Emergency medical help in Bali

• Calm the victim and help them remain as still as possible.
• Remove any jewellery, watches or tight clothing from the affected limb or bite area to prevent circulation problems if swelling occurs.
• Minimise movement of the bitten area – this slows the spread of venom.
• Monitor the person's breathing and responsiveness, and encourage them to stay calm and still.

If you are in a remote area with limited access to help

• Immobilise the affected limb using a non-elastic bandage to slow the spread of venom.
• If possible, rinse the wound gently with clean or bottled water before applying the bandage to reduce the risk of infection.
• If you do not have a bandage, use clothing such as trousers or a shirt.
• Move the victim only if necessary – ideally to a place where help can arrive faster.
• To reduce movement, improvise a stretcher or ask two people to form a seat with their crossed arms to carry the person.

If it is safe to do so

• Take a photo of the snake or remember its appearance – colour, head shape, markings. This can help medical staff choose the right treatment.

Call for emergency help

• Ask someone nearby to call 112 and bring an AED (automated external defibrillator).
• If you are alone, put your phone on speaker and call 112 yourself.

Chest compressions – begin immediately

• Kneel beside the person and place the heel of one hand on the centre of the chest.
• Place your other hand on top, interlocking your fingers.
• Lean over the victim, keep your elbows straight, and push hard and fast straight down at least 5 cm (2 inches) into the chest.
• Allow the chest to recoil fully between compressions, but keep your hands in contact with the chest.
• Perform compressions at a rate of 100-120 per minute.
• Compression and recoil times should be approximately equal.

Rescue breaths – 2 breaths after every 30 compressions

• Open the airway by tilting the head back and lifting the chin.
• Pinch the nose shut, take a normal breath and seal your mouth over the person's mouth.
• Give a breath lasting about 1 second, enough to make the chest rise visibly.
• If the chest does not rise, reposition the head and try again.
• Give a second breath, then resume compressions.

Continue CPR until

• An AED prompts you to stop,
• Emergency help arrives, or
• The person shows signs of life – coughing, breathing, moving, opening their eyes or speaking.

Call for emergency help

• Ask someone nearby to call 112 immediately and bring an AED.
• If you are alone, put your phone on speaker and call 112 yourself.

Rescue breaths – give 2 to 5 initial breaths (mouth to mouth and nose)

• Open the infant's airway by gently tilting the head back and lifting the chin, keeping the head in a neutral position.
• Take a breath and seal your lips over the infant's nose and mouth.
• Deliver a gentle breath lasting 1 second, watching for the chest to rise visibly.
• If the chest does not rise, adjust the head and try again.
• After each breath, allow the chest to fall and prepare for the next one.
• Repeat for 2 to 5 rescue breaths.

Chest compressions – give 30 compressions (two-finger technique)

• Place two fingers (index and middle) in the centre of the infant's chest, just below the nipple line, or wrap both hands around the chest with both thumbs pressing down in the centre.
• Press down to a depth of about 4 cm (1.5 inches), or one third of the depth of the chest.
• Allow the chest to recoil fully between compressions without lifting your fingers or thumbs.
• Perform compressions at a rate of 100-120 per minute.

Continue cycles of 30 compressions and 2 breaths until

• The AED instructs you to stop,
• Emergency medical services arrive, or
• The infant shows signs of life, such as breathing, coughing, eye movement or purposeful motion.

Call for emergency help

• Ask someone nearby to call 112 immediately and bring an AED.
• If you are alone, put your phone on speaker and call 112 yourself.

Rescue breaths – give 2 to 5 initial breaths

• Open the child's airway: tilt the head back and lift the chin so the mouth opens.
• Pinch the soft part of the nose closed with the hand resting on the forehead.
• Seal your mouth over the child's mouth and breathe out for about 1 second, until you see the chest or abdomen rise.
• If it does not rise, try repositioning the head.
• Keeping the head tilted and the chin lifted, take your mouth away and watch the chest fall as the air leaves the lungs.
• Repeat: 2 to 5 rescue breaths in total.

Chest compressions – give 30 compressions with one or two hands

• Kneel beside the child and place one hand on the centre of the chest.
• Depending on the child's height and weight, use one or both hands; with two hands, place one on top of the other.
• Lean over the child, keep your arms straight and press straight down to at least one third of the depth of the chest (about 5 cm).
• Release the pressure without lifting your hands off the chest, so the chest comes back up before the next compression.
• Perform compressions at a rate of 100-120 per minute.

Continue cycles of 30 compressions and 2 breaths until

• The AED instructs you to stop,
• Emergency medical services arrive, or
• The child shows signs of life, such as coughing, opening their eyes, breathing or purposeful movement.

Encourage coughing

• If the person can cough, speak or make any sound, encourage them to keep coughing to clear the blockage themselves.
• Do not interfere while the coughing is effective.

