Rules for Providing Pre-Medical First Aid

These Rules for Providing Pre-Medical First Aid (hereinafter referred to as the “Rules”) have been developed in accordance with Paragraph 2 of Article 122 of the Code of the Republic of Kazakhstan dated July 7, 2020, “On Public Health and the Healthcare System,” and establish the procedure for providing pre-medical first aid.

1) pre-medical care means medical care provided by mid-level medical personnel independently or as part of a multidisciplinary team, including health promotion, assessment of the patient’s condition, establishment of a pre-medical diagnosis, development of a plan of pre-medical interventions, performance of pre-medical manipulations and procedures, and care for patients, persons with disabilities, and dying persons;

2) primary health care means the first point of access to medical care oriented to the needs of the population, including prevention, diagnosis, and treatment of diseases and conditions, provided at the level of the individual, family, and community.

1) wound;

2) bleeding;

3) electric shock injury;

4) fracture;

5) dislocation;

6) bruise (contusion);

7) sprain (ligament sprain);

8) skull fracture (signs: bleeding from the ears and mouth, unconsciousness) and concussion (signs: headache, nausea, vomiting, loss of consciousness);

9) spinal injury (signs: sharp pain in the spine, inability to bend the back or turn around);

10) burn;

11) heatstroke and sunstroke;

12) food poisoning;

13) frostbite;

14) foreign bodies entering organs and tissues;

15) insect bite or sting (bees, wasps);

16) drowning.

1) elimination of the impact of dangerous and harmful factors on the injured person’s body (freeing the person from electric current, extinguishing burning clothes, removing the person from water);

2) assessment of the injured person’s condition;

3) determination of the nature of the injury posing the greatest threat to the injured person’s life and the sequence of actions for rescue;

4) performance of the necessary rescue measures in order of urgency;

5) maintenance of the injured person’s vital functions until specialists arrive;

6) calling emergency medical services or a doctor, or taking measures to transport the injured person to the nearest medical organization.

1) In case of a wound:

wash hands or apply iodine to the fingers;

carefully remove dirt from the skin around the wound; apply iodine to the cleaned area of skin;

open the dressing pack available in the first-aid kit in accordance with the instructions printed on its wrapper;

when applying dressing material, do not touch with your hands the part that is placed directly on the wound;

use a clean handkerchief or cloth for dressing;

drop iodine onto the cloth so as to obtain a spot larger than the wound, and place the cloth on the wound;

Not allowed:

to wash the wound with water or any medicinal substance, sprinkle powder on it, or apply ointments;

to remove sand or soil from the wound;

to remove blood clots or remnants of clothing from the wound;

to wrap the wound with insulating tape or place cobwebs on it in order to avoid tetanus infection.

2) In case of internal bleeding (pale appearance, clammy sweat on the skin, rapid intermittent breathing, rapid weak pulse), it is necessary to:

lay the injured person down or place them in a semi-sitting position;

ensure complete rest;

apply “cold” to the suspected site of bleeding;

urgently call a doctor or medical worker.

Do not give the injured person anything to drink if there is suspicion of damage to the abdominal organs.

3) In case of mild external bleeding:

apply iodine to the skin around the wound;

place dressing material and cotton wool on the wound and bandage tightly; if bleeding continues, without removing the applied dressing material, place layers of gauze and cotton wool over it and bandage tightly.

4) In case of severe bleeding:

depending on the location of the wound, for rapid control of bleeding, press the arteries against the underlying bone above the wound in the direction of blood flow at the most effective points (temporal artery; occipital artery; carotid artery; subclavian artery; axillary artery; brachial artery; radial artery; ulnar artery; femoral artery; femoral artery in the mid-thigh; popliteal artery; dorsalis pedis artery; posterior tibial artery);

in case of severe bleeding from an injured limb, bend the limb at the joint above the wound site, if there is no fracture of that limb. Place a wad of cotton wool or gauze into the hollow formed by bending, bend the joint as far as possible, and secure the bend with a belt, triangular bandage, or other materials;

in case of severe bleeding from an injured limb, apply a tourniquet above the wound (closer to the torso), wrapping the limb at the tourniquet site with a soft pad (gauze, handkerchief). First, press the bleeding vessel with fingers against the underlying bone. The tourniquet is applied correctly if no pulsation is detected below the application site and the limb becomes pale. The tourniquet is applied by stretching (elastic special tourniquet) or by twisting (tie, twisted handkerchief, towel);

transport the injured person with the tourniquet to a medical facility as quickly as possible.

