Red Cross Guidelines Resource Center

Opioid Overdose: The 2024 guidelines recommend that first aid providers receive training in responding to opioid overdoses, including administering naloxone. If a person is suspected of an opioid overdose and is unresponsive and not breathing normally, the first aid provider should activate the emergency response system, perform high-quality CPR (compressions and breaths) and administer naloxone when available.

Significance: Opioid overdose is a leading cause of preventable death in the US and Canada, and naloxone can temporarily reverse its effects, restoring consciousness and breathing. Naloxone nasal spray is available without a prescription, and community training significantly increases the rates of naloxone administration, making it a crucial addition to first aid training.

Recognition of Stroke in Children: The 2024 guidelines recommend activating emergency medical services and transporting the child to an emergency department if pediatric stroke is suspected. Stroke should be considered when common pediatric symptoms such as headache, dizziness and nausea are associated with other neurological signs such as seizure, speech and visual disturbances, limb weakness and facial droop.

Significance: Adult stroke scores are not validated for children and should not be solely used. Approximately 40,000 children worldwide experience stroke annually, often with initial signs missed, leading to delayed diagnosis. Pediatric stroke can present similarly to adult stroke but also in nonspecific ways, mimicking other childhood diseases, making early recognition and intervention crucial. Evaluation by trained medical professionals is essential.

Use of Pulse Oximetry in First Aid: The 2024 guidelines recommend that first aid providers primarily use physical examination and history to assess an ill or injured person. The guidelines warn of limitations of pulse oximetry results without a complete patient assessment.

Significance: Home pulse oximeters have increase in use since the COVID-19 pandemic. First aid providers should rely on foundational assessment skills and avoid over-reliance on technology, considering factors like chronic respiratory disease, nail thickness, heart rhythm, environmental conditions, and skin pigmentation that can affect pulse oximeter accuracy.

Bee and Wasp Stings: The 2024 guidelines for bee, wasp, and hornet stings emphasize immediate self- administration of an epinephrine autoinjector for anaphylaxis, with assistance from a first aid provider if needed, and activating the emergency response system. Stings to the eye require medical evaluation. Prompt removal of stingers, washing the area with soap and water, and using over-the-counter antihistamines, topical corticosteroids, acetaminophen, NSAIDs, and ice packs can help alleviate local symptoms.

Significance: Bee and wasp stings are common, with anaphylaxis causing about 60 deaths annually in the US, highlighting the importance of first aid training for both minor and severe reactions.

Ticks: The 2024 guidelines recommend consulting a healthcare professional within 72 hours after removing an engorged tick in geographic regions with high Lyme disease prevalence. Immediate removal of the tick is advised, using tweezers or a tick removal device to grasp the head close to the skin and pull upward with steady pressure.

Significance: With over 48,000 annual diagnoses of tick-borne illnesses in the United States and increasing tick geographic ranges, early and proper tick removal within 24-48 hours is crucial to prevent Lyme disease transmission and minimize infection risk.

Spider Bites and Scorpion Stings: The 2024 guidelines recommend calling emergency services if the person bitten by a spider or stung by a scorpion develops systemic symptoms such as difficulty breathing, muscle rigidity, dizziness or confusion. Medical care should be sought if pain extends beyond the bite/sting site, becomes severe, is not controlled by over-the-counter pain medications or if an open wound develops. Over-the-counter acetaminophen, NSAIDs, topical lidocaine (if the skin is intact), and ice can help alleviate local pain from scorpion stings.

Significance: Black widow and brown recluse spider bites, as well as bark scorpion stings, can cause severe symptoms, highlighting the importance of proper first aid measures for these insects.

Snake Bites: The 2024 guidelines recommend activating emergency services for any venomous or possibly venomous snakebite. Rest and immobilize the bitten extremity, remove constricting objects and avoid exertion if it doesn’t delay medical care. Ice, suction, electric shock, tourniquets and pressure immobilization bandaging are potentially harmful. These recommendations are specific to North American snakes.

Significance: Approximately 8,000 to 10,000 people are treated for snakebites annually in the United States, mostly from rattlesnakes, copperhead, and cottonmouths. These snakes cause tissue injury and other severe symptoms whereas coral snake bites can cause paralysis. Antivenom is the definitive treatment and must be administered by a healthcare provider.

Jellyfish Stings: The 2024 guidelines recommend that first aid providers observe a person with a jellyfish sting for systemic reactions and call emergency services if there are signs of difficulty breathing, shock or severe pain. Tentacles should be removed by lifting or pulling without manual contact or by rinsing with seawater if mechanical removal isn’t possible. After tentacle removal, non-scalding hot water immersion or a heat source can relieve pain, and topical lidocaine may be used if hot water is unavailable.

