows over the spinal column between the should blades. Stand behind the choking person and help him or her lean over, using one hand on the victim's chest to lend support. Then hit high on the back with the heel of your hand. Four or more back blows may be needed to dislodge the object in the windpipe.

Concussions
A concussion can result from a head injury and may be accompanied by a brief or longer period of unconsciousness. The victim may experience headache, blurred vision, or other signs of nervous system damage and may lapse into a coma. The victim, even if conscious, should be treated as an unconscious person. Keep the person quiet and warm, watch for signs of shock, and help maintain breathing if necessary while awaiting arrival of a doctor or emergency medical service (EMS) personnel.

Convulsions
A convulsion, or seizure, involves a disturbance of the nervous system that affects the muscles of movement. The person experiencing a convulsion may have uncontrollable twitching of the muscles, or the muscles may become rigidly contracted. There are many possible causes and types of such seizures. In general, however, first aid should be aimed at protecting the victim from self-injury. Place a firm but soft object, such as a folded handkerchief, in the mouth to protect the tongue. Do not try to protect the tongue with a hard object that may damage the teeth, and do not insert your fingers between the jaws of victim. Clothing about the neck should be loosened. Place pillows, cushions, or rolled blankets about the head and body. Meanwhile, summon a doctor or EMS personnel.

Drowning
Drowning is a form of asphyxiation due to an inability of the victim to get oxygen into the lungs. It may also be complicated by inhalation of fluid into the lungs. First aid for a drowning victim required CPR procedures to maintain breathing and circulation. Do not waste time trying to squeeze water out of the lungs, particularly if the accident occurred in freshwater. If the victim has been in seawater, try to keep the body positioned wit the head and chest lower than the abdomen and legs to assist fluid drainage from the lungs. See the "Methods of Cardiopulmonary Resuscitation (CPR)" sidebar earlier in this chapter.

Electric Shock
Severe electric shock can be caused by contact with ordinary electric lines in a home, office, or factory, as well as by high-voltage lines or a lightning bolt. An electric charge can have a number of effects on the body, including muscular contractions or seizures. Paralysis of the lungs, abnormal heart function, bone fractures, thermal burns, and changes in blood chemistry.

Saving a person from further injury or death by electrocution should be done carefully so that the rescuer does not also become a victim. The electric shock victim first must be safely separated from contact with the electricity by turning the electricity off or by removing a wire or electric appliance with an insulated tool, such as a dry stick. In some cases, it may be easier to throw a loop of rope or cloth about the victim's arm or leg and drag him or her away from the source of electricity. If the victim is alive but unconscious, summon a doctor or EMS personnel. If breathing has stopped or there is no pulse, begin CPR immediately while awaiting the arrival of medical professionals.

Fractures, Dislocations, and Sprains
Fractures, dislocations, and sprains generally will require the use of splints and, for arm injuries, slings to prevent movement. Splints can be made with wood, pillows, or rolled-up newspaper, if necessary.

A fracture is a broken bone. If medical help is not available, these emergency treatment methods should be followed:

Call an ambulance.
While waiting for professional medical help, prevent movement by splinting the injury in the position in which you found it. No attempt should be made to try to reset a broken bone.
If the broken bone punctures the skin, control the bleeding with direct pressure. Cover the wound with sterile dressing and secure it in place.
Keep the person warm and watch closely for signs of shock. A dislocation is an injury in which a bone is displaced from its proper position at a joint. Suspect a dislocation if the inured part is swollen or visibly out of shape, or if the person is in intense pain and cannot put weight on the injured part. If medical help is not available, these emergency methods should be followed:
Without an X-ray, it is difficult to tell whether a bone is dislocated or fractured, so treat the injury as if a fracture has occurred. To prevent movement, splint the joint in the position in which you found it. Do not try to correct the dislocation yourself.
Take the person to an emergency room for an X-ray and examination.

