Emergency Action Planning for CPR and First Aid

Your Emergency Action Plan is an integral part of any CPR or First Aid action that you may be required to take.

One of the most remembered pieces of advice I have carried through life came from my early years of training as a St John Ambulance Cadet. We were fortunate in those days as we benefited from training delivered by First Aid Ambulance Officers, qualified 'Sisters' from the local Hospital and also local Doctors who were all members of my local St John Division. The advice was this:

The first thing you should do in an emergency is zip, zilch ... N O T H I N G

How true is this? How often do we all go rushing in boots and all, with no regard for anyone's safety and no idea of what we are going to do.

The advice continued as follows:

Spend the initial few moments asking yourself

What has happened here?

Is it safe to investigate further (for me, for any bystanders and for the casualty)?

And if it is. . .

What am I going to do?

The answer to the last question is easy. It has been laid out carefully for us all.

The all important EMERGENCY ACTION PLAN

D R A B C D

Watch for the bolded words below

We shall firstly check for

D for Danger then if safe check for R for Response using the Touch and Talk method (no more shaking and shouting) and WE CALL OUT Can You Hear Me Open Your Eyes What's your Name Squeeze my hand (COWS).

If we get no response we Check the A for Airway by opening the mouth. If there is a blockage the casualty is turned onto their side into the lateral position and we
clear the airway firstly by using a finger sweep in the front part of the mouth
only, to clear any foreign matter then

OPEN THE AIRWAY BY using the correct head tilt as discussed in a previous blog.

Now check for breathing by placing one hand on the lower chest/abdomen area to feel for a chest rise and fall.

At the same time place your ear next to their nose/mouth to listen for sounds of B for Breathing and look at the chest. This all takes about ten seconds.

WHETHER BREATHING OR NOT - CALL FOR AN AMBULANCE

In Australia you call 000 or 112 on your mobile. All other countries - check your local emergency number but the 112 on the mobile (cell phone) is pretty universal.

When the ambulance has been called begin CPR - Give two breaths - place hands on chest as instructed in my previous Blog and begin C for Compressions at the rate of 2 breaths to 30 compressions, depressing one third of the depth of the chest.

DO NOT waste precious time giving breaths before the ambulance has been called. If the heart has stopped beating or is about to, your breaths are just a plain waste of precious time. GET THE EXPERTS ON THEIR WAY TO YOU like NOWWWWW.
What you need is a D for DEFIBRILLATOR and OXYGEN DELIVERY UNIT both of which are carried in ambulances along with lots of other useful products and implements.

I do hope this helps anyone who has previously not understood the process of handling an emergency.

Tomorrow I will be undertaking further training in defibrillation. If there is anything new to report I shall blog it to you.

CPR Compressions in First Aid

The technique you use to apply your CPR Compressions in First Aid is another very important aspect when it comes to saving life.

As outlined in the previous blog it is important to start with two rescue breaths and then we move up to commence CPR Compressions.

Timing is all important here. We no longer check for pulse nor do we caliper or measure the sternum. It has been found to be preferable to get straight onto the CPR Compressions.

Where then should you place your hands.?

The ruling is that you place the heel of your hand in the centre of the chest between the nipples.

Hey - sorry guys but that had to have been dreamed up by a man. Based on that instruction have you got any idea where your hand would be if you had to CPR my old Aunt Mary?

What the ruling should say is that you place the heel of your hand in the centre of the chest between where the nipples were when you were born. Now we are talking...

Place your other hand on top of the first one by grasping the wrist of the bottom hand.

Place yourself close enough to the body so that your bottom hand is directly lined up under your shoulder.

Lock your elbows - no bent arms in CPR Compressions.

If you are too far away your arms will be at an angle and you will not be able to compress efficiently as you will be rocking and that is wrong wrong wrong.

Once you have yourself set in place (in reality this should only take a few seconds)
you compress the chest about one third of its depth at the rate of about 1.75 to 2 compressions in a second. Yes that is fast. Whatever you do, do not be tempted to compromise the effectiveness of your pump by going faster than your strength allows you. You must depress that one third of the chest depth. Surface pumping does nothing.