Significance: The guidelines emphasize removal of the tentacles and pain control, noting that many traditional remedies lack consistent positive data.

Poison Ivy, Poison Oak, and Poison Sumac: The 2024 guidelines for managing exposure to poison ivy, oak and sumac emphasize immediate washing of the exposed area with soap and water or a decontamination product. Cool compresses and oatmeal baths may help relieve local symptoms, though the effectiveness of over- the-counter topical steroids and antihistamines remains uncertain.

Significance: Contact dermatitis from these plants is common, affecting millions annually, with 50% to 75% of individuals reacting to urushiol, the allergenic compound in the plants. Early decontamination can mitigate symptoms, and while the benefit of over-the-counter remedies is unclear, they may still be worth trying for symptom relief.

Suspected Foreign Body in the Eye: The 2024 guidelines recommend seeking immediate medical attention for high-velocity or penetrating eye injuries, irregular pupils, eye bleeding, vision loss or persistent foreign-body sensation. Contact lens users who suspect there is a foreign body in the eye should remove the lens and seek care. Avoid rubbing the eye and use a hard plastic shield to prevent touching. For low-energy foreign bodies (e.g., dust, dirt, other object blown into the eye by wind; eyelash in the eye), use natural tears or irrigate with water or eye wash solution and consider over-the-counter pain relief.

Significance: Eye injuries are common in emergency departments, often due to foreign bodies, and proper first aid can manage low-energy injuries.

Nosebleed: The 2024 guidelines recommend sitting with the head slightly forward and pinching the nostrils for 10-15 minutes to manage a nosebleed. If bleeding persists beyond 15 minutes or if the person becomes lightheaded, medical attention should be sought. Medical care is also advised for nosebleeds due to trauma, especially with signs of brain injury, nasal deformity or facial fracture. Those on anticoagulants, antiplatelet medications or with blood- clotting disorders should seek professional care if bleeding doesn’t stop. The effectiveness of ice for managing nosebleeds is unknown.

Significance: Nosebleeds are common, responsible for 1 in every 313 ED visits in the US. They are often manageable with simple first aid, but can be serious, particularly in older adults and those on blood thinning medications.

Recognition of Stroke in Adults: The 2024 guidelines recommend immediately activating emergency medical services if stroke is suspected. Using a stroke recognition scale like Face, Arms, Speech, Time (FAST) or Cincinnati Prehospital Stroke Scale (CPSS) is advised to help identify acute stroke in adults. First aid providers may measure capillary blood glucose in suspected stroke cases if it doesn’t delay emergency services activation.

Significance: Stroke is a critical, time-sensitive emergency affecting 800,000 people annually in the United States, and new data shows that FAST and CPSS can be effectively used by first aid providers and the public, especially with EMS telecommunicator guidance.

Use of Bronchodilators in Asthma: The 2024 guidelines recommend that first aid providers assist a person with asthma in using their prescribed bronchodilators, preferably with a spacer or nebulizer. If a commercial spacer is unavailable, an improvised spacer can be used.

Significance: These updated guidelines strengthen the recommendations to use spacers, including improvised ones (e.g. from a beverage bottle), to enhance the effectiveness of bronchodilator medication during an asthma attack.

Seizures: The 2024 guidelines recommend activating emergency medical services for first-time seizures, seizures lasting more than 5 minutes, multiple seizures without returning to baseline, seizures in water or those with traumatic injuries, difficulty breathing or in infants under 6 months and pregnant individuals. First aid providers should help the person to the ground, place them on their side, clear the area and stay with them. Restraint and putting anything in the mouth should be avoided. For febrile seizures in children, antipyretics (e.g., acetaminophen, ibuprofen, or paracetamol) are not effective in stopping or preventing seizures.

Significance: Seizures are common, with almost 3 million US adults living with epilepsy and febrile seizures occurring in 2% to 4% of children. First aid providers play a crucial role in protecting individuals during seizures and calling EMS when necessary.

Open Chest Wounds: The 2024 guidelines state that an open chest wound is a medical emergency requiring immediate activation of the emergency response system. It is reasonable to leave the wound exposed to air, use a clean nonocclusive dressing (e.g. dry gauze), or a specialized vented chest seal. Care must be taken to avoid partial or complete blockage if a nonocclusive dressing is used for active bleeding. First aid providers should monitor for worsening breathing if a dressing is applied and loosen or remove it if necessary.

