Three minor injuries in 25 minutes: what to treat, what to refer, what to log
09:15 in a small print works with 24 staff. You are the only first aider on shift. In 25 minutes you see three people: a 19-year-old apprentice with a 2 cm graze on the back of her hand from a guillotine guard, with a little grit in it; a 46-year-old press operator with a red, painful area on the inside of his right wrist about the size of a 50p coin, caused when a steam pipe vented 10 minutes ago, where the skin looks intact but shiny and he says it is getting more painful; and a 33-year-old who banged his shin on a pallet truck, leaving an intact-skin bruise about 8 cm across with swelling. The first aid kit is well stocked, but the sterile eyewash is 3 months out of date, the box of medium gloves is empty and there is no clinical waste bag. The accident book is in the office.
1. In what order do you treat these three, and what do you do for each?
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Order: burn, graze, bruise. The burn happened 10 minutes ago and is still painful - that means heat is still damaging tissue, so cooling cannot wait. The graze carries an infection risk but is stable. The bruise is the least urgent.
Burn (wrist): cool under cool running water for 20 minutes - the full 20 minutes, even though the area is small. Remove his watch or bracelet first, before swelling starts. No ice, no butter, no creams, no adhesive plaster directly on the burn. Afterwards cover with cling film laid in sheets along the arm (not wrapped round tightly) or a sterile non-adherent dressing. Reassess: if it blisters, it is deeper than it first looked.
Graze (hand): my hands clean and gloved, irrigate with clean running water or saline to float the grit out rather than scrubbing it. Pat dry with a sterile swab, apply a plaster or low-adherent sterile dressing. Ask when she last had a tetanus booster - a dirty wound with grit in it matters here.
Bruise (shin): a cold compress - ice wrapped in a cloth, never ice straight on skin - for about 10 minutes, elevate the leg, and advise simple pain relief according to the packet. Ask him to bear weight and check for deformity or severe pain, because a shin injury that stops him walking needs an X-ray.
2. Which of the three needs referral, and on what criteria are you deciding?
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Burn. Most small superficial burns in a healthy adult can be dressed at work, but I would refer him the same day if: it blisters; it involves the hand, face, feet or genitals, or crosses the wrist joint; it is larger than his palm; it is white, brown or charred and painless (full thickness); or pain is not controlled. A steam burn on the wrist is close enough to the hand and joint that I would send him to urgent care or his GP if there is any blistering at all, and I would advise him to come back to me if it changes. Cooling does not replace that decision.
Graze. Refer if I cannot get all the grit out, if there is a deep flap or the wound will not stop oozing, if he is not up to date with tetanus (or cannot say), or later if there are signs of infection - spreading redness, heat, pus, fever. A dirty wound is exactly the situation where tetanus cover is checked.
Bruise. Refer if he cannot weight-bear, if there is deformity, if swelling is severe and increasing, or if pain is out of proportion to the injury. A bruise alone is not a referral.
In each case I would record what advice was given and that the decision was shared with the casualty, not just announced.
3. How do you manage hygiene and the kit problems, and what goes in the accident book?
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Hygiene. Wash hands before and after each casualty; the medium gloves are out, so I find the correct size rather than wearing a loose pair that tears or a tight pair that splits - if none fit, wash hands and use the nearest correct size available. Cover any cuts of my own. Use single-use items and do not put used dressings back in the kit. The out-of-date eyewash does not get used - it is removed from the kit and replaced, and it is the reason I would not attempt eye irrigation today without checking stock. Blood-stained or soiled dressings go into a clinical waste bag; with none available, double-bag and seal them and keep them out of the general bin until proper disposal.
Record for each casualty: date, time, name, job, what happened and where; the injury as I observed it (size, site, whether skin was broken); treatment and materials used; advice given, including referral and return-to-work advice; whether they were sent elsewhere and by what means; my name and signature. Confidential, factual, timed - and it goes to the employer for the accident book and health and safety review.
Kit actions: replace the missing medium gloves, order clinical waste bags, check every expiry date, and set a monthly stock check with the person responsible for the first aid kit.