What you are doing here is pumping the blood out of the heart - it goes out to the lungs, collects some oxygen, returns to the heart and you pump it all around the body. Yes you are a manual pump.

Give thirty pumps then two rescue breaths and continue until the casualty starts breathing, you get too puffed out, an ambulance arrives and is ready to take over, a Doctor of Medicine pronounces the casualty very extremely dead or the situation becomes too dangerous for you.

Keep the time delay between pumping, breathing and pumping again to an absolute minimum. If you take too long to get up to breath and back you are losing compression in the blood vessels. You will either be less effective or ineffective.

The above applies to 9 yrs old and over

For 1 yr to 8 yrs of age - exactly the same technique except of course you may elect to use one or two hands. In either case you still depress one third of the chest depth and follow the rescue breathing and head tilt for this age group as outlined in the previous post.

Infants - same rate 2 breaths and thirty compressions. Now you use two fingers but still depress one third of the infants chest depth. Remember - no head tilt.

Next blog we will discuss your Emergency Action Plan

CPR First Aid Rescue Breathing

In First Aid, the new style CPR calls for two rescue breaths to be given followed by 30 compressions. To effectively apply these two rescue breaths it is necessary to be proficient in the application of the appropriate head tilt and the pistol grip as detailed in the two previous posts on CPR.

The CPR operator needs to be aware of how much air to breathe in. You only need to give a chest rise; in other words, share your breath with them.

The average adult has about one to one and a half litres of air in their lungs. Each breath taken replaces about 500mls. The air we breath contains about twenty to twenty-one percent oxygen. We use about four or five percent and breathe out about sixteen percent of the oxygen. Therefore when giving CPR to another adult the two of you would use about nine or ten percent of the oxygen contained in the air you breathed in and between the two of you about half the oxygen content would be breathed out again along with carbon dioxide etc.

If you want to get a greater concentration of oxygen into a casualty you need to be trained and have access to medical oxygen.

Obviously when we breathe, we do not totally expel all the air from our lungs, nor do we breathe in so much that our lungs are totally expanded. Its not natural is it? Therefore it is common sense that when we breathe into another person whilst doing CPR, it is neither necessary nor correct to over inflate their chest.

I cringe when I pick up first aid instruction books encouraging people to give "two full breaths". Naturally this implies that you take an enormous breath and blow hard. Bad Bad Bad. We are not trying to blow the socks clean off them. Think about it. Also you yourself will soon get out of breath.

Where will the excess air go after the chest has been filled?
Answer - Into the stomach
Result - they will quite likely throw it all back up.

Further, I would put it to you that when you try to perform compressions, the excess air in the chest will lessen the effectiveness of the first couple of pumps.

When giving CPR to a child the breath would be much less, so once again look for the chest rise.

In an infant under twelve months of age use a cheek puff - fill one cheek and blow it out gently as if you were trying to gently blow a feather off the end of your fingers. You need to place your mouth over both the nose and mouth of the infant.

After you give the first breath, lift your head (similar to how you would lift your head when freestyle swimming) and look at the chest. You can then take a fresh breath away from their mouth so you do not breath in what they are expelling.

After you give the second rescue breath - get up and get ready to start compressions.

Time is of the essence.

Next post - about giving compressions

CPR First Aid The Pistol Grip

First Aiders should use the Pistol Grip when performing CPR. Most people do not understand why this is important and as a result all sorts of far less effective grips are used. OK you ask - so why is it so important to use a Pistol Grip for CPR? All will be revealed...

What is a Pistol Grip?
Answer - A Pistol Grip is employed by grasping your hand into the shape one would use when (heaven help us) a pistol is used.

When you grasp the casualties chin/jaw it is important to open the airway properly. To attain the CPR pistol grip make a fist with your hand then release the thumb and first finger next to the thumb.

Next place your thumb on the casualties chin just below and horizontal to the bottom lip. The three remaining scrunched up fingers go under the chin to allow a good grip on the casualties jaw.