If the choking is severe – give up to 5 back blows

• Stand behind the person.
• Place one hand on their chest for support and lean them forward.
• Deliver up to 5 firm blows between the shoulder blades with the heel of your hand.
• Check after each blow to see whether the object has been dislodged.

If back blows do not work – give up to 5 abdominal thrusts

• Stand behind the person and place your arms around their waist.
• Make a fist with one hand and position it above the navel and below the rib cage.
• Grasp your fist with your other hand.
• Perform quick thrusts inwards and upwards, up to 5 times.
• Check after each thrust to see whether breathing is restored.

If the object is not expelled

• Call 112 immediately.
• Continue alternating 5 back blows and 5 abdominal thrusts until the person breathes normally or becomes unresponsive.
• If the person becomes unresponsive, begin CPR and continue until help arrives or normal breathing returns.

• If the infant cannot clear the airway by coughing, call the emergency services (112) immediately.

If the infant cannot cough or breathe – give up to 5 back blows

• Sit or kneel and hold the baby securely on your forearm.
• Place the baby face down along your forearm or lap, with the head lower than the body.
• Support the baby's jaw with your hand, taking care not to compress the soft tissue under the jaw.
• Deliver up to 5 firm blows between the shoulder blades with the heel of your other hand.
• Check after each blow to see whether the object has been expelled.

If back blows do not work – give up to 5 chest thrusts

• While supporting the head, turn the baby face up along your forearm or lap, keeping the head lower than the body.
• Place two fingers in the centre of the chest, just below the nipple line.
• Give up to 5 chest thrusts, pressing down about one third of the depth of the chest.
• Check after each thrust to see whether the airway is cleared.

Repeat until

• The infant breathes normally, or
• The infant becomes unresponsive.

Apply direct pressure

• Use direct pressure on the wound to slow or stop the bleeding.
• Ask the injured person to apply the pressure themselves if they are able, or do it yourself using a barrier – gloves, gauze or clean cloth – between your hands and the wound.

Call the emergency services

• Help the person lie down to prevent fainting.
• Call 112 and explain the situation.
• Stay with the injured person until medical help arrives.

Dress the wound

• Apply a dressing or clean cloth over the wound while maintaining pressure.
• If the first dressing becomes soaked with blood, place a second one on top – do not remove the first.
• Continue applying firm pressure directly on the wound.

Apply a tourniquet, if needed

• If direct pressure is not effective and the wound is on an arm or a leg, apply a tourniquet 5-10 cm (2-4 inches) above the wound.
• Tighten it until the bleeding stops.
• Secure the tourniquet and note the time it was applied.
• Use a tourniquet only when absolutely necessary – it can cause tissue damage if left on for too long.

Stabilise embedded objects, if present

• Do not remove an object stuck in the wound.
• Apply pressure around the object, not directly on it.
• Stabilise the object with dressings to prevent it from moving.

Help the person keep the injured area still

• Support them in a comfortable position so the injury cannot shift.
• If the fracture is open, stop the bleeding first and only then immobilise the limb.
• If it does not cause pain, keep the limb slightly raised to limit swelling.

Apply cold for no longer than 20 minutes

• Wrap the cold source in cloth so it does not damage the skin.
• Cool for no more than 20 minutes at a time.
• Stop cooling if it causes pain, and resume once the skin temperature is back to normal.

If you have to transport the person yourself, splint the limb

• Improvised materials work as a splint – boards, sticks or strips of cardboard, secured with a bandage, rope or clothing.
• A splint must immobilise at least two joints, one above and one below the fracture; its centre sits at the level of the injury.
• The splint must not press on large vessels, nerves or bony prominences.

Also

• Ask the person to rest and stay still.
• Seek medical help if you are not sure whether the injury is a fracture, a dislocation or a sprain.
• Note the time of the injury – this helps medical staff when they compare the injured limb with the healthy one.
• Keep reassuring the person and make sure they are comfortable. To help with shock, have them lie down and keep them warm.

Severe reaction or anaphylaxis

• Stop the exposure to the allergen – for example, wash it off the skin or help the person leave the place where it is present.
• If the person has an epinephrine auto-injector, help them use it. The best injection site is the middle of the outer thigh; the injection can be given through clothing if it is not thick.
• If an auto-injector is not available, call the emergency services (112) immediately.
• While waiting for medical help, alternative medicines such as antihistamines or corticosteroids may be used on the advice of a healthcare professional.
• If a person with symptoms of anaphylaxis has had a first dose of epinephrine and has not improved within 5-10 minutes, consider a second dose.

Mild allergic reaction

• Ask the person about diagnosed allergies and prescribed medicines.
• Help them into a comfortable position and take their own medicine if they have it with them.
• If you have been trained and local law allows it, offer common anti-allergy medicines – antihistamines or corticosteroids.
• For hay fever, rinsing the eyes and nasal cavity with saline may bring relief.
• If the reaction is on the skin, advise against scratching, as it makes the itching worse. For eczema, a moisturiser or an anti-itch cream may help.
• Keep watching the person closely: a mild reaction can develop into a severe one. If in any doubt, call 112.

