Hands only CPR

[Wingwalker]

I think its time to revive the old chestnut again below... :** laughs out loud **:

 

Incidentally, my other half runs a two hour course called Heart Start which is used in conjunction with the BHF and is supported by London Ambulance. She teaches the everyday layman how to recognise the signs for when a de-fib machine would be best required and how to use one in an emergency. Having seen the feedback forms I would definately reccommend that everyone should take up one of these courses as they really are most beneficial as you never know when you might need to use the skill that you will have been taught.

 

 

 

Why is it that all First Aid training centre’s have a run down coffee machine, pictures of the Queen in 1982, photo's of old Land Rover ambulances and a painting of Florence Nightingale? The courses are run by plump women in their 50's who either themselves or a member of their family have experienced every accident personally known to man, carry a face mask on their key ring and have a plain Jane assistant that sits in the corner usually called Polly.

 

Yes it was time for my 3 year check up and I have to say not the best. Sitting in a room full of strangers and making "instant friends" with the man sat next to me who took every opportunity to tap his hand on my arm, talk closely to me whenever he could and even tickle my stomach (I kid you not) as I was lying on the floor with my eyes closed as the "casualty" was not the best of situations. I can only imagine what his face was like as he wrapped his arms around me whilst mimicking the abdominal thrusts - or as it used to be called - the Heimlich Maneuver, and then likewise as I had to do it to him in return.

 

However, all that pales into insignificance as the most dreaded part of the day looms ahead of us. Six rounds each, taking it in turns to get up close and personal with a legless rubber doll. As we all do our bit shaking the torso of rubber Annie and shouting into her completely sealed off ears (after first of all applying antiseptic wipes around her mouth) we are told to imagine that she is unconscious and cannot see or hear. Hardly surprising when you looked at the state of these old mannequins, if Annie was a dog, she would have been put down.

 

At this stage I had successfully managed to shake off over friendly man to my left, to be replaced with beige corduroy trousers and matching corduroy jacket man to my right. As we marked each others competence on bringing lifeless Annie back from the brink of shifting off this mortal coil, he followed everything to the letter and got top marks.

 

Thankfully it’s all over again for another three years and back to work in the morning. My colleagues can now be rest assured that if they start foaming toothpaste at the mouth, cut their shin with a Stanley knife or slice the top end of a fake rubber finger off then someone is at hand who has done a course and get them back to tip top performance and at their desk to carry on working.

 

 

 

 

 

 

 

[OllieDuff]

Interesting side question: would you give aspirin to someone who's having a heart attack? It has a vasodilatant effect (according to the BMJ) but most current recommendations say not to administer it in case the person is allergic.

 

I am not a doctor, but I can't help but think that a potential anaphylactic shock would kill you much more slowly (if at all) than an in-progress cardiac arrest - if they take it, they might have a reaction but it might save their life.

[djw1981]

Anaphylaxis will kill you within minutes as airway closes up. Aspirin administration is probably best left for Paramedics, A&E once a heart attack is confirmed. Cardiac Arrest can happen for many other reasons, and in these circumstances Aspirin may be harmful not beneficial. Also, it is Aspirin 300mg which we give in cases of heart attack, and most cardiac arrest patients wont be able to swallow 4 of the standard 75mg tablets.

 

Aspirin's effect are in the minutes-hours time period, CPR is seconds-minutes, and anaphylaxis is seconds.

[bigclive]

my recent first aid update mentioned giving a heart attack victim a 300mg aspirin and telling them to crunch it and swirl it around in their mouth, since it will pass through the membrane under the tongue into the bloodstream quite quickly.

 

Of course, we're not allowed to have any pain killers in our first aid kit for liability reasons. I reckon that if someone asks for a painkiller and is used to a particular type then that's their call.

[kalmatthew]

The First aid Manual says that if the person is showing signs of a heart attack that they should be given one 300mg aspirin tablet to chew. The 300mg tablet is the standard size that is sold as a pain killer.

