With the progress and development of society, traffic accidents, work injuries and life accidents occur from time to time, and the incidence of sports system trauma involving extremities and spine is increasing. The survival or death of patients with serious trauma often depends on whether effective treatment can be obtained within a short period of time, so it is important to master the correct on-site first aid skills for the mortality and disability rate of the injured. The purpose of on-site first aid for sports system trauma is to save life, maximize the integrity of tissues and organs, avoid secondary damage, prevent wound contamination, reduce pain, create transportation conditions, and transfer the injured to the neighboring medical institutions as soon as possible so that they can get timely treatment. On-site emergency treatment procedures】 On-site emergency treatment tasks are to quickly evaluate the critically injured, identify and treat life-threatening trauma, perform cardiopulmonary resuscitation if necessary, treat shock and hypoxia, and quickly transport to a suitable hospital. (1) Assess the scene environment: according to the cause of injury, determine whether there are dangerous factors, then quickly and safely approach the casualty, evaluate the injury and then transfer the casualty to a safe area for rescue according to the situation. After taking a census of all casualties, focus on finding and treating the critically injured, and at the same time estimate the ability to treat and seek support. (2) keep the respiratory tract unobstructed: asphyxiation patients should promptly lift the respiratory obstruction and obstruction, the obstruction caused by the back of the tongue, can be immediately ventilated with the oropharyngeal tube, or the tongue out of the fixed; oral foreign body, blood clots, secretions, etc. immediately removed; untie the casualty collar, belt; conditions permit to take a sitting position, otherwise take the lateral or flat supine position head to the side, to prevent mis-aspiration; open pneumothorax for sealed bandages; Cardiopulmonary resuscitation is performed as soon as possible for those whose heartbeat and breathing have stopped. (3) Hemostasis: for massive bleeding should be timely and effective hemostasis, according to the different situations, apply compression, pressure bandage, caulking, tourniquet or anti-shock pants and other methods. For most of the bleeding, generally more bandages with pressure bandages to stop bleeding method. Should prevent the abuse of tourniquets, the application of tourniquets must indicate the time on the tourniquet and have obvious markings. (4) Treatment of shock: In case of shock, anti-shock treatment should be actively carried out, such as intravenous infusion with balanced saline and Lingual fluid to replenish blood volume. At the same time, acupuncture or acupressure points such as Renzhong, Shixuan, Yongquan and Lijiu can be used to improve circulatory and respiratory excitation and the body’s emergency capacity. (5) Treatment of wounds: soft tissue wounds are flushed clean with sterile saline, water or tap water. Large and shallow easy to remove foreign body in the wound, remove as appropriate. Foreign bodies that are deep and small and not easy to remove should not be removed reluctantly. The foreign body pierced into the body cavity or near the blood vessels should be kept in place and should not be pulled out rashly. Tightly bandage the wound to avoid exposure of the wound during transport and increase the chance of secondary infection. (6) Preservation of severed limbs: if the severed tissue is contaminated, rinse it with plenty of saline or water and dry it without sterilization, wrap it with clean dressing, put it in a clean and airtight plastic bag, exclude the air in the bag, tie the bag with a thread, and then put it in a container with ice (do not put it inside the ice to avoid frostbite). Forbidden to use any liquid immersion or placed in ice water. (7) Temporary fixation: limbs with fractures or with severe soft tissue injuries should be splinted or taken in place, and the injured limb should be fixed with cardboard, tree branches, sticks, books, etc. Fixation should extend beyond the joint above and below the wound. In the absence of available items, the upper extremity can be fixed to the chest and the lower extremity to the healthy leg. Suspected cervical spine injury should be fixed with a neck brace, and thoracolumbar spine injury should be carried on a flat or spade stretcher to avoid any twisting of the spine. (8) rapid transfer: after the above treatment, the casualty is quickly transported to nearby medical institutions according to the severity of the injury, the order of transport should be the first transfer of life-threatening, then transfer of open injuries and multiple fractures, and finally transfer of light injuries. The condition should be closely observed on the way, and those with critical vital signs should be rescued in time. The acute hemorrhage is the main cause of early death after injury. Bleeding from a medium caliber vessel injury can cause or aggravate shock. When large arteries bleed, such as carotid artery, subclavian artery, abdominal aorta and femoral artery, death can occur in 2 to 5 minutes. Therefore, when