By Gary Woolrich – Cairns First Aid Training
By Gary Woolrich – Cairns First Aid Training
Disclaimer: The following hints are not meant to be taken as medical advice, but are only part of the first aid content a student will learn within the structure of an accredited Apply First Aid course (HLTFA311A, HLTCPR211A). They are not meant to be taken on their own but within the structure of the Australian Resuscitation Council guidelines for first aid.
One of Australia’s leading killers. Each year 60,000 Australians suffer a heart attack. 20,000 will tragically end in death. Why do many survive? Simply because they called an ambulance. Sadly, many choose to ignore the serious nature of the pain and don’t call for help. Some cannot call for help.
Recognising a heart attack:
Heart attack doesn’t always present itself as a crushing pain in the chest. It may be, but it may also be no more than an uncomfortable fullness in the chest, or pain shooting down the arm or perhaps along the jaw line. Australian Resuscitation Council guidelines suggest that ANY pain in the chest lasting longer than ten minutes is likely to be a heart attack. Accompanying symptoms may include pale, cool, clammy skin; nausea; blue lips.
What to do:
The casualty must stop whatever they are doing and immediately rest in a sitting position.
Call 000 as quickly as possible.
Re-assure casualty and monitor.
Prepare to perform CPR.
CPR should only be performed on a casualty who is missing three signs of life. When we happen across a casualty we should always follow the DRSABCD protocol.
Check for danger to yourself AND to the casualty.
If safe, check for response.
It is in this process we look for the 2 signs of life which are:
1) Is the person moving and/or responding to your verbal commands or touch?
NOTE: If there is no reaponse, it can be assumed the casualty is unconscious.
We must now call for an ambulance before looking for the 2nd sign of life which is …
2) Is the casualty breathing normally?
To do this, we must first check if the airway is clear. If not clear, we must clear it by placing the casualty on their side and using our fingers to scoop out any blockage. Once airway is clear we can look, listen and feel to gauge casualty’s breathing (is it rhythmic and even? If casualty is gasping, this is not considered to be normal breathing).
So, if the casualty is not moving; does not respond to your command (squeeze my hand) and is not breathing normally, the first aider should commence CPR immediately. Every second counts!
NOTE: A pulse is no longer considered to be a sign of life. This might sound strange but research has shown that a pulse must be effective if blood is to be delivered to the body’s cells correctly. A good analogy is to think of a 6 cylinder car running on only 3 or 4 cylinders. The motor might be running but it is totally ineffective and the car will be slow and somewhat lucky to make its destination. As most people, both trained and untrained, cannot determine what is an effective pulse, it has been taken out of the equation.
Thankfully, after the latest changes, it appears there will be no more alterations to the current regime of Rescue Breaths and compressions within the foreseeable future.
Only recently has the medical fraternity come to understand the importance of keeping a casualty’s blood pressure well up if we want to increase the chances of recovery after a person’s episode of cardiac arrest. Researchers now realise this can only be accomplished by performing a high rate of compressions. In hindsight, it appears that previous rates of 5, 10 or 15 compressions were ineffective in building the casualty’s blood pressure high enough. Low blood pressure makes the transfer of oxygen from the arteries to the capillaries and then to the cells extremely difficult. These low rates may well be reason the previous success rate of manual compression CPR was only 4%.
To remove the confusion and to teach a CPR regime with a better probability of a good outcome, most (if not all) First Aid students are now taught a compression/breath ratio of 30 compressions to 2 breaths. This recommended rate is now taught globally. In time, the confusion will no longer be an issue.
Please note that in many instances a First Aider will not manage to resuscitate a casualty. But it must be remembered that the value of performing competent compressions is in supplying the casualty’s body with oxygenated blood which will keep the cells alive until an ambulance arrives with a defibrillator. (defibrillators have a recovery success rate of 75%).
It may come as a surprise to you but there are 2 levels of drowning: Drowning and Near Drowning.
Near Drowning means exactly that: death did not occur immediately after the event but as a result of the incident and some time later. Try to recall a time when you have swallowed a little bit of spit into your lungs. Typically your body responded by triggering a vigorous coughing fit until the offending spit was removed from your airway. Your lungs hate uninvited liquid and will do everything they can to prevent its entry. If a person is swimming and water enters their throat but the body fails to expel it, its next defence is to shut the throat down so no more liquid can enter. Everything up to this stage is called a Near Drowning.
