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Over the next few months, we are going to be addressing some of the most common myths surrounding mental health.

Firstly, let’s look at mental health – what exactly is it?

What words come to you mind when you hear the phrase mental health? Maybe psycho, depression, crazy, dangerous or resilience, emotion, coping? The majority of people will initially think of mental ILLNESS rather than health.

Mental health can mean different things to different people and there are a number of definitions around. The World Health Organization define mental health as
“a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”  To me it is about being human, managing our everyday emotions and coping with life as it happens.

Let’s put it a little simpler …Have you brushed your teeth today? Why? We don’t wait for a cavity in our teeth before we start caring for them – we brush them everyday to keep them healthy.

Do we care for our mental health the same way and take little steps to keep well and prevent illness or do we wait until we are at crisis point? Staying with the teeth analogy – we have regular check ups and sometimes we may need a filling, sometimes a root canal, sometimes even an extraction! That is the same with mental health/ illness. Sometimes we may be feeling stressed and need to do something for our selves, sometimes we may need professional support.

Why do we call it MENTAL health – wouldn’t it just be nicer to change the name?
When I first started as a mental health nurse in the mid 80’s, I like others, thought it would be like this..


Bethlem Royal Hospital, UK

Although we have come a long way since those days, there is still so much stigma around mental health.

If we change the name, are we then buying into the stigma and saying that is shameful to have issues with our mental health. What we should be doing is embracing the fact that we ALL have mental health and it can change the very same way our physical health can change.

There are so many great ways we can not only support our own mental health but reduce the stigma. Let’s start a conversation…….

We will be exploring tips to help you support your and your loved ones mental health, please share this journey with us.

Stay tuned, our next blog will look at when mental health changes to mental illness.

The post What is Mental Health? appeared first on Paradise First Aid.

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In this weeks blog post we are visiting the treatment of Dental Trauma. A shoutout to Medland Orthodontics for supplying the below information.

REMAIN CALM: Your response or reaction to illness, injury and trauma will affect a person’s ability to cooperate. All incidents should be handled calmly and quietly. A panicked person is more likely to cause difficulty for caregivers providing first aid or treatment and may lead to further trauma. In all cases, staff will remain with the person and not leave them unattended.

SURVEY SCENE FOR SAFETY: When a person is injured, ensure the environment is safe to proceed to the person without causing additional harm to self or others. Ensure others who are not directly involved with providing care are not allowed to stand about and impede the progress of care provided. Ensure the environment is safe and free from other potential hazards. (If the environment remains unsafe to provide first aid care, call 000 or local emergency medical services for assistance).

PROVIDE APPROPRIATE FIRST AID CARE: If the injury is ‘life-threatening’ call 000. Perform DRSABCD and FIRST AID.

DRSABCD (In life-threatening conditions):

D – Danger: Ensure the area is safe for yourself, others and the patient.

R – Response: Check for a response when you talk to them, touch their hands or squeeze their shoulder. No response – send for help.    Response – make comfortable and monitor response.

S – Send for help: Call triple zero (000) or ask another person to make the call. Try an answer as many questions asked by the operator.

A – Airway: Open the mouth and check the airway for foreign material. Foreign material- place in the recovery position and clear the airway. No Foreign material- leave in position. Open the airway by tilting the head back with a chin lift.

B – Breathing: Check if the casualty is breathing: Look, Listen, and Feel for 10 seconds. Not normal breathing-  ensure an ambulance has been called; start CPR. Normal breathing- place in the recovery position and monitor breathing. 

C – CPR: 30 chest compressions: 2 breaths. Continue CPR until help arrives or the patient starts breathing.

D – Defibrillation: For unconscious victims who are not breathing, apply an automated external defibrillator (AED) if one is available. They are available in many public places, clubs and organisations.

First Aid for Dental Trauma (In non-life-threatening conditions)

Injury to Gums or Lips:
1. Wear Latex or vinyl gloves and control bleeding with direct pressure.
2. Apply cold compress or ice to the swollen area.
3. Person to see a dentist or doctor if bleeding continues or wound is large.

Injury to Tongue:
1. Wear latex or vinyl gloves and control bleeding by pressing both sides of the tongue firmly but gently with gauze.
2. If bleeding does not stop after 15 minutes of firm but gentle pressure, contact emergency room for immediate treatment.

Fractured Tooth:
1. Rinse any debris from the tooth with cool to luke warm water. Try to find the broken piece and store in milk or water.
2. Place a cold compress over the injured area.
3. Contact the dentist for immediate treatment.

Knocked Out:
1. Find the tooth – this is for adult teeth only
2. Do not touch the tooth root with fingers.
2. Rinse any debris from the tooth with cool to lukewarm water.
3. If the tooth is intact, reinsert it in its socket and have the person bite down on a clean dressing to keep it in place.
4. If the tooth cannot be reinserted in its socket, place the tooth into a clean container of cool milk or water.
5. Contact the dentist for immediate treatment.

Loose:
1. Try to move the tooth/teeth gently back into their original position.
2. Close the mouth and use either a piece of gauze, napkin or a clean handkerchief between the upper and lower front teeth.
3. Contact the dentist for immediate treatment.

Keeping Record: A record should be kept (detail of first aid procedure and so forth) in case there are issues relating to insurance and public liability.

With thanks to Medland Orthodontics

The post Emergency Treatment of Dental Trauma appeared first on Paradise First Aid.

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G’day everyone and welcome to another blog. This one is going to give a broad outline on what to do for all the awesome things out there in this fantastic country of ours that can bite, sting or envenomate us!!! There have been a couple of blogs and guides done up in the past on our site, but I figured that this one will put it all in the one spot. To make it a bit easier, I will divide the blog up into the four treatment categories, then add in some of the animals/creatures into each category. Please note, this is not intended to be an exhaustive list of all creatures and subsequent treatments. I will, however, like to give a big recommendation to all of you to download the excellent Australian Bites and Stings app from your app store.

The four treatments we use for dealing with bites, stings and envenomation’s are:

  • Pressure Immobilisation Technique/Bandage
  • Vinegar
  • Cold compress
  • Heat therapy

So, let’s dive into each of the four treatments and see how to apply them to the applicable creatures that cause the dramas!

Pressure Immobilisation Technique

The four animals we treat with the pressure immobilisation technique are:

All venomous snakes (including sea snakes)

Snakebite venom acts on the body in a number of different ways, depending on the snake that bites you. Affecting many systems in the body, venoms can be neurotoxic (paralysing), pro-coagulant (clot the blood), anti-coagulant (thin the blood), weak cytotoxic (muscle damaging) properties. Some venoms are also show potent myotoxic (muscle damaging) properties. When bitten, the venom of the snake goes into the lymphatic system which will then, in time, make its way into the circulatory system.

Common signs and symptoms of snake bite envenomation include:

  • Paralysis
  • Interference with blood clotting
  • Pain
  • Muscle and tissue breakdown
  • Effects on the cardiovascular system (heart/lungs)
Funnel Web Spider

This delightful looking spider, commonly referred to as ‘The Sydney Funnel Web’ actually isn’t isolated just in Sydney. Granted, the species around Sydney has proved to have caused the most fatalities, but there are a number of other species of Funnel Web who range north to Queensland, south to Tasmania and west to South Australia.

Not a lot is known about the venom of the Funnel Web, nor its toxicity on humans. When they bite, in most cases very little venom is injected. However, all bites should be treated with the pressure immobilisation technique. There has also been some evidence showing that prolonged immobilisation can lead to inactivation of the venom.

Signs and symptoms can occur quite rapidly if effective first aid is not performed and include:

  • Pain
  • Numbness around the mouth
  • Spasms of the tongue
  • Nausea and vomiting
  • Abdominal pain
  • Profuse sweating
  • Salivation
  • Lacrimation (tears from eyes)
  • Piloerection (goose-bumps)
Blue Ringed Octopus

One of the oceans most lethal creatures, this beautiful little octopus shouldn’t be feared as it is a very shy creature and, although very common in Australian waters, is seldom encountered. They don’t go out of their way to attack humans and will only bite if they are handled. So… Don’t pick them up!!! They are between 10 – 20cm from tentacle tip to tip and are a yellowish-brown colour. The blue rings only show when they are agitated.

The bite of the Blue Ringed Octopus is painless. If unaware, you will only really know about it when the signs and symptoms start showing. The toxin released is a very powerful neurotoxin resulting in paralysis, especially to the respiratory muscles. The effects can be quite rapid. There is no known anti-venom for a Blue Ringed Octopus bite.

Signs and symptoms can include:

  • A puncture mark, possibly with a touch of blood, painless
  • Tingling around the mouth
  • Nausea and vomiting
  • Progressive weakening of the muscles, especially respiratory muscles, leading to slowing or stopping of breathing.
Cone Shell

The Cone Shell, also known as the Cone Snail, is another very venomous sea creature. But as with the Blue Ringed Octopus, this critter isn’t known to go out of its way to give us a hard time, only envenomating humans when handled. Of the several hundred varieties of Cone Shell, only a very small handful are known to be hazardous to humans. With no anti-venom available, the toxin of the Cone Shell is a concoction of hundreds of different toxins which cause similar signs and symptoms to the Blue Ringed Octopus.

