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Tibial stress fracture

August 21st, 2015 | Posted by corinne grace in Skeletal Injuries - (Comments Off on Tibial stress fracture)

A tibial stress fracture is a condition where there is an incomplete crack found in the lower leg bone or shin bone. When engaging in weight bearing activities such as running, severe force is placed on the tibia and several muscles that are connected to the tibia. When they contract, a pulling force is being exerted on the bone. Forces that are excessive, repetitive and beyond the capacity of the bone can gradually cause damage. With continued damage, it can result to a tibial stress fracture. Stress fractures require proper treatment in order to avoid further damage.

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Causes of tibial stress fractures

  • Running long distance that causes fatigue in the muscle as well as puts stress to the bone and cause a fracture.
  • Excessive weight-bearing on the bone caused by continuous contraction of the muscles such as in running.
  • Changes in the training regime such as running on uneven surfaces after running on even surfaces such as road or grass.
  • Repetitive stress or impact that is subjected to the bone can result to a fracture.
  • Other causes such as bad foot posture, strenuous training, poor biomechanics, stiffness of the joints, ill-fitting footwear, weakness or fatigue, unequal length of the legs, irregularity of menstruation and obesity
  • Poor eating habits
  • Individuals who have flat feet and high arches face a higher risk of developing stress fractures in the shin bone.

Symptoms of a tibial stress fracture

Tibial stress fracture

Severe pain that becomes worse when engaging in activities and minimized when resting.

An individual suspected with a tibial stress fracture usually have the following signs and symptoms.

  • Severe pain that becomes worse when engaging in activities and minimized when resting.
  • Pain can be felt in the outer area of the lower third tibia
  • The affected area is swollen
  • There is difficulty in walking along with pain
  • The individual experiences pain during night time and while at rest
  • Pain can be felt when pressure is applied to the shin.

Treatment and home remedies for a tibial stress fracture

  • Encourage individual to rest for at least 8 weeks. Avoid engaging in any weight-bearing exercises such as running. Running in water with a buoyancy aid or belt can be done instead of running in the road.
  • Apply an ice pack for 10 minutes at a time in order to minimize swelling and pain for 3-4 times every day.
  • If the cause of the fracture is caused by changes in training, these activities should be avoided in the future.
  • Using crutches can help avoid full weight bearing.
  • Massage the affected area.
  • Gradually return to training and sports.
  • Perform exercises that maintains strength and flexibility in the lower leg such as light calf raises if there is no pain felt and also perform exercises in the wobble balance board
  • Use appropriate footwear for any activity engaged in.
  • Maintain proper nutrition in order to keep the bones strong as well as eat foods rich in calcium and other nutrients.

First Aid for Wrist Sprain

July 5th, 2015 | Posted by Mikha Canon in Skeletal Injuries - (Comments Off on First Aid for Wrist Sprain)

A wrist sprain is a common injury that usually occurs when an outstretched hand is used to break a fall or a hard impact. This stress on the ligaments of the wrist that connect it to the bones of the hand may be overstretched or in more severe cases, partially or completely tear off. A ligament is a tough fibrous connective tissue that provides stability to the wrist joint and thus, explains the loss of function or the limited range of motion of the wrist experienced after injury. The most commonly injured ligament is the ligament that connects the scaphoid bone to the lunate bone, which are the two small bones found in the wrist. This ligament is otherwise known as the scapho-lunate ligament.

A wrist sprain is usually common in athletes such as basketball players, volleyball players, gymnasts and skaters just to name a few. A direct blunt force trauma to the wrist may also cause this injury.

Signs and Symptoms of a Wrist Sprain

A wrist sprain often presents with acute pain with some reports of hearing a popping sound upon the moment of injury. Other signs and symptoms are as follows:

  • Swelling and tenderness of the wrist
  • Bruising of the skin around the wrist
  • Inability to achieve full range of motion
  • Pain that is exacerbated when the wrist is moved

Grading of a Wrist Sprain

Grading of a wrist sprain depends on the extent of the injury on the ligaments. The grading is as follows:

  • Grade 1 – the ligaments are overstretched with or without minor damages to the fibers of the ligament but are not torn. This often presents with minimal tenderness and swelling.
  • Grade 2 sprain – a partial tear in the ligament that present with abnormal laxity of the wrist joint, moderate tenderness and swelling and decreased range of motion
  • Grade 3 sprain – a complete tear in the ligament that present with severe tenderness, swelling and loss of function

