Mr Bean gives CPR

This Mr Bean sketch where he find himself attempting to deliver cardio pulmonary resusitation (CPR) to a stranger always makes me chuckle, but I think there is a serious side to it as well.  It may be a complete exaggeration of how badly CPR can be performed, but given the number of changes there have been over the last decade, many people have been left confused about what the actual CPR guidelines are.
  
Just before I qualified as a first aider, the ratio of chest compressions to rescue breaths changed.  Since then the guidelines have become relaxed so that rescue breaths are no longer essential, ideal but not essential.  More recently the depth and speed of chest compression have also changed.
  
Mr Bean clearly knew the idea behind CPR, he carried out chest compressions, he gave rescue breaths and he knew to attach a defib (or sorts).  He also knew to check for danger, response, airway and breathing and he also knew to call for help.  So in theory, well done Mr Bean.  In practice, that's probably not the way I would have done it.  I would definitely discourage anyone from giving drugs to an unconscious casualty, even if you do find the drugs in their pocket.
  
What this video does is show the importance of staying up to date with the guidelines.  They can change as research finds new and better ways of doing things and it can be up to three years between assessments so make sure you don't fall behind.  The sketch also shows the importance of knowing first aid.  You never know, the next time you're standing at a bus stop, the person next to you could collapse.
  
Hopefully you will never have to perform CPR but if you do, make sure you're ready for it.
  
For more information on CPR, visit the St John Ambulance web site.

Happy International Volunteer Day

Across the world millions of people are celebrating this special day.  Millions of people who give up significant amounts of their own free time in order to serve others.  Millions of people who have a charitable nature that makes them want to give something to society.  So what are these people celebrating?  The 5th December has been designated by the United Nations as International Volunteer Day in order to recognise the contribution that volunteers make.
  
And this recognition is richly deserved.  I work alongside many volunteers on a regular basis and it is a great privilege to do so.  Many of them give so much yet expect nothing in return.
  
The volunteers at my division of St John Ambulance are out nearly every weekend and often during the week. It's the UK so inevitably they're standing out in the cold with rain and wind hitting them from all angles, but they always cope with good grace, taking pleasure in the fact that they are there to help others.  Between them they give thousands of hours each year to their local community, providing first aid, saving lives and making a difference.
  
So, a big thank you to all these volunteers for the fantastic job they do.

The call of duty

As most first aiders know, you should never use the ‘Q’ word when on duty as it just tempts fate.  On Friday night I think every St John Ambulance member at Bridgwater Carnival must have been screaming “quiet” from the roof tops considering the chaos that ensued.

  

The omens were ominous from the outset with the entrance to our county HQ being blocked by an HGV that managed to get itself bogged down in the flower bed outside.  This was followed soon after by the news of a river bank in Bridgwater collapsing and causing extensive flooding and road closures.  The treatment unit was sitting in several inches of water and the carnival had not even begun.

  

So, it couldn’t possibly get any worse. Or could it?  Shortly after the carnival procession started, news began to filter though of a crash on the M5 just south of the Bridgwater junction and my Twitter time line soon became flooded with information.

  

Has time progressed, it became apparent that it wasn’t going to be an early night.  The scale of the incident on the M5 meant that the local NHS ambulance service had nearly all their resources committed so we had to provide back up to cover the routine 999 calls in the area.

  

What made me exceptionally proud was when the control room supervisor asked if anyone would mind staying on, no one had to think twice.  Despite an already long shift, many of the volunteers having already spent the day at work prior to going on duty, almost everyone was willing to stay on and help out.

  

The circumstances were terrible, but it is occasions such as this that make it an honour to part of an organisation such as St John Ambulance.  It is an honour to work alongside so many people that are willing to give up their own time in support of others and be prepared to make a difference to other people’s lives.

Staying warm in the cold

Carnival season is well underway and some of the largest illuminated parades in Europe are taking to the streets all across Somerset with Shepton Mallet, Wells and Glastonbury all coming up soon.  It is a time for celebration and a time for revelry, but it is also a time when the long cold autumn nights can cause havoc with the body.  Each year during the carnivals there are a number of people who require treatment for cold-related conditions.

  

If you need treatment for a cold-related condition then there is every chance that your evening will already have been spoiled but there are steps that can be taken to protect against the cold.

  

• Layer up: start with a soft layer for comfort and finish with synthetic materials that will protect against wind and rain.  Be careful not to make yourself too warm as sweating creates moisture that can actually make you colder.  Add or remove layers to regulate your body temperature. 
• Wear gloves and a hat: most body heat is lost through unprotected extremities such as the hands or the top of the head so keep warmth in by covering up these areas.
• Wear waterproofs: a wet body will get cold far quicker than a dry body and will take longer to warm up again.
• Move around: maintain circulation of the blood and therefore warmth around the body. Even wriggling fingers and toes will help.
• Keep hydrated: cold air naturally draws moisture away from the body so drinking plenty of non alcoholic fluids will help prevent dehydration.  Drinking alcohol will lower the body temperature.

  

Enjoy the fun of the carnival!

Bonfire night safety

Bonfire night is an exciting time for everyone with a multitude of colours flashing across the night sky and explosions reverberating long into the night.  For the vast majority, fireworks and bonfires are fun but every year a small number of people suffer from burns as a result.  More often than not they are just minor burns so the following offers a brief guide on how to deal with them and so prevent your night from being ruined.
 

Sit or lie the casualty down if possible and flood the affected area with cold water (or any other cold drink) for at least ten minutes.  Remove any clothing that is covering the burn, unless it is sticking, and remove any constricting items.
  
Place a sterile non fluffy dressing over the burn, if one is not available you can use cling film (discard the first two turns from the roll first) or even a clean plastic bag.  This will help protect against infection and prevent fluid loss that could result in dehydration or shock.
  

Do not touch the burn, burst any blisters or apply any lotions, ointments or adhesive tape.  If the burn is to the face then do not cover it up, instead keep cooling the area with water.
  

If a burn that is blistering covers an area of the body greater than 5%, or if a burn that appears pale and charred covers an area greater than 1%, seek immediate medical attention.  As a guide, the area covering the palm of your hand and fingers is approximately 1% of your total body area.  You should also seek medical attention if the burn is to a child; if it is to the hands, face, feet or genitals; or if the burn extends all the way round a limb.  If you are in any doubt then seek medical attention.
  