Treatment of Sprains
A sprain is an injury to the ligaments. It occurs when a ligament or muscle is wrenched or twisted outside its normal range of movement and ligaments are torn. For a serious sprain, which may be indistinguishable from a fracture, treat the injury as if a fracture has occurred. For less severe, less painful sprains, follow these emergency methods:

Do not let the person stand on or use the injured body part.
Apply ice and compress the injury to decrease swelling.
Support and immobilize the sprain with an elastic bandage.
Keep the sprain elevated with either a pillow or sling.

Frostbite
The most common cold-weather injury is frostbite. Severe cold can constrict the blood vessels, thereby reducing the normal flow of warm blood to the exposed tissues. The symptoms usually include a very cold feeling in the exposed skin area followed by a loss of feeling. The skin may appear flushed or red at first, but later it becomes white or grayish yellow. Because of the loss of feeling, the victim is often unaware of the danger of frostbite.

The victim should be taken into a warm environment, and all tight or wet clothing in the affected body area should be removed. The frostbitten area should be immersed in warm-but not extremely hot -water (experts recommend a water temperature of around 105�F).

You can offer the victim hot coffee, tea, cocoa, or soup, but smoking should be avoided because it has an effect similar to that of cold, causing constriction of blood vessels. Do not rub the frostbitten tissues. If bleeding, swelling from fluid accumulation, or other complications develop after the exposed areas have thawed, notify a doctor immediately.

Heat Cramps, Heat Exhaustion, Heat Stroke
Prolonged exposure to high temperatures can lead to several life-threatening health problems. The most serious effects are heat exhaustion and heatstroke. Heat cramps are usually in the form of painful muscle spasms caused by excessive sweating and loss of body salt. The skin may be hot and dry or cool and clammy. In most cases, heat cramps can be treated with food and liquid containing sodium chloride (ordinary table salt).

Heat exhaustion, or heat prostration, is due to loss of body fluid. It is marked by nausea, weakness, excessive sweating, and faintness. The skin is pale and clammy, the pulse is weak, and the victim may show signs of shock. The loss of body fluid results in loss of blood volume and, in turn, a deficiency of oxygenated blood reaching the brain. Have the victim lie flat with the head down and give him or her small sips of cool, slightly salted liquids. Every few minutes. Do not give the victim too much fluid too rapidly.

Heatstroke, or sunstroke, is the most serious type of heat injury. It may begin suddenly with headache, dizziness, and fatigue. The skin is hot, dry, and flushed, and the pulse is extremely rapid. The victim can develop a very high fever of around 105�F, experience convulsions, or become unconscious. Unless first aid is given immediately, the person may suffer circulatory collapse and die. Cool the body by wrapping the victim in wet clothing or bedding. Use snow or ice, if available, or immerse the person in cool water while awaiting the arrival of an emergency medical service (EMS) crew or a physician. Check the victim's temperature every 10 minutes to make sure the body temperature does not fall too rapidly. Hypothermia, or excessively cold body temperature could complicate the condition.

Insect Bites
Bites or stings of ants, bees, hornets, wasps, yellow jackets, mosquitoes, and other insects usually result in the injection of substances under the skin of the person attacked. The body's reaction may vary from mild itching to a severe form of shock, depending on the venom or other foreign protein injected and the sensitivity of the person to the substance. Some hypersensitive persons can experience an extreme allergic reaction, known as anaphylactic shock, marked by breathing difficulty or circulatory failure within a few minutes after a bite or sting. Such individuals require special prescription drugs that should be carried when they expect to be near stinging or biting insects.

For most people who experience insect bites and stings, first aid may require only the application of ice or a cold compress to slow the rate of venom absorption. If the insect leaves its stinger in the skin, remove it with care, as the venom sac usually is still attached and should not be squeezed.

Ticks and other insects that may cling to the skin may require application of a petroleum product or similar irritant in order to remove them, in addition to casing local pain, swelling, and irritation, bites of ticks and other insects can result in serious infections requiring hospitalization.

Ticks and other insects that may cling to the skin may require application of a petroleum product or similar irritant in order to remove them, in addition to causing local pain, swelling, and irritation, bites of ticks and other insects can result in serious infections requiring hospitalization.