Signs and symptoms can include:

  • A puncture mark, possibly with a touch of blood, painless
  • Tingling around the mouth
  • Nausea and vomiting
  • Progressive weakening of the muscles, especially respiratory muscles, leading to slowing or stopping of breathing.
First Aid Treatment

Always remember DRSABCD! Specific Pressure Immobilisation Technique is as follows:

  1. Stop all movement, lay the patient down and encourage them not to move
  2. If bite is on the limb, apply a bandage firmly from just above the fingers/toes up to the armpit/groin. If bite is on the torso, apply firm pressure using a broad pad.
    • An alternate bandage technique is to apply a bandage directly over the bite site. Then bandage from the fingers/toes to armpit/groin.

     

  3. Using a pen, mark on the bandage where the bite is.
  4. Immobilise the limb by splint or sling.
  5. Have help come to the patient, do not move them.

The bandage should be tight enough so that it is difficult to slide a finger between the bandage and skin.

From left – Setopress or similar snake bite bandage is best, followed by heavy elastic bandage, followed by normal crepe bandage. If no bandages are available, improvise and use clothing.

Things not to do…
  • DO NOT cut the bite site
  • DO NOT suck the venom out
  • DO NOT wash the bite site – a swab of the bite site can be taken and the venom can be tested using a venom detection kit. If washed, this can’t happen.
  • DO NOT use a tourniquet
  • DO NOT move the casualty
  • DO NOT catch the snake to identify it – this can be done using a venom detection kit

Snake Venom Detection Kit – Australia is the only country that can do this!

Vinegar

There are two lots of critters that we treat using vinegar – the Box Jellyfish and jellyfish causing Irukandji Syndrome. Both are found in tropical waters of Australia

Chironex Fleckeri – Box Jellyfish – Sea Wasp

The Box Jellyfish, when it stings you, can be fatal. The tentacles, ranging in length up to 3m, are bunched on each of the four ‘corners’ of the Box Jellyfishes body, or bell. These tentacles contain millions of little cells called nematocysts. These nematocysts look like a little coiled up spring in a capsule. When the capsule hits flesh, the spring in the capsule is released and the venom contained in the nematocyst is released into the fish, prawn or, unfortunately, the human swimming in the water! There appear to be multiple components to the venom, however as it is extremely difficult to collect the venom, little is known definitively about the composition.

Signs and symptoms of Box Jellyfish envenomation are:

  • Sudden onset excruciating pain, described as being ‘hit with a whip’
  • Tissue necrosis (death of tissue)
  • Cardiac and respiratory function can be severely affected, and quite rapidly

What it looks like following envenomation by a Box Jellyfish

Jellyfish causing Irukandji Syndrome

So why not just the one Irukandji Jellyfish? There are actually a number of jellyfish that, collectively when they sting, have similar signs and symptoms known as Irukandji Syndrome. So it’s not just one jellyfish that causes the nastiness. Not a great deal is known about these jellyfish. They are small, between 5 – 25mm, their tentacles can grow anywhere up to 1m long. As with the Box Jellyfish, they sit on the ‘corners’ of the bell, but in this case, there is only one tentacle per corner. It is also thought that in addition to stingers in the tentacles, they also have stingers on the bell.

Signs and symptoms of Irukandji Syndrome can include the following:

  • Initial minor sting at the site of tentacle contact, most times without visually seeing the tentacle
  • Severe generalised pain follows in 5 – 40 minutes, cramping in nature, but can be worse in the lower back/abdominal region
  • Nausea and vomiting
  • Difficulty breathing
  • Sweating
  • Restlessness
  • Feeling of ‘impending’ doom

First Aid Treatment

As always, remember DRSABCD. The basic life support flowchart always takes priority. The treatment for any tropical jellyfish sting is to simply douse it with liberal amounts of vinegar. This does nothing for the venom already inside the patient, however it does neutralise the existing nematocysts on the tentacles still attached, thus rendering them safe to you the first aider and to your patient. You may also need to perform CPR as there is a high chance, particularly for Box Jellyfish, that your patient will go into cardiac arrest. It is imperative that an ambulance is called quickly so that anti-venom can be administered.

Cold Compress

When teaching first aid courses, I generally say that anything that is on the land that stings or bites you (other than those treated with the PIT), apply a cold compress, which is simply a wrapped bag of ice or wrapped instant ice pack. The following are animals/critters that you will use a cold compress for.

Redback Spider

Found throughout Australia, they like to build webs underneath things, such as underneath shelves, chairs, toilet seats, cars, etc. Containing a number of components in the venom, mainly protein based, signs and symptoms of a Redback Spider bite include:

  • Immediate pain at bite site, becoming hot, red and swollen
  • Intense local pain which may increase and spread
  • Nausea, vomiting and abdominal pain
  • Localised sweating at the bite site
  • Swollen glands in the armpit or groin of the limb where the bite occurs.

It is very rare that anti-venom is required, however it is available should it be needed.

All other Australian spiders

Including the White Tailed Spider, Mouse Spider and Huntsman Spider, you use cold compress.

Bees, wasps, ants, ticks

All are treated with a cold compress. The immediate signs and symptoms will be intense localised pain and swelling. However, some people may have a severe allergic reaction, so must be treated accordingly with their EpiPen.

Heat Therapy

Heat therapy we use for marine stings/envenomation, so long as it is not a tropical jellyfish (see above) or a Cone Shell or Blue Ringed Octopus (see above). One that is commonly confused with is the Blue Bottle Jellyfish, so we’ll start there!

Blue Bottle Jellyfish

Also known as the Portuguese Man-O-War, this jellyfish is common around Australia. The float can be between 2-15cm across and the tentacles can reach 10m in length. These tentacles contain nematocysts as described earlier, however if vinegar is applied, it can actually cause more nematocysts to discharge, so is not recommended.

Signs and symptoms and treatment:

  • Localised immediate pain, may spread to lymph nodes in armpits/groin, depending on where sting occurs
  • Skin lesions (appear like a ‘string of beads’)
  • Treat by removing the tentacles, preferably with forceps
  • Soak affected limb in hot water, as hot as the casualty can tolerate
  • If unrelieved, consider using ice-packs
  • Call Triple Zero if pain is intolerable, if sensitive areas are stung (e.g. eyes) or if larger areas are affected
Stonefish

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Hi all and welcome to another blog. When teaching a standard provide first aid course, we cover your primary survey (also called an emergency action plan or basic life support flow chart) in a decent amount of depth. But due to time restraints, we only briefly touch on the secondary survey. If you do the more advanced courses (such as Advanced First Aid and Remote First Aid), we go into the secondary survey in a lot more depth. So for this blog, I thought I would go through all the patient assessment tools that you the first aider might require. Some of these might be a bit more thorough and in-depth than what you need, but hey, it’s better to have too much knowledge than not enough!

Primary Survey

Your initial survey when you come across a casualty, DRSABCD, is familiar to all who do a first aid course. This is a systematic approach you take each and every time you come across a patient, regardless of where you find them. It helps you by not forgetting stuff, getting you hurt, or getting your patient hurt. It looks like this:

Danger – to you, your bystanders and your casualty. Always looking for hazards.

Response – talk and touch. Talk loudly, if they don’t respond, touch (i.e. painful stimuli).

Send – for help (Triple Zero – 000 or 112 from mobile phones anywhere in the world so long as there is mobile service available) and send for a defibrillator (every minute delaying the application of a defibrillator reduces the chances of survival by 10%).

At this point, you should have a quick look for any dangerous bleeding. If you recognise that there is, you should immediately stop it with sustained direct pressure or a tourniquet before proceeding.

Airway – make sure the airway is clear of obstructions, then open the airway by tilting the head back.

Breathing – look, listen and feel to see if the patient is breathing normally

CPR – if the patient is not responsive and not breathing (or not breathing normally), immediately commence cardiopulmonary resuscitation by doing 30 compressions and 2 breaths at a rate of 100 – 120/min, or about 2/second.

Defibrillation – apply a defibrillator as soon as possible to your patient.

Secondary Survey

After conducting the primary survey, if the patient responds to us, it is now time to figure out what is actually wrong with them. Because if they respond verbally, there is absolutely no need at this stage to check airways or breathing (because they’re talking to us) and we certainly don’t need to do CPR just yet. The secondary survey consists of two parts – visual assessment and verbal questioning. The visual component is the ‘head to toe’ physical assessment and the verbal component is basic medical questioning using the ‘SAMPLE’ acronym. Here is how these are done:

Head to Toe physical assessment

After gaining consent and informing the patient of what we’re about to do, the head to toe assessment gives us the opportunity to gather a lot of information. We are looking for signs that things aren’t right (a sign being something we can see). One thing to keep an eye out for when doing a head to toe assessment is to look for any medical alert jewellery. This can be in the form of bracelets, dog tags, necklaces, pendants, anklets. Most will be engraved with the relevant information, however some now contain a QR code that can be scanned allowing access to a secure URL with the patients information.