Fireworks and bonfires need not be dangerous if managed properly and good safety precautions will normally negate any need for first aid.  This includes standing well back, never returning to a firework that has not gone off and always supervising children.
 
Enjoy your bonfire night wherever you are, and stay safe.

The ultimate insurance policy

It's always difficult to tell what the general perception of first aiders is. I've been to plenty of events as a spectator and to be quite honest I’ve never really given them a moments thought. I'm relatively young and healthy so unlikely to become unwell, and the events I go to are not the kind where I am likely to get injured (except for the occasional Old Firm game).

I imagine that being the case for the vast majority of people as only a few will ever actually need first aid. Those few are nearly always grateful and extremely glad of our presence, but they are still the minority. For everyone else, first aiders just blend into the background. Noticeable by their yellow jackets, but that is about as much attention as they get.

I discovered differently however at a recent event I was at, the Loch Ness Marathon. This was my second (and last) marathon and it didn't quite go according to plan. By halfway I had completely shredded my nipples due to the rain-soaked running top I was wearing. The rain-soaked top soon became blood-soaked, and to make matters worse I tore my calf muscle shortly after the halfway point.


First aiders from the Red Cross were stationed every few miles so it was tempting to stop and get some help. In the end I stubbornly decided to press on, fearing that if I did stop I would probably struggle to get started again. Even though I didn’t need any first aid, it was comforting to know that trained first aiders were there. If the condition of my leg worsened and I physically could not go on, there would be someone who could deal with it and make sure I was given treatment safely and effectively.

Having first aiders at these events is just like having an insurance policy. Nearly everyone has their home insured, their car insured and, more commonly these days, their pet insured. Hardly anyone ever expects to make use of their insurance and most probably never will. It's just one of those things that sits in the background just in case the worst happens. And if the worst does happen, it's reassuring to know that help is readily available.

First aid post = ranting post

One of the problems with crewing an ambulance is that you're more or less stationary the entire time, unless of course you're called to an incident. Okay so you can walk a little distance from the ambulance but you can't go too far, especially when you're reliant on the vehicle radio.
 
Being in the position of not being able to escape is when the 'uniform responsibility' issue rears its ugly head. I've said in the past that being in uniform often makes you the target of people's irritations, regardless of what your role is and what you do. If you're in uniform then you're official, if you're official then you're a target. This I experienced yet again at an event I was at recently.
 
You'd think a big national televised event coming to a small city would please some people. It brings the crowds in who then spend money (maybe not always) and it helps put the place on the map.
 
Clearly it doesn't please everyone though as my colleague and I were accosted by a local businessman who felt his business was being "ruined" by a few road closures. I don't think in this case he was actually blaming us, I think he just felt that we should share his pain and suffering. Perhaps he thought that as we were in uniform it was, at the very least, our duty to listen to him. Maybe he expected us to show some solidarity by declaring ourselves to be put out by such a large event.
 
Agreement was never going to happen, personally I enjoy these events. My colleague did listen though and nodded dutifully.

Meningitis and the fear factor

Meningitis is perhaps the illness that instils most fear into any parent. The speed with which it takes hold and the damage it can cause is horrifying. As someone who was taken to hospital with suspected meningitis as a youngster I am well aware of the urgency required. As it happens I didn’t have meningitis but there’s nothing like a good health scare to keep your parents on their toes.

So what is it? Meningitis is the inflammation of the meninges, the membranes that line the brain and spinal cord, and can be caused by either a viral, bacterial or (very rarely) a fungal infection. While all three are extremely serious, it is the bacterial infection that is more dangerous, the most common of which is meningococcal bacteria.

In a worst case scenario, meningitis can kill. Even assuming survival, damage to brain tissue can lead to disabilities such as brain damage or deafness; and septicaemia (blood poisoning) as a result of the bacteria may require limbs to be amputated. Meningitis is a medical emergency, if you’re in any doubt then get the patient to hospital. Not so long ago most patients would die, now it's about 10%. It’s still high but the chances of survival are so much better.

So how would you recognise meningitis? The initial symptoms can sometimes be confused with those of the flu, especially in cases of viral meningitis. The speed with which meningitis occurs is often the biggest clue. If flu symptoms appear rapidly, get the patient to hospital.

The symptoms include fever / vomiting, a severe headache, a stiff aching neck, an aversion to bright light, drowsiness, confusion a rash and seizures. If the patient is a baby then there could also be bulging of the soft spot on top of their skull. With septicaemia the symptoms can also include limb or joint pain, cold hands / feet, shivering, pale or blotchy skin and the breathing rate would increase. These symptoms may not all appear, and if they do they may not be in that order.

It is the rash and glass test that I’m sure most people will be familiar with when thinking of meningitis. If the patient has a rash then press a glass against it and the rash will normally go away as long as the pressure of the glass is applied. In the case of meningitis, as the rash is caused by burst blood vessels, the rash will not go away when a glass is placed against it. That said, if you do suspect meningitis, do not wait for a rash to appear as it may not appear until later, if at all.

As for treatment, the patient needs to get to hospital urgently. There is very little that can be done outside of hospital other than to make them comfortable. In hospital they will be able to give antibiotics to fight against bacterial infection, and keep the patient under close observation. A lumbar puncture (extraction of fluid from the spinal cord using a syringe) may be performed so fluid can be tested for infection and therefore confirm meningitis. If it's viral meningitis then antibiotics are of no use so the patient would be given rest, hydration and pain relief.

Meningitis can be quite a complicated illness so I’ve tried to make this as unscientific as possible so it is understandable. Instead I’ve concentrated on the symptoms and emphasised the urgency of getting the patient to hospital. If you would like more information on meningitis then visit the websites of either the Meningitis Research Foundation or the Meningitis Trust.

Meningitis Awareness Week runs from the 19th to 25th September 2011.

Whatever happened to personal responsibility?

I remember the good old days when we used to pick up the newspaper and have a laugh at our cousins on the other side of the pond for suing each over the most ridiculous things.

There was a story about a man who stole a motorbike, crashed it, then sued the owner because of the injuries he sustained. There was a woman who sued a shop because she had tripped over a toy left in the middle of an aisle, a toy her own child left there. And of course there was the woman who sued a well known fast food chain because she spilled a cup of hot coffee over herself. I’ve no idea how true any of these stories were but I’m sure you get the picture.

