Save-A-Life September

As part of my New Year's Resolutions this year I decided that I wanted to 'Be Useful', and part of that is sharing my knowledge and skills beyond the Dragon Shed. I have been a member of an organization which provides First Aid training and cover for events for more than a decade - and a trainer for the last 8 years.

What is taught in official courses is obviously much more in depth and involved, but what I have put together here are the main and most important parts of First Aid.

THIS IS NO REPLACEMENT FOR A FULL EMERGENCY FIRST AID COURSE!

... but it should be enough to prepare you for an emergency.

 Video HERE

The easiest way to remember the process of First Aid is with the acronym DR. ABC. In every situation you should always go back to DR. ABC, if things change then start at the beginning again.

First and most important is D - Danger

Remember to LOOK AFTER YOURSELF FIRST. It sounds like cowardice, but this is a vital part of the safe practice of First Aid.

Danger can take many forms...

• Environment - Inside, outside, night, day, wet, dry, hot or cold. All of these can and do effect how you and the casualty react. Be sure to look all around the scene (ideally from the doorway initially), remember to look up and behind you. If you can identify the cause of the injury is it still a threat to you? Can you remove the threat BEFORE approaching?
• Casualty - Have you identified (and removed or contained) the cause of their injury? Are they likely to hurt you - are they drunk, drugged or acting oddly?
• Yourself - Do you have the necessary skills to make the area safe - do you need more help? Are you actually needed?

If, for any reason, you do not feel comfortable you do not have to approach.

If you do not feel safe you do not have to approach.

If things change and you no longer feel safe you can - and should - step away.

It is much better to have a live witness - who can give information to the authorities - than another casualty for them to deal with.

THIS IS REAL LIFE, NOT THE MOVIES.

Next, R - Response

So, you have checked for danger - and satisfied yourself that it is safe to approach - now you need to yell for help if you know there are people around. That is the second most important of First Aid - make sure it is safe to approach and THEN call for backup. Whether you just need a friend or an ambulance you need a response.

In this day and age you can reach into your back pocket to call for an ambulance - always put it on speaker so that you can relay information whilst you work.

If the cause of the injury is not clear then follow the RULE OF THREE...

1. One casualty, call for help and approach with care.
2. Two casualties, call for help - and make sure it's coming - then approach with caution.
3. Three or more casualties DO NOT APPROACH. Call emergency services and provide them with information from a safe distance.

Recap

D - Danger. Check for dangers to the patient AND yourself. Do what you can to make things safe BEFORE approaching.

R - Response. Call for help. Get a response from someone - you may not need an ambulance, but it is always wise to have an assistant or a witness.

Video HERE

DO NOT attempt to practice this on a healthy person!

This is where DR. ABC really comes into effect.

D - Check for Danger - from the doorway, then continuously as you approach.

R - Call for help. Get out your phone and dial 999. Get a Response from the casualty...

• Yell at them, call their name, tell them to open their eyes. Don't be polite, be assertive.
• Tap them on the shoulder

A - Airway.

• Open the airway by lifting the jaw and tipping the head back.

B - Breathing.

• Bend down close to their mouth, listen and feel for breathing, look along the chest to see it move for 10 SECONDS.
• If they are NOT BREATHING PROPERLY then start compressions.

C - Circulation.

• Call for an AED*
• Place your hands on the centre of the chest and start compressing to the beat of Stayin' Alive or Nelly the Elephant (around 100-120 beats per minute).
• Press down 1/3 of the thickness of the body - depending on your relative size to your patient you may need both hands or just one.
• Keep going. Once you start you cannot stop - if you have an assistant then you can take turns compressing for about 2 minutes each.

We no longer teach lay-people to perform rescue breaths, because in many situations CPR is not started or is stopped because people are worried about or unable to do the breathing part. Unless the casualty has a KNOWN BREATHING PROBLEM (ie. choking or drowning) breaths are not required, the act of compressing the chest also compresses the lungs and provides an adequate circulation of air.

AED

A non-breathing casualty has most likely suffered a heart attack and will need their heart shocking back into rhythm. Most public spaces now have AED (Automated External Defibrillators) available and the staff should be able to bring one to you.

CPR alone will maintain circulation at a base level, but if the heart is not working CPR alone cannot restart it.

CPR and use of an AED within minutes of collapse increases the probability of recovery.

AED's come in many different styles, but all are IDIOT PROOF.