Nosebleeds
Nosebleeds are usually cause by rupture of the numerous capillaries in the soft tissues near the tip of the nose. A nosebleed may be started by an injury, high blood pressure, physical activity, or sudden change in atmospheric pressure, as may occur in traveling from sea level to a mountaintop. First aid requires keeping the victim quiet and in a seated position with the head leaning forward. Apply pressure to the outside of the bleeding nostril, or insert gauze pads in one or both nostrils and squeeze the outside of the nose toward the midline. Also, apply ice or a cold compress to the nose and surrounding areas of the face. If the nose continues to bleed, notify a doctor.

Poisoning
A poison is anything that may be injurious to health of dangerous to life if it is swallowed, inhaled, or touched by the skin. Common sources of poisons include contaminated foods, carbon monoxide gas, cleaning products and solvents, certain household plants, pesticides, and medicines.

In any case of a swallowed poison, the container of food or other substance should be saved, with the label and any remaining contents, so that doctors or poison control center personnel can recommend the most rapid and effective treatment.

First aid for most cases of swallowed poisons depends on the type of substance involved and the condition of the victim. Do not try to induce vomiting in any poisoning victim if he or she is unconscious or having convulsions.

Corrosive Poisons
Do not induce vomiting if the victim may have swallowed a corrosive substance, such as an acid or alkali, or has a burning pain in the mouth or throat. Examples of corrosive substances are toilet-bowl cleaners, drain cleaners, lye, washing soda and chlorine bleach.

Do not attempt to "neutralize" swallowed acids or alkalis.
Do not use activated charcoal for swallowed corrosive poisons.
Do not give the victim adequate amounts of milk or water.
Do begin CPR if breathing stops.

Food Poisoning
Food poisoning may be caused by enterotoxins, or poisons produced by bacteria that may or may not still be in the food. Symptoms usually include nausea and vomiting, cramps, diarrhea, fever, and headache, which may begin minutes to hours after the food has been eaten.

First aid in most cases includes bed rest, preferably close to a bathroom and avoidance of any food or beverage until vomiting has stopped. When vomiting has ended, the victim should be offered sweetened tea or soft drinks and strained broth or bouillon with a little salt added. It is important to replace the body fluids and electrolytes (minerals) lost in vomiting or diarrhea.

In addition to vomiting, cramps, or diarrhea, symptoms of poisoning may include loss of consciousness, confusion or disorientation, an unusual odor on the breath, pain or a burning sensation in the mouth or throat, and stains or discoloration in or about the mouth from the leaves or berries of poisonous plants.

If the symptoms are severe, with signs of shock or the presence of blood or mucus in the diarrhea, a doctor should be notified.

A potentially fatal form of food poisoning that does not always cause vomiting or diarrhea is botulism. It is cause by a bacteria-produced poison, usually found in home-canned or processed foods. Botulism attacks the nervous system. The victim may feel no symptoms for a day or two and then experience visual problems, dry mouth and swallowing difficulty, and constipation as the poison gradually paralyzes various organ systems, immediately hospitalization is needed to prevent the spread of the paralyzing effects to the respiratory system.

Inhaled Poisons
A common type of inhaled poison is carbon monoxide gas, as produced by a car or truck engine in a confined area or by a faulty furnace or fireplace. The first symptoms are usually headache, yawning, breathing difficulty, dilated pupils, dizziness, faintness, ringing in the ears (tinnitus), nausea, and heart palpitations, followed by loss of consciousness. A distinctive sign is a cherry-red coloring of the mucous membranes. Persons with a light complexion may show a similar bright red coloring of the skin.

First aid requires fresh air and oxygen. Give mouth-to-mouth resuscitation until an emergency medical service (EMS) unit can arrive to provide 100 percent oxygen by mask. Do not give any stimulants, but keep the victim warm and as quiet as possible. In rescuing a person from an inhaled poison, such as smoke or carbon monoxide, protect yourself against becoming a victim of the same dangerous situation. Be sure that oxygen is available by opening doors or window of an enclosed space. If possible, carry an independent air supply if you must enter a confined or overheated area to rescuer a victim of inhaled poisons. When a second rescuer is present, tie a rope around your waist and give the other end to the second rescuer, who can pull you to safety if you also are overcome by poisonous fumes.