When conducting a head to toe assessment, it is literally that – start at the head and work your way down to the toes. At each stage, you’re wanting to do two things: inspect and palpate (you can also auscultate if you have a stethoscope, but that’s a bit above your standard first aid level of training). So, let’s do a head to toe assessment now:

Head – inspect for any bleeding and obvious deformity. Check the ears for blood, fluid or bruising. Check the eyes for reactivity to light and equal size pupils. Check the nose for bleeding or deformity. Check the mouth for missing teeth, clench their teeth (to see if the top meets the bottom) and anything blocking the airway. Listen to them speaking for any hoarseness or other abnormalities. Palpate the skull, feeling for any soft boggy areas or crepitus.

Neck – inspect for any bruising, bleeding or deformity. If trained, palpate for a carotid pulse.

Chest – inspect for equal rise and fall, paradoxical movement (normally, when you breath in and out your chest rises and falls respectively. With paradoxical movement, you breath in and your chest falls, breath out your chest rises. This is indicative of a flail chest injury.), bleeding, bruising, accessory muscle use (think asthma). Palpate for tenderness and crepitus.

Abdomen – inspect for bruising, bleeding, penetrating injuries, distention, priapism (spinal injury). Palpate for pain/tenderness, guarding, rigidity, rebound tenderness (this is when you push down, no pain, release suddenly and they have pain).

Pelvis – inspect for bruising, bleeding and deformity. Palpate for tenderness along the bone, but DO NOT SPRING THE PELVIS (i.e. push down on both sides of the pelvis. If they have a pelvic fracture, this will make things a whole lot worse).

Arms and legs – inspect for bleeding, bruising, deformity, range of motion. Palpate for strength/weakness, sensation/touch/temperature, pulses, crepitus.

Back – inspect for bleeding, bruising, deformity. Palpate for pain/tenderness.

Now that we’ve had a good look at our patient, they may have identified some pain when you’ve done your inspecting and palpating. It’s important to really question your patient about their pain as this can provide a lot of valuable information. The acronym (or mnemonic) that we use for pain assessment is OPQRST.

Pain assessment

Onset – Find out what the patient was doing when the pain started (were they active, sitting down, did they just have an argument, stressful event) and if they believe that has contributed. Find out whether the pain has come on suddenly, gradually, or has been a part of a long-term chronic illness/condition.
Provocation – Ask the patient what makes it worse – movement, palpation, positioning or if it’s like that when at rest. You can also ask if there is anything that makes it better – position, movement, rest.
Quality – Ask either an open-ended question (can you describe the pain to me?) or a leading question (is the pain sharp, dull, crushing, stabbing, burning, tearing, etc). Ask if it is constant, intermittent or comes in waves.
Radiation – Ask the patient to point with one finger where the pain originates from. You can then ask the patient if the pain radiates (extends) anywhere (e.g. chest pain – does it radiate down the arms, up the neck to the jaw, to the shoulder blades, to the top of the stomach).
Severity – Ask the patient to describe the pain on a scale of zero to ten, with zero pain being no pain at all, through to ten being the worst possible pain. You can ask the patient to compare it to previous injuries or be imaginative (ten is like getting your arm ripped off…). For little kids, it’s hard to determine, so you can use the Wong-Baker faces scale as an indicator.

Timing – Ask the patient how long it has been going for. You can also ask if it has changed since the onset (better, worse, new/different symptoms), if they’ve had this before.
Treatment – This is a good time to ask if the patient has taken any medication themselves or have done anything to help themselves with the pain.

Finally, it’s time to drill down and get some sort of medical history from your patient. You can do this by doing a SAMPLE survey, yet another acronym/mnemonic we use in first aid. Let’s have a look at this one:

Medical history

Signs and Symptoms – You’ve got this by doing your head to toe assessment. Symptoms are something that the patient needs to describe to you, so ask! Do you feel sick? Is there any pain?
Allergies – Good information to know as it might explain the state of your casualty. It will also help for any medication that might be given by you (e.g. Aspirin) or the paramedics.
Medications – Find out what medication they are taking. You can also check to see if they have taken the medication they’re supposed to be taking! Good information for you and for responding paramedics.
Past medical history – Ask the patient what medical conditions they have. Asthma, diabetes, epilepsy? Any recent surgery? Anxiety, depression?
Last ins and outs – Find out when the patient last ate and drank. If they have had any alcohol or illicit substances. Find out when they last went for a pee (how long ago; was it clear/dark yellow; did it sting; did it smell; was their blood in it?), when they last went for a poo (hard/soft/runny; how long ago; was their blood in it?). For females, ask if they’re bleeding down below. If they are, question if it’s their normal menstrual cycle. If not, question if there is a chance that they might be pregnant (could indicate miscarriage, ectopic pregnancy). It’s a lot of prying we are doing, but the information we get can greatly assist in getting a good solid diagnosis from our patient.
Events leading up to – Ask the patient what they were doing in the minutes/hours/days prior to you treating them. This can help narrow down a diagnosis, because some signs and symptoms can be attributed to a number of conditions.

There are a number of other assessments we can do in our secondary survey as well, such as mental status assessment, respiratory assessment, neurological assessment, perfusion status assessment and Glasgow Coma Scale. But that would see this blog post triple in size. The above is more than sufficient for providing a good solid patient assessment which can then nail down a diagnosis.

In wrapping up, hands on learning is a great way of solidifying and confirming your knowledge. Book in to one of our provide first aid courses to get the basics at any of our three locations (Coomera, Biggera Waters or Mermaid Beach). But if you want a lot more exposure to good solid patient assessments (as well as some excellent training), consider taking part in either our advanced first aid or remote first aid courses held regularly at Biggera Waters. Of course, if you have the numbers, we can come to you as well. Just give us a call at our head office on 07 5572 5299 or visit us at www.paradisefirstaid.com.au to make a booking. Stay safe folks and thanks for reading.

The post Primary and Secondary Survey – A How To appeared first on Paradise First Aid.

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Paradise First Aid by Craig Middleton - 4M ago

G’day everyone and welcome to a belated start to the blogs for 2019. This first blog comes as a result of one of our Facebook quizzes we ran a few weeks back. It was also prompted by this news article I read yesterday: https://www.brisbanetimes.com.au/national/queensland/driver-impaled-by-metal-pole-in-warrego-highway-crash-20190225-p5106b.html.

Some of the questions raised were: What happens at a traffic crash? What do we do? So, dive in for a look at some stats on road traffic crashes, the types of injuries you can expect to encounter and what you as a first responder should do when first on scene at a traffic crash.

As a fireman for 15+ years, I have attended a lot of traffic crashes. Sadly, a number of them resulted in serious injuries and fatality. However, the statistics I found when researching this blog were astounding. Starting big picture – since 1989 until January 26 of 2019, there have been 48,592 fatalities on Australia’s roads. In January 2019 there have been 119 deaths in Australia, 18 more than in 2018. And in the 12 months to end of January 2019, there were 1,166 fatalities, which was actually a decrease of 5% on the 12 months before. Whilst these numbers reflect the fatalities, the information I can interpret from other sources for injury rates put these significantly higher, to the tune of 50X more injured than those killed.

So, what causes all these deaths? You’ll notice that I haven’t used the term ‘accident’ in here at all. That’s because the vast majority of these road deaths are deemed to be predictable and preventable. This is why public health officials have spurned the word ‘accident’ when it comes to road crashes. As these crashes are preventable, it would come as no surprise that the predominant factors in crashes are related to inexperience and risky behaviour. Things such as drink/drug driving, speeding, distracted driving (talking/texting on the phone) are big contributors. Driving late at night results in fatigue related crashes, as does people driving older vehicles with less or no safety features. According to a Bureau of Infrastructure, Transport and Regional Economics report from 2016, half of all road crashes occurred on roads with a posted speed limit of 100km/h or higher, with only 12% being on roads at or under 50km/h.

Knowing how a vehicle can crash goes a long way to understanding the types of injuries a person may sustain. Below shows a number of common impacts that vehicles sustain in a crash:

Head on impact

Vehicles impact on the centreline, straight on. Vehicles can also impact head on to a stationary object, such as a tree or pole.

Quarter impact

When the front or rear quarter of the vehicle is hit.

Side impact

As the name suggests, commonly called a ‘T-Bone crash’

Rear impact

Another one that is self-explanatory… Sometimes called ‘Rear Ended’. Generally these crashes occur at lower speeds, but not always.

Roll over

Another descriptive term. Sometimes you’ll find the vehicle on its side, roof or completely rolled over back onto its wheels.