First Aid Treatment of a Wrist Sprain

Treatment of a wrist sprain will depend on the grading of the injury. A grade 1 sprain or even some grade 2 sprain may resolve with first aid and home remedies. The following can be done:

Apply ice on a wrist sprain to reduce swelling

Apply ice on a wrist sprain to reduce swelling

  • Rest – immobilize and rest the injured wrist for at least 2 days. A splint may be used if necessary
  • Ice – apply ice compress over the injured area for 2 to 3 times a day for at least 10 minutes
  • Compress – a compression bandage can ease the swelling
  • Elevate – elevate the injured wrist above the heart while sitting or lying down
  • Non-steroidal anti-inflammatory drugs such as ibuprofen or aspirin can help ease the pain and swelling
  • Physical therapy or occupational therapy may also be recommended to restore mobility and to strengthen the wrist

 

For more severe injuries, such as a grade 3 sprain, surgery may be required in order to repair the detached ligament. This is followed by physical rehabilitation in order to strengthen the wrist and regain full range of motion.

To learn how to properly give first aid on wrist sprain, enroll in First Aid Courses.

A wrist sprain occurs when the ligaments found in the wrist are stretched beyond its limits producing pain, discomfort and in more severe cases, loss of function.

Wrist stress fracture

June 26th, 2015 | Posted by corinne grace in Skeletal Injuries - (Comments Off on Wrist stress fracture)

Stress fractures are small cracks in the bone that are caused by overuse and repeated use of force. These fractures usually occur in the lower leg and the bones of the foot. Among runners, the bones in their legs and feet carry most of the weight, thus long repetitious exercises such as jogging can cause stress fractures. In some cases, stress fractures can also occur in the wrists.

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A stress fracture is an injury where the muscles are exhausted due to repeated physical stress. These tiny cracks in the bone are called stress fractures. Individuals who play tennis, gymnastics, basketball and diving face the highest risk of overusing their wrist, thus they can suffer from wrist stress fractures. There are eight tiny bones in the wrist and a hairline crack can happen in any of these bones.

A hairline crack found in the wrist usually occurs among women above the age of 40 years old or in menopausal women. Even women who play sports and athletes are also prone to stress fracture of the wrist due to eating disorders such as anorexia, osteoporosis and irregular menses.

Wrist-stress-fracture

The pain becomes worse when moving the wrist joint or working on certain activities such as writing or holding an object.

Symptoms of a stress fracture

  • Pain in the joint of the wrist when there is hairline fracture. In a severe stage, the pain is sharp and gradually reduces and becomes dull and achy. The pain becomes worse when moving the wrist joint or working on certain activities such as writing or holding an object.
  • Bruising in the wrist area is the next common symptom. This occurs due to a leak in the blood vessels of the bone or other tissues. In most cases, the bruise appears bluish or greenish in color. After a few days, the color turns black and will remain for a few days and then steadily vanish.
  • There is swelling of the joint of the wrist and palm that can be seen in hairline fractures of the wrist joint. This occurs due to the inflammatory reaction of the bone and the tissues.
  • There is accumulation of fluids in the first two days of the injury.
  • A tingling or loss of sensation on the affected area.
  • A limited movement of the joint of the wrist.

Treatment and home remedies of stress fracture of the wrist

  • Rest the affected wrist at least three weeks and avoid activities that cause stress fractures of the wrist.
  • Apply an ice compress over the affected area since this helps in minimizing the swelling and pain.
  • Apply a compression bandage, splint or a cast since these can help promote faster recovery from cracks of the hairline.
  • Elevate the wrist in order to minimize swelling for the first two days.
  • Drink warm milk that is mixed with a teaspoon of turmeric powder every day to promote faster healing.
  • Eat foods that are rich in calcium during this period in order to strengthen the bones and accelerate the callous formation.

Buckle fracture of the wrist

March 6th, 2015 | Posted by corinne grace in Skeletal Injuries - (Comments Off on Buckle fracture of the wrist)

Torus fracture is also called as a buckle fracture and it occurs when one side of the bone is pushed in and the other side of the bone is bending out but will not cause a break in the bone. Children and older people are more susceptible to torus fracture and it occurs in any bones of the body but it usually affects the long bones such as the radius, ulna, humerus or femur. The recovery from a buckle fracture is quick compared to other fractures where the recovery takes months.