During my first trip to New York I remember having a chuckle at the adverts on the metro – 1800 DIVORCE, 1800 LAWYERS, 1800 WESUE4U. Okay so I made that last one up, but every single advert related to the legal profession and how best to get money out of someone else.

I think it was all so amusing because it was all so far away.

Those days are now long gone. More and more adverts feature on UK television suggesting you should get legal advice on any little accident you may have had. Am I even allowed to use the word accident anymore? As I write this there are probably lawyers trying to get it removed from the dictionary because there is no such thing as an accident, someone must always be at fault.

It is becoming more and more common for people to automatically think “who can I blame?” and “what can I get out of this?” whenever they have an accident. It's always someone else's fault, there no longer seems to be any sense of personal responsibility. The lawyers are probably right, someone is always at fault, but more often than not, the fault rests with the person who injured themselves in the first place.

Don’t get me wrong. I’m all for people being compensated when there is genuine need, when they have suffered long term damage as a result of someone else's actions. People should be held to account when they have been negligent, or perhaps even if they have just made an honest mistake, but a mistake nevertheless.

I fell down my father’s stairs recently. Maybe I should sue him for having stairs that are too narrow. Perhaps I should take legal action because he hadn’t taken the necessary precautions to ensure the carpet had enough grip to enable safe passage. On the other hand, perhaps I should just be a bit more careful in future and apologise to my father for waking him up in the middle of the night as I clattered down the stairs.

So the next time you have an accident and start to think how you can profit from it, just take a moment to think it through. Maybe you should look where you’re going next time. Maybe you should be less clumsy in the future. Maybe, just maybe, the accident was just your own stupid fault.

Despite mentioning the possibility of legal action in this post, it does not negate what I said in a previous post on whether first aiders can be sued if they get it wrong. No one has ever been successfully sued in the UK for carrying out first aid.

World first aid day

We've all heard the phrase 'accidents happen' and it's absolutely correct, accidents do happen. Okay so we tend to call them incidents these days for legal reasons but whatever they're called, people do have mishaps and do get injured. To make life worse people also have a habit of becoming unwell, some more seriously than others.

A few years ago St John Ambulance, in preparation for its 'the difference' campaign, conducted a study that concluded that 150,000 people in the UK died each year in situations that did not need to result in death. The study concentrated on five scenarios: an unconscious patient who is breathing, an unconscious patient who is not breathing, a patient having a heart attack, a patient with a severe bleed and a patient who is choking.

All five scenarios have the potential to result in death, perhaps a few decades ago death was the natural result. This is the 21st century though and there are things that can be done to help people in need - you can give first aid. The study didn't for one moment suggest that all 150,000 would still be alive today if they had been given first aid, but it would have given them a chance and that chance is better than nothing.

First aid doesn't require experts, far from it. The skills aren't difficult to learn but they are skills that can keep the patient going. In all five scenarios, timing was vital. The target time for an ambulance to arrive in life-threatening cases is eight minutes. It doesn't take a great deal of imagination to realise how much someone could deteriorate if they're not breathing for eight minutes, or if they've been bleeding profusely for that time. The omens would not be good. But if you, or anyone else, could just maintain their breathing or stem the bleeding until help arrives, their chance of survival will increase.

Today is World First Aid Day so if there's one thing you do - resolve to save a life. If someone you loved or someone you didn't even know was injured or unwell, wouldn't you want to make a difference? Wouldn't you want to go to bed that night thinking "wow! I saved a life"? I know I would.

For more information on first aid and first aid courses visit the St John Ambulance web site.

First aid mythology

Can you carry out CPR on someone who potentially has a spinal injury? After all, if you're repeatedly pushing down on their chest directly above the spine then you could aggravate any injury. It could even result in paralysis for the patient. Fair point? It's a genuine question I've been asked several times.

Now let's look at this logically, what are the consequences of not carrying out CPR? If the patient is not breathing then quite soon they are going to die as the organs are starved of oxygen. I don't know about you, but death sounds like a far worse form of paralysis to me.

An article the Independent's website, based on a survey carried out by the British Red Cross, suggested that people are discouraged from learning first aid because they are scared of the consequences should they get it wrong. This fear is caused by the myths that exist about first aid, myths like the example given above.

I'm not a lawyer so it would be inappropriate for me to offer legal advice. In order to successfully be sued, I would guess that a patient must demonstrate that a first aider caused more harm than would otherwise have occurred. As the Independent article states, nobody has ever successfully been sued in the UK for carrying out first aid.

So would you sleep better at night knowing that you helped someone in need, potentially you saved a life? Or would you sleep better knowing that the patient's condition deteriorated but never mind, at least you did no wrong? Let's look at it the other way, wouldn't you want someone to help you out if you were ill or injured? Or would you be happy for everyone to walk on by?

Don't be put off by the myths, go to the St John Ambulance website now (or once you've finished reading this) and find out where and when the next course is. Learn to save a life, learn to be the difference.

First aid is such an easy skill to learn and like any form of learning, you build on it as your confidence and experience grows. That's not to say the patient's condition won't worsen, it may will do. As long as you act within your limits; as long as you have assessed the patient by examining them, questioning them and advising them; and as long as you feel confident you could justify your actions; it sounds to me like you have a fairly credible defence.

What kind of defence is doing nothing in case you get it wrong?

Practice makes perfect

I did my First Aid at Work (FAW) course about 4 ½ years ago and in that time I have treated one person at work. I've treated many more outside of work with St John Ambulance, but only one at work. Admittedly I treated her twice in the space of two days for completely unrelated things, but two incidents in that time is not a lot. Most of the other first aiders I know at work have treated a similar number.

That doesn’t mean I propose more people at work should get injured (although as a civil servant it's often tempting), it means that to me it's apparent there would be a significant amount of skills fade over that time. From passing the initial assessment, it's three years before the first aider next needs to be assessed

I have no doubt that the FAW students would do a fantastic job if someone collapsed in front of them as they came out the assessment centre. They would be probably do a great job if it happened a week later, a month later, maybe even six months later. But what about a year later or three years later? Would they still be competent then?

I am keen runner and I try to get out as often as I can but if I go a couple weeks without running then I really notice it when I do hit the streets again. I did a course on defence acquisition two years ago during my previous job but if you were to ask me any questions on it, I would probably struggle to answer them. The reality is that any ability, skill or knowledge you have will start to fade if it is not used.

