First aid at home

Most household injuries are minor, and most of them are handled badly — not because people lack equipment but because the folklore about what to put on a burn, how to stop a nosebleed and what to do about a graze is remarkably persistent and mostly wrong.

A kit is worth having. Knowing the half-dozen things that actually change an outcome is worth more.

What belongs in a household kit

• Plasters in several sizes, including waterproof ones, and a few larger fabric dressings.
• Sterile dressings and sterile gauze swabs, for covering wounds too large for a plaster. Gauze is for covering, not for cleaning.
• A crepe or conforming bandage, and a triangular bandage.
• Micropore or similar tape, and a pair of blunt-ended scissors.
• Disposable gloves, non-latex, several pairs.
• Tweezers with fine points, for splinters, and a tick remover if the household walks anywhere with ticks.
• A digital thermometer. Mercury thermometers have long been withdrawn and should not be in a kit at all.
• Paracetamol and ibuprofen, in both adult and children's formulations where there are children in the house. They work differently and can be alternated.
• An antihistamine, tablets or liquid, for stings and allergic reactions.
• Hydrocortisone cream, one per cent, for insect bites and irritated skin.
• Cling film, which is the recommended covering for a burn and is probably already in the kitchen. A clean plastic bag works for a hand or foot.
• A cold pack, instant or from the freezer, and a cloth to wrap it in — never applied directly to skin.
• Saline sachets or a bottle of sterile saline, useful for eyes.
• A first aid leaflet or booklet, and the numbers for 111 and the local out-of-hours service written somewhere that does not depend on a phone being charged.

Two things that often appear on lists written elsewhere do not belong in a British kit. Antibiotic ointment is prescription-only in the UK, is not recommended for routine minor wounds, and contributes to resistance when used that way; clean water is what minor wounds need. And antiseptic liquids and wipes are largely unnecessary — they can irritate the wound and slow healing, and running tap water does the job better.

Keep the kit somewhere known to everybody and not locked away, out of reach of small children, and go through it twice a year for expiry dates. Medicines, sterile dressings and cold packs all expire. A second, smaller kit in the car is sensible.

If anyone in the household has been prescribed an adrenaline auto-injector, it does not live in the first aid kit. Two should be carried with the person at all times, and everyone in the house should know where they are and how to use them.

Grazes and small cuts

Press on it with something clean until the bleeding stops — ten minutes of steady pressure, not repeated peeking. Raise the part if that is possible.

Then rinse it under cool running tap water to get the dirt and grit out. This is the single most useful thing in wound care and the step most often replaced by something less effective. Pat the surrounding skin dry, and cover with a plaster or dressing. Change it when it becomes wet or dirty.

Leaving a small clean wound uncovered once it has stopped bleeding is fine, and may heal marginally faster. Covering it is mostly about keeping dirt out and stopping it catching on things.

Medical attention is needed if: the bleeding will not stop after ten minutes of firm pressure; the wound is deep, gaping, or has fat or muscle visible; it was made by something dirty, rusty, or by an animal or human bite; something is still in it; it is on the face or across a joint; or it is in someone with diabetes or poor circulation. Wounds generally need closing within a few hours, so this is not a wait-and-see decision.

On tetanus: the routine UK childhood schedule gives lifelong protection after five doses, so most people are covered. Anyone unsure of their history, and anyone with a dirty or puncture wound, should ask — a booster may be offered.

Bruises

A wrapped cold pack for ten to twenty minutes, repeated over the first day or so, reduces swelling. Raising the part helps. After the first couple of days, gentle movement is better than immobility.

Bruises change colour as they resolve, over one to three weeks, and nothing much speeds that up. Arnica is widely sold for it; the trial evidence is weak and inconsistent, and the homeopathic preparations contain essentially none of the plant. It is unlikely to do harm, which is a different claim from working.

Comfrey is traditionally recommended as a poultice for bruises, sprains and even broken bones, and it is the one herbal remedy in this area worth a warning. It contains compounds that are toxic to the liver and are absorbed through broken skin, so it should never be applied to a graze, a cut or any open wound, and oral preparations are restricted in the UK for the same reason.

Bruising that appears without obvious injury, or that is unusually extensive, frequent or slow to resolve, is worth mentioning to a GP — it occasionally points at a clotting or blood problem, and it matters more in anyone on an anticoagulant.

Burns and scalds

This is where the folklore does the most damage, so the sequence is worth learning properly.

