First Aid tips that are a Cut above the Rest.

There’s an awful lot of miss- information on emergency first aid and what to do if you’re the only person available. Here are some of them.

Myth 1: If someone has swallowed a poison, make them vomit. 

It is better NOT to make someone vomit who has swallowed a poison e.g. bleach. Any substance doing damage on the way down to the stomach will do more damage on the way back up, if you make them vomit. If the substance hasn’t affected the airway on the way down, it may irritate the airway as it as the substance is vomited up mixed with stomach acid. The best treatment is to call 999, 911, 111 or take the casualty and a sample of the substance they have swallowed, (or the packet) to A&E

Myth 2: A first aider can’t give medication 

This used to be the case but is no longer – but with restrictions. First aiders are not pharmacists – we don’t have the medical level training to assess a casualty and prescribe medicines. However, experience and research now considers it reasonable to allow the use of three medicines by a first aider. All medicines have a use by date so always check that before use.

These are the three medications we may give to a casualty as a first aider: 

Asprin – It would be reasonable to offer aspirin (150-300mg) to a casualty that you suspect is having a heart attack.  Always check first they have had asprin before and they are not allergic to it.

In Educational settings, you can keep spare asthma inhalers and epi-pens for specific children who rely on them.
Very useful to know if you happen to be teaching abroad.

Asthma inhalers – Inhalers can be shared between sufferers if needed – just wipe the mouthpiece with a medi-wipe before hand. (Make sure to check the dose and make of the medication beforehand with the person needing it.

Epi-pens (Adrenaline Auto Injectors)– These are specific to a person and cannot be shared. Check with your Educational Authority on use in your setting as some local guidance varies. Someone suffering an anaphylactic shock needs their medication immediately. They should be carrying 2 injectors with them at all times.

Myth 3: If someone is having a heart attack, ask them to cough

There is no medical evidence to support ‘coughing’ as a way to manage a heart attack. If we suspect a heart attack we need to call 999, 911, 111 this is a medical emergency. more information can be found on the British Heart Foundation website about ‘coughing’. A heart attack is a life threatening emergency and many years of research has gone into the advice we give on First Aid courses. Don’t believe the myths and hearsay in an emergency. Go with the science! If coughing worked, it would have appeared on the First Aid course syllabus by now.

Myth 4: A first aider can’t use an AED

Public access AEDs (Automated External Defibrillators) or just ‘defibrillators’ as they are commonly called, are designed for non health care staff to use. They can be used by untrained people in a life saving situation to save lives. An AED is needed when someone has stopped breathing because of a cardiac arrest. The quicker an AED is used the better the casualties chances of being revived.  They are easy to use as they talk you through what is needed.

If you are doing CPR and an AED is available, open up the box, press the green button and follow the instructions.
The ones that are designed for public use have safety features making them impossible to work if the patient still has a heartbeat not in the point of requirement to deliberate.

Myth 5: Put butter on a burn to cool or sooth the burn

The oil in the butter may itself heat up and make the burn worse. The best treatment for a burn is to cool it with running tepid or cool water for at least 20 minutes, or until there is no further pain. Cover with a dressing to keep out infection and seek medical help if it covers more than 5% of their body area or has broken through the skin.

Myth 6: Never move a casualty with a spinal injury 

This is great advice in general, but there may be times when a casualty with a potential spinal injury does need to be moved. If the casualty is in life threatening danger they need to be moved to a safe area. If a casualty is unconscious and vomiting they need to be placed carefully in the recovery position.  The risk with vomiting is that their airway becomes blocked and they cannot breath. This is why A- airway is always at the top of all first aid training A-airway, B-breathing C- circulation. D-damage to spine or other injuries comes after these first three. Damage or injuries can be repaired afterwards – a blocked airway cannot.

Myth 7: If someone has a nosebleed, tilt their head back

Current best practice is to lean the casualty forward and let the blood drain from the nose rather than tilt their head back, where the blood could run down their throat and cause them to vomit. It would also be good practice to pinch the soft part of the nostrils and ask the casualty to breathe through their mouth.  If a nosebleed doesn’t stop after 10 minutes, call for an ambulance or take them to hospital.