What to expect

Knowing how a vehicle can crash can lead us now to understand the types of injuries that may be sustained in an impact. This is what you can expect to encounter:

  • Head on or frontal impact
    • Down and under – The path the occupant takes, sliding downward into or under the steering column then under the dash. The upper legs take most of the impact here, so expect patella (knee cap) dislocations, mid-shaft femur fractures, upper leg/hip fractures or dislocations.
    • Up and over – Where the occupant travels forwards into, then over, the steering wheel forward to the windscreen. Chest, neck and head impacts are the big ones to look for here – lacerations to the head and face as well as skull and facial fractures. When the skull stops, the brain keeps moving, so a lot of internal head trauma happens, such as bleeds and bruising, as well as damage to the brain stem. Whiplash type injuries as well as more serious fractures can happen with the cervical spine region. Chest injuries occur, such as fracture ribs and sternum, flail chest, heart and lung contusions. Abdominal injuries may occur, as can thoracic vertebral injuries.
  • Rear impact – As it mostly occurs at lower speeds, neck injuries such as hyperextension resulting in ligament strain/tears as a result of poorly positioned head-rests occur. Head strike and associated lacerations and bruising can occur. Obviously, injuries will be substantially more if in a high-speed impact.
  • Side impact – Most of the injuries will be on the same side of the impact. Head and chest injuries, flail chest, lung contusion, rib fractures, thoracic aortic tears, cervical spine fractures or ligament tears and numerous musculoskeletal injuries can occur.
    Rotational impact – When the vehicle spins around after an impact, injuries will be consistent with those found in both frontal and side impacts.
  • Roll over – Hard to predict where the injuries will occur, it depends on how well restrained the occupant is and what damage is done to the vehicle. As the occupant impacts the vehicle in several places, expect injuries to the external and internal body at these locations, as described above.
  • Ejection – When an occupant is thrown from the vehicle. Expect lacerations if through the windscreen as well as numerous internal and musculoskeletal injuries as described above. Increased mortality associated with these types of incidents.
  • Vehicle safety restraints – Whilst seatbelts and airbags can save lives, they can also contribute to some significant injuries. Spinal soft tissue and skeletal injuries can happen, as can chest soft tissue and skeletal. Abdominal injuries are common, such as friction burns from the seatbelt, internal damage to abdominal organs and soft tissue damage. This is why seatbelt position of the lap sash is so very important. Do not place it on the abdomen, but rather lower down over the pelvis.

Look for this on dashboards, steering wheels, inside the pillars of the vehicles and in the footwells. Indicates an airbag is located here (several other places they might be, but these are the more common locations).

What you need to do at a car crash
  • On approach, make the scene safe. Park at least 10 metres away from fallen power lines. Park vehicle to protect the scene, hazard lights on and warning triangles if you have them.


A UK police car parked in the ‘fend off’ position. This position makes the scene on the other side safe. Any vehicles that approach are theoretically ‘fended off’ and away from the incident.

  • As with all incidents, your first priority is to check for DANGER. Approach the scene cautiously, looking constantly for hazard. Such hazards can include, but are not limited to:
    • Traffic
    • Leaking fuel
    • Bystanders
    • Body fluids
    • Aggressive patients
    • Undeployed airbags
    • Hazardous materials
    • Electricity (above and below ground)


This is a photo of a green electricity pillar box. I have been to a car crash where the vehicle ended up on top of the box. The whole vehicle then became energised. If not for one bystander looking for and identifying the hazard, more people could have been seriously injured or killed.

  • On accessing the vehicle, turn off ignition and remove the keys (place them on the floor of the vehicle or give them immediately to the first responding emergency services). Apply the park brake if you can and if you are able to, place a chock on the down hill side of the vehicle’s tyres.
  • If a motorbike rider and you’re concerned with helmet removal, see this blog: https://www.paradisefirstaid.com.au/how-to-remove-motorbike-helmet/
  • Ensure Triple Zero (000) has been called.
  • Manage the patient and injuries that you can see.
    • If the patient is unconscious, clear and open airways immediately. Then provide manual in line stabilisation of the head so as to protect the neck. Airways have priority, do not be scared or concerned about tilting the head back to access and open the airways. Check and manage any dangerous bleeding, have other people continue doing any first aid that may be required.
    • If the patient is conscious, encourage them to stay still and apply stabilisation to the head. Control any dangerous bleeding and have helpers manage any other first aid that may be required.
    • If the patient is unconscious and not breathing, immediately remove them from the vehicle if possible and commence CPR.

And that sums up what you should look for at a traffic crash. I have focussed here mainly on car crashes, but the information easily applies to heavy vehicle and motor cycle crashes as well. Just remember that the way the vehicle and body impact determine the nature of the injuries. As always, if you are still not too sure what to do in terms of hands on first aid, please don’t hesitate to get in touch with us on 07 5572 5299, Monday to Friday. We run courses 6 days a week at our three training centres in Helensvale, Biggera Waters and Mermaid Beach. Check us out at https://www.paradisefirstaid.com.au/. Stay safe folks and thanks for reading.

Reference list and photo credits

https://www.brisbanetimes.com.au/national/queensland/driver-impaled-by-metal-pole-in-warrego-highway-crash-20190225-p5106b.html

https://www.abc.net.au/news/2018-01-25/every-road-death-in-australia-since-1989/9353794

https://bitre.gov.au/statistics/safety/

https://www.aihw.gov.au/getmedia/ea5ab3f1-3ece-4c68-a021-3c659222fee9/15552.pdf.aspx?inline=true

http://autoworld.com.my/news/2015/11/04/video-honda-internal-head-on-crash-test-between-cr-v-and-jazz/

https://www.insurancehotline.com/fault-determination-in-common-scenarios/

https://www.youtube.com/watch?v=JGc4eh0dPJo

https://en.wikipedia.org/wiki/Side_collision

https://www.google.com/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwir8N79j9jgAhUVYysKHQuMDPcQjRx6BAgBEAU&url=https%3A%2F%2Froyinjurylaw.com%2Fblog%2Fauto-accident%2F5-most-common-injuries-from-a-rear-end-auto-accident%2F&psig=AOvVaw29JzEPseE7Ci2nbJmWE3wP&ust=1551226703790486

https://www.sternberglawoffice.com/rollover-car-accidents-in-florida/

https://bitre.gov.au/publications/ongoing/road_deaths_australia_annual_summaries.aspx

https://bitre.gov.au/publications/ongoing/road_deaths_australia_monthly_bulletins.aspx

Curtis, K. and Ramsden, C. (2011). Emergency and Trauma Care for Nurses and Paramedics.

ANZCOR Guideline 2 – Managing an Emergency

https://the-riotact.com/green-electricity-boxpillar-in-front-of-house/132304

http://www.ukemergency.co.uk/this-scene-shows-a-police-mercedes-benz-in/

https://www.flickr.com/photos/stevan/26044406

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Paradise First Aid by Craig Middleton - 6M ago

G’day everyone, hope you’re all doing well in the lead up to the silly season. This blog will be having a look at some of the weird and wonderful first aid myths that crop up from time to time in our courses and on the internet. Some are outdated, some are misguided, and some are just plain dangerous. So, in consultation with some other trainers and health care professionals, let’s right some wrongs. There is quite the list…

CPR

You don’t have to give breaths

You don’t, but it’s best if you do. The Australian Resuscitation Guidelines say that if you’re trained and willing you should. The blood in our body only contains so much oxygen, if we were to do compression only CPR, we’ll soon run out of oxygenated blood being pumped around. If you were to do compression only CPR on a casualty who has drowned, you would be pumping deoxygenated blood around and it’d be pointless. Same deal for a baby, who has a very high oxygen demand and very low blood volume. This will be the topic of a future blog as it seems to cause a lot of confusion.

Just a puff out of your cheeks for baby CPR

I challenge anyone to tell me exactly how much air is in your cheeks when you puff… It’s simple for this one, put just enough air in to make the chest rise. Works on adults, children and babies, no need to worry about how much air is in your cheeks.

Encircling the chest of the baby when doing compressions

Although using thumbs as an alternative method of providing chest compressions on an infant may be acceptable if the rescuer is unable to get the correct chest depth using their fingers, encircling the chest with the hands It’s not a technique that should be used. Problems that can occur when a lay rescuer performs this incorrect compression technique include squashing the chest cavity (rather than focussed pressure on the lower half of the sternum) and failing to allow the chest cavity to expand when breaths are given in two-person CPR.

This is not a good technique

The poor baby is getting squished!

Picking the baby up to do compressions on your arm

This one crops up a lot on courses and is not correct. By picking up a baby and doing compressions on your arm (or in your lap), you are unable to get the correct depth of compressions. You’re also unable to effectively support the baby’s head. Finally, when holding the baby in your arm doing CPR, you’re going to get a very tired and sore arm. The best technique is to place the baby on a firm surface (the ground or on a table/bench), hold the head of the baby in the neutral position and commence compressions using two fingers in the centre of the chest (lower half of the sternum).

This method is incorrect

Placing baby on a hard surface is the best

Use the patients fingers to scoop out what’s in their mouth

When you’re unconscious, all the muscles in your body relax. This is why we must position an unconscious patient on their side with their head back and face down, so as not to let the tongue and other upper airway anatomy block the airway. If all muscles are relaxed, the effectiveness of using a patients’ own fingers to clear their airway would be about as effective as shooting pool with a length of rope. It’s just not going to happen. Take the appropriate standard precautions for infection control (i.e. gloves), use your own fingers and scoop the goop or flick the sick. If it looks like they’re seizing, don’t put your fingers in there, just wait until the seizing is finished.

