How to be a life saver: What to do in a medical emergency
Would you know what to do if someone had a heart attack or severe burns? In a medical emergency, every second counts. Rebecca Armstrong consults the experts
Tuesday 11 March 2008
There are more than 2.3 million people with diabetes in the UK, and up to another 750,000 sufferers who don't know they have the condition. Cathy Moulton, care adviser for Diabetes UK, says that hypoglycaemia is what happens when the blood's sugar level drops too low. "If a diabetic becomes hypo, they might complain of tingling lips, feel anxious and start to perspire," she says. The easiest form of treatment is consuming rapid-acting glucose in the form of a non-diet drink, a glucose tablet or glucose gel that can be squeezed into the mouth. "If you encounter someone who you think is suffering from hypoglycaemia then it's a case of pointing it out to the person and giving them their hypo treatment. About 15 minutes later, to keep blood glucose levels up, the sufferer should consume a slower-acting carbohydrate such as a sandwich or some biscuits." If they're not treated, then diabetics can fall unconscious – in which case nothing should be given by mouth and an ambulance should be called immediately.
"Doubt kills" is the name of the latest campaign from the British Heart Foundation, the idea behind which is that every five minutes somebody in the UK dies from a heart attack – often because people are unsure what to do. June Davison, a BHF cardiac nurse, explains that the most important thing you can do is call 999 immediately if you suspect someone is suffering from a heart attack. "The quicker someone suffering from a heart attack gets treatment, the higher the chances are that they won't die," she says. "Then it's important to make sure that the casualty sits and rests while waiting for paramedics to arrive. Don't let them move about. A commonly held belief is that they should take an aspirin immediately, but anyone having a heart attack shouldn't wander around the house looking for aspirin. Instead, call an ambulance and make sure the casualty is comfortable, then locate some aspirin for them to take. Don't let them put any unnecessary strain on the heart."
"Butter, oil, grease – I've even heard about honey being used on burns – but all these things only help the burn to continuing burning," says James. "Burnt skin is very hot and that is what's causing the pain so you need to get rid of the heat. Place the burn under a cold tap for 10 minutes. If it's a chemical burn, then double the time under the tap because you're trying to get rid of the chemical and stop the burning." Generally, says James, if the burn is no bigger than the size of the palm of the person's hand, it won't need medical treatment. However, the elderly and very young are more susceptible to the after-effects of burns, so even if it's smaller than the palm, they may still need to go to hospital. "Once the burn has cooled down, cover the affected area with clingfilm. Put it over the burn but don't wrap it tightly. If you don't have any clingfilm, use a clean dressing from a first aid kit or a clean cloth. This will protect it from infection and stop it getting knocked. If burn blisters break, then the wound is open to infection."
"The most common misconception with choking is that everyone needs the Heimlich manoeuvre," says Clive James, senior training officer at St John Ambulance. "In most cases, if you can get the person who is choking to do a big cough, the obstruction will come out." If that doesn't work, he says, bend the casualty forward and slap them five times between the shoulder blades quite hard. "You need to bring the heel of your hand right down on the middle of their back. Then it's important to check the mouth." If you've cleared the blockage you'll know, because the first thing the person will do is take a big gasp of breath in.
But if the choking persists, "you need to do what we call the abdominal thrust – what's called the Heimlich manoeuvre in America," he says. "Stand behind the casualty, put both arms around them and put one clenched fist between the navel and the bottom of the breast bone. Then put the other hand over the top and grab your wrist, pull in and upwards sharply up to five times. If that still doesn't clear the blockage, then go back to doing the back slaps and alternate between five back slaps and five abdominal thrusts. If you've repeated that cycle three times to no effect then you should call an ambulance."
With children, the advice is very much the same, except that you have to remember to be more gentle and St John Ambulance advises that if you perform an abdominal thrust on anyone, adult or child, they should go to hospital for a check up.