1. Stop the burning. Move away from the heat. For an electrical burn, isolate the power before touching the person.
2. Cool it under cool running water for twenty minutes. Not two minutes — twenty. Cooling still helps if started up to about three hours afterwards, so it is never too late to begin. For a chemical burn, irrigate with running water for at least fifteen minutes.
3. Remove clothing and jewellery from the area while cooling, but leave anything that has melted or stuck to the skin where it is.
4. Cover it with cling film, laid on in loose lengthwise strips rather than wrapped around. A clean plastic bag suits a hand or foot. Not on the face.
5. Keep the person warm while cooling the burn — a blanket over the rest of them. Children and older people lose heat quickly, and this is the one risk of prolonged cooling.
6. Painkillers, and get it looked at if it meets any of the criteria below.

What must not be applied: ice, iced water or an ice pack, which deepens the injury; butter, oil, toothpaste or any greasy substance; and burn gels, which remove heat less effectively than water. Blisters should not be burst.

A burn needs assessing if it is larger than the person's palm; if it is on the face, hands, feet, a joint or the genitals; if it is deep, white, leathery or painless, which indicates a full-thickness burn; if it was chemical or electrical; if it is in a baby, a small child, an older person or anyone pregnant or immunosuppressed; or if it becomes more painful, smelly or oozing over the following days. Anything substantial goes to an emergency department, and burns services give telephone advice at any hour.

Nosebleeds

Sit up, lean forwards, and pinch the soft part of the nose — not the bony bridge — firmly for ten to fifteen minutes without letting go to check. Breathe through the mouth. Spit out any blood that reaches the throat rather than swallowing it.

Tilting the head back is the instinct and it is wrong: it sends blood down the throat, which causes nausea and vomiting and makes it impossible to tell whether the bleeding has stopped.

Afterwards, avoid blowing the nose, bending down and hot drinks for several hours. Seek help if the bleeding continues beyond twenty to thirty minutes of proper pressure, if it followed a significant blow to the head, if it is heavy enough to cause faintness, or in anyone taking an anticoagulant.

Sprains and strains

For the first day or two: rest it, a wrapped cold pack for up to twenty minutes several times a day, a supportive bandage that is firm rather than tight, and the limb raised where possible. Painkillers as needed.

Then start moving it gently. Prolonged complete rest delays recovery, and the current emphasis is on returning to gentle movement earlier rather than immobilising for a week.

For the first few days avoid heat, alcohol, running and vigorous massage, all of which increase bleeding into the tissue.

Get it seen if the joint cannot bear weight or be used at all, if it looks deformed, if there is numbness or the limb is cold or pale, if the pain is severe, or if there is no improvement after a few days.

Splinters, stings and bites

A splinter near the surface comes out with clean fine tweezers, pulled along the direction it went in. One that is deep, in the eye, under a nail or won't come freely needs seeing rather than digging at.

For a bee or wasp sting: scrape a visible sting out sideways rather than squeezing it, then a cold pack and an antihistamine or hydrocortisone cream for the swelling. Swelling at the site over the next day or two is normal and alarming-looking. Difficulty breathing, swelling of the face, lips or tongue, a widespread rash, or faintness is anaphylaxis — that is 999, adrenaline if available, and lying the person flat.

Animal and human bites that break the skin should be seen, even when they look trivial, because they become infected far more often than other wounds and usually need antibiotics.

What not to put on anything

A long tradition recommends household and herbal remedies for wounds, and a few of them cause injuries of their own. Raw garlic applied to skin causes chemical burns, and does so reliably enough to appear in medical case reports. Neat or barely diluted essential oils — tea tree, lavender, thyme — do not belong in an open wound; they sting, they can cause contact allergy, and they do nothing an antiseptic would not do better, which is to say not much. Comfrey is covered above. And flower essences and homeopathic preparations are sometimes suggested for shock, which is worth being plain about: shock in the medical sense is a failure of circulation and a life-threatening emergency, and the response to it is to call 999 and lie the person down with their legs raised.

When to call 999

• Unconsciousness, or anyone who cannot be roused.
• Difficulty breathing, or breathing that has stopped.
• Bleeding that will not stop with firm pressure.
• Signs of anaphylaxis — swelling of the face or throat, wheeze, collapse.
• A suspected heart attack or stroke.
• Seizures that do not stop, or a first seizure.
• A serious burn, or any burn to the airway — soot around the mouth, a hoarse voice, singed nose hairs after a fire.
• A serious head injury, especially with drowsiness, vomiting or confusion.
• A suspected broken bone in which the limb is deformed, cold or pale.
• Suspected poisoning or an overdose, which is urgent even when the person seems well.

For everything else that cannot wait for a GP appointment, 111 will direct to the right place.

One last thing, and it is worth more than any kit: a few hours on a first aid course. Chest compressions, the recovery position and how to deal with choking cannot be learned adequately from a page, and they are the three that save lives.