If the person is not retrieved from the water then death may occur occur as the episode progresses to drowning. The problem for a person suffering from a near drowning is that water has entered their lungs. The casualty may appear to have survived the experience but their lungs have now become a fertile breeding ground for whatever bacteria and viruses were living in the water.
60 people die from near drowning in Queensland each year due to infected lungs. The person MUST go to hospital even if they appear to have fully recovered from the experience.
We have an abundance of venomous snakes in Queensland. Their bite may appear as one or two puncture marks, numerous puncture marks, or scratches across the skin. However they appear, most casualties know they have been bitten because the majority of bites happen as a result of someone standing on, or very near, a snake.
First Aid for snake bite
Snake venom typically enters the casualty’s lymphatic system first. The lymph will carry the venom to the cardiovascular system and that’s when the problems start. If we can prevent the venom from reaching the bloodstream we can buy time for the paramedics to arrive and take the casualty to hospital where anti-venom can be administered.
The Pressure Immobilisation Technique (PIT Bandage)
Have the casualty remain as still as possible – any muscular movement on their part will help push the venom to its target area. Place a firm bandage directly over the bite site to help contain the venom.
Run a second bandage from the casualty’s toes and up the leg as far as possible to further contain the lymph. This bandage must be tight but not so tight that it completely cuts off all blood flow. To check for continued blood flow, squeeze the casualty’s toe and make certain blood returns (albeit slowed). Do not run the bandage from the top of the leg down to the toe.
Tie the legs together to further restrict movement of the casualty.
Most importantly, re-assure the casualty and keep them still.
Do not try to suck venom out – you will become envenomated!
Do not apply a tourniquet – applying a tourniquet will possibly kill the casualty’s limb.
Do not cut the bite site – this will increase bring blood into the area into which the venom will slip into and thus allowing the venom to be quickly carried to its target system.
Do not wash the bite site – the hospital will want samples to determine which antivenom to use.
If one or two bones are protruding through a wound in the lower arm or leg and it is bleeding, our first priority is to stop the bleed with a bandage. Bandaging over a broken bone can cause extreme pain as well as tissue and nerve damage, so we must place the bandage above the injury. The bandage will need to be firm enough to stop the bleed but not so firm that it cuts off circulation completely. Circulation return can be tested by gently squeezing the tip of the casualty’s finger or toe (depending where the injury is) to push the blood out of the small vessels. When you release your finger the blood must return (this is called capillary return). If it doesn’t, or does so but very slowly, the bandage is too tight and should be re-applied.
Once the bleed is under control the next step is to protect the exposed bones and tissues from infection. Applying donut bandages and splints can cause terrible pain so I suggest that once the casualty has found a comfortable position to sit or lie in, then all we do is gently drop a clean triangular bandage or similar bandage over the wound. This will help to control infection and will also prevent the casualty from seeing their own bones.
First Aiders should never get too ‘tricky’ with First Aid. Simple is good. Once we have taken care of any life-threatening conditions, it is best to simply ask the casualty not to move (not always possible), call an ambulance and provide comforting re-assurance.
Shock can be extremely dangerous and in serious cases has been the cause of many fatalities. Defined as a lack of blood perfusion into tissue, shock will lead to the deprivation of oxygen on a cellular level and at the end of the day, without oxygen, the body’s cells will die. Causes are numerous and include: Severe bleeding, diarrhoea, vomiting, severe sweating and dehydration, severe burns, heart disorders, head trauma.
Recognising shock: The brain goes into survival mode to protect itself, the heart and lungs. It will therefore redirect blood supply away from the skin and digestive system and hoard it for itself. This is a stop-gap measure and may only serve to buy some time. Without blood coursing through the skin, a casualty’s face will appear pale and cool. The skin will be clammy and the casualty might be anxious, vague, confused. As blood is primarily created from water, the casualty may feel very thirsty but they cannot be given a drink as, in severe cases, this could induce vomiting.