According to Epilepsy Action 456,000 people – one in every 131 – in the UK have epilepsy. If someone is having a seizure, it is important to protect the person from injury by removing any harmful objects from nearby and cushioning their head. If the casualty is someone you don't know, look for an epilepsy identity card or identity jewellery. Once the seizure has finished, breathing can be aided by gently placing them in the recovery position. Don't restrain the person, don't try to bring them round, don't move them unless they are in danger of injuring themselves and don't give them anything to eat or drink until they are fully recovered. Epilepsy Action recommends calling 999 if "you know it is the person's first seizure, the seizure continues for more than five minutes or if one seizure follows another without the person regaining consciousness."
"If someone is knocked unconscious, you need to make sure the casualty is breathing and put them into the recovery position," says James. To do this, start with the victim lying on their back and with the legs straight out. Kneel on one side of the victim, facing the victim. Move the arm closest to you, so it is perpendicular to the body, with the elbow flexed. Move the farthest arm across the body so that the hand is resting across the torso. Bend the leg farthest from you so the knee is elevated. Reach inside the knee to pull the thigh toward you. Use the other arm to pull the shoulder that is farthest from you. Roll the body toward you and leave the upper leg in a flexed position to stabilise the body. "The most important thing is to protect their airway – if that blocks with vomit, saliva, blood or their tongue, they can die. After putting them in the recovery position, call 999."
"If someone's bleeding, your main priority is to stop the bleeding as quickly as possible," says James. "Direct pressure and elevation are what's needed, so put something over the wound and, if you don't have anything else – and you know the person concerned – put your hand over it, as long as you don't have cuts and abrasions on your hand. If you have gloves, so much the better." James advises that if it's an arm or a leg that's bleeding, you should put your hand over the wound, squeeze it tight and raise the limb.
"If it's a bad cut, people may well feel shocked, so they might feel dizzy – in that case, lay them down, with the legs lifted. The last thing you want is for them to fall over while you're trying to treat the bleeding. If someone is so dizzy they can't stand up, you should call an ambulance." If you have any doubts about whether someone should go to hospital, contact a doctor or NHS Direct.
"The seriousness of an asthma attack can be underestimated, even by healthcare professionals," says Sally Rose, an asthma nurse for Asthma UK. According to the charity's statistics, about 90 per cent of deaths relating to asthma could be prevented through an improvement in emergency asthma care. "In the event of an attack, you should encourage the person to try to relax and stay calm. Then they should take their reliever inhaler, which is usually blue. This can be used every minute for five minutes during an attack. If symptoms don't improve after five minutes, call 999." The person should continue to take one puff from their reliever every minute until help arrives. Sit the person down, but don't let them lie down, and loosen any tight clothing. "If the attack has been caused by an allergic response to something, find out if the sufferer has an EpiPen (an auto-injector of adrenalin) and use it," she advises. And if the sufferer is unconscious, try to resuscitate them, then call an ambulance.
Breathing has stopped
Use CPR (cardiopulmonary resuscitation). Attempt to wake the casualty. If they do not wake, check ABCs and call 999. If the casualty wakes, moans or moves, do not proceed with CPR.
1. Check ABCs:
Airway – look for chest movement, look for throat obstruction
Breathing – listen and feel for air flow through mouth or nose
Circulation – look for pulse in wrist and neck
2. If the casualty isn't breathing, open their airway. Tilt head back, use two fingers to lift chin. Begin rescue breaths. Pinch casualty's nose, make a seal over their mouth with yours, and give a breath big enough to make their chest rise. (For babies and small children, cover mouth and nose and give a gentle breath). Let chest fall. Repeat twice for adults, five times for babies and small children.
3. If there is no circulation, begin chest compressions. Place heel of hand in middle of casualty's chest. Place other hand on top of first and interlace fingers. (Use two fingers for babies and small children.) Compress chest to a third of its depth. Lift off and allow chest to recoil completely. Perform 30 compressions at the rate of 100 per minute.
4. Repeat rescue breaths and chest compressions alternately for two minutes.
5. Continue to check ABCs and perform CPR and rescue breaths until ambulance arrives.
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