One in a series of stories about patients that stand out for one reason or another. No names, no pack drill, no dates.
As a Community Responder, I get called out to many things (mostly chest pains where the patient clearly has forgotten where his or her chest is) but occasionally (on average 1 in 20 calls) it is a Cardiac Arrest.
A Cardiac Arrest is where the heart has stopped beating effectively (no pulse detected), as opposed to a heart attack, which is where most of the heart is working (beating) but part of it is being killed off by a clot.
Myself and a colleague had just cleared from a Job and were being sent to another. We had (at the time) pagers that sent through details of all jobs in the area, whether or not we were allocated to them. The details all included a Job code in the form 'number letter number'. (AMPDS for those that know). This job came through as a 6A1, which is a cardiac arrest - the most serious - and also showed the road, which I was just about to pass. I called in to Ambulance Control and was rapidly stood down from the job I was on my way to and reallocated to this. 30 seconds later I reached the door......
......only to be shown into a very much alive patient.
I started to get a history and it turns out that he'd jut been discharged from Hospital after receiving heart bypass surgery and was told to go home and take it easy. He did as anyone would do, given those instructions and took himself off to the pub for a smoke and some beers to celebrate.
Upon returning home, he had, indeed, gone into cardiac arrest, but had come round by the time that I, hotly followed by an Ambulance Solo Responder, arrived. As we started to get all this history, his heart stopped again. A quick precordial thump (not by me, I hasten to add) and the old ticker was running again....until it stopped.
It probably stopped and restarted 3 or 4 times by the time that an ambulance crew arrived to take him to hospital and we managed to get it going each time. Inbetween, he was perfectly awake, sat up and chatting away to us.
As far as I know he is still alive today, he certainly survived that day. Blokes (I'm sure this has to be a male trait) if your doctor tells you to take it easy as your heart has just been through hell and back, trust me. (S)he knows what he/she is talking about. Put your feet up, moderate exercise and lay off the stuff that earned you the bypass in the first place.
It's funny the things that stick out. Obviously, for the reasons above, the job itself sticks out, but I also remember him wearing a jacket, taking an interest in his appearance. Never mind his heart stopping from all those cigarettes, at least he looked presentable.
PS. Why do I go to a lot of patients with emphysema / COPD from years of smoking. They are on permanent Oxygen therapy, piped around the house for their benefit, catching their breath yet the rest of the household still see fit to puff away. Quite often I come home and shower as the air is so thick with tobacco fumes it gets everywhere. Spare a thought for your family member struggling to breathe in the next room.
Tuesday, 29 November 2016
Tuesday, 22 November 2016
What price for a life?
So, I've just completed a First Aid in Education questionnaire for some random student that found me online and found this gem during my research:
Average Secondary School spend per pupil in 2014 - £4,550
(http://www.sec-ed.co.uk/news/how-much-per-pupil-funding-will-your-school-get)
At the moment, pupils get no First Aid Training as part of the Curriculum.
If we assume 2 hours First Aid training per pupil per year: Say £100 per class of 30 to bring three Trainers in (at a max 1:12 ratio). That's just over £3 each. 0.06% of the budget. That's Peanuts. So why don't we do it?
How much of that £4,550 goes on, say, Religious Education? Surely £3 off that budget and 2 hours off the RE (RI, whatever) curriculum to save lives rather than souls would be money better spent?
If you have to do CPR on someone, it's more likely that it is someone that you know than someone you don't know. What more of an incentive do we need?
Tuesday, 15 November 2016
Can you learn First Aid from a video?
In 2013, the UK's Health and Safety Executive (HSE) - the Body that oversees Health and Safety in the Workplace - approved Blended learning when teaching First Aid.
What Blended learning means is that whilst some aspects of First Aid still need to be taught and practised face to face, a lot of it can be done remotely - for example by using video tutorials online.
On the face of it, this seems to be a strange move. First Aid is very much a practical skill. There is already a layman's fear of doing harm to a patient. To now say that you can try to save someone's life using techniques that you have watched online does not completely sit comfortably. How do you know that what you are doing is correct in terms of depth, speed, positioning and so on?
Recording a Training video once and playing it many times is an economical way of delivering material and this is reflected in the cost of courses. Whereas a typical course in a classroom will cost between £50 and £100 per person, ProTrainings (the certification Company that 4Minutes uses), for example, charges just £25 for the online part.
What Blended learning means is that whilst some aspects of First Aid still need to be taught and practised face to face, a lot of it can be done remotely - for example by using video tutorials online.