So what benefit does the FAW qualification provide? In my place of work there are several first aiders who don’t seem to know one end of a bandage from the other, and some who can never remember the ratio of chest compressions to rescue breaths during cardio pulmonary resuscitation (CPR). These are fairly basic skills. To be quite honest, these people are not up to scratch and it would be better for my employer just to provide a first aid kit. Let people sort themselves out if injured rather than rely on someone else. I would rather be treated by someone who knew they weren't competent than someone who mistakenly thought they were.

So do employers now need to have a staggered programme of when their first aiders qualify just so there are at least some competent ones at any given point in time? Should employers ensure that at least one member of staff gets injured each week just to make sure that first aiders get plenty practice?

I personally think that if the FAW qualification is to be of any benefit, rather than just another tick-in-the-box exercise to meet yet another government target, the assessments should be changed to being held every year. Three years is simply too long. Employers should be encouraged to provide additional training to their first aiders if only to ensure they do not forget what they have already learnt.

Perhaps a Continuing Professional Development scheme could be put in place so first aiders don’t allow their training to go to waste. Setting up an online system so that every few months they have to answer some questions would at least keep them thinking about first aid.

It’s important that when the time comes and someone in the office actually becomes ill or gets injured, at least the first aider would remember what to do without having to hesitate.

Moat Boat Race

So why do we sign up to be volunteer first aiders? Is it the sense of satisfaction we get when providing treatment and making the patient feel better? Is it the warm feeling we get when the patient says ‘thank you’ and we know we’ve made a difference? Or perhaps, and this is probably more likely, it is the opportunity to take part in the annual Moat Boat Race.

The Oxford / Cambridge Boat Race and even next years Olympics pale into insignificance when it comes to racing home-made rafts along the moat of the Bishop’s Palace in Wells – the blue riband event of the British sporting calendar.

Our theme this year was Dad’s Army so our raft – ominously named ‘We’re Doomed!’ – was draped in the latest in camouflage technology, shredded black and green bin liners tied round some garden netting. Our oarsmen, led by Chief Engineer Ian Abraham, were dressed up as various characters – Captain Mainwaring, Sergeant Wilson, Corporal Jones, Private Frazer, Private Godfrey and the delightful Mrs Fox – all wearing their finery from the era, and the odd colander as well.

Photo courtesy of Christina Borastero

Our efforts (Ian’s efforts) in boat and costume design were soon rewarded as ‘We’re Doomed!’ was judged to be the best boat. The ensuing celebration was short-lived however as we were stripped of our title a few minutes later as the judges realised not all the boats were in the water.

In the end the cavers were given the honour (our honour) but promptly dismantled their boat once the judging was over. One would think that judging should be based on the vessel to be raced rather than some reconstructed model. We’re not bitter but already we have our lawyers scrutinising the rule book to see if there are grounds for appeal. It may even go as for as the Court of Arbitration in Sport.

With that controversy out the way, Lady Luck smiled on us once more as we got off to a exceptional start in our first race – the Community Challenge. Taking an immediate lead we managed to hold the racing line, demonstrated exquisite naval manoeuvrability to make a perfect turn at the halfway point before charging our way down the final straight to win the race. There may have been stiff competition from the police, but we won and the trophy was ours.

With that glorious victory in the bag there’s perhaps no need to report on the rest of the event. More to the point, the less said about the rest of the event the better. Suffice to say we won no more trophies and we did get a little wet. The good news is that we got some other teams very wet too as the final race finished with a massive water fight. I really hope the police don’t hold any grudges as they were somewhat targeted. Of course when I say the final race finished with a massive water fight, it would be slightly more accurate to say the water fight started long before the race ended. Nobody ever said naval warfare was a fair game.

Someone get this drunk out of here

A few years ago when I was relatively new to first aid, I took part in a training exercise on the Mendip hills with some St John Ambulance colleagues. It had been reported that an aircraft had come down but thankfully the pilot had ejected and was last seen floating gently to the ground just a few miles away.

After searching the area near where he was last seen, we eventually came across him and it was immediately apparent his landing hadn't gone to plan. His parachute landing that is, obviously the aircraft landing hadn’t really gone to plan either (I think that’s what they call a bad day at the office). The parachute had become tangled in some branches and he needed to cut himself free to escape. Gravity being the pesky thing it is meant he promptly continued the rest of his journey to the ground. Bump. Snap!

To make matters worse, he was not alone. An annoying drunk guy had appeared on scene and thought he was helping us by grabbing hold of the pilot’s badly broken leg and shaking it about, just to show us where the injury was.

We managed to get the drunk away and proceeded to establish the severity of the break and what needed to be done to treat the injury, relieve the pain and prepare the pilot for transport to hospital. Incidentally this meant carrying the pilot in a stretcher down an eighty feet high cliff. They don't like to make these exercises easy for us.

Frustratingly the drunk guy kept returning and shouting his incoherent ramblings at us and generally being a nuisance. Fortunately for us, and more so for him, we had a more experienced member of the team with us and it didn’t take her long to realise we were no longer dealing with one patient and a drunk. We were dealing with two patients and the ‘drunk’ was potentially the more serious.

In trying to find out what exactly had been consumed to put him in this state, she soon found out he hadn’t drunk anything. Nor for that matter had he eaten anything.  Perhaps not the best thing to do, or not do, when you’re diabetic. Our ‘drunk’ turned out to be having a hypoglycaemic attack and his situation could get extremely grave without any treatment.

Now knowing the full story, we treated him for hypoglycaemia and managed bring him back round again. While that was ongoing, the pilot was having his leg strapped up so we could transport him down the cliff (to our actor’s great delight) and off to hospital.

Photo courtesy of Matt Gridley

So the moral of this story. Never assume a patient is drunk or under the influence of anything.  They may be suffering from something more severe. Of course, even if they are under the influence of alcohol, that is perhaps no reason to judge them. They should be treated the same as anyone else. Making assumptions however, could quite easily hide a very serious illness that requires urgent medical attention.

A sting in the tail

It's that time of year again. The sun is out (occasionally), barbecues are lit (sometimes), summer fetes are held (possibly indoors) and wasps are coming out to play (always).

I've been on first aid duty at a few events where wasps have been an issue and it's fascinating, and somewhat amusing, to see the various reactions by people when stung by these vicious beasts.