Choking

Use the Heimlich Manoeuvre

Taught in America and advocated in their guidelines, the Heimlich Manoeuvre (aka abdominal thrusts) has been deemed too high risk by the Australian Resuscitation Council and should therefore not be used and definitely not taught. There are too many highly vascularised organs under the lower ribs/upper abdominal region that could be damaged if performed incorrectly and there are in fact documented cases of life threatening complications when this technique has been used.

Dangerous bleeding

You can’t use a tourniquet

A hangover from older first aid courses, I remember being taught this years ago. However, much research and hard-won experience on the battlefields of Iraq and Afghanistan, not to mention mass casualty events such as the Boston Marathon bombings and the Sandy Hook Massacre in the USA, have proven the effectiveness of the tourniquet. A recent study in Texas, USA showed that the civilian application of the tourniquet for dangerous vascular bleeding gave almost a six times greater chance of survival than for those who didn’t get one applied. Quite simply, they save lives. Read up on my previous blog introducing the ‘Stop the Bleed’ workshop that we run – https://www.paradisefirstaid.com.au/stopping-the-bleed/

If you use a tourniquet, you have to take it off after x amount of time

Again, another hangover from older first aid courses. This is a technique taught at higher levels of pre-hospital care when there is an extended transportation time. This is not something that we do at our level.

You need to elevate the limb

For an arterial bleed, this technique is ineffective. Let’s face it, the blood pumps uphill from our heart to our brain. Stands to reason that if we held an arm that had an arterial bleed above our heart, it’s going to pump all the way up there too. There is no evidence to say it works, in fact it has shown to cause further injury. The correct techniques are taught in our first aid courses, the ‘Stop the Bleed’ workshops or in the same blog as mentioned above in tourniquets.

Embedded Object

Use a donut bandage

An antiquated technique that simply doesn’t work. For starters, it takes a long time to make (and if you’ve pre-made them, it takes up a hell of a lot of room in your first aid kit). Secondly, they only go on a nice and straight embedded object. Thirdly, you’d have to be pretty damn lucky (or unlucky?) to have the embedded object the perfect size of the pre-made donut bandage. Fourthly, it won’t go on if it’s an uneven shaped object that has embedded into you (say a pair of scissors for example). Finally, it doesn’t provide the pressure at the base of the embedded object, the whole point of the exercise.

Donut too small, doesn’t fit

Donut too large, does nothing

A triangle bandage wrapped around the base of the embedded object and bandaged in place is very quick and does the job. Even quicker, two rolled bandages either side of the embedded object and bandaged in place is effective.

One correct technique for dealing with embedded objects.

Burns

Use butter/pawpaw cream/egg white/toothpaste

Please. Don’t. Cool running water for 20 minutes. Follow that up by placing cling wrap, or a wet absorbent dressing, or a burnaid dressing on the burn. You can read a whole lot more about burns here – https://www.paradisefirstaid.com.au/first-aid-for-burns/

Crush Injury

Don’t move what’s on them/Don’t move it after x amount of time

Another hang up from older first aid courses where there was no definitive guideline. Current best practice is to remove the crushing force ASAP, regardless of how long it has been there. Treat any external bleeding, reassure whilst waiting for ambulance to arrive. Due to a number of factors, such as potential hypothermia, hidden dangerous bleeding as well as the standard airways and breathing, the patient should be exposed from under the crushing force as soon as possible, regardless of how long they have been subjected to the crushing force.

Spinal Injury

You can’t move them

If the patient is conscious, breathing and lying on their back, then sure, leave them be. However, if they’re unconscious and breathing, they must be placed on their side in the recovery position. It’s all about life over limb, and the guidelines clearly state that airway has precedence over everything else (with the exception of dangerous bleeding). Because when we’re lying on our back unconscious, all muscles, including the tongue and other upper airway anatomy, actually drop back and block the airway. So we’d die. Do your best to roll the patient safely using the spinal log roll. But if you are on your own with your patient, roll them the best way you can.

The research I’ve done basically says that you’ll have an initial injury that may not produce paraplegia. However, secondary spinal cord injury does occur in the hours to days following the initial injury. This can be attributed to processes at a cellular level, such as hypoxia, inflammation and cell death. Nothing of which we can control at a first aider level. So please, if you come across an unconscious and breathing patient, place them in the recovery position. Or if they are still in a car following a crash, support their head in an upright position to maintain a clear and open airway.

Marine Stings

You need to pee on it

This little chestnut crops up on almost every single first aid course! Please don’t do this, especially to me!!! For tropical jellyfish (box jellyfish and Irukandji), you’ll want to apply copious amounts of vinegar. For non-tropical jellyfish, hot water as hot as the casualty can tolerate, or ice packs if you don’t have hot water. For all other marine stings, hot water as hot as the patient can tolerate is the treatment. Peeing on people just makes for a very awkward situation that can easily be avoided…

This is a Box Jellyfish envenomation. Casualty wouldn’t appreciate getting peed on…

Snake bite

Cut the bite and suck the venom out

I think we have Hollywood to thank for this one. Australian snakebite venom reaches the bloodstream via the lymphatic system. This system works off muscle movement and is just below the skin. Hence the treatment for all Australian snakebites (as well as the Funnel Web, Blue Ring Octopus and Cone Shell) is the Pressure Immobilisation Technique and not cutting and sucking. See correct snake bite first aid treatment here.

Heart Attack

Coughing if you’re on your own so you don’t need to do CPR

I believe this one did the rounds (or is still going) on social media. The message delivered was that, if you were alone and thought you were having a heart attack, by coughing vigorously, you would stay conscious longer and therefore prolong the negative effects of said heart attack. Quite simply, there is no evidence to support this.

It’s not a bad idea firstly to understand actually why a person is having a heart attack. For the most part, it’s because the heart is no longer getting a suitable amount of oxygenated blood, likely due to a clot or restriction of the coronary artery (the blood vessels that keep the heart muscle supplied). When this occurs, the patient may experience pain, shortness of breath, pale, cool clammy skin, nausea and vomiting. Coughing then won’t really do anything to reverse this. The patient needs the chain of survival – early access to help, early CPR, early AED and early Advance Life Support. So it’s better to recognise the signs and symptoms and know how to do effective CPR. If you’re on your own, phone Triple Zero ASAP!

Anaphylaxis

The green EpiPen is for kids

This one admittedly caught me by surprise, as I had always taught that it was by age that the different EpiPen’s were administered. But reviewing the ASCIA frequently asked questions web page, it clearly says that it’s by weight. Green EpiPen Jr is for under 20kg and yellow EpiPen is for kids and adults over 20kg. Always learning, love it!

Legal stuff

The age of consent in Qld is 16 years old

Strictly speaking, in Queensland, a person under the age of 18 is deemed a minor. However, when it comes to consent for first aid procedures, younger people can give consent. Michael Eburn discusses this very topic in his excellent emergency law blog, found here – https://emergencylaw.wordpress.com/2016/10/13/consent-first-aid-and-minors-in-queensland/

So there you have it folks, a wrap up of some of the myths that are out there in the realm of first aid training and delivery. The best thing you can do when it comes to this sort of mis-information is to come visit us and sit in our CPR and/or provide first aid course. We run these daily at three awesome locations on the Gold Coast, or we can come to you. Check out our website for more information. Folks, this will probably be the last blog for the year, so be sure to have a very merry Christmas and a safe and happy New Year. Thanks for reading and see you in 2019!

REFERENCES

ARC Guideline 6 – Compressions
ARC Guideline 9.1.1 – First Aid for Management of Bleeding
ARC Guideline 9.1.6 – Management of Suspected Spinal Injury
ARC Guideline 9.1.7 – Emergency Management of a Crushed Victim
ARC Guideline 9.4.1 – Australian Snake Bite
ARC Guideline 9.4.5 – Jellyfish Stings
ARC Guideline 9.4.7 – Envenomation – Fish Stings
ARC Guideline 12.2 – ALS for Infants and Children: Diagnosis and Initial Management
ARC Guideline 13.6 – Chest Compressions during Resuscitation of the Newborn Infant

Queensland Ambulance Service Clinical Practice Procedures: Trauma/Arterial Tourniquet

American Heart Association Guidelines for CPR and Emergency Cardiovascular Care, Part 5, section 10.5

https://www.heart.org/idc/groups/heart-public/@wcm/@global/documents/downloadable/ucm_312865.pdf

Greaves, I., Porter, K., & Smith, J. (2003). Consensus Statement On The Early Management Of Crush Injury And Prevention Of Crush Syndrome. Journal Of The Royal Army Medical Corps, 149(4), 255-259. doi: 10.1136/jramc-149-04-02

Curtis, K. and Ramsden, C. (2014). Emergency and Trauma Care for Nurses and Paramedics.

https://emergencylaw.wordpress.com/

https://www.resus.org.uk/cpr/statement-on-cough-cpr/

http://www.legalaid.qld.gov.au/Find-legal-information/Personal-rights-and-safety/Health-and-medical/Medical-consent

The post First Aid Myths appeared first on Paradise First Aid.