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Causes of buckle fracture

Fractures can happen due to a variety of mechanisms, sudden trauma or fall or it can be caused by some conditions such as cancer. The inclinations of some people by putting out their arms in order to break a fall can lead to a buckle break in bones, especially in the radius and the ulna.  Sometimes, a break can also be caused by blunt force trauma or accidents.

Buckle fracture of the wrist

Difficulty in moving or using the injured part of the body

Symptoms of buckle fracture

  • There is warmth that is accompanied by bruising or redness in the affected areas.
  • Pain and swelling of the affected area
  • Difficulty in moving or using the injured part of the body

The young and the elderly are most susceptible to buckle fractures because their bones are still soft and more likely to break due to diminished flexibility. Buckle fractures usually occurs when a child falls and lands with an outstretched arm. Among the elderly, osteoporosis can be a cause of an increased risk of having a fracture. Good nutrition is the key in ensuring bone health and strength.

A buckle fracture can cause the forearm bones to be compressed creating a “buckle” or a bump that can be found in the dorsal surface of the bones that can be seen on an X-ray and the opposite side of the bone is normal.

Treatment and home remedies of buckle fracture

With a buckle fracture, the affected arm can be put in a cast for at least 4-6 weeks. Some individuals prefer splinting of the wrist in order to protect the bones and keep them in place while they are healing.

  • Elevate the affected area above the level of the heart in order to minimize swelling and pain.
  • Place an ice pack or ice placed in a plastic bag that is wrapped in a towel. Leave the ice pack on the affected area for 15-20 minutes at least 3-4 times a day for 2-3 days.
  • If the affected area has plaster or fiberglass cast, you have to keep the cast rested on a pillow for the first 24 hours until fully hardened and instruct the individual to avoid scratching the skin under the cast using sharp objects. Check the skin under the cast every day. You can apply a lotion on any red or sore areas and always keep the cast dry and clean.
  • If the affected area has plaster splint, the individual should wear the splint as directed. Loosen the elastic found around the splint if the fingers become numb, there are tingling sensations or the fingers turn bluish in color.
  • Avoid putting pressure on any part of the cast or splint since it might break.
  • Take over-the-counter or prescribed medications to ease the pain.

If you want to properly manage the symptoms of a buckle fracture, all you have to do is enroll in a class on first aid today.

How to treat a broken arm

January 30th, 2015 | Posted by corinne grace in Skeletal Injuries - (Comments Off on How to treat a broken arm)

A broken arm is when one or more of the bones found in the arm are cracked and common in children and adults. The arm consists of three major bones. The humerus starts at the shoulder up to the elbow which is called the upper arm. At the elbow, the humerus is connected to two bones – radius and ulna. These are found from the elbow to the wrist which forms the forearm.

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Causes of a broken arm

Any injury to the arms that results to broken bone can be caused by falls and direct trauma.

A fall that will result into a fracture happens when falling on an outstretched hand. The fracture can occur from the wrist up to the shoulder and depends on the direction of the fall, age of the individual and other factors and stresses placed on the bone.

A direct trauma can be a direct blow from an object such as a bat, vehicular accident and other forces that causes a direct force on any part of the arm.

Broken arm

Any injury to the arms that results to broken bone can be caused by falls and direct trauma.

Symptoms of a broken arm

  • There is evident swelling
  • Pain that becomes severe when the affected arm is moved
  • Deformity of the affected arm
  • An open wound maybe caused by a bone that pierces through the skin or there is a cut in the skin during the injury.
  • Decreased sensation or there is difficulty in moving the limb which may indicate nerve damage.

Severe symptoms

  • There is large amount of swelling or deformity of the affected arm if compared to the opposite arm.
  • Diminished functionality of the affected arm and there is pain when it is pressed
  • Pain that cannot be relieved by application of ice and pain medications such as acetaminophen.
  • There is bone sticking out of the skin along with heavy bleeding from an open wound
  • Lack of sensation or movement on the affected arm
  • Loss of consciousness

Treatment and home remedies

  • Stabilize the affected arm by using a towel as a sling. Place it under the arm and then around the neck. By preventing the arm from moving, place rolled newspaper along the area that is swelling and tape it in place.
  • Apply an ice compress on the injured area in order to minimize pain and swelling for 20 to 30 minutes at a time. Place a towel between the ice compress and the skin to prevent it from getting too cold. Avoid placing ice directly to the skin. You can learn more about cold therapy by enrolling in a first aid course.