[Andrew Edwards]

A designated first aider can assist the casualty to take any medication such as aspirin, angina spray or salbutamol. Assist being the operative word, they cannot do it all themselves. It certainly shouldn't be held or dispensed from a first aid kit.

 

The good samaritan law only extends so far. IIRC it can go the other way too though and you can be in trouble for not helping when you can.

 

It has been mentioned, but no hands CPR is to try remove some of the fear that everyday people might have that prevents them from increasing someone's chance of useful recovery.

 

Any kind of CPR is better than nothing and the guilt for just standing by and watching has to be worse than trying something even if it does next to nothing...

(I'm not saying that it does nothing BTW)

 

When it comes to the majority of potentially fatal heart problems, whether that be a complete stop or fibrillation etc, the chances of survival drop to zero well within 8 minutes if you do nothing. Proper chest compressions might reduce the possibility of long lasting brain injury while you're waiting for the medics to arrive.

 

Oh and AEDs should be absolutely everywhere...

 

EDIT : SPaG

[DavieDimmers]

Is it acceptable to insert a 300mg aspirin tablet into someones rectum if you believe they are having a heart attack? I believe the rectal cavity allows fast permeation of the drug into the bloodstream.

 

I once had to do this to a woman whom I believed was having a heart attack, but it turned out she'd just bent over to pick up a folder and she slapped me really hard. http://www.blue-room.org.uk/public/style_emoticons/default/sad.gif

[Seano]

A designated first aider can assist the casualty to take any medication such as aspirin, angina spray or salbutamol. Assist being the operative word, they cannot do it all themselves.

 

The HSE's first aid FAQ seems to make something of an exception for aspirin:

 

"Are first-aiders allowed to give tablets and medication to casualties?

 

First aid at work does not include giving tablets or medicines to treat illness. The only exception to this is where aspirin is used when giving first aid to a casualty with a suspected heart attack, in accordance with currently accepted first-aid practice. It is recommended that tablets and medicines should not be kept in the first-aid box.

 

Some workers carry their own medication that has been prescribed by their doctor (eg an inhaler for asthma). If an individual needs to take their own prescribed medication, the first-aider's role is generally limited to helping them to do so and contacting the emergency services as appropriate."

 

The good samaritan law only extends so far. IIRC it can go the other way too though and you can be in trouble for not helping when you can.

 

"Good Samaritan law"? I thought that was something whereby you could get into trouble for failing to help if you were able.

No such thing in the UK afaik, but does exist elsewhere in Europe. France? <unsure>

[kerry davies]

The conundrum arises in where these aspirin materialise from when they aren't supposed to be in the First Aid kit, but we can gloss over that one.

 

There is indeed no UK Good Samaritan law as in Oz or the slightly different one in France. David Cameron was all excited about having one in his "elf'n'safety cost us the Empire, ban conkers" days.

 

I have a suspicion that someone gave him an aspirin and explained that we have sufficient civil law and precedent to make enacting one a retrograde step.

[matt_beal]

Hi BR,

 

I'm sorry if this post comes across a little snotty, it's really not meant to be... :)

 

On a safety note though, I really have to say that alongside the masses of good information in this topic, there is a fair amount of misinformation. They are mainly simple misunderstandings, still I feel it is important to remind everyone to consider the information in this topic in the same way that they would consider the information given in any other safety related post on any internet forum... and that is cautiously.

 

I'm sorry not to expand more than this, and not to correct the errors, but it's one of those areas I could get myself into a lot of trouble if I get my contribution wrong. I was trying to stay out of the discussion, but now that we're discussing giving drugs I thought it was important to respectfully remind everyone.

 

If anyone is unsure if their practices are correct or up to date, can I politely suggest that they ought to address that in the proper way, with the help of a first aid trainer.

 

Meant with best intentions! ;)

 

 

Matt

[bigclive]

As far as AEDs go, you can't generally make a situation worse with them. They will only administer a jolt if the person is in a condition likely to lead to death.