the human body is traumatized, the first priority should be to ensure a clear airway and take immediate and effective hemostatic measures to prevent shock and even death due to acute hemorrhage. (1) Acupressure method: Use fingers, palms or fists to compress the proximal arterial trunk of the bleeding area to temporarily control bleeding. For example, for bleeding in the head and neck, finger pressure can be applied to the temporal artery, jaw artery and vertebral artery; for bleeding in the upper limbs, finger pressure can be applied to the subclavian artery, brachial artery, elbow artery, ulnar and radial arteries; for bleeding in the lower limbs, finger pressure can be applied to the femoral artery, N artery and tibial artery. The acupressure method is an emergency measure, because the arteries of the extremities have collateral circulation, so its effect is limited, and it is difficult to last. Other methods of hemostasis should be used according to the situation. (2) pressure bandage hemostasis method: the most commonly used. General small artery and vein injury bleeding are available to stop bleeding by this method. The method is to fill or place sterile gauze or dressing in the wound, plus gauze pad pressure, and then bandage pressure bandage. The pressure of the bandage should be uniform and the range should be large enough. To moderate control of bleeding and does not affect the wound blood flow as degree. After bandaging the injured limb will be elevated to increase venous return and reduce bleeding. (3) Caulking method: for muscle, bone end and other blood leakage. First use 1-2 layers of large sterile gauze to cover the wound, fill it with gauze strips or bandages, and then bandage it. This method is not thorough enough to stop bleeding, and may increase the chance of infection. In addition, when debridement and removal of the plug, the clot may be removed at the same time as the plug, which may result in larger bleeding. (4) Strong joint flexion to stop bleeding: If bleeding from the forearm and calf artery cannot be stopped, if there is no combined fracture or dislocation, immediate strong flexion of the elbow or knee joint and fixation with a bandage can control bleeding and facilitate rapid transfer to the hospital. (4) Tourniquet method: generally used for extremity injuries bleeding profusely, and pressure bandage can not stop the bleeding situation. When using hemostasis, the contact area should be larger to avoid nerve damage. Tourniquet in the best local inflatable tourniquet, its side effects are minimal. In emergency situations, rubber tubes, triangular towels or bandages can also be used instead. Note when using: ① tourniquet should not be directly ligated on the skin, should first use a triangular towel, towels, etc. to make a flat liner wrapped around the part to be ligated tourniquet, and then on the tourniquet. ② The site of the tourniquet is at the proximal end (above) of the wound. The upper extremity aortic bleeding should be ligated in the upper 1/3 of the upper arm, avoid ligating in the middle 1/3 below the site to avoid injury to the radial nerve; lower extremity aortic bleeding should be ligated in the middle of the thigh. And in the actual work of rescuing casualties, often the tourniquet ligated in a healthy part near the wound, which is conducive to the maximum preservation of the limb. ③ ligature tourniquet should be loose and tight, to stop bleeding or distal arterial pulsation disappears as degree. If the ligature is too tight, it can damage the pressurized local area, and if the ligature is too loose, it cannot achieve the purpose of hemostasis. In order to prevent ischemic necrosis of the distal limb, in principle, the time of using tourniquet should be shortened as much as possible, generally the tourniquet should not be used for more than 2-3 hours, and loosened every 40-50 minutes to temporarily restore the blood supply to the distal limb. While loosening the tourniquet, finger pressure is still applied to stop bleeding to prevent re-bleeding. After the tourniquet is loosened for 1 to 3 minutes, it is re-ligated in a slightly lower plane than the original ligature site. If there is still heavy bleeding or the distal limb is not preserved, it is not necessary to loosen the tourniquet during the transfer. ⑤ After ligating the tourniquet, mark the obvious part with the time of ligating the tourniquet and transport to the hospital as soon as possible. ⑥Release of tourniquet should be done only after blood and fluid transfusion and other effective methods of hemostasis are taken. If the tissue has undergone obvious extensive necrosis, the tourniquet should not be loosened before amputation. The purpose of dressing is to protect the wound, reduce contamination, compress and stop bleeding, fix the fracture, joint and dressing and stop pain. Commonly used materials are bandage, triangular towel and four-headed band. Without the above items, you can use clean towels, wrapping cloth, handkerchiefs, clothes, etc. instead of local materials. A bandage use method (a) ring method will be bandaged for the ring winding, the first circle for the surround slightly oblique, the second circle should overlap with the first circle, the third circle for the ring. The ring method is usually used for limb