1. Remove the patient's shirt (don't worry about buttons, just tear it off).
2. Someone suffering a heart attack will be sweaty so dry them off with their shirt, or a towel if there's one in the AED.
3. Turn the machine on and DO WHAT IT SAYS!
4. Place the pads on the chest as indicated by the diagrams printed on them.
5. The machine will survey the casualty's condition and IT WILL DECIDE whether a shock is needed.
6. Make sure no one touches the patient whilst the AED is scanning.
7. If the machine decides a shock is needed YOU need to make sure that no one is touching the casualty and YOU press the button.
8. The machine may decided that no shock is needed so continue with compressions, the machine will re-scan after a few minutes.
9. Recovery will take a few seconds to continue compressing the chest until the patient starts to react - then return to DR. ABC to check for changes, a breathing casualty needs to be rolled into the RECOVERY POSITION, with the pads left in place because the machine continues to monitor their condition.
10. If the casualty has started breathing keep an eye on them, check that they are still breathing every 5 minutes - the AED may have restarted their heart but it hasn't solved the underlying issue and they could arrest again.

RECAP

D - Danger
R - Response - from the Casualty and from the Emergency Services.
A - Airway - open the airway by lifting the jaw and tipping back the head.
B - Breathing - are they BREATHING PROPERLY (2-4 breaths per 10 seconds).*
C - Circulation - compress the chest to help push blood around the body.

If they are not breathing properly an ambulance and an AED are required ASAP.

Video HERE

This process you CAN and SHOULD practice on a regular basis. Teach your children as soon as you think they can understand. This technique allows a relatively small person to roll a bruiser without straining.

D - Check for Danger - from the doorway, then continuously as you approach.

R - Call for help. Get out your phone and dial 999 if necessary. Get a Response from the casualty...

• Yell at them, call their name, tell them to open their eyes. Don't be polite, be assertive.
• Tap them on the shoulder

A - Airway.

• Open the airway by lifting the jaw and tipping the head back.

B - Breathing.

• Bend down close to their mouth, listen and feel for breathing, look along the chest to see it move for 10 SECONDS. - Breathing present.

C - Circulation.

• In order to protect the continues circulation of blood and oxygen you need to roll the casualty into the Recovery Position...

Recovery Position

1. Speak to your casualty, they may be able to hear you (you're also telling bystanders what your intentions are.)
2. Lift the casualty's closest arm out of the way.
3. Check the pockets on the nearest side, remove valuables and place in or by the closest arm. Remove glasses.
4. Take the other hand, palm-to-palm and just interlace your fingers enough to hold it (if you lock them tight you risk getting stuck if the casualty comes around.) If they are wearing rings with stones in then just turn them towards the palm.
5. Place the hand against their cheek. (If you are short or have limited reach then you can bring the arm with you as you sort out the leg)
6. Lift the furthest leg by trouser fabric or the outside of the knee until the foot sits flat.
7. Press down on the knee to start the body rolling, catching them on your knees as you shuffle backwards. Unconscious bodies move in stages, first hips, then torso and shoulders so using your knees slows the roll and helps you control everything.
8. Lift the top leg and knee into a right-angle.
9. Make sure the head is supported and tipped back and that the arms are flat on the floor, not pressing on each other.
10. Check that they are still breathing and continue to monitor until help arrives or they recover.
11. If help is delayed then roll the patient onto their other side after 10-15 minutes.

The Recovery Position

• Maintains an open airway.
• Raises the stomach and lowers the mouth so that any vomit is channeled out.
• Stabilizes the casualty for a short period so that help can be fetched.

 Video HERE

DO NOT attempt to practice this on a healthy person!

Choking is a major cause of injury - even death - in both infants and the elderly, however, the treatment for someone who is choking is almost as dangerous as the condition itself. All Emergency First Aid courses include this process as it is one you must NEVER perform on a healthy individual.

It is a simple 5-Step Process...

1. Ask the casualty 'Are you Choking?' - Yes, it seems stupid, but if they are able to give a verbal answer then they are NOT ACTUALLY choking, they have a partial obstruction which could be cleared by stages 2 and 3 without progressing to something more dangerous.
2. Encourage the casualty to COUGH - the first instinct is to gasp in, to get air, forgetting that there is air already in the lungs that could push out the obstruction.
3. Give BACK SLAPS - Supporting the casualty over one arm, slap in an upwards direction between the shoulder blades UP TO 5 times. (If it comes out after 3, stop!)
4. Give ABDOMINAL THRUSTS - position yourself as close as you can behind them, make a fist from your dominant hand with the thumb out, cover with your other hand and pull in and up sharply between the bottom of the ribs and the belly button. UP TO 5 times.*
5. Repeat back slaps and thrusts until the blockage clears of the casualty collapses - then start CPR.

If the casualty has a KNOWN BREATHING PROBLEM - ie. choking or drowning - then you MUST start with 5 rescue breaths before compressions, and attempt 2 more every 30 compressions if you can.