Preventive measures

  • Wear seat belts when riding a vehicle, use wrist guards when skating and skateboarding as well as use appropriate pads when playing contact sports in order to prevent fractures.
  • Prevent and treat conditions such as osteoporosis which is a disease that causes loss of bone in older women since it can increase to risk for fractures as they age.

How to treat a dislocated finger

December 26th, 2014 | Posted by corinne grace in Skeletal Injuries - (Comments Off on How to treat a dislocated finger)

A dislocated finger is a common injury among athletes. The fingers become dislocated when the bones are moved from the usual position, but a finger can become dislocated at any point and happens in the knuckle found in the middle of the finger.

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Dislocated fingers can be a result of accidents like a person may fall and attempts to break the fall with an outstretched hand. Players of basketball experience dislocated fingers if the ball hits them in their fingertip when trying to catch or rebound it. Baseball players sustain dislocated fingers when the baseball hits them on exposed fingertips. As for football players who make tackles are at high risk of dislocated fingers because the fingers can be bent in an awkward manner or be caught in a pad or jersey.

Dislocated finger

Pain is the initial symptom of a dislocated finger.

Pain is the initial symptom of a dislocated finger. The finger may look crooked along with swelling and it can be bent at an odd angle or straight up. A severe dislocated finger causes numbness or tingling sensations and the fingers becomes pale. A dislocated finger that breaks through the skin will require an immediate medical attention. If you want to properly manage this injury, read here.

Treatment of a dislocated finger

  • Watch for symptoms of swelling or joint pain immediately after the accident
  • Separate the area and prevent additional movement by using splints that can be made out of newspapers, magazines, sticks or anything on hand. Do not try to realign the bones by yourself since this can cause further injury to the affected area.
  • Apply ice compress to the affected area immediately and elevate the affected area in order to reduce swelling and pain.
  • Take acetaminophen or ibuprofen for pain relief
  • Seek the help of a physical therapist regarding range-of-motion exercises in order to restore the range of movement and the strength.
  • Avoid eating foods or drinking fluids before the treatment in order to prevent aspiration of foods or liquids into the lungs when the person is sedated.

Exercise for a dislocated finger

  • Stand over a table or against a wall with the palm facing downward and fingers spread. Press the hand against the flat surface and hold for five seconds. Repeat the procedure for ten times for a single set at least three times a day.
  • Curl the fingers into the palm of the hand to make a fist. If the dislocated finger cannot move, utilize the unaffected finger when moving the dislocated finger to make a fist. Hold the fist position for five seconds and repeat the procedure ten times for a single set at least three times a day.
  • Wrap the fingers around the sides of a tennis ball and then squeeze the ball with the hand and fingers as hard as the person can squeeze for five seconds then relax the hand. Repeat the procedure ten times for a single set at least three times a day.

Treating a broken shoulder blade

August 13th, 2014 | Posted by corinne grace in Skeletal Injuries - (Comments Off on Treating a broken shoulder blade)

A shoulder blade is a flat, large triangular-shaped bone at the rear part of the shoulder, and is also known as the scapula. The shoulder blade is positioned over the second up to the the seventh rib on each side of the back, and it is a component of the pectoral girdle that helps connect the arm to the chest area. It connects the humerus which is the arm bone, with the clavicle, known as collar bone. The scapula has a large area for muscle attachment. There are 18 muscles that are attached to the scapula; they are attached either by insertion or by origin points. The injuries to these areas are in the form of pulled muscles, due to a large number of muscles that are attached to it. If a scapula is injured or broken it is a severe sign of trauma.

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A broken shoulder blade can be caused by direct pain that involves a large amount of force or violence. There are common causes of a broken shoulder blade:

  • Vehicular accidents
  • Falling from a tree or anywhere that hits your shoulders
  • Falling onto an outstretched arm
  • A direct pain from a baseball bat or hammer or anything hard that hits your shoulders

Symptoms of a broken shoulder blade

  • There is swelling, pain and bruising over the shoulder blade
  • There is pain in moving the arm
  • Difficulty in lifting the arm
  • There is pain with each breath caused by the movement of the chest wall with each breath, and this movement makes the shoulder blade to move and causes pain
  • The shoulders looks flattened and deformed
Shoulder blade

A broken shoulder blade can be caused by direct pain that involves a large amount of force or violence.

