Basic first aid
Last week I went for my first aid refresher at the European School of Osteopathy. I like to go over my first aid skills regularly as administering first aid when needed is so important and can save lives. There are so many preventable deaths around the world if only first aid is given at the time. I’ve decided to write up a portion of my notes from my course as this week’s blog. I couldn’t write them all up as it would make for a very long blog! But I wanted to quickly go over the primary survey, CPR and using a defibrillator as these are the bits of first aid that many people panic over and find scary. They are actually surprisingly simple so I encourage you to read this blog and share it as the more people who understand first aid, the more lives we can potentially save.
What is first aid?
First aid is the first available help given to someone who is either sick or injured before the emergency services have arrived. The aims of first aid are simplified into three ‘P’s’:
P – Preserve life
P – Prevent the situation worsening
P – Promote recovery
The primary survey
The primary survey goes through four steps which must be done in order to assess and treat a casualty. Follow the steps in the order of DRAB.
D – Danger – before any attempt of first aid is given, you must look out for any dangers and you should never put your own life at risk. Dangers may include things like: traffic, trip hazards, water, electricity etc.
R – Response – once the area has been made safe, approach the casualty and try to get a response from them. Check to see if they are conscious. Tap or gently shake their shoulders. Ask them ‘are you all right?’ or ‘can you hear me?’ If they respond, keep them still, find out what’s wrong and get help if needed.
A – Airway – if there is no response from the casualty, you must make sure their airway is clear. To do this, simply gently tilt their head back by using one hand on their forehead and one on their chin to open the airway. (If the casualty has vomited but they are unconscious, tilt them over to one side to drain the mouth before turning them back on their back and opening the airway).
B – Breathing – After tilting the head back, lean close to the casualty’s face and listen for breathing for up to ten seconds. While in this position, also look at the chest to see if it is rising and falling. If the casualty is breathing, place them in the recovery position and call the emergency services. If the casualty is not breathing, call the emergency services and start CPR.
Important: If you are the only person at the scene, make sure you ring the emergency services FIRST. Once you start CPR, you cannot then stop to call the emergency services. Calling them on a mobile phone is best as you can then speak to them on loud-speaker whilst you administer first aid. If there is more than one person at the scene, get them to call the emergency services whilst you carry out first aid.
CPR is provided if the casualty is unconscious and not breathing. If the heart has stopped working properly, CPR is performed to keep blood pumping to the brain. Brain cells start to die if they don’t get oxygen within 3-4 minutes so the quicker CPR is started, the better.
To apply CPR:
The casualty would ideally be lying on their back on the floor
Kneel at the side of the casualty
Place the heel of one hand over the centre of the casualty’s chest and then place your other hand on top and interlock your fingers
Keep your arms straight and position yourself so that you are vertically above the casualty’s chest – this is the most efficient position to be in. CPR is very tiring even when in the correct position so it is important to make sure you are in the best position possible to apply the chest compressions
Chest compressions – using your own body weight, apply pressure straight down through your arms onto the casualty’s chest and press to a depth of 5-6cm
Release the pressure but don’t lose contact between your hands and the casualty’s chest
Do thirty chest compressions at a rate of 100-120 per minute
After thirty compressions, open the airway (tilting the casualty’s head back) and give two rescue breaths. The rescue breaths are applied to push more oxygen into the casualty’s body. In order to make them effective, gently pinch the casualty’s nose and exhale into the casualty’s mouth – this stops any oxygen you give coming back out through their nose. The casualty’s chest should rise indicating that air has been successfully passed into their lungs.
After the rescue breaths, start again with thirty chest compressions and two rescue breaths
Repeat until the emergency services arrive
If there is more than one person at the scene, it may be a good idea to take it turns with the CPR so you don’t exhaust yourself. If taking turns, the transition should be completely smooth so that CPR is not interrupted.
Using a defibrillator increases the casualty’s chance of survival hugely and using one is extremely easy. Many people think you need to be trained to use them but they are actually designed so that even if you have never come across one before, you will be able to use it straight away. Many places of work/buildings have one. There are also defibrillators in public places such as in some telephone boxes. It’s important to know where your local defibrillator is kept.
However, if you have started CPR, you cannot then leave the casualty to find a defibrillator. If you have someone there with you and you know there is a defibrillator near you, send them to get it whilst you continue with CPR. The amazing thing about defibrillators is that they talk to you. As soon as you switch them on, they start telling you what to do. All you need to do is switch it on and do as it says.
Switch the machine on
It will then tell you to attach two pads to the casualty’s chest (there will usually be a picture on the defibrillator demonstrating exactly where to place the pads – normally one under the right collar bone and one on the casualty’s left side over the lower ribs). Note - if using a defibrillator, you will need to remove some of the casualty’s clothing as the pads need to be stuck directly on the skin of the chest.
The pads are connected by wires to the defibrillator. It’s through this connection that the machine can analyse the casualty’s current heart rhythm.
When the pads are connected, the defibrillator will then analyse the heart. (This is all done automatically so you don’t have to worry about anything). When the machine starts to analyse the heart, it will tell you to stop CPR and to stop touching the casualty.
The machine will then use the data from the heart analysis to determine whether a shock is required. A shock is when the machine sends an electric shock to the heart of the casualty to try and correct the heart rhythm. If a shock is required, it will normally ask you to press the shock button on the defibrillator. (This button will normally flash when ready. Other defibrillators may shock automatically so you don’t have to worry about pressing the shock button – this will be made obvious when looking at the defibrillator).
Make sure no one is touching the casualty when delivering the shock. The defibrillator will then ask you to resume CPR and rescue breaths at a ratio of 30:2 as before.
If no shock is required, it will simply say ‘no shock required’ and ask you to resume CPR.
The defibrillator will then do another heart rhythm analysis in around two minute’s time and will ask you to stop CPR again whilst it checks the heart. It will then tell you whether
another shock is required or not and when to start CPR again. This keeps going until the emergency services arrive.
This was a very brief snapshot into applying basic first aid. It may be basic but learning these skills, could be the difference between saving and losing a life. You never know when you might need to put them into practice. I hope the information has been useful. I have absolutely tons of notes about first aid so if you have any questions, please get in touch with me and remember, there’s no such thing as a stupid question! The more people who understand first aid, the better!