thickness equal parts, such as chest, limbs, abdomen. (B) spiral reflex method first spiral winding, to be gradually thick place to each circle of the bandage reflex, cover the front circle of 1/3 to 2/3, from the bottom up winding for limb wrapping. (C) spiral method so that the bandage spiral upward, each circle should be pressed in the 1/2 of the previous circle. Apply to the extremities and torso, etc. (iv) 8-letter method This bandage method is a circle up, and then a circle down, each circle in the front and the previous week crossed, and pressed cover the previous circle of 1/2. more with the shoulder, iliac, knee, condyles, etc. outside. When using the above method, fingers and toes without trauma should be exposed to observe the blood circulation such as pain, edema, purple, etc. (E) Back-and-fold method This method is mostly used for head and broken limb end. Use the bandage to fold back and forth several times. The first circle often starts from the center, then each circle a left and a right, until the wound is all wrapped, used as a ring will be folded back the end of the bandage fixed. This method often requires an assistant to press the reflexed end of the bandage when it is reflexed. The elasticity should be moderate. Second, the use of triangular towel method (a) head triangular towel bandage method The bottom edge of the triangular towel is placed at the center of the forehead arch, the top corner of the position to the occiput, and then the bottom edge of the ear to tie tightly pressed top corner, crossed at the back of the neck, and then by the ear to the forehead tightly knotted, and finally the top corner upward reflex embedded in the bottom edge with tape or pin fixed (Figure 17) (b) triangular towel upper limb bandage method The triangular towel laid on the chest of the casualty, the top corner aligned Elbow joint slightly lateral, flex the forearm and press the triangular towel, the bottom edge of the two ends around the neck in the back of the neck knot, the top corner of the elbow reflexion with pins to fasten. Fixation methods】 Bone and joint injuries must be fixed and braked to reduce pain, avoid damage to blood vessels and nerves at the fracture end, and to help prevent shock and transport evacuation. Heavier soft tissue injuries, should also be local fixed braking. Before fixation, pull the injured limb and correct the deformity as much as possible, then place the injured limb in the appropriate position and fix it on a splint or other support (local materials such as planks, bamboo poles, tree branches, etc.). The purpose of emergency fixation is not to reset the fracture, but to prevent the fracture end from moving, so the fracture end that is stabbed out of the wound should not be sent back. The fixation should be done gently, securely, and with the appropriate amount of soft material between the skin and the splint, especially at the bone protrusions and gaps at both ends of the splint, to prevent ischemic necrosis caused by local pressure. (1) Clavicle fracture fixation: two finger-width banded triangles are wrapped around the two shoulder joints and knotted at the shoulder; then the bottom corners of the triangles are stretched tightly respectively, and the bottom corners are stretched tightly and knotted at the back in the case of excessive posterior tension of the two shoulders. (2) Humerus fracture fixation: fix the injured limb with two triangles and a splint, then suspend the forearm with a dovetail triangle in the middle so that the two bottom corners are knotted upward around the back of the neck, and finally use a banded triangle to knot in the axilla of the healthy side via the back of the chest respectively. (3) Elbow fracture fixation: When the elbow joint is bent, the joint is fixed with two banded triangles and a splint. When the elbow joint is straightened, a bandage and a triangular scarf can be used to fix the elbow joint. (3) Radius and ulnar fracture fixation: place a suitable splint under the injured limb, fix the injured limb and splint with two bandage triangles or bandages, then suspend the injured limb with a dovetail triangle, and finally use the two bottom edges of a bandage triangle to tie a knot around the back of the chest and under the healthy axilla respectively. (4) Finger bone fracture fixation: use a popsicle stick or short chopstick as a small splint, and use two pieces of adhesive tape for bonding fixation. If there is no fixed stick stick, the injured limb can be glued; fixed on the healthy limb. (5) Femoral fracture fixation: use a long splint (length of the casualty’s axilla to heel) on the side of the injured limb, and another short splint (length of the perineum to heel) on the inside of the injured limb, and use at least 4 strip triangles to wrap around the injured limb in the axilla, waist, thigh root and knee respectively, paying attention to the protruding parts of the joint to put soft pads. If there is no splint, the injured limb can be fixed to the healthy limb with a bandage or bandage. (6) Tibia and fibula fracture fixation: similar to femur fracture fixation, except that the splint length is slightly longer than the knee joint. (7) Cervical fracture fixation: the injured person lies on his back, pads a thin pillow in the head-occipital department, makes