On the face of it, this seems to be a strange move. First Aid is very much a practical skill. There is already a layman's fear of doing harm to a patient. To now say that you can try to save someone's life using techniques that you have watched online does not completely sit comfortably. How do you know that what you are doing is correct in terms of depth, speed, positioning and so on?
Perception vs Reality
Of course, it is not quite that bad. In practice, there are no completely online First Aid courses (Refreshers, yes. Initial courses, no). If you wish to obtain a (Emergency) First Aid at Work ( (E)FAW ) qualification, or one of the child / paediatric certificates you have to demonstrate practical skills at some point. However, a lot of the course groundwork can be undertaken online before the classroom session. The concepts and principles can be stepped through using videos and online question papers. Once the student can demonstrate a suitable level of understanding, (s)he can be signed off and allowed to attend the remainder of the course in a classroom.What's in it for me?
The advantages of blended learning boil down to time and money.Time
First Aid at Work is a three day course, Ofsted compliant Paediatric is two days. For smaller organisations it can be hard to release an employee for that length of time and still keep the Business going. With one day of online work, this can be carried out whilst at work so that the employee is still available for work-related matters. It's not often that an Employer will encourage employees to sit around watching videos on work time....Money
As they saying goes, time is money. If you, as an employer send an employee away on a course, you still have to pay them for that day (plus expenses) but also possibly pay for cover. Agencies are not known for their altruism, staff drafted in will invariably cost more than regular staff.
Recording a Training video once and playing it many times is an economical way of delivering material and this is reflected in the cost of courses. Whereas a typical course in a classroom will cost between £50 and £100 per person, ProTrainings (the certification Company that 4Minutes uses), for example, charges just £25 for the online part.
Precedent already set
Of course, First Aid is not the first to use blended training. Anyone that has taken a driving test in the last few years will know that there is now a Theory part that needs to be passed before the Practical. You still have to learn and take your test in a vehicle, thank goodness. At least for now. Once self-driving cars become more mainstream, I can see a day when there is a theory-only test. Interesting times ahead.
Any downsides?
Well, yes. As already mentioned, there is no feedback from the instructor if you are unsure and just watching someone perform CPR will not give you a feel for just how difficult it can be on a mannikin or a real person.
Summary
Blended learning and online-only learning is here to stay, like it or not. Whilst it has its place, 4Minute's stance is that all courses should have some face to face element when learning the major life-saving techniques. For underpinning knowledge and other parts of the course, then online at your own pace is almost as good as watching a trainer in person step through a series of Powerpoints.
What do you think?
Monday, 23 November 2015
FirstAid.Directory November 2015 Newsletter
FirstAid.Directory November Newsletter
A new look
Registration discount offer
Blowing hot and cold
Good News - Bad News
A New Look
The First Aid Directory has undergone a radical makeover. Next time that you are out in public, do take a moment to look at everyone passing by, heads bowed, moving purposefully forwards. Perhaps darting to one side every now and again.
No, they are not on a Route March to work, more likely they are engrossed in their mobile device. It's funny how things come full circle. PCs started with low resolution screens and when t'Internet came along, websites were optimised for smaller screens (640 x 480 pixels, typically).
As technology improved, screen resolution improved and websites got wider to fit more in. It was unthinkable to put any content 'below the fold' as it would not get seen.
When mobile phones arrived, screens were text only. Then Nokia started to introduce low resolution graphic displays, good for playing snake or Tetris and that was about it. However, in the mobile arms race, this extended to larger and larger screens and they also became touch sensitive.
At the current time, a significant number of users use mobile devices that to some extent reflect the low resolution PCs and website designers have had to allow for this. Hence the long, scrolling pages that you see nowadays. Below the fold content is now expected and Google has publicly stated that it will give preference to mobile-enabled websites.
TL;DR The FirstAid Directory is now a single column website, optimised for mobile devices, whilst still being perfectly useable on a PC or Mac. Behind the scenes we have made it much more manageable and are adding a plethora of features for you.
If you are a First Aid Provider and you haven't signed up yet, then why not? A basic listing is free and if you want to really sell your services, the premium option is not very much - one paying enquiry per year will easily cover the cost.
Registration discount offer
Still not convinced? Register and upgrade to a Premium Account before the end of 2015 and we'll even knock some money off for you!
Click here to get going.
Blowing hot and cold
Traditionally, the treatment for strains (muscles and tendons) and sprains (ligaments) has been RICE - Rest, Ice, Compress and Elevate.