Noncorrosive Poisons
Most medicines, such as aspirin, may be noncorrosive poisons. Generally, the doctor may recommend that you try to induce vomiting if the person has swallowed a noncorrosive poison that is not a petroleum distillate product. If you do not know whether the swallowed substance is corrosive or noncorrosive-or even if it is actually poisonous-call a poison control center.

To induce vomiting, use syrup of ipecac (1 tablespoon for a child; 2 tablespoons for an adult) when it is available. The syrup of ipecac should be followed with one or more 8-ounce glasses of water.

If the person does not vomit within 15 minutes after one dose of syrup of ipecac, repeat the dose.

If syrup of ipecac is not available, use soapy water or a hand washing liquid detergent dissolved in water, or place the handle of a spoon or your finger at the back of the victim's throat. If the victim is a child, hold the child with the head lower than the hips while you induce vomiting. This poison will reduce the change of vomit entering the lungs.

Save a sample of the vomit so that it can be analyzed in a medical laboratory.

Petroleum Distilaltes
For swallowed petroleum distillates, such as gasoline, kerosene, lighter fluid, paint thinner, or furniture polish, call the nearest poison control center or hospital emergency room immediately for specific instructions. The exact type and amount of the poison may determine the treatment. Some products contain more than one kind of poison.

Symptoms may include coughing, choking, cyanosis (blue skin), breath holding, a burning sensation in the stomach, lethargy, coma, convulsions, and spontaneous vomiting.

Do not induce vomiting. There is a great risk that some of the vomited poison may enter the lungs; some hydrocarbon products are more than a hundred times as poisonous in the lungs as in the digestive tract.
Do, if recommended by a doctor, give the person a glass of milk to dilute the poison and reduce stomach irritation.

Plant Poisons
The major contact poison plants in North America are poison ivy, poison oak, and poison sumac. They are usually identified by their clusters of three shiny leaflets. Signs and symptoms of contact with these plants include itching skin and blisters. These are effects of a poisonous resin in the leaves. Some first aid relief can be had by diluting and washing away the resin with a strong laundry soap and water. Follow-up treatments can include moistened dressings, starch baths, or oatmeal baths to relieve the itching. Do not break the blisters. If the blisters are oozing and crusting, exposing them to dry air may give some relief. More serious adverse effects can result from chewing the leaves of poison ivy or inhaling the smoke of plans being burned. Swallowing or inhaling the resin causes painful swelling of the lining of the throat, accompanies by fever and weakness. The symptoms may require professional medical treatment.

Snakebites
Most snakebites should be treated like those of any wild animal. If the bite is from a poisonous snake the symptoms may vary according to the type of snake and its venom. But most poisonous snakebites will be followed immediately by an intense pain and a feeling of numbness in the bite area. The bite of a pit viper, such as a rattlesnake, cotton-mouth, or copperhead, is often identified by fang punctures about one-half inch apart. Such a bite may also produce swelling. Other snakebites may or may not leave fang marks. A wound from the bite of a coral snake may show a chewing action of the snake's jaw.

In general, a snakebite victim should remain still. Any body movement will tend to increase the spread of venom. If the bite is in an arm or leg, the limb should be immobilized and kept lower than the level of the heart. If a hospital or other medical facility is less than 30 to 40 minutes away, the victim should be delivered there for professional care as quickly as possible. Other first-air measures are suggested only for cases in which a doctor or hospital is not easily available.

A constriction band should be tied around the arm or leg a few inches about the bite and between the bite and the heart. The bite may be washed with soap and water and covered with a sterile dressing. Ice or a cold compress can be applied, but not directly over the bite. As in any other serious injury, the victim should be monitored closely for signs of shock. In some cases, an incision can be made in the bite area for removal of some of the venom by suction. Incision and suction, however, should be performed only if a doctor is not available and immediately after the bite has been inflicted. The person making the incision should be aware that when cutting into an arm or leg, there is a high risk of causing permanent damage to nerves, blood vessels, muscles, or other tissue.