 

As such the only people that AEDs should NOT be used on under any circumstances are lawyers. B-)

 

Modern first aid is teaching administering of an aspirin to thin the blood. The likelihood of the person being allergic to aspirin is very low, and quite frankly the least of their worries at that point.

[Andrew Edwards]

I not sure I see any difference with what I said and the slightly better worded extract from the HSE.

"Help to administer the casualties personal supply" NOT "put some of your first aid kit aspirin in the unconscious casualties mouth"

 

No Good Samaritan law? Ok. Misinformed by two first aid trainers then...hmm (tm ynot)

 

My brother is a paramedic and they have AEDs on the wagons. Slightly more sophisticated than the ones you might find in a shop or theme park, but automatic none-the-less. Does a measurement and then gives what it deems to be the correct shock. That's not to say that the medics have been any anyway deskilled.

 

He along with another 20 year service paramedic provided me with the information regarding chance of survival against time. It was based upon real statistics and had a formula that tended to zero over time.

 

Unless you drop in front of the station or a passing ambulance the outlook is extremely grim.

 

CPR does save lives but I think with my pragmatic hat on that it does way more to comfort the people who it happens right in front of. At least I tried...

 

We need to be much more open about this kind of thing and try and remove some of the fear. Hollywood is partly to blame for showing weedy chest compressions and drowning victims being given a quick blow and coughing all their water out.

[kalmatthew]

I not sure I see any difference with what I said and the slightly better worded extract from the HSE.

"Help to administer the casualties personal supply" NOT "put some of your first aid kit aspirin in the unconscious casualties mouth"

 

Step 4 of 4: Give an aspirin

 

If available and not allergic, give them a 300mg aspirin tablet to chew slowly (provided they are not under 16 years of age)

If they have any medication for angina, such as tablets or a spray, assist them to take it

Constantly monitor and record breathing and pulse rate, until help arrives

If they become unconscious, refer to the treatment for someone unconscious but breathing.

http://www.sja.org.uk/sja/first-aid-advice/heart-attack.aspx (you will need to move onto step 4 as you cant deep link.)

This is the advice from SJA who along with the British Red Cross and St Andrews Ambulance association publish the First Aid Manual from which the HSE write the FAW syllabus. I would say it pretty clearly states that medication just needs to be available in the first line.

No Good Samaritan law? Ok. Misinformed by two first aid trainers then...hmm (tm ynot)

IANL but I am a First Aid Trainer and I'm sure there is no explicit law that provides protection and I know that there is no specific law that requires you to render aid unless you are a health care professional. However there is common law and precedent that if you actions are reasonable and in line with any training then you will not be prosecuted and would protected from civil cases.

[Andrew Edwards]

That makes much more sense than the good samaritan law. I suppose you could argue that they were using a colloquialism as the description was as you said Matthew.

 

I'm not saying that anybody shouldn't use aspirin, first aid trained or otherwise BTW.

 

I was under the impression that you could only assist. Also, it still only says 'give them'. Does this mean put in their hand to take themselves or put in their mouth. It is still ambiguous.

[kalmatthew]

That makes much more sense than the good samaritan law. I suppose you could argue that they were using a colloquialism as the description was as you said Matthew.

 

I'm not saying that anybody shouldn't use aspirin, first aid trained or otherwise BTW.

 

I was under the impression that you could only assist. Also, it still only says 'give them'. Does this mean put in their hand to take themselves or put in their mouth. It is still ambiguous.

 

Indeed, I agree about the first, but TBR especially in safety is generally keen to clarify these sorts of details!

 

I didn't think you were necessarily just trying to link to an authority to clear up any confusion. However as to the give them, I would say that giving some one asprin is exactly that, giving it to them for them to take. I would also argue that if the aren't capable of taking it themselves then you would need to consider if letting them put anything in their mouth is a good idea as it could be a choke hazard and DR ABC puts Airway above everything else! As to actually placing things in peoples mouths, I would avoid that at all times, they have teeth in their you know :P. I should probably state that all the above posts are my own opinions and do not represent the opinion of St John Ambulance.