Not allowed:

to tighten the tourniquet excessively, as this may damage muscles, compress nerve fibers, and cause paralysis of the limb;

to keep the tourniquet on for more than 2 hours in warm weather and more than 1 hour in cold weather, because of the risk of tissue necrosis. If it is necessary to leave it longer, it must be removed for 10–15 minutes, first pressing the vessel with a finger above the bleeding site, and then reapplied to a new area of skin.

5) In case of electric shock:

free the injured person from the action of electric current;

take measures to separate the injured person from live parts if it is not possible to quickly de-energize the electrical installation. For this purpose, one may: use any dry non-conductive object (stick, board, rope); pull the injured person away from live parts by their clothing if it is dry and loose from the body; cut the wire with an axe with a dry wooden handle; use a conductive object by wrapping the contact area for the rescuer’s hands with dry cloth or felt;

move the injured person out of the danger zone to a distance of at least 8 m from the live part (wire);

depending on the condition of the injured person, provide first pre-medical aid, including resuscitation (artificial respiration and external chest compressions). Regardless of the injured person’s subjective well-being, transport them to a medical facility;

Not allowed:

to forget personal safety measures when assisting a person affected by electric current. Particular caution is required when moving in an area where a live part (wire) is lying on the ground. Movement in the ground-fault current spread zone must be carried out using insulating protective equipment (dielectric protective equipment, dry boards) or, if without protective equipment, by shuffling the feet along the ground without lifting them apart.

6) In case of fractures:

immobilize (create rest for) the fractured bone;

in open fractures, stop bleeding and apply a sterile dressing;

apply splints (standard or improvised from plywood, boards, sticks). If there are no items to immobilize the fracture site, bandage it to a healthy part of the body (injured arm to the chest, injured leg to the healthy leg);

in a closed fracture, leave a thin layer of clothing at the splint application site. Remove other layers of clothing or footwear without worsening the person’s condition (for example, cut them off);

apply “cold” to the fracture site to reduce pain;

transport the injured person to a medical facility, ensuring a stable position of the injured body part during transportation and handover to medical personnel;

it is not allowed to remove clothing and footwear in the usual way if this causes additional physical impact (compression, pressure) on the fracture site.

7) In case of dislocation:

ensure complete immobility of the injured part using a splint (standard or improvised);

apply “cold” to the injury site;

transport the injured person to a medical facility while maintaining immobilization;

reduction of the dislocation is allowed only for a medical worker.

8) In case of bruises (contusions):

ensure rest of the bruised area;

apply “cold” to the bruise site;

apply a tight bandage;

it is not allowed to apply iodine to the bruised area, rub it, or apply a warming compress.

9) In case of sprains:

bandage the injured limb tightly and ensure rest;

apply “cold” to the injury site;

create conditions to ensure blood circulation (raise the injured leg, support the injured arm in a sling around the neck);

it is not allowed to carry out procedures that will heat the injured area.

10) In case of skull fracture (signs: bleeding from the ears and mouth, unconsciousness) and concussion (signs: headache, nausea, vomiting, loss of consciousness):

eliminate harmful environmental influences (frost, heat, being on the roadway);

move the injured person, observing safe transport rules, to a comfortable place;

lay the injured person on their back; if vomiting occurs, turn the head to one side;

fix the head on both sides with rollers made from clothing;

if choking occurs due to the tongue falling back, advance the lower jaw forward and maintain it in that position;

if there is a wound, apply a tight sterile dressing;

apply “cold”;

ensure complete rest until the doctor arrives;

call medical workers and ensure appropriate transportation for qualified medical care;

Not allowed:

to give the injured person any medications;

to talk to the injured person;

to allow the injured person to get up and move around.