Treatment of broken shoulder blade

  • First thing to do is to control the bleeding. If there is bleeding, apply steady and direct pressure with a clean cloth or bandage for 15 minutes. If the blood seeps through the cloth, put another cloth over the first.
  • Make a sling to support the affected arm, put a triangular bandage beneath it and over the unaffected shoulder, and then tie it adjacent to the neck.
  • Treat the symptoms by applying ice to the injury to relieve pain and inflammation.
  • Provide the individual with over-the-counter pain reliever acetaminophen (Tylenol) for relieving pain.

Prevention

Aside from the first aid measures that you can perform, there are ways to prevent the injury from occurring in the first place.

Broken shoulder blades can be prevented by avoiding activities like:

  • Activities with dangers in causing a fall like rock climbing, hand-gliding, or skydiving
  • Contact sports like football, baseball, and basketball
  • Driving a vehicle without seatbelts

A physical therapy for a broken shoulder blade is very important because it helps regain the mobility of the joints, and preventing condition like “frozen shoulder” from happening. It also helps strengthen the shoulder and preventing future injuries and will restore proper mobility in the areas of the arm.

First Aid for Fractured Hips

February 13th, 2014 | Posted by vanfirstaid in Skeletal Injuries - (Comments Off on First Aid for Fractured Hips)

Hips contain socket and ball joint that allow great rotation which makes it possible for the legs to bend and rotate. The hips act as the most used body parts and any impact can result to a break also referred as fracture. This is a serious condition that requires surgery for treatment. Here are some tips for effective first aid for fractured hips.

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Best Practices for Fractured Hips First Aid

Supporting victim with fractured hips

Supporting victim with fractured hips

Hip fractures are more common to old people because of the weak bones as a result if aging. However, this is not to mean that young people to do not suffer from this problem. The first thing you need to do is to call for emergency when it occurs. You can call 911 or any other emergency service provider you know. Never try to move the patient as this may make the condition worse. As you make the call, let the operator understand what happened and describe the condition of the patient. In most cases, an effective operator will give you instructions. Ensure you follow all the instructions carefully and never deviate. Let the patient feel comfortable and if it is possible, place something soft such as a pillow or cushion under the head. One of the mistakes, you should avoid is to give drinks or food. Most of the victims of fractured hips will look pale and weak but giving them food or drink will make the surgery process complicated.

If you are a certified first aid provider, you may move further by immobilizing the limbs. You do this to the legs by use of thick layers of soft materials, for example, towels and hold them using heavy objects. Pad the victim from above the hips as you go down the knee. It is important to check for any symptoms of shock for the victim. This is a fatal and the earlier treatment increases chances of recovery and survival. Some of the signs that can show you that the patient is in shock include weak pulse, weak breathing, vomiting and excessive sweating. Help the victim remove any tight clothing, keep the patient warm and try to calm him or her down. To ensure that he remains conscious, provide a lot of fresh air and keep talking to him.

Don’ts for Hip Fracture First Aid

Do not try to offer first aid for fractured hips if you are not trained because this may make the condition more complex. Ensure that there is no movement as the patient should remain calm until the emergency help arrives.

Elbow dislocation

February 7th, 2014 | Posted by corinne grace in Skeletal Injuries - (Comments Off on Elbow dislocation)

Elbow dislocation occurs once the surfaces of the joint are separated and can be partial or complete. A complete dislocation takes place if the surfaces of the joints are separated completely. As for the partial dislocation, the surfaces of the joints are only separated incompletely.

Causes of elbow dislocation

Dislocations of the elbow are not quite common and they typically take place once an individual falls with the hands outstretched. The moment the hand strikes a hard surface, the force is sent directly to the elbow and there is usually a turning motion from this force that can rotate or drive the elbow out from its socket. This injury can also occur during vehicular accidents if the individual reaches forward to suppress the impact.

In a simple elbow dislocation, no major bone injury is incurred while a complex elbow dislocation involves severe ligament and bone injuries. In worst cases, the nerves and blood vessels throughout the elbow can be affected. In such cases, there is a possibility that the arm will be removed. Individuals who inherently have laxness in their ligaments are at risk for dislocation.

