Four emergencies, and the instinct that makes each one worse

Quick answer: Press hard on bleeding and don't lift to check it. Cool a burn under running water for a full 20 minutes. Give abdominal thrusts to an adult who can't cough or speak. Ice and wrap a sprain, and don't walk it off.

Most first aid goes wrong in the first ten seconds, and it goes wrong the same way every time. Somebody does the obvious thing. They peel back the towel to see how bad the cut is. They grab the butter. They hand a choking man a glass of water.

Every one of those feels right. Every one makes it worse. What follows is the right move for each of the four injuries you're most likely to face, in the order you'd actually do it. And you'll almost certainly face them in your own kitchen, your own backyard, with someone you love.

Before you touch anyone

Look first. Is the knife still on the counter? Is the grill still lit? Is the power still on to whatever shocked him? You're no help to anybody if you become the second patient.

Then take charge, out loud. Don't say "someone call 911." Everyone will assume someone else did it. Point at one person: "You, in the gray shirt. Call 911 and tell me when they answer." Specific people do specific things. Crowds stand around.

If you have gloves, put them on. If you don't, a plastic grocery bag over your hand beats nothing. For a longer view of handling the wait, read what to do in the ten minutes before the ambulance arrives.

Bleeding: press, and stop peeking

The wrong instinct is to look. You press a towel on the cut, then lift it after twenty seconds to see if it's working. Each time you lift it, you tear open whatever clot was forming and start over.

Do this instead:

• Press hard. Harder than feels polite. Use a clean cloth, gauze or a T-shirt, and put your body weight behind it.
• Hold it. Ten minutes by the clock, without lifting. Have someone else watch the time, because ten minutes feels like forty.
• Stack, don't swap. If blood soaks through, put another layer on top and keep pressing. Leave the first layer where it is.

That handles almost every kitchen and workshop cut. For a minor one, rinse it under clean running water once the bleeding's stopped and cover it.

Get it looked at if the edges gape open, if it's deep enough to see fat or muscle, if it's on the face, if it was a dirty or rusty object, or if it's still bleeding after ten solid minutes of pressure. Stitches work best when they're done within hours of the injury, so don't sleep on it. If it's been a while since your last tetanus shot, ask the doctor about that too.

When it's spurting or pouring from an arm or leg, pressure may not be enough, and you have minutes. That's what a tourniquet is for. Call 911 first. Place the tourniquet two to three inches above the wound, never on a joint, and tighten until the bleeding stops. It'll hurt him. That's expected. Note the time and tell the paramedics.

A belt doesn't make a good tourniquet. Improvised ones tend to fail because you can't get them tight enough. If you're going to keep one in the truck, buy a real one, like the CAT (Combat Application Tourniquet), and take a Stop the Bleed class so you've put one on before your hands are shaking. Old advice said tourniquets cost people their limbs. Current emergency medicine says they save lives, and the guidance changed for good reason.

Burns: 20 minutes of cool water, and nothing else

The wrong instinct is a home remedy. Butter, ice, toothpaste, mustard, cooking oil. Somebody's grandmother swore by every one of them. Butter and oil hold the heat in. Ice can damage skin that's already damaged.

The burn keeps cooking for a while after the heat source is gone. Your job is to stop that.

1. Get it under cool running tap water. Cool, not ice cold. Keep it there for 20 minutes. Most people quit at two, because it stops stinging. Keep going anyway. That's the part that actually limits the damage.
2. Take off rings, watches and tight clothing near the burn, early, before it swells. If fabric is stuck to the skin, leave it and cut around it.
3. Cover it loosely. Plastic kitchen wrap laid over the top works well, or a clean nonstick dressing. Skip fluffy cotton that'll shed fibers into the wound.
4. Leave blisters alone. They're a sterile bandage your body made for free.

For a chemical burn, brush off any dry powder first, then flush with running water for at least 20 minutes. For an electrical burn, make sure the power is off before you touch him, and get him seen even if the mark looks small. Electrical burns can do damage you can't see from the outside.

Go to urgent care or the ER for any burn bigger than about three inches across, any burn on the face, hands, feet or a major joint, anything that looks white, leathery or charred, and any significant burn on a baby or an older person. A deep burn can hurt less than a shallow one because the nerves are damaged. Don't let that fool you.

Choking: the man who walks away from the table

The wrong instinct isn't really yours. It's his. Choking is embarrassing, so adults get up and walk off to the restroom to deal with it privately. Then they collapse behind a locked door where nobody can help.

If someone at your table stands up suddenly and heads off with a hand at his throat, follow him.

If he's coughing hard, let him cough. A forceful cough clears more than you can. Stay close, tell him to keep coughing, and don't hand him water. Don't pound his back while he's coughing well, either.

If he can't cough, speak or breathe, ask, "Are you choking?" If he nods, act.

• Stand behind him with one foot between his feet for balance.
• Make a fist. Put the thumb side just above his belly button and well below the breastbone.
• Grab the fist with your other hand and pull sharply in and up, like you're trying to lift him.
• Repeat until the object comes out or he passes out.

The American Red Cross teaches alternating five firm back blows between the shoulder blades with five abdominal thrusts. The American Heart Association teaches thrusts alone. Both are recognized methods. Learn one properly and do it with conviction.

For a pregnant woman or someone too large to get your arms around, put your hands in the center of the chest and give chest thrusts instead.

If he goes limp, lower him to the floor, make sure 911 is called and start CPR. If you see the object in his mouth, pull it out. Never sweep blindly with a finger, because you can push it deeper.

If you're alone and choking, call 911 if you can, then thrust your own fist into your upper belly or drive your belly hard against the back of a chair.

Babies under one year are different. Hold the baby face down along your forearm, head lower than the chest, and give five back blows with the heel of your hand. Then turn the baby face up and give five chest thrusts with two fingers just below the nipple line. No abdominal thrusts on an infant. Ever. If you have kids, a class that covers infant CPR is the best afternoon you'll spend this year.

Anyone who got abdominal thrusts should see a doctor afterward, even if he says he's fine.

Sprains: don't walk it off

The wrong instinct is pride. He rolls his ankle on the last step of the deck, says "I'm fine," and spends the rest of the barbecue limping around on it. Or he goes home and puts a heating pad on it, which feels great and makes the swelling worse.

For the first day or two:

• Rest it. Get off it.
• Ice it for 15 to 20 minutes at a time, with a thin towel between the ice and skin, every two to three hours while you're awake. A bag of frozen peas molds to an ankle better than ice cubes do.
• Wrap it with an elastic bandage, snug but not tight. If the toes go numb, tingly, pale or cold, it's too tight. Rewrap it.
• Raise it above the level of his heart. Propped on a chair isn't high enough. Lie down and stack pillows.

Skip heat, massage and alcohol for the first two or three days.

One honest concession: some sports medicine people now question how much ice and anti-inflammatory pills actually help healing, and most agree that resting too long is its own mistake. After the first couple of days, gentle movement within what doesn't hurt usually beats sitting still for two weeks.

Get an X-ray if he can't put weight on it and take four steps, if there's tenderness right on the bony knob of the ankle, if he heard a pop and it swelled fast, if it looks out of shape, or if it isn't getting better after a few days. A bad sprain and a broken bone can look a lot alike from the outside.

The part nobody does

Reading this won't make you good at it. Hands are what learn this, not eyes. Sign up for a Red Cross or American Heart Association first aid and CPR class, and bring your wife or your older kids. A few hours on a Saturday buys you the one thing this article can't: having done it before.

Then, after you ever use any of it, restock the kit before you put it away. The next person to open it deserves a full one.