11) In case of spinal injury (signs: sharp pain in the spine, inability to bend the back or turn):

carefully, without lifting the injured person, slide a wide board or a similar object under the back, turn the injured person face down, and strictly ensure that the torso does not bend in any position (to avoid spinal cord injury);

exclude any load on the spinal muscles;

ensure complete rest;

Not allowed:

to turn the injured person onto their side, seat them, or place them on their feet;

to lay them on a soft, elastic surface.

12) In case of burns:

for first-degree burns (redness and pain of the skin), cut and carefully remove clothing and shoes from the burned area, moisten the burned area with alcohol, a weak potassium permanganate solution, and other cooling/disinfecting lotions, then seek medical care;

for second-, third-, and fourth-degree burns (blisters, necrosis of the skin and deeper tissues), apply a dry sterile dressing, wrap the affected area in clean cloth/sheet, and seek medical care. If burnt clothing pieces have stuck to the burned skin, apply the sterile dressing over them;

if the injured person shows signs of shock, urgently give them 20 drops of valerian tincture or a similar remedy;

in case of eye burns, apply cold lotions made from a boric acid solution (half a teaspoon per glass of water);

in case of chemical burns, rinse the affected area with water and treat it with neutralizing solutions: for acid burns — baking soda solution (1 teaspoon per glass of water); for alkali burns — boric acid solution (1 teaspoon per glass of water) or acetic acid solution (table vinegar diluted by half with water);

Not allowed:

to touch burned skin with hands or apply ointments/fats to it;

to open blisters;

to remove substances, materials, dirt, mastic, or clothing stuck to the burned area.

13) In case of heatstroke and sunstroke:

move the injured person to a cool place;

lay them on their back with a roll (can be made from clothing) under the head;

unbutton or remove clothing that restricts breathing;

moisten the head and chest with cold water;

apply cold compresses to skin areas with many blood vessels (forehead, parietal area);

if the person is conscious, give cold tea or cold salted water to drink;

if breathing is impaired and there is no pulse, perform artificial respiration and external chest compressions;

ensure rest;

call an ambulance or transport the injured person to a medical facility (depending on health condition);

it is not allowed to leave the injured person unattended before the ambulance arrives and before delivery to a medical organization.

14) In case of food poisoning:

give the injured person at least 3–4 glasses of water and a pink potassium permanganate solution, followed by inducing vomiting;

repeat gastric lavage several times;

give the injured person activated charcoal;

give warm tea, put them to bed, and keep them warm (until medical personnel arrive);

in case of breathing and circulation disorders, begin artificial respiration and external chest compressions;

it is not allowed to leave the injured person unattended before the ambulance arrives and before delivery to a medical organization.

15) In case of frostbite:

in case of mild freezing, immediately rub and warm the cooled area to relieve vascular spasm (excluding the possibility of skin damage/injury);

in case of loss of sensation and whitening of the skin, do not allow rapid warming of hypothermic body parts while the injured person is indoors; use heat-insulating dressings (cotton-gauze, woolen, etc.) on the affected areas;

ensure immobility of hypothermic hands, legs, and torso (splinting may be used);

leave the heat-insulating dressing in place until a sensation of warmth appears and sensitivity returns to the hypothermic skin, then give hot sweet tea;

in case of general hypothermia, urgently transport the injured person to the nearest medical facility without removing heat-insulating dressings and materials (in particular, frozen shoes should not be removed; the legs may only be wrapped in padding);

it is not allowed to tear off or puncture formed blisters, as this may cause suppuration.

16) In case of foreign bodies entering organs and tissues:

attempt to remove the foreign body only if there is confidence that this can be done easily, completely, and without serious consequences.

