First aid isn't all about sticky plasters

I feel I have been very remiss in not writing a blog post for quite some time but I've actually done very little first aid work since moving from Somerset to Berkshire. I have started going to a new division though and the training session last night inspired me to get writing again.
  
The session was led by an A&E trauma nurse who went into detail on what happens when it all goes horribly wrong and more than a sticky plaster is required. This got me thinking about what people's expectations are when they sign up as a first aider. I won't deny that a lot of first aid work can be mundane, dealing with nothing more serious than cuts, scrapes or wasp stings. That does not mean it won't get more eventful though and first aiders should perhaps be more prepared for the worst.
  
I've been quite fortunate to have dealt with a few interesting cases. Okay so fortunate is probably not the right word to use as that clearly implies someone was rather unwell but I'm sure you understand what I mean.
  
Crewing an ambulance as it rapidly transfers a small child to hospital with suspected meningitis; trying to extract a racing driver with a suspected broken back from his car; performing CPR in the middle of a supermarket with no defib available; and crewing an ambulance during a major incident have all provided me with quite a varied experience. They are not all experiences I would necessarily want to got through again but I value them nevertheless and have learnt a lot from them.

Having an A&E trauma nurse telling everyone that instead of learning our ABCs we should be learning our CABCDEFGs hammers it home that the next duty may involve more than just sticky plasters and all first aiders should be ready for anything.
  
You can never truly prepare for the worst as the worst case scenario would be something you've not prepared for. I'd like think however, that along with many of my St John Ambulance colleagues back in Somerset, we'd at least be ready a bad day in the office.
  
I'm sure there are plenty of other acronyms that people use, but for the record CABCDEFG is:
  
Catastrophic haemorrhage
Airway
Breathing
Circulation
Deformity
Environment
(Don't)
(Ever)
Forget
Glucose

Try not to over react

Allergies are perhaps the most common medical condition in the UK with about a third of the population suffering from an allergy at some point in their life. An allergy is just an abnormal reaction by the body's immune system to a normally harmless substance.
  
The symptoms of an allergic reaction include itchiness, reddening of the skin and swelling. Not all these may appear.  In most cases they’re nothing more than a nuisance with the sufferer sneezing more than normal or developing a small rash.
 
In some case it can be more serious and the person may suffer from anaphylaxis. During anaphylaxis, the blood vessels can widen causing blood pressure to drop, and the airway constricts causing problems with breathing. Anaphylaxis constitutes an emergency and urgent medical attention is required.
 
Phone 999 and advise them of the patient’s condition.
 
Many people know they are severely allergic to certain stimuli – wasp stings, peanuts etc. – and try to avoid a severe allergic reaction by avoiding the allergen. This is not always possible however so they help themselves further by carrying an auto-injector Epi-pen®* to relieve the symptoms. If they are carrying an Epi-pen® then help them to use it. Unless you are trained to use one it would be inadvisable to use it yourself. My wife carried out an audit among health professionals using a dummy pen and many of them used it incorrectly with some of them injecting themselves. Had it been a real pen they would probably have lost their thumb.
 
Until help arrives, make sure the casualty is comfortable and help maintain the airway. This can be done by sitting them in an upright position.
 
Should the patient lose consciousness then check their airway, check their breathing and be prepared to perform cardio pulmonary resuscitation (CPR). Otherwise monitor the vital signs as you are able to do, take their pulse and check their breathing – rate and strength for both.
 
For further information on allergies visit the Allergy UK web site or for advice on treating allergic reactions visit the St John Ambulance web site.
 
*The Epi-pen® contains epinephrine which is adrenaline.

Early CPR is vital

If the events on Saturday at White Hart Lane have taught us anything, it's the value of prompt cardio pulmonary resuscitation (CPR) and getting a defib attached to the patient as soon as possible. When Fabrice Muamba collapsed during the FA Cup quarter-final between Tottenham Hotspur and Bolton Wanderers, the medical staff were delivering CPR within moments and a defib was attached only a few minutes after that. In total Muamba's heart had stopped for 78 minutes, yet he survived. Credit is thoroughly deserved by all those who worked furiously to make it happen.
  
Having trained people available who knew what to do saved Muamba’s life. If someone collapsed in the street near you, would you know what to do? Or would you stand back and do nothing because you don’t know what to do? The British Heart Foundation video with Vinnie Jones shows just how simple CPR can be, anyone can do it. If you haven’t seen it then please spare a few minutes, it could save someone’s life.

What other important fact can we note from this incident? Cardiac arrests don’t just happen to the elderly or those with an unhealthy lifestyle.
  

It wouldn’t be right to speculate on the exact cause of Muamba’s cardiac arrest but the reality is that he's a 23 year athlete at the peak of his physical fitness. You would not expect it to happen to someone like him. The cardiac arrest did not occur during the final minutes of a pulsating end-to-end game when players are exhausted, it happened in the first half during a quiet spell. You would not expect it at that time.
  

Cardiac arrests could happen to anyone, at any time. It always pays to be prepared and to know exactly what to do if the situation arises.
  

It's too early to tell what the extent of Muamba's recovery will be but whatever the outcome, he is a very lucky man. He is still alive while others are not so lucky. A few days earlier a 15 year old collapsed during a rugby match and despite the best efforts of the ambulance crew, he died soon after.

CPR in practice

I hope everyone has seen the British Heart Foundation's advert with Vinnie Jones demonstrating cardio pulmonary resuscitation (CPR). If you haven't seen it yet, watch the YouTube video now.

What the British Heart Foundation are trying to achieve with this advert is to show that you don't need any formal qualifications in order to perform CPR, all you need is a bit of knowledge and perhaps a lot of confidence.
  
I've been a first aider for several years and have carried out CPR on a Resusci Anne more times than I care to remember. When it comes to CPR procedures I'd like to think I'm quite comfortable with what to do.
  
This is just as well as this morning I found myself in the extremely uncomfortable position of having to perform CPR for real. Not on a manikin this time, but on an elderly gentleman who had collapsed in the supermarket and stopped breathing.
  
What surprised me to begin with was how spongy the chest felt, I expected it to be more rigid. Don't get me wrong, the Resusci Anne is a fantastic training aid, but it doesn't feel anything like a real chest. What really shocked me though was the colour of the patient's face. Perhaps one day they'll produce a manikin that gradually turns a bright purple colour.
  
What no manikin will ever be able to teach you is how you are going to feel afterwards. Once the paramedics had taken the patient to hospital, it took a great deal of will power just to stop myself throwing up in the middle of the supermarket.
  
I don't know what the final outcome was once the paramedics had taken the patient to hospital, I probably never will know. What I do know is that if no one had performed CPR, the patient certainly would have died. I think a wee bit of nausea is a reasonable price to pay for potentially saving a life.