60,000 Australians suffer from a stroke each year. It is the second highest cause of death in Australia behind heart attack. The risk increases for everyone over the age of 50. A stroke occurs when the blood supply to the brain’s cells is cut off because an artery is either blocked or bleeding. The cells depending on the blood supply from the affected artery will not receive the oxygen they require and will begin to die. To what extent a casualty is affected will depend largely on what area of the brain the artery was feeding blood to. Strokes can occur at any time and often the casualty is, at first, unaware of what is happening to them.
Recognising a stroke:
Because a stroke only affects one side of the body, a simple test is to ask the casualty to:
1) Smile for you.
2) Raise both arms
3) Speak to me
The acronym used is FAST … Facial (smile) Arms (raise both arms) Speech (talk to me) and T stands for Time, meaning there is no time to waste.
If the casualty can only smile or talk from one side of their mouth, or can only raise one arm, it is likely they have suffered a stroke. It is vital to get an ambulance as quickly as possible.
Stroke is a frightening disease as the casualty is suffering a life-changing event and may die or be physically impaired for the rest of their life. As you are waiting for the ambulance, lay the casualty on their back with a pillow under the head and give them plenty of reassurance as they will be scared. If they go unconscious, place them in the stable recovery position and follow the DRSABCD.
The days are hotting up and it’s time to remember the dangers of spending too much time in the sun without replenishing our bodies with water. Heat Exhaustion is easily managed but if we allow ourselves to become too dehydrated we run the risk of tripping over into Heat Stroke and this is extremely dangerous.
Recognising Heat Exhaustion:
What to do:
Recognising Heat Stroke:
This is a life-threatening condition. The casualty suffers the same symptoms as heat exhaustion but now the body is in overdrive to lower its core temperature. Systems are failing because the cooling system has become inoperative. The casualty’s pulse is full and bounding because the heart is redirecting blood to the skin in a last ditch attempt to throw heat off. The casualty’s skin is dry as most of the body’s available moisture has evaporated and is no longer available for sweating.
What to do:
It has come to light that most attempts to perform CPR fail because the rescuer’s compressions are too shallow. If compressions aren’t deep enough then all efforts to save a person’s life may well be futile. The depth of compression is 1/3 of the casualty’s chest and no less. It’s this mighty effort that’s required to mimic the enormous workload of a healthy heart. Remember that a person can live with broken ribs or pierced lung but they can’t live without oxygen. Never let the fear of breaking a rib cause you to pull back on your efforts. Unless a miracle kicks in, performing 2 hours of ineffective compressions will not save anyone.
Earlier this year an American, who’d been working out at a gym, went into cardiac arrest. 20 people in the gym responded to the emergency, each performing good CPR for 2 minutes then resting for 40 minutes before compressing again. The paramedics arrived and shocked the casualty 11 times. 90 minutes after the casualty’s collapse he regained consciousness. Due to the great efforts of those involved he showed no signs of brain damage. It’s very unlikely that we’ll have 20 healthy, fit and willing bystanders available to help in such an emergency, but this example shows how long a person’s brain cells can be kept alive when good, deep compressions are applied.
If you are small and the casualty is big, then we do what we always do in First Aid … the best we can.
Things to remember:
In just about any situation when you skills as a First Aid are called upon, if you stick to 5 basic steps then you will have done the best First Aid any casualty could hope for. And the good news is … it’s simple.
If all you ever do is the above 5 points, then you’ve done great First Aid. A casualty will benefit greatly by hearing your words of re-assurance. Tell them your name and ask them theirs. Let them know they are going to be alright and that you’re there to care for them until the ambulance arrives. Remember that the paramedics are not too far away so there’s no real need to be splinting people up. It can cause a lot of unnecessary pain. Use a pillow or something similar to help make the casualty comfortable whilst you wait.