17) In case of drowning:

act thoughtfully, calmly, and carefully;

the rescuer should be able to swim and dive well, know methods of transporting the injured person, and know how to free themselves from the person’s grips;

urgently call an ambulance or doctor;

if possible, quickly clear the mouth and throat (open the mouth, remove any sand, gently pull out the tongue and fix it to the chin with a bandage or handkerchief, tying the ends at the back of the head);

remove water from the airway (place the injured person stomach-down on the rescuer’s knee, with head and legs hanging down; tap the back);

if, after removing water, the injured person is unconscious, has no carotid pulse, and is not breathing, begin artificial respiration and external chest compressions. Continue until breathing is fully restored or stop only upon appearance of clear signs of death confirmed by a doctor;

when breathing and consciousness return, wrap, warm, and give hot strong coffee or tea (for an adult, give 1–2 tablespoons of vodka);

ensure complete rest until the doctor arrives;

it is not allowed to leave the injured person alone (unattended) before the doctor arrives, even if there is visible improvement in condition.

18) In case of bites from snakes and poisonous insects:

suck out the poison from the wound as soon as possible (this procedure is not dangerous for the rescuer);

limit the injured person’s movement to slow the spread of poison;

ensure abundant drinking;

transport the injured person to a medical organization only in a lying position;

Not allowed:

to apply a tourniquet to the bitten limb;

to cauterize the bite site;

to make incisions to improve venom drainage;

to give the injured person alcohol.

19) In case of animal bites:

apply iodine to the skin around the bite (scratch) site;

apply a sterile dressing;

refer the injured person to a medical organization for rabies vaccination.

20) In case of insect bite or sting (bees, wasps):

remove the stinger;

apply “cold” to the swollen area;

give the injured person plenty of fluids;

in case of allergic reactions to insect venom, give the injured person 1–2 tablets of diphenhydramine and 20–25 drops of cordiamine, place warm heating pads around the person, and urgently transport them to a medical organization;

in case of breathing impairment and cardiac arrest, perform artificial respiration and external chest compressions;

it is not allowed for the injured person to drink alcohol, as it increases vascular permeability, venom is retained in the cells, and swelling worsens.

1. The indication for performing external chest compressions is cardiac arrest, which is characterized by the combination of the following signs: loss of consciousness, absence of a pulse in the carotid arteries, absence of normal breathing, or gasping/irregular breaths. In case of cardiac arrest, without losing a second, the injured person must be placed on a flat, firm surface: a bench or the floor; in extreme cases, place a board under the back.

2. If assistance is provided by one person, the rescuer positions themself at the side of the injured person and, leaning over them, places the palm of one hand on the lower half of the sternum (do not press on the upper half of the sternum, the abdomen, or the lateral surfaces of the chest). The palm of the second hand is placed on top of the first, locking the fingers of the lower hand and lifting them so as not to press on the lateral surfaces of the chest. Press on the chest using the weight/incline of the rescuer’s torso.

3. Compressions should be delivered with quick thrusts so as to depress the sternum to a depth of 5–6 cm (in children, 4–5 cm; in infants, approximately one-third of the chest depth). The compression rate shall be 100–120 compressions per minute (compression duration not more than 0.5 seconds, interval between individual compressions not more than 0.5 seconds).

4. During pauses between compressions, do not remove the hands from the sternum (if assistance is provided by two people); the fingers remain lifted, and the arms remain fully extended at the elbows.

5. If resuscitation is performed by one person, after 30 compressions of the sternum, 2 rescue breaths shall be given, then 30 compressions again, and then 2 breaths repeated.
Per minute, 100–120 compressions and 10–12 ventilations should be performed; therefore, the pace of resuscitation measures is high. Chest compressions must not be interrupted for more than 10 seconds.

6. If assistance is provided by two or more people, the ratio of chest compressions to rescue breaths in children is 15:2; after every 15 compressions, 2 rescue breaths shall be given. In adults, the ratio remains 30:2, regardless of how many people are providing assistance. It is recommended to change the person performing compressions approximately every 2 minutes.