Woman tend to take the sting in their stride by just brushing it off and getting on with their day. I don’t think I’ve ever actually had a woman request first aid for a wasp sting.

Children are quite shocked at first by this new pain sensation as they cannot see any obvious cause such as a wound or a bruise. They'll sob for a short time until they realise the pain is fading and then start to enjoy the attention they receive.

As for blokes, their reaction is the most entertaining as they approach the first aid post, hiding the pain by speaking through gritted teeth, and asking for some kind of magic medicine. It’s nearly always the burlier blokes who look the most upset. It's often tempting to congratulate them on being such brave little soldiers before sending them on their way.

So how would you treat a sting? Look out for any signs of danger first as a sting can have dire consequences. Are there any indications that they could go into anaphylactic shock - rapid pulse, laboured breathing, swelling around face or developing a rash? Is there a history of it, have they or a family member suffered from anaphylaxis? Was the patient stung in the mouth or on the neck where any swelling could cause breathing difficulties? If so then seek medical attention. If the patient is anaphylactic and has an auto-injector (epinephrine) pen then you could help them to use it.

In the meantime, sit them in a comfortable position that relieves any breathing difficulties, this usually means sitting them upright. If the pulse rate drops and they begin to look pale, lie them down and put their feet up as this gets blood and oxygen to the upper part of the body where it’s needed most.

In the vast majority of cases however, a sting is not in any way serious, just a wee bit of pain that soon fades. If this is the case and there are no indications of an allergic reaction or breathing difficulties, I would be inclined to leave it. Speaking as someone who is a wasp magnet and has been stung many times, the pain does go away quickly.

If you have something chilled, e.g. cold drink or ice, then place this against the sting in order to numb the pain and reduce any inflammation.

Of course the best thing to do is not to get stung in the first place. If you do see a wasp nearby, just leave it alone and don’t start taking wild swipes at it. Inevitably you will miss, look silly and get stung in the process.

Exterminate, exterminate!

If you’ve been to a football match or a concert then you’ll have seen volunteer first aiders from St John Ambulance.  They stand out quite well in their shiny yellow jackets.  As well as sporting events and music shows, there’s loads of other event we cover and some of these are slightly more… bizarre.  This week was one of those - the Dalek Invasion at RNAS Yeovilton.

I'm sure everyone who's ever visited Planet Earth before knows who (or what, not quite sure on that one) a Dalek is, and the ‘invasion’ was a chance for Dr Who enthusiasts to celebrate his arch nemesis.  Okay so I'm not sure you can celebrate someone whose sole raison d'être is to exterminate, but it was a chance for fans of the long running TV show to display their fully functional replica Daleks, most of which were controlled by an operator inside.

It didn't end with the Daleks.  Dozens of actors were dressed up in costumes depicting characters from across all eras of Dr Who and the majority of visitors had donned the outfits of their favourite hero / villain.  And it didn’t end there either.  Each person took on the full persona of their character and played that role to perfection throughout the day. It's quite incredible the lengths people will go for their chosen hobby.

St John Ambulance and Dr Who has a joint history stretching back to the very first episode when the logo appeared on the side of the Tardis.  It soon disappeared but in recent years it has made a return and it’s now displayed in all its glory on the side of the most famous police call box in the world.  I can only assume its presence is to identify Dr Who as a first aider.  Well his sonic screwdriver does everything else so it may as well act as a first aid kit too.

I'm not quite sure how you treat someone who's been attacked by a Dalek but naturally you need to look for signs of danger first.  Politely ask the Dalek if it would kindly stop exterminating people for just a brief moment.  If the patient has been exterminated then admittedly there's very little a first aider could do.  On the other hand, I'm not sure first aiders have the authority to diagnose extermination.  Best leave that one to the professionals.

As for treating a Weeping Angel victim, I have no idea. Does the patient even exist in the first aider's dimension?  Would the first aider need to go back in time and how would they do this, by also becoming a victim?  That really doesn't comply with the whole ‘watch out for danger’ policy.  Best leave that one to first aiding Time Lords.

Sometimes the bite is worse than the bark

The NHS Information Centre released figures showing that the number of hospital admissions for animal related injuries in England and Wales has seen quite an increase in the last year. Dog related admissions are up 5% to 6,120 cases. Admissions due to non-venomous insect bites and stings, insects such as bedbugs and mosquitoes, are up 19% to 3,620 cases. Admissions as a result of other animals, particularly larger animals such as cows and horses, increased by 8% to 2,560 cases.

It is perhaps worth noting that these figures are for all admissions so they are not just bites as you might first expect. With the larger animals like cows and horses the injuries are likely to be bruising or fractures caused by being knocked over. Thankfully injuries from the larger animals are few and far between. Cows in the UK are relatively placid unlike their Belgian cousins as I discovered recently. Belgian cows tend to snarl rather than moo, and don’t ever go into their field as they will hunt you down.

Bites are more concerning though as you never know how deep the bite has gone and how much damage has been done to the tissue under the skin. Nor can you tell what nasty germs have been transferred from mouth to wound. Tetanus and rabies are both a risk although the latter not so much in the UK. The vast majority of dogs are all bark and no bite but if they do feel threatened in any way then animal instinct may take over as they try to protect themselves or their territory.

So how would you treat a dog bite? Well if you’re the first aider, the first thing to do is make sure the dog is not a threat to you. It’s very difficult to treat a patient while you have a set of jaws clamped round your arm. Make sure it is no longer present, properly restrained or someone trained to deal with dangerous dogs has been called and are on their way.

The wound itself, in the first instance, would be treated like any other wound. If it is bleeding heavily, get the patient to apply pressure by placing their hand over the wound, and also get them to elevate it (if possible). Both actions are designed to stem the flow of blood. The wound should be cleaned out with soap and warm water and a dressing applied. Obviously if you're in the middle of a park, soap and water are in limited supply so just clean it out as best you can until you are able to do it properly. If you don't have any dressings then use anything appropriate to bandage the wound. A shirt or a tie would do as long as they're clean.

The level of treatment required depends on the extent of the injury, but in all except the most minor of cases I would suggest getting seen by a medical professional. This does not necessarily mean going to A&E, it could just be going to see your GP or the out-of-hours GP. It is best to see a medical professional just to make sure you’re not going to get an infection. If you do get an infection, at least it can be treated promptly.