This question pops up a lot and there are still a number of people who are so concerned about being sued that it puts them off of providing First Aid to those who need it. There is always a lot of rumour and speculation ‘out there’ and rarely is it true. At the end of the day the proof is in the pudding. How many people have you read about or watched on tele who have been sued for doing lousy First Aid? I can give you the answer … none! And that’s because First Aiders and Paramedics are protected by Division 7 of the Queensland Civil Liabilites Act. It states:
26 Protection of persons performing duties for entities to enhance public safety
(1) Civil liability does not attach to a person in relation to an act done or omitted in the course of rendering first aid or other aid or assistance to a person in distress if—
(a) the first aid or other aid or assistance is given by the person while performing duties to enhance public safety for an entity prescribed under a regulation that provides services to enhance public safety; and
(b) the first aid or other aid or assistance is given in circumstances of emergency; and
(c) the act is done or omitted in good faith and without reckless disregard for the safety of the person in distress or someone else.
In short, you can’t be held liable no matter how bad your first aid is. So, if you see someone who needs help, jump in and do what you can. Any First Aid is better than no First Aid.
We all know what happens when a chook’s head is cut off … the body runs around for a while before collapsing. This is because the body isn’t dead until the supply of stored oxygen within the cells has been exhausted. Likewise, if a human suffers cardiac arrest, they can still move whilst in a state of unconsciousness (though not quite as erratic as a chook). And so, spasmodic movement is not a reliable sign of life. So what signs should we be looking for?
An unconscious casualty who moves spasmodically and has a pulse may be in cardiac arrest. The only reliable indicator of life is breathing, which we determine by looking for the continuous rising and falling of the chest or tummy, or by listening for breathing and feeling for movement by placing our hands on the abdomen. By breathing I mean the easy, rhythmic and effective breathing such as you are doing right now. Gasps and snorting are not considered to be effective breathing and are not reliable signs of life.
Remember, skin is king … if the casualty’s skin is warm and pink and blood quickly returns to any spot that we squeeze, this is a sign that the heart is probably working well.
What if I’m wrong and I commence compressions? Can I hurt the casualty?
The survival of a casualty in cardiac arrest is, to a large degree, dependent on how quickly we commence CPR. If in doubt, the Australian Resuscitation Council recommends we immediately commence chest compressions and breaths (30 to 2). If we perform CPR on a casualty who doesn’t need it chances are they won’t be hurt. If we don’t do it then the outcome may not be good.
When in doubt … do it!
When any part of the body is crushed under significant weight the recommendation is to remove the object as soon as possible if it’s safe for you to do so (you don’t want the weight falling on top of you). Tissue damage pulls multiple adverse effects into play and they’re all bad. Firstly, a crushing object will cut the oxygen supply off from the limb below it and this will cause the cells to die and release toxins which can shut the heart down. Secondly, the tissue damaged by the crushing force will release a different set of toxins that may send the casualty’s kidneys into failure. Thirdly, if the casualty has suffered significant blood loss below the crushing weight then releasing the weight can cause a sudden and fatal drop in blood pressure.
If you didn’t witness the incident, or at least attended the incident within 15 minutes, it’s probably best that you do nothing other than ring 000 and comfort the casualty. Whenever you’re not certain of what to do always take the safe road and ring 000. If you do decide to remove the weight, have bandages ready in case the casualty suffers severe bleeding.
NOTE: Damage to nerves can interfere with the casualty’s pain sensation. They may feel no pain but the absence of pain is NOT an indication of the absence of injury. Crush injury can be very serious. Typically, it takes more than just a hand or foot to be crushed for these complications to manifest.
Remember that good First Aid is simple First Aid. In most instances, all you need to do is call 000 and re-assure the casualty. If you can also place a person in the correct position for their injury then it only gets better from there.
Breathing difficulties such as Asthma or Anaphylaxis: Sitting upright and leaning forward with arms raised.
Heart issues … pains in the chest: Sitting in a reclining position.
Unconscious and breathing: Left Recovery position. Place on right hand side if damage has been sustained to the right side of chest or head (damaged side down). REMEMBER, unconscious casualties with suspected spinal injuries must still be placed into the Recovery Position.
Stroke: Lying down, face up, with head slightly raised.
Abdominal injuries: Lying down with knees raised. If any organs are exposed, place on abdomen but don’t try to place them back into body cavity. Cover with wet cloth, preferably one that won’t stick.
Shock: Lying down, face up.
Head injuries: Lying down, face up.
IN ALL CASES, LOTS AND LOTS AND LOTS AND LOTS OF RE-ASSURANCE.