Myth 8: Use a tourniquet for a big bleed from an arm or leg

Although we now teach the use of tourniquets by first aiders, in appropriate circumstances, the best way to manage a bleed is still by applying direct pressure. Other options include Haemostatic dressing which have a special agent within them that can stop big bleeds in minutes. They still need direct pressure though. Only when this is not working should a first aid consider using a tourniquet.

Myth 9: If someone is choking on an object, try to remove it from their throat

Putting your fingers down someone’s throat to remove a foreign object may well push the object further down. Also, they may bite you and you then have an infected finger wound and your blood in their mouth. Correct first aid is to get them to try and cough it up followed by a combination of back slaps and abdominal thrusts which should remove the blockage.  Adult and child or infant choking requires slightly different approaches due to the size of their airway and their body frames.

Myth 10: Can’t use plasters on children 

Of course you can! Some people, including many children, are allergic to plasters. Stock your first aid kit with Hypo-allergenic plasters and there should be no problem. The most important thing is to check, clean and cover that wound to prevent infection. See what the Health and Safety Executive says here about plasters in your workplace.
Myth 10: A tampon will plug a gun-shot wound…

Injuries from gun shot wound’s are unique as opposed to many other mechanisms of injury associated with penetrating trauma. The location where the bullet goes in to the body will cause an entrance wound and depending on whether the bullet leaves the body, there may also be an exit wound. Bullets do funny things when they enter the body. They may continue on a straight path in and out. They may follow bone structure, or ricochet. In some instances, the bullet may not exit the body at all.

There are many factors which impacts the path of a bullet, and the amount of trauma from a GSW. These include:

• The weight of the projectile

• The type of projectile

• The velocity of the projectile

• The angle the bullet hits the body

• The distance of the body to the firearm.

Gun shot wound’s are unique because of the injury profile created in the wake of a bullets’ path, known commonly as cavitation.

So why can’t the tampon plug the hole?

The entrance wound is typically where the fabled tampon is supposed to be inserted to assist with stopping bleeding. Remember, the entrance wound is determined by the size of the bullet, it is the wound you can physically see. The severity of the trauma caused internally, the cavitation, is often hidden, especially if there is no exit wound.

Depending on the calibre, the entrance hole might be small. In some cases, such as a .20 or .30, they’re smaller in diameter than a regular tampon. This means you would have to cause further damage just to shove it in the hole to plug it – it doesn’t make sense. But remember, just because the entrance hole is small, it does not mean the damage behind it is not significant.

This is the part that can trip people over. Due to the occult (hidden) nature of the trauma behind the skin layers, it won’t always present obviously or immediately.

Plugging the hole with a tampon might mean the blood is not visually coming out of the body. This does not mean it is in circulation. Blood will pool into the temporary cavitation. You’ll be thinking you’ve done your job, but wondering why your patient is still deteriorating and exhibiting signs of hypovolemic shock.

Let’s remember, the goal of controlling bleeding is not to absorb blood, but to keep it in circulation. Even if we wanted to absorb the blood, a regular tampon could absorb approx. 9g of blood (about two teaspoons). In no world would the 9g of absorption be beneficial to “stop an arterial bleed, capable of pumping out 1000 mLs in just over 3 minutes”.

So what does work for gun-shot wounds?

You’ll hear medical professionals say it all the time – pressure wins the war against bleeding. This is the last (and possibly most pertinent point) as to why a tampon won’t work when treating a GSW – at best it will simply stretch the skin of the entrance wound and plug it creating a hidden cavity that will simply pool blood removing it from circulation.

Depending on the size, location and severity of the wound, your best best is direct pressure, tourniquets, chest seals or packing the wound with gauze if the injury is capable of being packed and in junctional area suitable for the delivery of wound packing.

It is critical to remember that once you have managed the bleed, you still need to manage the casualty for hypovolemic shock.

Knowing what to use and when is crucial, this is why we suggest taking a course in first aid and carry a decent first aid kit with you.