The remaining finger (the one next to the thumb) just sits anywhere comfortable above the scrunched fingers. Great - you have cracked it; the you-beaut CPR Pistol Grip.
Why It is important?
The use of two fingers on the bottom of the chin just doesn't cut the mustard. Here is why:

When the casualty is laying on their back the tongue can fall back and block the airway. Employing a CPR pistol grip allows the rescuer to be able to pull the jaw forward slightly, in turn pulling the tongue clear so the airway is partially opened. The head tilt we talked about in the previous blog to this does the rest of the job in opening the airway fully.

Additionally the CPR pistol grip assists in clearing the epiglottis. The epiglottis is the little flap located in the upper airway. It blocks the airway when food, drink or foreign matter is likely to endanger the airway. In most cases The CPR pistol grip assists in moving the epiglottis and slightly opening the airway. (for instance It may become very swollen in the case of epiglottitis or even an allergic reaction, to name a couple of problems). Also in a near drowning incident the casualty will have a laryngeal spasm whereby the muscles surrounding the voice box spasm and the epiglottis endeavours to stop the passage of water into the lungs.

Next blog we shall take a look at the where's and whyfors of rescue breathing

CPR head tilts

How much head tilt to use when performing CPR is quite important.

From my experience I have found that CPR instruction is much better understood if you take a little bit of extra time to explain why particular techniques are used. Over the years we have seen quite a lot of changes and people get frustrated. The latest changes make CPR so much easier to remember which is comforting to a lot of people.

I have decided to drip feed little snippets of CPR through these pages in the hope that it will become more clear and easy to perform and today head tilting gets the nod.

No head tilt for an infant.
The head of an infant under the age of 12 months makes up roughly 18 percent of its body. To keep the infants airway open it needs to lay in the "sniffing" position when performing CPR. This means that the nose is the highest point therefore no head tilt. Just place your hand gently at the back of the infants head while you perform the rescue breathing.

Slight head tilt for age group 1 yr to 8 yrs
The head in this age group makes up about 14 percent of the child's body so a slight head tilt is all that is required when performing CPR.

Full head tilt for 9 years of age and above
The head now makes up about 9% of the body so for effective CPR a full head tilt is necessary. The best way to achieve this is to tilt the head back by placing the hand on the forehead and using a pistol grip to help tilt the head. One of the main reasons why people have difficulty in getting air in is because of insufficient head tilt in an adult. It is harder to achieve this by using the older style of holding the nose.

To block the nose you tilt your own head so you can see the chest and place your cheek against the nostrils.

Watch this space for the reasons we need to use a pistol grip for effective CPR

Aches and Pains and Mini Electric Blankets

Have you ever had so many aches and pains that you just wanted to curl up on an electric blanket to ease the pain. I would stake my life on the fact that in the last week or so I have been able to feel each and every one of my 206 bones and 600 hundred or so muscles. However, aching or not, living in the tropics doesn't generally lend itself to using electric blankets in the middle of the wet season. I have just got to share this with you all.

What I thought was a flu bug turned out to be viral pneumonia. What a woose I am. I hate this. There was I after lunch trying to get comfy despite all the aches and pains when it hit me... Somewhere in the dark depths of my overfilled cupboards was a mini electric blanket. The one I used years ago when I had a whiplash. It is about the size of a pillow slip folded in half. Just the ticket I thought.

It took about ten minutes to locate this wondrous item. Whoever thought of this is an absolute genious. I turned it on low and covered the worst aches one at a time. What a sight - with the aircon on full blast to keep cool and a little electric blanket to warm the sore bits and pieces. Before I knew it I feel into a deep slumber and woke up about two hours later feeling oh so refreshed and much much better.

I would thoroughly recommend these blankets to anyone who suffers from aches and pains as an ongoing form of relief. Anything to get to sleep right? If anyone out there knows who makes these little things, please drop me a line. I have decided to get a spare just in case this little fellow packs up on me.

Cyclonic First Aid Kit

Yet another cyclone is wending its way toward us. Well that's the price for living in the tropics - even paradise has its little ups and downs.

So what should we take if we have to evacuate our homes and where do we go? Generally the answer to that question can be found in your local phone book or in the cyclone watch pamphlet sent to all households pre cyclone season. But what about the First Aid Kit. With all the other gear such as food, torches, clothing, water etc which limits space - what can we do about first aid equipment.