the head into a positive position, the head does not bend forward or backward, and then pads pillow service rolls on each side of the head, and finally fixes the head with a band through the injured post, restricting the head from swaying back and forth. (8)Thoracic and lumbar fracture fixation: make the casualty lie flat on his back on a hard wooden board or other board, pad a thin pillow at the injury to make the spine protrude slightly upward, and then fix the casualty with several straps so that the casualty cannot turn from side to side. (9) Pelvic fracture fixation: place the middle section of a banded triangular towel on the lumbosacral region, tie a knot around the front of the hip to the small abdomen and fix it, then place the middle section of another banded triangular towel on the middle of the small abdomen, tie a knot around the back of the hip to the lumbosacral region and fix it. The purpose of moving is to get the patient out of the danger zone quickly, correct the sick position that affects the patient at that time, in order to reduce the pain, reduce re-injury, and send the patient to the ideal hospital for treatment safely and quickly, so as not to cause disability. Usually more than the use of stretchers or unarmed transport. Wartime fire on the line of casualty handling, must be protected from enemy fire, and often impossible to use the usual handling tools. Carry the wounded available back, clip, drag, lift, frame and other methods. ① back: back casualties creeping forward, or with a back belt plus short wood, so that the casualties ride on it, and then back away. ② clip: clip the casualty, sideways forward. ③ drag: with a coat, raincoat, cloth, etc. wrapped wounded, tethered rope or belt in its armpit, and then dragged away. ④Lifting: two people lifting the casualty with their bare hands. ⑤ frame: local materials made of temporary stretchers, carrying the wounded. Whether in peacetime or wartime, the fracture, especially the spinal injury casualties, handling must keep the injury stable, do not bend or twist. For comatose casualties, handling must keep the airway open, can be used in a semi-prone or lateral position. [Spinal injury field transport] spinal fracture dislocation correct field first aid and transport is particularly important. After a spinal fracture, its strength and stability are greatly reduced, which can easily lead to spinal cord injury. However, some injured people, although the spine has been fractured, but the spinal cord has not been injured, the limbs can still move freely, then, in the first aid scene incorrect first aid and transport, can lead to further damage to the unstable spine, thus leading to or aggravating the spinal cord injury, the limbs can still move, after the wrong first aid and transport but the emergence of difficult to recover the limb paralysis, therefore, the car accident, fall from height, etc. Therefore, for people injured in accidents, such as car accidents, falls from height, etc., when a spinal fracture is suspected, do not move arbitrarily, rescue, handling must be carefully protected to prevent re-injury. The method is as follows: (1) first make the injured person’s two lower limbs straight, close together, the two upper limbs are also straight, stick to the side of the body, the board or hard stretcher placed on the side of the injured person, by three people, standing on the side of the injured person, respectively, with both hands into the back of the patient’s shoulders, waist and hip and the two lower limbs dorsal side, while lifting, maintaining the horizontal position of the spine, to flatten the method or rolling method lightly placed on a hard door board, board or hard stretcher transport. Note that all patients with spinal fractures must lie flat on a hard, straight stretcher and be transported smoothly. The patient should never be carried on the back, cradled or carried with one head and one foot, nor should he or she be carried with the back bowed. Never let the spine bend or rotate, and always follow the “rolling” principle when turning over, that is, the upper and lower body should be rotated at the same time, like rolling a log, to avoid twisting body movements that may damage the spinal cord. Prohibit cradling or one person to lift the head, one person to lift the foot method, because these methods will increase the bending of the spine, aggravating the injury to the vertebrae and spinal cord. At the same time, a thin pillow can be padded at the injury, so that the spine here slightly upward, and then use a few straps to fix the casualty on a wooden board or hard stretcher, so that the casualty can not turn around, move. Generally use 4 straps: thorax, humerus level, forearm waist level, thigh level, calf level, one strap each to tie the casualty to the rigid stretcher. (2) for cervical spine injury casualty, to have a person to support the fixed head, along the longitudinal axis gently traction, maintain the cervical spine in the straight position, so that the head and neck with the torso rolling, or by the casualty’s own hands to hold the head, slowly move. It is strictly forbidden to move the head forcibly. After sleeping on the board, use the neck brace to fix or use sandbags, cardboard, folded clothes, etc. on both sides of the neck to fix.