7. External chest compressions and artificial respiration shall be performed:

until clear signs of life appear in the injured person (restoration of consciousness, stable spontaneous breathing, and cardiac activity);

until the injured person is handed over to medical personnel;

for as long as resources (physical capacity) are available.

Если хотите, я могу дальше перевести следующий раздел в том же стиле (единый официальный перевод для всего приложения).

1. Experience shows that the greatest amount of time is spent on artificial respiration. Insufflation must not be prolonged: as soon as the injured person’s chest expands, it must be stopped. The duration of each breath is approximately 1 second, and about the same time is needed for the air to leave the lungs. The 30:2 ratio of compressions to rescue breaths must be strictly observed.

2. Artificial respiration is also performed in cases where the injured person is not breathing or is breathing very poorly (rarely, convulsively, as if sobbing/gasping), and/or if breathing is steadily worsening regardless of the cause (electric shock, poisoning, drowning). The most effective method of artificial respiration is the “mouth-to-mouth” or “mouth-to-nose” method, as it ensures delivery of a sufficient volume of air into the injured person’s lungs.

3. The “mouth-to-mouth” or “mouth-to-nose” method is based on the use of exhaled air from the rescuer, which is forcibly delivered into the injured person’s airways and is physiologically suitable for breathing.
Air may be insufflated through gauze or a handkerchief. This method of artificial respiration makes it easy to monitor air entry into the lungs by observing chest expansion after insufflation and its subsequent fall due to passive exhalation.

4. To perform artificial respiration, the injured person should be laid on their back, clothing restricting breathing should be unfastened, and upper airway patency should be ensured, as in the supine position during unconsciousness the airway may be blocked by the tongue falling back. In addition, the mouth may contain foreign material (vomit, sand, silt, grass), which must be removed with the index finger wrapped in a handkerchief (cloth) or bandage, after turning the injured person’s head to one side.

5. After this, the rescuer positions themself at the side of the injured person’s head, places the palm of one hand on the victim’s forehead, and with two fingers of the other hand lifts the lower jaw, extending (tilting back) the head (do not tilt the head back if cervical spine injury is suspected; in children, do not overextend the head). This raises the root of the tongue and opens the entrance to the larynx, and the injured person’s mouth opens. The rescuer then leans toward the injured person’s face, seals their lips tightly around the injured person’s open mouth, and gives a normal exhalation, blowing air into the mouth with some effort; at the same time, the rescuer closes the injured person’s nose using the hand on the forehead. The injured person’s chest must be observed and should rise by approximately 1 cm. As soon as the chest rises, air insufflation is stopped; the rescuer lifts their head, and passive exhalation occurs in the injured person.

6. If the injured person has a clearly detectable pulse and only artificial respiration is required, the interval between rescue breaths should be 5–6 seconds, which corresponds to a breathing rate of 10–12 breaths per minute.

7. During artificial respiration, the rescuer must ensure that the insufflated air enters the lungs and not the injured person’s stomach. If air enters the stomach, as indicated by abdominal distention in the upper abdomen (“under the spoon”/epigastric area), gently press the palm on the abdomen between the sternum and the navel. This may cause vomiting; therefore, the injured person’s head and shoulders should be turned to one side (preferably the left) in order to clear the mouth and throat.

8. If the injured person’s jaws are tightly clenched and the mouth cannot be opened, artificial respiration should be performed using the “mouth-to-nose” method.

9. In small children, air is insufflated into the mouth and nose simultaneously. The smaller the child, the less air is needed for each breath and the more frequently insufflation should be performed compared with an adult (up to 15–18 times per minute).

10. When the first weak spontaneous breaths appear in the injured person, artificial breaths should be timed to coincide with the start of the person’s own inhalation.

11. Artificial respiration is discontinued after the injured person has regained sufficiently deep and rhythmic spontaneous breathing.

12. Assistance to the injured person must not be withheld, and the person must not be considered dead in the absence of such signs of life as breathing or pulse. Only a medical professional is authorized to determine death.

13. If, for any reason, you are unable to perform artificial respiration, then during basic resuscitation only chest compressions (continuous) are performed.