A basic kit and not too bulky to carry should comprise your snake bite kit (a sealed plastic bag containing one 7.5 cm heavy crepe roller bandage and 2-3 15cm heavy crepe roller bandages plus two triangular bandages). Additionally it would be helpful to carry one or two survival blankets, an emergency cold pack, a few tubes of saline solution, one or two dressings and extra triangular bandages.

Improvising is the name of the game in an emergency so let's consider what we could use when push comes to shove.

Emergency splints. Try using cardboard, rolled up newspapers, school exercise books. If using sticks make sure they are well padded with clothing. Sometimes the best splint is the casualties own body; splint one leg to the other or an arm to the body.

If you have no triangular bandages to secure your splint you could resort to using good old ducting tape or similar. Make sure you never tape too tightly as you don't want to cut circulation.

Emergency triangular bandages can be made by cutting large squares out of sheeting or old curtains or any fabric about one to one and a quarter square metres. Then cut in two diagonally to get your triangular bandage which can be used as a sling or for tying up splints etc.

Dressings and roller bandages. Use the cleanest item you can find to cover an open wound then pad the wound and if you have no roller bandages and no tape I suggest you use a clean sock (if you cut the top off it will serve as a tube bandage, the foot with the toe cut out can be used for ankle, elbow or knee but make sure it is not too tight) and better still if you have access to lycra clothing the legs and arms can be cut up to make excellent tubes to fit over arms and legs. Any other stretchy clothing can be useful for this as well.

If you have no saline to clean wounds with use clean water (preferably preboiled and cooled).

Emergency blankets can be made by using sheets of newspaper or opening up cardboard boxes and don't forget the windscreen sun protector. Bear in mind it can sometimes be more important to keep the casualty warm and dry underneath. Many people make the mistake of covering a casualty up with a blanket and the person can become hypothermic (so cold it can kill them) because the surface they are laying on is chilling them. Conversely if a person is laying on a hot surface they can become burned if you have nothing to protect them from the hot surface

Anyone got any ideas for Flu First Aid

Crikey I've Got the Flu

Just what you need in a tropical hot steamy summer (not)

Shock, Horror... No remedies for this in my first aid courses. OK, Never mind, how sad, too bad. Let's play this by ear. Some wonderful person out there may just have the dinky di cure for this malady. All well meaning solutions will be considered.

Symptoms - Chest cough; aches and pains in parts of my body I never knew existed till now; headache; Blowing very hot and cold. What to do - Can't take penicillin or antibiotics (darned allergies) so how about resting up. What do you think I have been doing for the past couple of days. I would love to be able to get up if my head would stop spinning long enough. This is cruelty itself for someone who normally rises at 5.30 am ish...

Advice received to date from the Well Meaning
Take some cough medicine - I've tried chesty cough medicine, still got a chesty cough - Bugger!
Take plenty of fluids - If I take anymore I may well turn into a lake! Complete with its own waterfall if I don't make it to the loo anytime soon.
Try a hot toddy - If I could get out to get some booze I would but hey I'm bed bound here. Duh!
Lemons - Yeah, cracker stuff, you just can't beat the juice.
Try Manuka Honey - onto that mate, eases the throat really good.
Olive Extract - heard that's good, in fact that's next on my sons shopping list before he heads off to Brisbane. Don't think I'll be able to convince him about the ingredients for the hot toddy though.

Snake Bite Envenomation Australian First Aid

My heart goes out to the family of the poor young lad who died yesterday after being bitten by a Brown Snake.

Everyone who resides in Australia needs to be aware of the dangers of snakebites and although fatal envenomations are rare they obviously can and do occur. Unfortunately most people do not pressure bandage and if they do the bandage is often either too loose or too tight.

Most people who are bitten have either been trying to handle the snake or have stepped on or near one or have been climbing among rocks and when reaching for a handhold unwittingly placed their hand close enough to present a threat to the snake.

To avoid a potential snakebite we need to be aware that we should wear appropriate footwear and clothing in their territory - decent boots, socks and long trousers for example. Be prepared: Preferably attend a first aid course so you know what you are doing.