In recent times, this has been subject to some scrutinizing and there is a body of thought that this might not be best practice. In this article from Healthline, "researchers have been questioning the way these injuries are treated. They've found that the RICE advice came about more from educated guesswork than actual research."
In the medium to longer term, Sports Therapists and Physios have been known to alternate heat and cold, for instance.
No-one is saying that you should currently deviate from currently accepted Good Practice (RICE) as a First Aider - and, indeed, you open yourself up to all sorts of liabilities if you do. However, First Aid does not stand still and, over the years, all sorts of practices come and go as they are either disproven (Revised Sylvester, anyone?) or superseded (tourniquets and ring bandages, for instance). Leeches were in, then they were out. Now, they are back in again in a Hospital environment as their saliva has good clotting attributes.
Good News
Morgan Sindall installs heart attack machines on all sites
Morgan Sindall is installing life-saving defibrillators in all its sites and offices.
The contractor has signed a deal with Cardiac Science to provide Powerheart G5 automated external defibrillators (AEDs).
Morgan Sindall teams are now installing a minimum of one AED at each of its office and site locations across the country.
The kit will be made available to each of Morgan Sindall’s business operations through its internal plant hire division Magnor Plant.
Bad News
Tory MPs block bill to give first aid training to children by talking non-stop until debate ends
Conservative MPs have blocked a bill to bring first aid training to schools by talking non-stop until time to discuss and vote on it ran out.
The Compulsory Emergency First Aid Education (State-Funded Secondary Schools) Bill would have required schools to teach first aid training to children as part of the national curriculum.
Friday, 10 January 2014
4Minutes First Aid's January 2014 Newsletter
In this issue:-
At some point in the spring, I want to make some training videos. It's very much at the concept stage, but if you think you'd like to act as a First Aider or as a casualty, drop me an email via the Contact Form.
It's not a lesson scenario, so we'll go through what you need to do so that you are happy - no pressure.
You will be paid for your time and also get a credit at the end of the clip. However, you will need to sign a model release as it is a commercial venture. Children are more than welcome as well if interested, but their parent / guardian will need to sign a release on their behalf.
- Essential First Aid course date
- 4Minutes can now provide First Aid Cover
- Top tip of the month
- Actors / actresses wanted
This is the course for those that want to know something should you need to treat friends or family. Figures show that if you have to deal with a casualty it will be, in all probability, someone that you know.
The first course for 2014 has been put online - make a note for your diary, it's February 10th 0930 - 1230 at the Magnet Leisure Centre in Maidenhead. View Course details and book here:
The first course for 2014 has been put online - make a note for your diary, it's February 10th 0930 - 1230 at the Magnet Leisure Centre in Maidenhead. View Course details and book here:
Remember, places are limited to 12 on a First Come, First Served basis. Also, if you can drag someone else along with you, it will cost you less per person.
If this time of day is not convenient for you, let me know via the Blog (Click on the link at the top) and suggest what days of the week and what times of the day work for you and I'll see what I can do!
4Minutes can now provide First Aid Cover
With immediate effect, we can provide First Aid cover for your event. At the moment, we only provide First Aid, not an ambulance or higher levels of cover, but if you are running a small event and need basic cover, then drop us a line.
Been let down at the last minute? Again, give us a call and we'll see what we can do.
Top Tip of the month
Using cling film to cover a burn once you have cooled it down?
Remember to take off the first couple of turns since it's been rattling round your kitchen drawer for weeks. Then tear off strips and apply them in layers onto the burn. Do Not wrap it round an arm or leg.
A burnt area will swell, but the cling film will not. If it is wrapped round, it will constrict the blood supply to the end of the arm / leg and cause circulation problems.
If it is applied in layers, then the layers will slide over each other if any swelling occurs.
Remember - cool the burn before applying.
Actors / Actresses wanted
It's not a lesson scenario, so we'll go through what you need to do so that you are happy - no pressure.
You will be paid for your time and also get a credit at the end of the clip. However, you will need to sign a model release as it is a commercial venture. Children are more than welcome as well if interested, but their parent / guardian will need to sign a release on their behalf.
That's it for this Newsletter. Happy First Aiding
Andy
Andy
Monday, 16 September 2013
Who ya gonna call?
A couple of reports earlier this year have found that a) we are normally never more than six foot away from our mobiles and also that we suffer withdrawal symptoms if we are parted from it for too long.
Whilst this smacks of a Society that is increasingly dependent upon, nay, addicted to mobile 'phones, it does have an advantage in that should you be unexpectedly knocked unconscious, the Emergency Services can get hold of someone to call - 'Mum', 'Dad', 'Aunty Maude' for example. Brilliant.