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Paradise First Aid by Craig Middleton - 6M ago

G’day everyone, hope you’re all doing well in the lead up to the silly season. This blog will be having a look at some of the weird and wonderful first aid myths that crop up from time to time in our courses and on the internet. Some are outdated, some are misguided, and some are just plain dangerous. So, in consultation with some other trainers and health care professionals, let’s right some wrongs. There is quite the list…

CPR

You don’t have to give breaths

You don’t, but it’s best if you do. The Australian Resuscitation Guidelines say that if you’re trained and willing you should. The blood in our body only contains so much oxygen, if we were to do compression only CPR, we’ll soon run out of oxygenated blood being pumped around. If you were to do compression only CPR on a casualty who has drowned, you would be pumping deoxygenated blood around and it’d be pointless. Same deal for a baby, who has a very high oxygen demand and very low blood volume. This will be the topic of a future blog as it seems to cause a lot of confusion.

Just a puff out of your cheeks for baby CPR

I challenge anyone to tell me exactly how much air is in your cheeks when you puff… It’s simple for this one, put just enough air in to make the chest rise. Works on adults, children and babies, no need to worry about how much air is in your cheeks.

Encircling the chest of the baby when doing compressions

This is actually an advanced technique for paediatric life support taught to paramedics, doctors and nurses. It’s not a technique that should be taught at a basic CPR course level (that’s us, the ‘lay rescuer’). Problems that can occur when a lay rescuer performs the incorrect compression technique include squashing the chest cavity (rather than focussed pressure on the lower half of the sternum) and failing to allow the chest cavity to expand when breaths are given in two-person CPR.

This is not a good technique

The poor baby is getting squished!

Picking the baby up to do compressions on your arm

This one crops up a lot on courses and is not correct. By picking up a baby and doing compressions on your arm (or in your lap), you are unable to get the correct depth of compressions. You’re also unable to effectively support the baby’s head. Finally, when holding the baby in your arm doing CPR, you’re going to get a very tired and sore arm. The best technique is to place the baby on a firm surface (the ground or on a table/bench), hold the head of the baby in the neutral position and commence compressions using two fingers on the centre of the sternum.

This method is incorrect

Placing baby on a hard surface is the best

Use the patients fingers to scoop out what’s in their mouth

When you’re unconscious, all the muscles in your body relax. This is why we must position an unconscious patient on their side with their head back and face down, so as not to let the tongue and other upper airway anatomy block the airway. If all muscles are relaxed, the effectiveness of using a patients’ own fingers to clear their airway would be about as effective as shooting pool with a length of rope. It’s just not going to happen. Take the appropriate standard precautions for infection control (i.e. gloves), use your own fingers and scoop the goop or flick the sick. If it looks like they’re seizing, don’t put your fingers in there, just wait until the seizing is finished.

Choking

Use the Heimlich Manoeuvre

Taught in America and advocated in their guidelines, the Heimlich Manoeuvre (aka abdominal thrusts) has been deemed too high risk by the Australian Resuscitation Council and should therefore not be used and definitely not taught. There are too many highly vascularised organs under the lower ribs/upper abdominal region that could be damaged if performed incorrectly and there are in fact documented cases of life threatening complications when this technique has been used.

Dangerous bleeding

You can’t use a tourniquet

A hangover from older first aid courses, I remember being taught this years ago. However, much research and hard-won experience on the battlefields of Iraq and Afghanistan, not to mention mass casualty events such as the Boston Marathon bombings and the Sandy Hook Massacre in the USA, have proven the effectiveness of the tourniquet. A recent study in Texas, USA showed that the civilian application of the tourniquet for dangerous vascular bleeding gave almost a six times greater chance of survival than for those who didn’t get one applied. Quite simply, they save lives. Read up on my previous blog introducing the ‘Stop the Bleed’ workshop that we run – https://www.paradisefirstaid.com.au/stopping-the-bleed/

If you use a tourniquet, you have to take it off after x amount of time

Again, another hangover from older first aid courses. This is a technique taught at higher levels of pre-hospital care when there is an extended transportation time. This is not something that we do at our level.

You need to elevate the limb

For an arterial bleed, this technique is ineffective. Let’s face it, the blood pumps uphill from our heart to our brain. Stands to reason that if we held an arm that had an arterial bleed above our heart, it’s going to pump all the way up there too. There is no evidence to say it works, in fact it has shown to cause further injury. The correct techniques are taught in our first aid courses, the ‘Stop the Bleed’ workshops or in the same blog as mentioned above in tourniquets.

Embedded Object

Use a donut bandage

An antiquated technique that simply doesn’t work. For starters, it takes a long time to make (and if you’ve pre-made them, it takes up a hell of a lot of room in your first aid kit). Secondly, they only go on a nice and straight embedded object. Thirdly, you’d have to be pretty damn lucky (or unlucky?) to have the embedded object the perfect size of the pre-made donut bandage. Fourthly, it won’t go on if it’s an uneven shaped object that has embedded into you (say a pair of scissors for example). Finally, it doesn’t provide the pressure at the base of the embedded object, the whole point of the exercise.

Donut too small, doesn’t fit

Donut too large, does nothing

A triangle bandage wrapped around the base of the embedded object and bandaged in place is very quick and does the job. Even quicker, two rolled bandages either side of the embedded object and bandaged in place is effective.

One correct technique for dealing with embedded objects.

Burns

Use butter/pawpaw cream/egg white/toothpaste

Please. Don’t. Cool running water for 20 minutes. Follow that up by placing cling wrap, or a wet absorbent dressing, or a burnaid dressing on the burn. You can read a whole lot more about burns here – https://www.paradisefirstaid.com.au/first-aid-for-burns/

Crush Injury

Don’t move what’s on them/Don’t move it after x amount of time

Another hang up from older first aid courses where there was no definitive guideline. Current best practice is to remove the crushing force ASAP, regardless of how long it has been there. Treat any external bleeding, reassure whilst waiting for ambulance to arrive. Due to a number of factors, such as potential hypothermia, hidden dangerous bleeding as well as the standard airways and breathing, the patient should be exposed from under the crushing force as soon as possible, regardless of how long they have been subjected to the crushing force.

Spinal Injury

You can’t move them

If the patient is conscious, breathing and lying on their back, then sure, leave them be. However, if they’re unconscious and breathing, they must be placed on their side in the recovery position. It’s all about life over limb, and the guidelines clearly state that airway has precedence over everything else (with the exception of dangerous bleeding). Because when we’re lying on our back unconscious, all muscles, including the tongue and other upper airway anatomy, actually drop back and block the airway. So we’d die. Do your best to roll the patient safely using the spinal log roll. But if you are on your own with your patient, roll them the best way you can.

The research I’ve done basically says that you’ll have an initial injury that may not produce paraplegia. However, secondary spinal cord injury does occur in the hours to days following the initial injury. This can be attributed to processes at a cellular level, such as hypoxia, inflammation and cell death. Nothing of which we can control at a first aider level. So please, if you come across an unconscious and breathing patient, place them in the recovery position. Or if they are still in a car following a crash, support their head in an upright position to maintain a clear and open airway.

Marine Stings

You need to pee on it

This little chestnut crops up on almost every single first aid course! Please don’t do this, especially to me!!! For tropical jellyfish (box jellyfish and Irukandji), you’ll want to apply copious amounts of vinegar. For non-tropical jellyfish, hot water as hot as the casualty can tolerate, or ice packs if you don’t have hot water. For all other marine stings, hot water as hot as the patient can tolerate is the treatment. Peeing on people just makes for a very awkward situation that can easily be avoided…

This is a Box Jellyfish envenomation. Casualty wouldn’t appreciate getting peed on…

Snake bite

Cut the bite and suck the venom out

I think we have Hollywood to thank for this one. Australian snakebite venom reaches the bloodstream via the lymphatic system. This system works off muscle movement and is just below the skin. Hence the treatment for all Australian snakebites (as well as the Funnel Web, Blue Ring Octopus and Cone Shell) is the Pressure Immobilisation Technique and not cutting and sucking.

Heart Attack

Coughing if you’re on your own so you don’t need to do CPR

I believe this one did the rounds (or is still going) on social media. The message delivered was that, if you were alone and thought you were having a heart attack, by coughing vigorously, you would stay conscious longer and therefore prolong the negative effects of said heart attack. Quite simply, there is no evidence to support this.

It’s not a bad idea firstly to understand actually why a person is having a heart attack. For the most part, it’s because the heart is no longer getting a suitable amount of oxygenated blood, likely due to a clot or restriction of the coronary artery (the blood vessels that keep the heart muscle supplied). When this occurs, the patient may experience pain, shortness of breath, pale, cool clammy skin, nausea and vomiting. Coughing then won’t really do anything to reverse this. The patient needs the chain of survival – early access to help, early CPR, early AED and early Advance Life Support. So it’s better to recognise the signs and symptoms and know how to do effective CPR. If you’re on your own, phone Triple Zero ASAP!