Carry with you at least one 7.5cm wide and two or three 15cm wide HEAVY Crepe Bandages which are usually brown in colour. The lighter white crepe bandages tend to loosen up very quickly after they have been applied. Also carry one or two triangular bandages which you can use to splint the limb. Stick these into a plastic bag together with a dressing and a marker pen so you can mark the spot where the bite occurred on top of the bandages.

Suggestion
It is a good idea to practice with your bandage around someones arm or leg. Compare one limb with another to see if your tension is firm enough without cutting of the blood supply.

Treatment Note this same treatment can be applied to envenomations from Funnel Web Spiders, Coneshell and Blue ringed octopus envenomations.

In the event of a snakebite try to calm the casualty. Ask them to lay down and keep as still as possible. The reason for this is that you need to slow down their lymph system. Do not raise the limb you are bandaging - keep it as flat as you can.

Make sure the ambulance has been called. In Australia call 000 or 112 from your mobile and be specific about which state you are in and your exact location. Do not hang up till you are told to.

You may see fang marks, a scratch or bruise or maybe even the wet saliva like substance of the venom on a trouser leg or sleeve. If you are not sure take no chances and treat for snakebite anyway. That way you have nothing to lose have you?

Place a dressing; preferably plastic or gladwrap, over the site of the bite. Although it is possible to test the venom if it has soaked into a bandage, it is obviously going to be easier to test if the venom has not soaked in. Don't worry - leaving it there will not cause any further problem.

How to apply the bandages

It is important not to bandage too tightly, You are NOT trying to restrict the flow of blood, it is the lymph system you are trying to restrict. Apparently the fangs of Australian snakes are not as long as some of the overseas varieties.

Keep reassuring the casualty. Using the same tension as you would if you were bandaging a sprained ankle, take the smaller bandage and wind it over the site of the bite in a figure of eight fashion. Take one of your larger bandages and start at the lower end of the limb ie hand or foot and wind the bandage all the way from the bottom to the top as far as you can go. When one bandage is used up, anchor another one over it and carry on up the limb. Do not bandage downwards. Work quickly and don't forget to mark the site of the bite.

Next use the triangular bandages to splint one leg to the other around the ankles and knees or in the case of an arm to secure the arm to the side of the body. Remember we do not want to elevate the limb. We are trying to prevent the venom from entering the blood system.

Be prepared to do CPR.

Bring help to the person. Do not move the person toward the help. You need to keep them still until the Ambulance or Flying Doctor arrives.

A new Stingray victim in Port Douglas

This morning saw another stingray victim on the fabulous Fourmile Beach in Port Douglas, Australia. This follows too closely for comfort the attack on Steve Irwin on the reef off Port Douglas late last year. Believe me this is very rare. In this case it was not an attack as such, the lady trod on the poor stingray on the beach.

Stingrays have been much maligned of late which is very sad. They don't seek us out but merely protect themselves if they feel threatened. That of course is no comfort whatsoever to the poor casualty. These barbs cause excrutiating pain. Unfortunately not too many people are aware of the proper First Aid treatment. Allow me to remedy that...

Never attempt to pull the barb out - they are shaped similarly to a crude fish hook and any attempt to pull the barb out could cause further serious injury; not to mention the accompanying pain.

Call an ambulance as soon as possible; in Australia you call 000 from a landline or 112 on your mobile. The only relief a first aider can give is to immerse the barbed area into hot water. To achieve this without scalding the casualty, it is imperative that the other limb; ie the uninjured one is submerged into the hot water until you establish how hot the casualty can tolerate it. Then immerse the barbed limb.

Keep the limb immersed until the ambulance arrives or for a minimum of thirty minutes or longer if the emergency operator instructs you to. You will of course need to keep adding to the hot water.

Apparently the heat disperses the poison and lessens the pain.

Don't let this incident put you off any proposed visit to Far North Queensland. I was walking on that beach myself last evening. It is just gorgeous - I have to say we live in paradise. Yes our little piece of paradise does have a few fearsome critters but believe me it is unusual to see them never mind be harmed by them and if you are in their habitat use your common sense and treat them with respect. It is a good idea to do your homework and check on the first aid treatment of our particular varieties before you come.

If you have any questions please feel free to ask. I am a qualified First Aid Instructor and have been involved in First Aid since I was ten.