As Nick Ross would say though, "don't have nightmares, do sleep well." Nearly all dogs are harmless and playful. There are over ten million dogs in the UK so that puts the number of hospital admissions into perspective. The most dangerous creature you'll ever come across is man, and they have a far nastier bite.

Give society some credit

Okay so this blog is nothing to do with first aid but it is about volunteering.
 
For many of us, the last few days I’m sure has been quite distressing / despairing / embarrassing (delete as appropriate, or add more). Neighbourhoods have been burnt down, communities destroyed, livelihoods lost. People are rioting, so we are told, because they live in such poverty that this is the only way of getting their voices heard. Yet they seem to be stealing from others who are no better off than them.
 
The dominant image of the last few days was of 89 year old Aaron Biber in his ransacked hairdressing salon. He didn’t look a wealthy man. There was that video of some guy sitting on the ground, already bleeding, in tears and looking traumatised. He didn’t look rich, but they mugged him anyway. Many of the owners of the damaged shops probably started off in as much poverty as the looters, but they fought their way out of that poverty by setting up their own businesses, businesses now destroyed. With that destruction goes the hope of employment to others desperate to escape the poverty.
 
With this as the backdrop to the situation we find ourselves in, it’s quite embarrassing to be British right now, knowing the rest of the world is watching the footage and wondering if this is how we behave normally. You know this country has sunk to such low levels when even the Iranians are calling for restraint.
 
Fast forward a few hours though and civilised society has started to mobilise and a new army of people have taken to the streets. People armed only with a broom, a pair of gloves and the occasional cup of tea. People arriving by the trainload are volunteering their own time so they can take to the streets and clean up the carnage that was created only a few hours previously.
 
This is so much more than just cleaning up the mess. It is about people taking pride in their neighbourhood, community or city. It is about taking pride in themselves. It is about showing support for those who have lost everything and letting them know they are not alone in this. It is about telling the rioters to do what they want, civilised society will always rise above them.
 
There have been a few commentators who, rather than blame the looters, are blaming society for forcing them to take the action they did. That’s fine, I don’t want to use this forum to condemn the violence or try to understand the excuses. But if society is to blame, look at all the volunteers who are out cleaning the streets. That is society, follow its example.
 
Well done to every single person who took part in the #RiotCleanUp campaign. It’s not just the streets you are cleaning but the image of this country. By giving up your time to help others, you have restored a declining faith in humanity and helped make British people proud to be British again.

New resus guidelines (not really)

IIt was recently reported that a team from Bristol including researchers from the University of the West of England, Great Western Ambulance Service NHS Trust and University Hospitals Bristol NHS Trust who were doing research into cardio pulmonary resuscitation (CPR).  The research was aiming to establish if there was a better way of resuscitating a patient in cardiac arrest.

It was reported that the study was going to take a year to complete but obviously they've come to a quick conclusion already.  I guess I must have missed that bit of reporting.

It looks like chest compressions are no more and rescue breaths have disappeared too.  What seems to be favoured, at least according to cabin crew at Ryanair, is to give the patient a sandwich and a soda. Charging for them of course.

During a flight from England to Sweden a passenger went into cardiac arrest but instead of performing CPR as they are supposedly trained to do, the cabin crew offered the passenger a sandwich and a soda.

They reported that "he had low blood pressure."  Indeed a patient's blood pressure does tend to drop when they stop breathing and the heart stops circulating blood around the body.

There was good news though and "the man appeared to stabilize."  At this point he was presented with his bill. Clearly a sandwich and soda does work as a form of treatment in cases of cardiac arrest so I will be sure to pack them in my first aid kit from now on.  I wonder if there will be further research on what sandwiches and types of soda work best - peanut butter on white bread washed down with a bottle of Irn Bru sounds like a winner.  What could possibly go wrong?

I just need to work out a new pricing policy now.

What's your number?

Have you ever been to visit a friend's house for the first time? You've already been given the address so after navigating your way there you eventually find the correct street. Arriving at one end you start looking for house numbers – which side of the road is odd, which is even? Now you at least know the side you're supposed to be on. Then you check a few numbers in a row so you know whether the numbers are going up or down. You now know in which direction you’re meant to go.

It can actually get quite time consuming, especially when you can’t even find a house number. Some have names – they may sound lovely but they aren’t very helpful. Some have numbers in small letters or unreadable script – wonderful typography but you have to squint to read it. Others are obscured by foliage – very pretty and if you had the time you might stop to admire the plants more closely, but again it’s not very helpful. It can often take a while to find the right house.

Now think how a first responder might feel trying to do the same thing. Time is limited. They need to respond quickly, potentially to save a life. They cannot afford to waste time driving up and down the street looking at numbers and trying to find the right one. They certainly don’t have time to admire the stunning foliage or the splendid typography.

Always make sure your house number is prominent. Make sure it is fully visible from the road. You never know, it could save your life.

Whose responsibility is sun protection?

I read with some interest an article on the BBC web site about schools having to adopt a comprehensive sun safety policy to ensure that children do not get sunburnt while at school. The article basically implied, or maybe I mistakenly inferred, that teachers should be responsible for the pupils’ protection if they are to go outside.

That sounds great in theory and I fully agree that children should be protected from the sun. Will it work in practice though? I strongly doubt it and I personally think parents should be responsible for educating their children on sun safety and ensuring they wear sun protection.

I guess the two options are that the teachers physically apply the sun lotion to the pupils or they just monitor the application of the sun lotion by the pupils themselves.

Option one, not to mention the time it would take to apply sun lotion to every pupil, would potentially open up a whole load of abuse claims against teachers.

As for option two, I’m supposedly an adult yet I know how difficult my wife finds it to get me to wear sun lotion and in the end it is normally done grudgingly and liberally with lots of places missed. Would that provide any protection to the pupil? No. And when they go outside and get sunburnt, who would be to blame? Apparently the teacher.

The issue is not so much that teachers shouldn't have responsibility, it's that they shouldn't get the blame. With responsibility comes blame, as sad as it is, that's the society we live in.

Next is the question of who would provide the sun lotion? The schools? At what expense would that be? I guess if the teachers are spending half their day applying sun lotion to pupils then they wouldn't have time for so many text books. If parents provide sun lotion but one pupil forgets, should they be banned from going outside with their friends?

I would fully agree with a teacher reminding pupils to wear sun protection if they go outside but responsibility must rest with the parents.