*If you have applied abdominal thrusts to ANYONE, whether the obstruction clears or not, they MUST GO to hospital. You have just mashed their internal organs and possibly done some serious damage, they need to be checked out.

For a child the process is pretty much the same, although you should only use ONE HAND for abdominal thrusts.

For an infant DO NOT PRESS THE ABDOMEN - use chest thrusts instead.

Infant CPR

D - Check for Danger - most likely this is going to be panicky parents. If you can get them to go and make the call for the ambulance, but do not banish them from the room.

R - Call for help. Get out your phone and dial 999 if necessary. Get a Response from the casualty...

• Yell at the baby, tap them on the forehead or feet.

A - Airway.

• Keep the head in a neutral position then listen and watch for breathing.

B - Breathing.

• If the infant is not breathing you need to seal your lips around their MOUTH AND NOSE and give 5 rescue breaths. DO NOT blow hard, small puffs are enough.
  

C - Circulation.

• Compress the chest 1/3 of its thickness with two fingers resting along the middle of the chest. Aim for 120bpm.
• Give 2 breaths to every 30 compressions.

If you are on your own give 2 minutes of CPR before calling for assistance - or ideally, you can carry the infant to the phone whilst giving compressions.

As with all emergency situations, if you forget in the panic the 999/911 controller will talk you through what you need to do.

Video HERE

Some issues with technology here, apologies. When I learn how to import slideshows onto video I may try this again...

The 3 B's of First Aid - being the most common things you will come across.

1. Bleeding

Blood is best on the inside, but when it finds a way out then you need to know how to deal with it.

Basically you need to stop the bleeding, either by applying direct pressure to the wound or raising the bleeding limb or - ideally - both.

NEVER ATTEMPT to remove anything that is in a wound - if the patient has pulled it out DON'T put it back! Try to apply dressings around an object without pushing it further in.

NEVER ATTEMPT to investigate a wound by poking around inside.

PUT NOTHING IN, TAKE NOTHING OUT!

Anything bigger than an inch or so should be seen by a medical professional - not necessarily as an emergency, Walk-In centres will stitch and glue minor wounds. Head wounds and anything of significant or unknown depth should also be seen by a medic. If in doubt, Walk-In.

Animal bites - particularly human - should be professionally cleaned and dressed. Tetanus or other boosters may be required.

2. Burns

A burn can open the body to infection and risks of dehydration, particularly in children. Burns are measured in palms - a casualty's palm is roughly 5% of their surface so this makes for a good comparison of size.

All burns MUST BE cooled with running cool water BEFORE any form of treatment can begin. (Chemical burns may be different, see below)

Superficial - Minor sunburn, irritating but not serious. However, more than 5 palms-worth (20%) will require medical attention. Once cooled in the shower apply a WATER-BASED moisturizer, never oil. Ideally you will be applying sun screen, wearing long sleeves and a hat when out in the sun... As a blonde of Scottish heritage I consider sunburn a self-inflicted injury.

Partial Thickness - Red and blistered - painful! More than 1 palm (5%) will require medical attention, as will any burn that circles a limb - but I suggest that anything bigger than an inch around should be seen by a medic anyway. NEVER pop blisters (medics might have to, but the fluid in a blister protects the skin beneath)

Full Thickness - Blackened with almost no pain. Call for an ambulance immediately, huge risk of infection and dehydration. This MUST go to hospital.

ANY burn on a child MUST go to hospital.

Chemical Burns

With the recent upswing in cases of acid attacks, here are a few tips...

• First pour a little water onto the burn, if there is no increase in reaction then continue to irrigate with as much fresh water as you can.
• Try to pour at an angle away from any undamaged skin and from yourself to avoid spreading the burn.
• After the initial rinse encourage the patient to remove any affected clothing and continue to rinse.
• Do not use chilled water if at all possible - tepid or room temp is better.
• Call for an ambulance as soon as possible.

3. Breaks (Fractures)

A broken bone is not necessarily visible - but if there is a clear deformation of a limb then do not attempt to move it.

They may have heard a crack or have suffered an unusual force. Encourage the patient to flex their limb and note any obvious pain, can they weight-bear, or make a fist, do they have full movement. You do not have X-Ray eyes so if in doubt seek medical advice.

If the bone is visible treat as a wound, but do not attempt to push it back in.

If there is a history of a fall (that is from more than their own knee level), a knock of force or at some speed or a hard landing on the backside you should suspect a spinal injury (particularly if they are complaining of pins and needles or 'strange' sensations) and TREAT FOR THE WORST CASE SCENARIO. Lay them flat if you can, supporting their head.



So that was Save a Life September. I hope you learned something useful, but I also hope that you understand the importance of actually attending a proper First Aid course every 3-5 years. Back to normal service next month.