Anaphylaxis

The green EpiPen is for kids

This one admittedly caught me by surprise, as I had always taught that it was by age that the different EpiPen’s were administered. But reviewing the ASCIA frequently asked questions web page, it clearly says that it’s by weight. Green EpiPen Jr is for under 20kg and yellow EpiPen is for kids and adults over 20kg. Always learning, love it!

Legal stuff

The age of consent in Qld is 16 years old

Strictly speaking, in Queensland, a person under the age of 18 is deemed a minor. However, when it comes to consent for first aid procedures, younger people can give consent. Michael Eburn discusses this very topic in his excellent emergency law blog, found here – https://emergencylaw.wordpress.com/2016/10/13/consent-first-aid-and-minors-in-queensland/

So there you have it folks, a wrap up of some of the myths that are out there in the realm of first aid training and delivery. The best thing you can do when it comes to this sort of mis-information is to come visit us and sit in our CPR and/or provide first aid course. We run these daily at three awesome locations on the Gold Coast, or we can come to you. Check out our website for more information. Folks, this will probably be the last blog for the year, so be sure to have a very merry Christmas and a safe and happy New Year. Thanks for reading and see you in 2019!

REFERENCES

ARC Guideline 6 – Compressions
ARC Guideline 9.1.1 – First Aid for Management of Bleeding
ARC Guideline 9.1.6 – Management of Suspected Spinal Injury
ARC Guideline 9.1.7 – Emergency Management of a Crushed Victim
ARC Guideline 9.4.1 – Australian Snake Bite
ARC Guideline 9.4.5 – Jellyfish Stings
ARC Guideline 9.4.7 – Envenomation – Fish Stings
ARC Guideline 12.2 – ALS for Infants and Children: Diagnosis and Initial Management
ARC Guideline 13.6 – Chest Compressions during Resuscitation of the Newborn Infant

Queensland Ambulance Service Clinical Practice Procedures: Trauma/Arterial Tourniquet

American Heart Association Guidelines for CPR and Emergency Cardiovascular Care, Part 5, section 10.5

https://www.heart.org/idc/groups/heart-public/@wcm/@global/documents/downloadable/ucm_312865.pdf

Greaves, I., Porter, K., & Smith, J. (2003). Consensus Statement On The Early Management Of Crush Injury And Prevention Of Crush Syndrome. Journal Of The Royal Army Medical Corps, 149(4), 255-259. doi: 10.1136/jramc-149-04-02

Curtis, K. and Ramsden, C. (2014). Emergency and Trauma Care for Nurses and Paramedics.

https://emergencylaw.wordpress.com/

https://www.resus.org.uk/cpr/statement-on-cough-cpr/

http://www.legalaid.qld.gov.au/Find-legal-information/Personal-rights-and-safety/Health-and-medical/Medical-consent

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Paradise First Aid by Craig Middleton - 8M ago
Removal of Motorcycle Helmets in the First Aid Setting

G’day everyone and welcome to another blog. The topic for this blog has come about as a result of one of the more common questions that we as first aid trainers get asked: What do you do if a motorcyclist has a helmet on and you need to render first aid after they have crashed? With the help of some family members recruited as models, this should now make things a little bit clearer for you, and if you are a trainer, could be used as an additional reference tool.

First up, let’s have a look at the types of helmets you will encounter.

FULL FACE HELMET

Covers the whole head with a fixed chin bar and offers the best level of protection.

FLIP FACE or MODULAR HELMET

Full face helmet that can be worn with the chin bar locked into place or lifted open. This helmet provides the best protection with chin bar locked down.

HALF HELMET

Covers only the top of the head, providing minimal overall protection.

OFF ROAD HELMET

Same design as a full-face helmet with an elongated chin bar. Generally worn with goggles and are more lightweight in construction.

OPEN FACE or ¾ HELMET

Covers head, cheeks, and back of the head. Leaves the face and chin open with no protection.

Management of Motorcycle Crash Victims

As with all road traffic crashes that you attend as a first aider, you must always consider your safety. So in line with your first aid training, DANGER is the first thing we want to consider when approaching the casualty. Hazards to consider include, but are not limited to:

  • Traffic
  • Bodily fluids
  • Weather conditions
  • Terrain
  • Other people/bystanders
  • Power
  • Leaking fuel/oil
  • Hot surfaces
  • Broken glass, broken plastic, bent metal all produce sharp edges
  • Any ignition sources

Next up you want to stabilise any movement of the casualty. To do this, we perform a maneuver known as MILS, or Manual In-Line Stabilisation. This is keeping anatomical alignment of the spine by holding on to the head. From this point, we can perform the remainder of our checks in line with DRSABCD.

Manual In-Line Stabilisation (MILS) is demonstrated in the image below.

Responsive Patient

If a patient is responsive and talking to you, it’s fair to say that they have a clear and open airway. If this is the case, simply maintain MILS and continue with secondary survey and any first aid treatment that may be required.

Unresponsive Patient

In an unresponsive patient, airways and breathing must take priority. With most helmets, this must necessitate the removal of the helmet. With half helmets, ¾ helmets and open modular helmets, airways and breathing can be determined to a certain degree, however with full face helmets it is almost impossible to determine accurately. Therefore, for an unconscious patient where you are unable to determine a clear and open airway with breathing, or if you can determine that the patient has a compromised airway and CPR is required, then the helmet must come off.

Helmet Removal

To remove the helmet from your casualty, you want to minimise any additional movement of the cervical spine (e.g. neck). Using two people, this is achieved by undertaking the following steps:

Step 1

Maintain MILS. First aider #1 to hold on to the head of the patient, hands either side of the helmet.

Step 2

First aider #2 to use trauma shears to cut chin strap. Alternatively, undo the chin strap.

Step 3

First aider #2 to take over MILS of the patient. To do this, slide one hand under the head to the occiput (rounded back of the skull). Other hand is to support the jaw, being mindful of not squashing down on the throat.

Step 4

First aider #1 to grasp the helmet at the bottom either side of the head. They are to then pull outwards (laterally), before easing the helmet up and off the head.

Step 5

Be cautious of the nose, you may need to tilt the helmet backwards (towards the ground) to get the chin bar past the nose. REMEMBER TO TILT THE HELMET, NOT THE HEAD.

Step 6

Once helmet removed, first aider #1 to take over MILS by placing hands either side of the head.

NOTE – IT IS IMPORTANT TO REMEMBER THAT, IF A HELMET HAS BEEN REMOVED, IT IS TO REMAIN WITH THE PATIENT THROUGH TO HOSPITAL.

This lets the treating medical staff inspect the helmet to determine any impact or damage that may have occurred to the casualties’  head.

If the patient is in the prone position (i.e. lying on their front), perform a log roll as best you can to move the patient on to their back, then perform the above steps.

Safety Technology

It also pays to be on the lookout for some helmets that contain additional safety technology.

This photo illustrates the Emergency Quick Release System. The red tags, when pulled, remove the cheek pads of the helmet, making the removal process of the helmet removal significantly easier.

This photo shows the Eject Helmet Removal System. This is a pre-installed deflated airbag located inside the helmet on top of the head. A tube is routed to the back of the helmet. A small hand bulb can then be attached to this tube, inflating the helmet and thus pushing the helmet off the head.

Another helmet system commercially available is the VOZZ Helmet. The technology surrounding this helmet is best demonstrated by viewing the video at this link https://www.youtube.com/watch?v=mpED2rK7Ftk 

And that is pretty much all there is to it. Don’t fall into the trap of listening to bystanders shouting at you to leave the patient where they are and not to remove their helmet. Follow your first aid training knowing that airway and breathing have precedence and therefore helmets must be removed to perform any techniques required. However, if they are talking to you, then yes, leave the helmet on.

If you’re a bit behind in your recertification for first aid or CPR, as always, we encourage you to book in to attend training. Paradise First Aid offers courses at three locations on the Gold Coast, Mermaid Beach, Helensvale and our new training venue at Biggera Waters, just outside of Harbour Town. If you have the numbers and want us to come to you, that can be arranged as well. Just give our friendly staff in the office a call to book your course in, either with us or at your site, on 07 5572 5299 or view dates here. Stay safe on the roads folks.

RESOURCES

https://www.shoei-helmets.com/

https://www.cyclegear.com/

http://dririder.com.au/helmets

https://ultimatemotorcycling.com/2017/06/28/201326/

https://ultimatemotorcycling.com/2014/08/11/simpson-shock-doctor-eject-helmet-removal-system-review/

Queensland Ambulance Service Clinical Practice Manual (CPP, Trauma/Helmet Removal)

Curtis, K. & Ramsden, C. (2014). Emergency and Trauma Care for Nurses and Paramedics

Special thanks to my wife Lauren for assisting me with first aid on my father-in-law Gerald in the photos demonstrating helmet removal. Mother-in-law Jane was the photographer.

The post Motorcycle Helmet Removal appeared first on Paradise First Aid.