Who you gonna call?

Nearly everyone these days has a mobile phone, a phone that is usually packed full of contacts. Tens, perhaps hundreds, maybe even thousands of phone numbers that could be called.

Not in an emergency though. In an emergency, first responders will want one number that could make the difference between life and death. First responders may want to call someone to find out your medical history, what medication you are on, what allergies you have. In fact, anything that could be a factor in deciding on the best available treatment.

If they don't know who to call however, they probably won't call anyone at all. Common sense as well as confidentiality dictates that they cannot start at the A's and work their way down. So how could you help them?

In your mobile phone address book, insert a new contact, give it the name 'ICE' - in case of emergency - and enter the phone number of the person you would want contacted in an emergency.

This is becoming a standardised system favoured by first responders. When they reach the scene of the incident, they can check the patient's phone and instantly know who the right person is to call. They could instantly find out vital information that helps determine the best course of action.

So when you've finished reading this, spend just one minute entering ICE into your phone, it could save your life.

It’s probably worth mentioning though, if you password protect your mobile phone then there is no point in doing any of this as the first responder would not be able to access it. It’s only some professions that seem to think it’s acceptable to hack into mobile phones.

Carrying the torch for first aiders

There are thousands upon thousands of St John Ambulance volunteers up and down the country providing first aid to those in need; developing young people and equipping them with the skills they need for the future; or carrying out countless other charitable acts in order to serve their local communities.

With the Olympics taking place next year, the organisers are looking for 8,000 truly inspirational people to carry the Olympic flame around the United Kingdom between the 19th May and the 27th July. Reflecting on that, I could instantly think of several volunteers I know who have been an inspiration to me and others, people who would fit the bill perfectly.

People who have given up so much of their own time to help save lives in their local community; who ease the suffering of those who become ill, injured or in pain; who just provide comfort to those in need.

People who pass on the skills and knowledge they have learnt to those around them so many more people can save lives, ensuring that everyone who needs it could receive first aid from those around them and no one should suffer for the lack of trained first aider.

People who encourage their fellow volunteers to be the best they can be and give them the confidence they need to go out and make the difference between a life lost and a life saved.

People who recognise the importance that youth have in our society and so give their time to helping those young people to grow in themselves, building upon their knowledge, skills and experience.

People who, despite the pressures of school and the many distractions that exist outside of school, choose to become a cadet in order to learn more, to better themselves and most importantly to help other people.

There are so many volunteers in St John Ambulance who are an inspiration so let's get nominating them. Wouldn't this be such a great way to acknowledge all that these volunteers have achieved and what they have done for others.

To nominate someone (thet must be over 12 year old) visit the London 2012 website and complete the form by the 29th June.

Let them eat cake!

I’ve found it to be a common misconception that people with diabetes are not allowed to consume sugar as their body is unable to deal with it.  Is this right?  What exactly is diabetes that apparently causes it to be so cake-limiting?

Diabetes is a result of the pancreas not producing sufficient insulin, the chemical the body uses to regulate the blood sugar level.  There are two main types, imaginatively named type 1 and type 2.

Type 1 diabetes is insulin dependent and is often diagnosed at an early age.  People with type 1 don’t produce enough insulin in the body so require regular injections to top them up.

Type 2 diabetes normally develops later on in life and is often linked to obesity or just an unhealthy lifestyle.  People with type 2 either don’t produce enough insulin or the body does not use the insulin it does produce effectively.  In this case insulin injections may be required but in most cases it is controlled by having a healthy diet and taking regular exercise.

So diabetes is not about the body not being allowed sugar.  You can let them eat cake, it’s just that the blood sugar level needs to be managed.  The two consequences of not managing it properly are either hypoglycaemia or hyperglycaemia.

When the body’s blood sugar level gets too low this is known as hypoglycaemia and is usually something that occurs fairly rapidly and perhaps as a result of missing a meal, consuming too much alcohol, taking too much exercise or just the body starting to overheat.

When the body’s blood sugar level gets too high this is known as hyperglycaemia and this tends to occur over a period of time, even over a period of days.  This condition is a lot more serious and requires urgent medical attention.  Hyperglycaemia tends to be more acute so there are usually some warning signs - needing the wee more often (leading to dehydration), increased thirst (due to the fluid loss and dehydration) and weight loss.  The symptoms that the first aider is likely to recognise in cases of hypoglycaemia and hyperglycaemia are:

Of course the biggest clue as to whether a patient is diabetic and therefore likely to be hypoglycaemic or hyperglycaemic is to talk to them.  Patients are remarkably adept at knowing what illness they have and how to deal with it.  There may be other clues such as a medic alert tag.

So how would you treat someone who is either hypoglycaemic or hyperglycaemic?  If it is the latter then it is a medical emergency.  Phone 999 and request an ambulance.  Place the patient in a comfortable position and take some observations – pulse, resps etc.  If it is the former then give them a sugary drink or perhaps a chocolate bar in order to get some sugar in them.  If they start to improve then give them a bit more to eat or drink and encourage them to have a full meal as soon as they can, ideally something with plenty carbohydrates.  Also encourage them to seek medical attention.

In either case if the patient has impaired consciousness then do not give them, anything to eat or drink as this could affect their treatment later on.  If their condition worsens then be prepared to put them in the recovery position, maintain the airway and even perform CPR if things get really bad.

If you’re not sure whether it is hypoglycaemia or hyperglycaemia, merge both treatments.  Phone 999 and give them something sugary to eat or drink.

Phoning 999 won’t be a problem even if you get it wrong.  I’m sure ambulance crews would much rather be called to a non-emergency than not be called to an emergency.

As for giving them something sugary, it may sound odd giving sugar to someone whose blood sugar level is already too high but it won’t harm them.  It will however help someone whose blood sugar level is too low.  Remember that hypoglycaemia develops rapidly so can also be resolved fairly quickly.  Hypoglycaemia on the other hand would have built up over time so won’t be resolved as quickly, topping the patient up with a bit more sugar won’t cause any more harm in the short term.

For more information on diabetes visit the St John Ambulance web site.

Keep your finger on the pulse

It’s Heart Rhythm Week, a period of action organised by the heart charity Arrhythmia Alliance and dedicated to the notion that everyone should know their pulse, the beat of the heart as it pumps blood around the body.  Knowing your pulse is vital as it could indicate an arrhythmia, a disturbance in the normal heartbeat.
 