Call the emergency services (112) if

• The seizure is in a child
• It is the person's first seizure
• The person is pregnant or has diabetes
• The person has injured themselves
• The seizure lasts longer than five minutes
• The person does not regain consciousness afterwards
• The person is under the influence of alcohol or drugs
• The seizures repeat, become more frequent or differ from the person's usual pattern

First aid

• Protect the person by moving away nearby objects or furniture they could be injured on.
• Do not try to restrain their movements and do not put anything between their teeth.
• If the person is breathing normally, turn them onto their side and keep the airway open.
• Do not move the person unless there is a direct danger.
• Put something soft under their head, such as a pillow or a jumper.
• If they wear glasses, remove them, and loosen tight clothing around the neck.
• If a family member or a carer is present, ask whether the person takes anticonvulsant medication.
• If breathing is impaired, begin CPR.
• Note the time the seizure started and ended, and whether it repeated, and pass this on to the medical staff.
• For infants and children, measure the temperature. If it is too high, remove excess clothing and move them into fresh air; give appropriate medication if needed.

After the seizure

• Check the person's breathing regularly.
• Remove the soft object from under their head if it interferes with breathing.

What you may see

• People with epilepsy may experience an aura before a seizure – an unexplained feeling of anxiety or a specific taste or smell.
• Active phase: sudden loss of responsiveness, sudden loss of consciousness, involuntary muscle movements such as twitching, jerking, spasms, arching of the back or clenching of the jaw.
• After the active phase the person may fall into a deep sleep, breathe normally or deeply, become unresponsive again after a few minutes, or be unaware of what is happening.

Jellyfish

• Calm the person and encourage them to stay still – movement can spread the venom or break off the spines.
• If tentacles remain on the skin, remove them carefully with the edge of a plastic card or a similar object. Do not touch them with your hands.
• Rinse the affected area generously with vinegar. Vinegar neutralises the stinging capsules that have not yet fired. Do not use fresh water – it can trigger the release of more venom.
• Immerse the affected area in hot water, about 40-45 °C, for 20-30 minutes. Hot water helps reduce the pain.

Sea urchins

• Do not pull the spines out dry – they are brittle and can break off inside the skin.
• Rinse the wound with clean fresh water to remove sand and other contamination.
• Immerse the area in hot water, as hot as the skin can tolerate, for 30-90 minutes. Hot water helps break down the venom and relieves the pain.
• See a doctor as soon as possible if the spines are deep in the skin, the wound is contaminated, or there are signs of infection – redness, swelling, pus – or of an allergic reaction.
• Tetanus prevention: if your tetanus vaccination is not up to date, or you are not sure, consider a vaccination.

There are three stages of birth

• The first stage begins with contractions and the waters breaking.
• In the second stage the woman pushes the baby out.
• In the third stage the placenta is delivered.

Talk to the woman to work out whether

• Labour has started and may take several hours, or
• This is an imminent birth. Birth is likely very soon if the contractions become more intense and painful, come about every five minutes, and the waters have broken.

First aid – first stage

• Create a private, protected space for the woman.
• Help her into a comfortable position: sitting, standing or moving around.
• Massage her lower back or suggest relaxation techniques, such as listening to music.

First aid – second stage

• An upright position is preferable. If she prefers to lie on her back, place a small cushion under her right hip – this helps prevent the baby from pressing on major blood vessels.
• If possible, wash your hands thoroughly with soap and water. Put on gloves if you have them.
• Place a clean cloth under the woman where the baby will be born.
• When she is ready to push, make sure she is in a stable position.
• Watch the baby's head as it emerges and make sure it is supported. Do not pull the baby by the head or shoulders, and do not press on the abdomen during or after the birth.
• If the umbilical cord is around the baby's neck, make sure it is not compressing the neck and gently lift it over the head. Do not pull the cord.
• Check whether the baby responds and is breathing normally. There is no need to cut the cord immediately – a healthcare professional should do it where possible.

If the baby is silent, open the airway

• Place one hand on the forehead and the other under the chin.
• Gently tilt the head back into a neutral position, taking care not to tilt it too far.
• Check the breathing. If the baby is not breathing or the breathing is abnormal, such as irregular gasps, follow the infant CPR section above.

After the birth

• Wrap the baby in a clean cloth to keep them warm.
• Place the baby on the mother's chest or abdomen as soon as possible.

Third stage

• Check the woman for bleeding. Light bleeding from the birth canal is normal.
• If the bleeding is heavy, help her lie down and keep her warm until medical help arrives.
• Keep the placenta – a healthcare professional will need to check that it is complete. It usually comes out on its own within about 30 minutes of the birth.