Whoah, hang on a minute. "I've password protected my phone", "I'm an orphan and my parents never had any siblings". OK, the latter is rare, but with concerns about privacy, the former should be adopted by one and all.
Quick aside. Have you switched on tracking on your Apple device? Cool, huh. If it gets nicked, you can track it, lock it and wipe it. That'll teach them. No it won't unless you have also password protected the whole device. Otherwise, savvy thieves will go straight to 'settings' and turn tracking off. IPad lost forever. If you haven't password protected your Apple Device, do it now. It's not foolproof, by the way, but a lot better than an unprotected device.
Where was I? Oh, yes. Dialling for help.Here's some stuff that you should know.
1. ICE (In Case of Emergency). http://news.bbc.co.uk/1/hi/uk/4674331.stm
Dreamt up by a Paramedic, it's amazingly simple. Pick someone that you want to be contacted if you have an emergency and are incapable of communicating your wishes. In your 'phone address book, create a new contact with the name "ICE". Add the contact details to the ICE contact. More than one Contact - use ICE2, ICE3 etc.
Do it. Now.
2. Getting around Phone locks. ICE is all well and good, but what if you lock your 'phone? Luckily Manufacturers are cottoning on. Here are some developments that I am aware of. Feel free to add to the list.
Whilst this smacks of a Society that is increasingly dependent upon, nay, addicted to mobile 'phones, it does have an advantage in that should you be unexpectedly knocked unconscious, the Emergency Services can get hold of someone to call - 'Mum', 'Dad', 'Aunty Maude' for example. Brilliant.
Whoah, hang on a minute. "I've password protected my phone", "I'm an orphan and my parents never had any siblings". OK, the latter is rare, but with concerns about privacy, the former should be adopted by one and all.
Quick aside. Have you switched on tracking on your Apple device? Cool, huh. If it gets nicked, you can track it, lock it and wipe it. That'll teach them. No it won't unless you have also password protected the whole device. Otherwise, savvy thieves will go straight to 'settings' and turn tracking off. IPad lost forever. If you haven't password protected your Apple Device, do it now. It's not foolproof, by the way, but a lot better than an unprotected device.
Where was I? Oh, yes. Dialling for help.Here's some stuff that you should know.
1. ICE (In Case of Emergency). http://news.bbc.co.uk/1/hi/uk/4674331.stm
Dreamt up by a Paramedic, it's amazingly simple. Pick someone that you want to be contacted if you have an emergency and are incapable of communicating your wishes. In your 'phone address book, create a new contact with the name "ICE". Add the contact details to the ICE contact. More than one Contact - use ICE2, ICE3 etc.
Do it. Now.
2. Getting around Phone locks. ICE is all well and good, but what if you lock your 'phone? Luckily Manufacturers are cottoning on. Here are some developments that I am aware of. Feel free to add to the list.
- Many device manufacturers have provided a mechanism to specify some text to be displayed while the mobile is in the locked state.
- Some devices let the owner of the phone specify their "In Case of Emergency" contact and also a "Lost and Found" contact. For example, BlackBerry mobiles permit the "Owner" information to be set in the Settings → Options → Owner menu item (source: Wikipedia)
- IPhone. You can download apps that can create a iPhone lock screen with emergency details, e.g. "Emergency Info Screen" app
- IPhone with Siri. Siri works even if the 'phone is locked. Press and hold the button to activate Siri, then say "Siri. Call ICE"
- Galaxy S3. When the screen is locked there is the option to make an emergency call. If you press that the key pad comes up so you can dial 999. On the bottom left is an icon that looks like a person with a light bulb. If you press this it shows you the group of people who you have assigned as your ICE contacts (SG on Facebook - thanks. Contact me if you want a full credit)
- Galaxy S3 (again) You can go into settings-lock screen-user information and type in a message there. I now have my name and emergency contract number scroll across the screen when it's locked! (SG again)
- Nokia & Windows. This would work for all others as well. TYPE "ICE" plus your number into a Word Processor. Photograph it. Set the photograph as your screensaver.
That's my list so far. If you can come up with any others, do let me know.
Monday, 29 July 2013
The Good Samaritan Act et al - Hit or Myth?
Morning.
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 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.
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.
- You were acting within your training
- Ribs break. I've broken hundreds over the years. Especially in the elderly. You just carry on.
- They are pretty unlikely to have pierced a lung
- 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
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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