600,000 people in the UK diagnosed with Atrial Fibrillation (AF), the most common form of arrhythmia in the UK, and this figure is rising by 200,000 each year.  Conditions such as AF can lead to further complications such as heart failure or a stroke but early detection could help alleviate this.

 

Everyone is different and it would be impossible to say exactly what someone’s pulse should be as there are a number of determining factors – age, fitness, medical condition, caffeine intake and smoking to name just a few.  Activities performed will also have an affect – being busy at work, being stuck in traffic or participating in exercise all have the potential to raise the heart rate.  The table below gives an indication of what the pulse and respiratory rates should be.

Certainly many people could have a pulse or respiratory rate much higher than these or even lower.  It is perhaps important to emphasise that these are only to be seen as a rough guide.  They do however give an idea of what a normal healthy person’s pulse and respiratory rate should be at rest.
 

In order to get a baseline of what your pulse is at rest, try taking it when you wake in the morning and before going to bed.  It is often a good idea to take your pulse at various points throughout the day, particularly if you are participating in exercise or doing something that you could consider stressful.
 

The pulse can be taken at several places on the body – neck, elbow, groin, knee, ankle etc. – but the easiest pulse to take is the radial pulse, on the wrist just below the joint of the thumb.

Before you start make sure you can see a clock or a watch that has a second hand.  Using your index and middle finger on one hand, feel the wrist of the other at the base of the thumb until you detect the beat of the pulse.  Apply sufficient pressure to feel the pulse but not so much as to cut it off.  Ideally you should count for a minute, but failing that count for thirty seconds and then multiply your count by two to get the beats per minute.
 

So what does this tell you?  If your pulse is constantly too fast or too slow then you should consider seeking medical attention by arranging to see your GP.  The pulse should have a relatively constant beat so lookout for any irregularities such as an extra beat or a missed beat.  Again if you are concerned then arrange to see your GP.

As if a heart attack wasn't bad enough

One of the suggested ways of identifying whether someone is having a heart attack and perhaps one of the most memorable entries in the first aid manual is the reference to a “sense of impending doom” the patient may have.   Is it just me or does this make anyone else think of Private Frazer in Dad’s Army proclaiming “we’re doomed, I say, doomed” in his dour Scottish accent?
 
Joking aside it seems that this sense of impending doom is actually more relevant to the condition than previously thought.  It's certainly relevant to the long term health of the patient.  Researchers writing in the European Heart Journal have now theorised that this sense of impending doom, this fear of dying, can actually cause more damage to the patient and ultimately reduce their chances of making a full recovery.
 
The gist of the research was that an increased level of fear can cause a change in chemical levels within the body potentially causing problems in the future.  As if having a heart attack wasn’t bad enough, the stress caused by having a heart attack can be even more damaging.
 
So, if you do happen to be having a heart attack then chin up, try not to be too gloomy.  Perhaps you could try singing ‘always look on the bright side of life’ out loud.  You never know, it could be a life-saver.
 
If you’re not personally having a heart attack but someone else is, in reality there’s very little you can do to treat the physical aspects of a heart attack.  Place the patient in a comfortable position, offer them a 300mg aspirin tablet to chew (as long as they’re not allergic to aspirin) and perhaps provide oxygen if able to do so.  Other than, all you can do is wait until the paramedic arrives.
 
Although, as the evidence suggests, that is not all you can do.  You can talk to the patient, provide reassurance and not only make them comfortable physically, but make them comfortable emotionally.  Give the patient something to feel confident about and this could help lessen their sense of impending doom.
 
For further information on heart attacks, or any other condition, please look at the St John Ambulance web site.

Stay ahead of the game, stay FAST

Strokes are the third most common cause of death in the UK after heart disease and cancer.  150,000 people suffer a stroke each year and it’s not just the elderly, 20,000 cases are people under sixty-five, including children and infants.  Today is Stroke Awareness Day so please take just a few minutes to see how you can indentify and help someone who is having a stroke.

All organs within the body require oxygen not just to function, but to survive, and this is carried around the body and transferred to the organs via the blood supply.  A stroke is when the blood supply to part of the brain is cut off as without oxygen the cells begin to die.  This can lead to brain damage and ultimately death.

There are two main causes of strokes – ischaemic and haemorrhagic – and these cause a stroke in two different ways. The former accounts for over 80% of all strokes and is the result of the blood supply becoming blocked due to a clot.  The latter is when a weakened blood vessel supplying the brain bursts resulting in a bleed.  There is also a related condition known as a transient ischaemic attack where the brain’s blood supply is temporarily restricted.  This is sometimes referred to as a mini-stroke but should still be treated seriously as it can be a warning that a stroke is coming.

There are factors that cause strokes that you cannot do anything about including race, age and gender.  There are however things that you can do something about and you’ll not be surprised to hear that these include increasing exercise, decreasing smoking, moderating alcohol intake and eating a healthy diet.  A healthy lifestyle is far more likely to lead to a healthy body.

The simplest way to identify a stroke is to perform the FAST test, I have no doubt you will have seen the adverts on TV many times.

• F is for face.  Ask the patient to smile and so lift up the corners of their mouth.  If only one side lifts, then they may have lost muscle control in the other indicating a potential stroke.  The patient may also have blurred vision in one or both eyes.
• A is for arms.  Ask the patient to hold out both arms in front of them.  If one drops faster than the other then again it suggests they may have lost muscle control on one side.  They may also feel weak or numb on one or both sides of the body.
• S is for speech.  Talk to the patient and try to get them to talk back.  If their speech is slurred or inappropriate then this is another sign of a potential stroke.  The patient may also feel dizzy or have a bad headache.
• T is for time.  A stoke is a medical emergency and needs urgent hospital treatment so phone 999 immediately and tell them you suspect a stroke.  Treatment begins with a scan to establish what type of stroke it is – ischaemic or haemorrhagic.  If it is the former, as in the majority of cases, clot busting drugs can be given that could prevent further damage and increase the chances of a recovery.

Once you have called 999, help the patient into a comfortable position and monitor the vital signs as you are able to do, take their pulse and check their breathing – rate and strength for both.  Should the patient lose consciousness then check their airway, check their breathing and be prepared to perform cardio pulmonary resuscitation (CPR).

For further information on strokes, or any other condition, please look at the please look at the St John Ambulance web site.