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Paradise First Aid by Craig Middleton - 8M ago

Not long ago, I was reading the news online as I do most days. There was a story that chilled me to the core, and one that I’m sure nearly all parents would relate to. I read about the drowning death of a 3 year old boy on the Gold Coast. What makes this story especially sad, is that it isn’t a one-off event and it’s something that we will continually read about into the future. Because even though Australia is the driest inhabited continent in the world, we have one of the highest reported incidences of drowning in the developed world. Another article I read late last year basically said that if the number of people who drowned in rip currents were the same as people being attacked by sharks, there would be a national outcry for a shark cull. Yet drownings continue to happen.

Want some more scary statistics? OK, brace yourself… In the 2016/17 financial year, there were 291 deaths in Australia due to drowning in aquatic locations. From my interpretation of the Royal Lifesaving Society report, this also includes drownings in bath tubs and inside the home. On average, that’s a bit over 5 people a week drowning. Males, at 75% of the total deaths, are the biggest culprit when it comes to drowning. Now whilst these numbers are bad, it gets worse – there were an estimated 685 people who were involved in non-fatal drowning incidents that required hospitalisation. I could go on, but there’s just so much data out there it’s kind of depressing…

So, what is drowning? The World Health Organization define drowning as the process of experiencing respiratory impairment from submersion/immersion in liquid. In other words, unless you’re Kevin Costner in Waterworld, we can’t breathe underwater. The process of drowning when you look at it from a pathophysiological perspective is actually quite fascinating. It occurs in the following stages:

1. Initial submersion in water leads to apnoea (the person stops breathing), unless the person suffers a catastrophic illness or injury that renders them unconscious. Now if that person submerges involuntarily, most adult victims begin to panic and struggle. This then leads to an increase in blood pressure and heart rate.

2. Now, after an interval that depends on pre-submersion oxygenation (i.e. how much oxygen you had on board before you went under), physical fitness, intoxication, injury or illness and the degree of panic/struggle, the combined effects of hypercapnia (elevated levels of carbon dioxide in the blood) and hypoxia (lack of oxygen in the tissues) lead to the person taking an involuntary breath. This is known as the ‘breaking point’. It’s at this stage that large volumes of water are often swallowed/inhaled.

3. After the initial inhalation of fluid, the patient will experience bronchoconstriction (airways tighten up), increased pressure in the lungs, as well as other effects such as laryngospasm (constriction of the larynx).

4. Secondary apnoea occurs, closely followed by total loss of consciousness. Vomiting or regurgitation of swallowed fluid is common, which leads to aspiration of the stomach contents into the lungs.

5. Involuntary gasping respirations cause flooding of the lungs, causing damage.

6. Hypoxia leads to bradycardia (very slow heart rate), hypotension (very low blood pressure) and irreversible brain injury within 3 – 10 minutes.

As a trainer, I am often asked, at least once a week, ‘why can’t we just do compressions?’ Knowing how drowning happens might at first seem somewhat morbid, however this knowledge can greatly increase our understanding of why the first aid techniques we teach during our courses are so important. It’s with this knowledge that we can see why compression only resuscitation techniques are somewhat useless. First up, let’s refresh what needs to be done if you encounter a person drowning.

Drowning First Aid

  • Remove the casualty from the water ASAP. DO NOT ENDANGER YOURSELF. Throw a rope or use a buoyancy aid to affect the
  • rescue. Call for help.
  • In minor incidents, following removal from the water, coughing may occur followed by spontaneous breathing.
  • In serious incidents, if the patient is unconscious and not breathing, follow your Emergency Action Plan of DRSABCD.
  • Assess the patient with their head level with the rest of their body. This decreases the chances of vomiting or regurgitation.
  • The airway of the patient can be assessed whilst they are lying on their back. The exception to this is if there is obvious water,
  • blood, vomit or sand in their mouth. If this were the case, the patient should be promptly rolled to their side and the airway cleared.
  • If CPR is required, carry out as per training. If clear or frothy fluid accumulates in the upper airway during resuscitation, continue
  • CPR and do not attempt to drain fluid.
  • Continually monitor patient if successfully resuscitated. Patient should be transported to hospital.

So why are compressions only CPR so useless? The primary cause of cardiac arrest in drowning is lack of breathing. This then results in no oxygen in the blood and an increase in carbon dioxide. By doing compressions only, all we are doing is circulating oxygen poor blood around the body. This is pointless and doesn’t assist the patient at all. If done at all, it should only be done briefly prior to the arrival of a barrier device, face mask or bag valve mask. The use of oxygen is beneficial, however resuscitation should not be delayed awaiting the arrival of oxygen equipment. As always, the use of an Automated External Defibrillator (AED) is highly recommended. Most times, the patient who drowns will not be in a shockable rhythm, however if the drowning occurs due to a pre-existing medical condition, the use of a defibrillator will be advantageous.

How do we slow down the number of drownings? The simple answer is prevention. Teach your kids to swim. Don’t wait until they’re in school to learn, get them in the water and comfortable with it as babies. Keep in contact with them when they’re young, keep a close eye on them when they’re older. Always swim between the red and yellow flags when at the beach. Always empty the bath of water. Never leave buckets of water lying around the house (nappy or clothes soaking buckets). If you have to soak something, put the bucket in the laundry tub. Keep pool fences and gates maintained. Establish some ground rules around pool for kids.

The best thing you can do is prepare for the worst by doing a first aid course. Provide first aid covers CPR, teaching you how to effectively and efficiently perform compressions and rescue breaths. We can do this at either of our two training locations in Helensvale or Mermaid Beach, or we can come to you onsite. Stay safe folks.

Information sourced from the following:

Australian Resuscitation Guideline 9.3.2 – Resuscitation of the drowning victim

Royal Life Saving National Drowning Report 2017

Emergency and Trauma Care for Nurses and Paramedics (Curtis and Ramsden, 2011)

The post Drowning First Aid appeared first on Paradise First Aid.

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Hi all and welcome to 2018. The first blog of the year will look at the very ugly and potentially deadly stonefish. In light of recent media coverage of four stonefish envenomation’s in South East Queensland (3 x females aged 11, 12 and 35 at Tallebudgera Creek on the Gold Coast and a male at Bulcock Beach at Caloundra), we thought it an excellent idea to familiarise ourselves with this fascinating creature, which is considered the most venomous fish in the world.

There are two types of stonefish found in Australia – the Reef Stonefish (Synaceia Verrucosa) and the Estuarine Stonefish (Synanceia Horrida). Both are extremely well camouflaged fish, with eye placement being one of the ways to tell the two apart (Reef – separated by deep depression, Estuarine – elevated and separated by bony ridge). Both stonefish have 13 spines with 2 x venom glands located at the base of each spine. The venom is discharged through ducts located within the spines. The amount of venom injected into the person is dependent on how much pressure is placed on the spine – the more pressure placed on the spine, the more venom is injected.

So, what to do if we stand on a stonefish… Marine envenomation is a component of the provide first aid course, which should be updated every three years. However, if you’re a little rusty, this is what to look for and the first aid you should do.

Signs and Symptoms

Signs and symptoms may include the following:

  • Pain – pain will be immediate and intensely excruciating.
  • This pain may last for several days.
  • Single or multiple puncture marks – these may be bleeding
  • A bluish tinge may be seen around the envenomation site
  • Localised swelling around the envenomation site
  • In extreme cases, whole limb swelling may occur
  • If left untreated, muscle paralysis, breathing difficulties and death may occur.

The good news with Stonefish envenomation is that there have been no recorded deaths in Australia since European arrival. The development of an antivenom in 1959 further helps reduce mortality with Stonefish envenomation. It should also be noted here that other signs and symptoms including nausea, vomiting, low blood pressure, slow heart rate and incoherent behaviour are generally associated with the patients’ pain response, not the effect of envenomation. So what do we do to help them?

First Aid Treatment
  • Ensure rescuer will not become envenomated. When walking in potential stonefish habitat, wear stout soled shoes, or shuffle feet along ocean floor.
  • Phone 000 or 112 calling for ambulance, state suspected stonefish envenomation
  • If the spine is embedded – manage as per penetrating injury (pad base of spine and apply pressure to pads, DO NOT REMOVE SPINE)
  • If the wound is to a limb, place affected limb in hot water as hot as patient can bear (45°C for no longer than 30mins at a time)
  • If the patient is unresponsive and not breathing normally, follow DRS ABCD emergency action plan.

How does the hot water immersion work? No one knows… Pressure Immobilisation Technique is not used as it is a localised envenomation and the venom does not enter the lymphatic system (such as you would encounter with snake envenomation).

In wrapping up, prevention is better than the cure. When swimming or wading in the ocean, we’re entering the home of the Stonefish. Take care where you walk and what you wear on your feet and don’t pick them up. And if the worst were to happen, having completed a first aid course will give you the confidence to provide accurate and timely assistance. First aid courses can be undertaken with us at Helensvale, Mermaid Beach, or on site at your workplace.

Information for this article was sourced from the following sites:

http://www.qm.qld.gov.au/
https://australianmuseum.net.au/
http://oceana.org/
https://www.ambulance.qld.gov.au/clinical.html
https://resus.org.au/guidelines/

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