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Signs and symptoms of a dislocated elbow

If there is complete dislocation of the elbow, it is very painful and the affected arm has an odd twist at the area of the elbow. As for a partial dislocation, it is difficult to detect and usually occurs right after an accident. Due to the partial dislocation, the bones have the possibility to relocate in a spontaneous manner while the joint appears normal. In some cases, pain and bruising is present either inside or exterior the elbow.

How an elbow dislocation is diagnosed

Once a doctor is consulted, the affected arm is examined for swelling, tenderness an

d deformity. The skin will be assessed and the circulation in the arm while the pulses at the wrist are checked. In case an artery is damaged, the hand is cool to the touch or exudes a purple or white hue.

X-ray is required to determine if the bones are damaged and can define the direction of the dislocation. This diagnostic exam can confirm if the elbow is dislocated. A CT scan is performed if the damage is difficult to identify on the X-ray.

How elbow dislocations are treated

elbow dislocation

A dislocated elbow can cause pain.

Dislocations of the elbow must be considered as an emergency. The main

objective of immediate care for an elbow dislocation is to restore the elbow to its proper alignment while the long-term objective is to restore functionality to the affected arm.

The normal alignment of the elbow is restored in an emergency room in

any hospital. Prior to the procedure which is called reduction maneuver, pain medications and sedatives are administered. The procedure is performed in a slow and gentle manner.

For minor elbow dislocations, it can be treated by immobilizing the elbow

using a sling or splint for 2-3 weeks and followed with motion exercises. Take note that if the elbow is not exercised for an extended period, it can affect its range of motion. Always remember that physical therapy is needed during the recovery period.

When the Bones are Dislocated, It is Time to Get MedicatedCarmel was in Spain for an official business trip when she dislocated her right thumb. She was alone in her hotel room when decided to take a bubble bath after a full day of meetings and sightseeing.  Her foot was already inside when she realized that she forgot her iPod so she quickly rushed to get it from her luggage. Her foot wet the marble floor or her bathroom but she didn’t mind it much. On her way back to the tub, she slipped and tried to save herself by landing on her right hand. This quickly turned into one of her most painful experiences. Although Carmel was relatively thin, the body weight caused her thumb to bend the wrong way, thus causing its dislocation.

When the bone has been forcibly moved from its normal position at the joint, a dislocation occurs. When the two ends of bones are displaced from their normal positions, the bones become dis or “apart” or location or “a place of settlement or activity,” hence there is a dislocation. A dislocated bone may lead to impairment of ligaments, nerves and blood vessels.

Dislocation usually results from falls, car accidents or collision during contact. The most common dislocation sites are the shoulders and elbows for adults and children, respectively. The larger joints of the body are more prone to dislocation. Nonetheless, the hand’s position makes the thumb susceptible to dislocation when it is bent the wrong way. Due to the dislocation, there will be a momentary dislocation and disable the action of the joint. Swelling and severe pain are some of the symptoms of dislocation.

If treated early, most dislocations will not lead to permanent damage. Therefore, medical attention must be called for immediately.  The victim should not be moved, especially if neck injury is suspected. Only move the victim if there is danger in the immediate surroundings. More so, dislocated bones should not be pushed back to its joint. Moving the bone may result to damaging the joint and its adjacent muscles, ligaments, nerves or blood vessels. Small nerve and blood vessels may be trapped and result to numb digits. Immobilize the injured area.

If one is trained to do so, sling and/ or splint the injury in its original location. Boards, rolled newspaper and numerous other materials may be used as splints. To minimize discomfort, splints may be padded. Slings may be used for arm or shoulder injuries. To reduce swelling and assist in relieving pain, apply ice

on the affected joint. This will control internal bleeding and accumulation of fluids in and surrounding area of the affected joint. Ice must not be directly applied to the skin and should be wrapped in a towel or other pieces of clothing. Check for breathing if injury is serious. If no breathing is observed, commence CPR. Raise the feet one foot. To reduce body heat loss, cover the patient with a blanket.

In most medical emergencies, first aid training and CPR may be applied. Especially athletes and those who work with them should be knowledgeable of proper treatment. workplace approved programs offer first aid training and CPR courses which are offered to the community.