Monday, 29 July 2013

The Good Samaritan Act et al - Hit or Myth?


In true QI fashion, it's time to clear up a few beliefs about First Aid. Some are true, others not so.

Disclaimer: These are all as I understand them and if anyone has any up to date information, do let me know. Do not treat this as secular Gospel, it's just as I read it and teach it, but no-one's perfict at the end of the day. Oh, and if you live outside the UK, move on - nothing to see here. You're on your own.

  • The Good Samaritan Act
  • Why do First Aid courses teach Cardio Pulmonary Resuscitation (CPR) when Vinnine Jones is on TV telling us to just do chest compressions?
  • If I do mouth to mouth, will I catch HIV or something else?
  • CPR will bring a heart back to life
  • A defibrillator restarts the heart
  • You must be trained to use a Defibrillator

The Good Samaritan Act.

"If I do something wrong, the Good Samaritan Act will cover me".

The bad news. There is no such thing as the Good Samaritan Act.

The good news. If you treat a casualty, staying within the bounds of your skill set and do what you think is in the best interest of the patient, then no challenge will be upheld in Court.

Think about it for a minute. You, as a First Aider, treat a random person in the street. They have had a Cardiac Arrest. You are trained in CPR, which you commence. As you undertake CPR, you hear a rib or two crack, as does the spouse of the patient. Six minutes later, you hand over to an ambulance crew. The patient dies, despite all your efforts. The spouse then sues you for breaking a rib that may have killed the patient. (Compensashun Culture). What will happen in Court?

The case will be thrown out.

  1. You were acting within your training
  2. Ribs break. I've broken hundreds over the years. Especially in the elderly. You just carry on.
  3. They are pretty unlikely to have pierced a lung
  4. and, so what? Before you started, the patient was dead. International advice is to commence CPR, which you did, textbook style. Your actions gave that patient the best possible chance of survival
The Chain of Survival

If the Court prosecutes you for this, that will be the last time that anyone tries to save someone else's life. It's not going to happen and the case will be thrown out.

For someone to have any legal case they must first prove that your actions made the situation worse. When dealing with life threatening situations such as resuscitation, where someone who is left will certainly die, it is inconceivable how anyone could make the situation worse than it already is.

Of course, if you start attempting Thoracotomies with pen tops and straws, then you're on your own.

Why do First Aid courses teach Cardio Pulmonary Resuscitation (CPR) when Vinnine Jones is on TV telling us to just do chest compressions?

Studies have found that lay people attempting resuscitation are a bit squeamish about mouth to mouth on strangers and that they often choose to do nothing at all.

By teaching lay members of the public to do chest compressions only, this is better than no effort.
Obviously CPR is the ideal treatment for a cardiac arrest but chest only compression is better than doing nothing. If we teach you full CPR, then you have the choice.

You have watched the video, haven't you?

If I do mouth to mouth, will I catch HIV or something else?

As far as I am aware, no-one has ever caught HIV from Mouth-to-Mouth. You need to be sensible with precautions and if either you or the patient has cuts, you may need to weigh up the situation and use a mask or the Vinnie Jones approach. The risk of catching HIV from exchange of saliva alone is very, very small.

CPR will bring a heart back to life.

Very unlikely. Sure, if you Google it, I'm sure that you will find cases of CPR having this effect, but I wouldn't bank on it. (If you come on one of my First Aid courses, I'll tell you about the time that I disproved this rule!) When a heart stops, the patient stops breathing in Oxygen and the heart stops pumping this around the body. Body parts that need oxygen will soon use up what's left in the bloodstream then start to die. By simulating the breathing and the heart pumping, you can buy the patient time for the ambulance crews or First Responders to arrive with their defibrillators.

A defibrillator restarts the heart.

A heart is made of muscles. The muscles contract in a regular pattern to squeeze the blood out round the body. The rate of contraction is all controlled by a 'pacemaker' called the 'Sino Atrial Node', which 'beats' at your natural heart rate.
If the heart muscles start to ignore this pacemaker, they will start firing off at their own pace and anarchy will result. Without co-ordinated contractions, blood will not be pumped.

All this works on electricity. A Defibrillator sends a massive bolt of electricity through the heart causing all the individual muscles to stop beating. After a pause, the natural pacemaker takes over again and all the rest of the muscles follow in a nice, natural beat.

So, a Defibrillator actually STOPS the heart. Now you know.

Note, there are situations where a defibrillator is ineffective and may need repeated attempts. There are also situations where it is unable to shock.

You must be trained to use a Defibrillator

Absolutely not. End of. Yes, it's nice to be trained but the Resus Council specifically states that anyone should be able to pick up a defibrillator and use it.
  • It talks to you, telling you exactly what to do and when.
  • The pads have pretty pictures on them so you know where to put them
  • Most Defibrillators only have one button and they tell you when to push it.
  • They will not let you shock someone inappropriately
Trust me. If you are ever with someone that has had a Cardiac Arrest and there is a Defibrillator nearby, get it and use it. You will not kill them. Yo will not make them worse off. You might just save their life.

Look for the sign and give it a go. I have handed my defibrillator to Adults, and to Scouts with no prior training and they quickly sussed it.

Any Questions? Any feedback?

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