Significance: The guidelines provide expanded guidance for the management of open chest wounds. The goal of sealing an open chest wound is to increase air flow resistance through the wound without causing a tension pneumothorax to form. The guidelines review the literature about chest seals, including animal studies and simulation studies.

Hypothermia: The 2024 guidelines recommend protecting a person with hypothermia from further heat loss by moving them to a warm environment, removing saturated clothing, and allowing passive rewarming with blankets or active rewarming if available. If immediate relocation is not possible, insulate the person from the ground, cover their head and neck, and shield them from wind with a plastic or foil layer. Rewarming devices should be used according to manufacturer instructions, with insulation between the heat source and skin, and frequent monitoring for burns. For those with decreased responsiveness, activate emergency services and rewarm by any available method. High-calorie foods or drinks are recommended for alert individuals with mild hypothermia.

Active rewarming through damp clothing using the “hypothermia wrap” technique is reasonable if the person cannot be moved to a warm environment.

Body-to-body rewarming is not recommended over other techniques like chemical heat packs or forced air systems. Small chemical heat packs are ineffective as the primary rewarming method. Avoid applying heat sources, rubbing, or massage to extremities, and do not use warm showers or water immersion for those with moderate to severe hypothermia due to risks of core temperature drop, injuries from potential falls and other complications.

Significance: Hypothermia is a serious emergency, responsible for about 1,300 deaths annually in the United States, and the guidelines draw from extensive research to provide comprehensive first aid recommendations.

Frostbite: The 2024 guidelines for frostbite recommend rewarming frostbitten tissue using clean lukewarm water immersion at 37–40 °C (99–104 °F) as soon as possible, provided there is no risk of refreezing. If this is not feasible, allow spontaneous rewarming in warm room air or next to the person’s own warm skin. Prompt medical attention is advised, and jewelry or constricting materials should be removed. Core rewarming should precede frostbite treatment in cases of moderate-to-severe hypothermia. Protect frostbitten tissue from further injury, avoid walking on frozen feet, and apply bulky, clean, dry gauze or sterile cotton dressings. Ibuprofen may help prevent further tissue damage and treat pain, but removing dead or damaged tissue is not recommended.

Significance: Frostbite can cause permanent tissue damage and limb loss, with treatment varying by setting to prevent rewarming and refreezing injuries. The 2024 guidelines for frostbite first aid greatly expand the detail in these recommendations.

Oral Rehydration of Exertional Dehydration: The 2024 guidelines recommend that first aid providers assist or encourage individuals with exertional dehydration to rehydrate orally with any available rehydration drink or potable water, provided there is no shock, confusion or inability to swallow. If available, a 4% to 9% carbohydrate- electrolyte drink is preferred.

Significance: Updated based on new information demonstrating that fluid from 4% to 9% carbohydrate- electrolyte drinks is generally retained better than other oral rehydration options such as 0% to 3.9% carbohydrate-electrolyte drinks, coconut water, potable water or low-fat cow’s milk.

Care of Thermal Burns After Cooling: The 2024 guidelines recommend that individuals with full-thickness burns, partial-thickness burns larger than their palm or burns involving the face, hands, feet, or genitals seek prompt medical evaluation. Emergency services should be activated for smoke inhalation injuries, such as facial burns or difficulty breathing. While awaiting professional evaluation, loosely cover burns with intact skin or blisters with a clean cloth or non-adherent dressing. Jewelry and tight items should be removed from burned areas. For small partial-thickness burns managed at home, apply petroleum jelly, antibiotic ointment, honey or aloe vera with a clean, non-adherent dressing after cooling and over-the-counter pain medications can be given.

Significance: These updated recommendations emphasize best practices for minor burn treatment and wound healing, including the use of topical therapy that creates a good environment for wound healing.

Dental Avulsion: When a permanent tooth is knocked out, initial actions include briefly rinsing the tooth to remove visible debris, taking care not to damage it or any attached tissue and attempting to replant it in the socket. If replantation is not possible, the person should seek immediate dental or medical care and bring the tooth with them.

If the tooth cannot be immediately replanted, it should be stored in Hanks’ Balanced Salt Solution (HBSS), oral rehydration salt solutions, propolis, preprepared rice water or wrapped in cling film to prevent dehydration. If these are unavailable, cow’s milk or the person’s saliva can be used. As a last resort, another person’s saliva, probiotic media, egg white or almond milk may be considered. Tap water should not be used for storing an avulsed tooth.

Significance: The 2024 guidelines emphasize the importance of these storage media (in order of most to least effective) to preserve the periodontal ligament cells for the best chance for successful reimplantation.