Oh stop moaning! It is getting better.

The A.R.C (Australian Resuscitation Council) has been reviewing data from America and Europe following a 5 year study.

We have always known that for C.P.R to be successful the operator had to deliver adequate compressions to the chest and for this to do perfectly the operator has to went through the CPR Course or CPR training. The current research has now shown that the focus really must be about the compressions.

The means compressions come first! Remember the point of C.P.R is to move oxygen via the blood around the body; the body contains enough oxygen in the blood to last for at least 4 minutes without extra oxygen being supplied. Hence, by commencing compressions immediately the transport of blood continues and you then supply oxygen via 2 breaths following the first 30 compressions.

As of mid January our new Basic Emergency Life Support Flow chart looks like this:

ü  Danger: check for any dangers to you, the bystanders or your causality.

ü  Response: Check for any response by using “touch & talk”

ü  Send for Help: If there is no clear signs of Response, send for help ASAP. The first 10 minutes are critical

ü  Airway: Check if the airway is blocked, if any signs of fluids roll them on the side to clear it.

ü  Breathing: When checking the Airway, check for signs of normal breathing, this will take about 10 seconds

ü  Compressions: If no normal breathing, give 30 compressions at a rate of 2 per second. For an adult you MUST push at least 5cm (about a match box).

ü  Defibrillation: Attach a Defibrillator (A.E.D) ASAP and follow the prompts.

So why change it again??

We know we can hold our breath for 3 to 5 minutes without any brain damage or damage to other organs or cells, but what they do need is the blood that contains the oxygen moved around their body with the help of our compressions.

DONT delay the compressions. Now after checking for a response and calling for help if there is no NORMAL BREATHING we begin with compressions, this ensures the rapid movement of what remains of the oxygen contained within the blood.

Often first aiders are concerned about opening the airway, finding a mask lost in the glovebox or buried deep in their purse or even worse, the feeling of “ick” at having to put their lips onto those of a stranger, with or without vomit. This all takes time, time the casualty does not have.

In summary it is best explained like this:

In the older D-R-A-B-C-D sequence chest compressions are often delayed while the responder opens the airway to give mouth-to-mouth breaths or retrieves a barrier device or other ventilation equipment. By changing the sequence to D-R-S-A-B-C-D, chest compressions will be initiated sooner and ventilation only minimally delayed until the completion of the first cycle of chest compressions (30 compressions should be accomplished in approximately 18 seconds).

Other considerations that HAVE changed

Push a little harder. How deep you should push on the chest has changed for adult CPR. It was 4-5 cm, but now you should push at least 5cms deep in to the chest of an adult.

• Push a little faster. Instead of pushing on the chest at about 100 compressions per minute, you should to push at least 100 compressions per minute. At that rate, 30 compressions should take you only 18 seconds.
• Don’t stop pushing. Every interruption in chest compressions interrupts blood flow to the brain, which will lead to brain death if the blood flow is interrupted for too long. It takes several chest compressions (about 20) to get blood pressure to the level that is affective. You should keep pushing as long as you can. Push until an A.E.D is in place and ready to analyse the heart. When it is time to perform mouth to mouth, do it quick and commence compressions again immediately.

_{One thing that has not changed is the simple but very true motto of the A.R.C}

_{“Any attempt at resuscitation is better than no attempt at all”}

For people who have never performed CPR or even been at the scene of an incident while it is being done there is a range of different images of exactly what the scene may be like. For some it is the image of the person who has been pulled from the water by a bronzed Lifeguard from Bondi Rescue. The causality receives 2 quick breaths, coughs, splattering up water and maybe some lunch. They thank the Lifeguard for saving their life and go off to the hospital to be checked over. Or maybe it is a little more dramatic; it is an elderly stranger in a shopping centre, he collapse just meters from you, and his partner is screaming for help. You are the only one who comes forward to help, your mind races back to that First Aid Training Course you HAD to take; it all comes back in a flood of images. Breaths, Compressions, don’t stop, must move the blood around his body, before you know it, the Ambulance has arrived and take over. That 1 day you spent doing a First Aid course because you HAD to have saved this man’s life, it could have been your dad, your partner or your child, could you have done it?

But what are we doing when we perform CPR?
The air around has contains approximately 21% of oxygen, when we breath that air in our body uses only 5% and we exhale 16%, it is that 16% of oxygen that we exhale that helps to replace the oxygen that is no longer getting in to circuitry system of a person who has no movement of their heart (it has arrested).

We know that between 3-5 minutes without oxygen to our cells the cells will start to die, particularly our brain cells, our brain needs about 20% of the oxygen that we have in our system and is very sensitive to a lack of oxygen.

So we now have oxygen in the blood but how does it move to the cells?

A normal healthy adult hearts beats between 60 – 100 times a minute when resting, this ensures that the oxygen rich blood can reach all of the millions of cells in our body. When we perform CPR you must deliver your compressions at a rate of 100 per minute so as to replicate the action of a beating heat.

The skills that are taught in a First Aid Course are ones that could save a life, it is always hoped that you may never have to be in the position to have to perform CPR. But if you do the skills will be with you and you may be able to assist.
Remember, any attempt at CPR is better than no attempt at all.

When you mention heart attack to most people, their first thoughts are that it is fatal.
Often they are right, but what is heart attack and heart disease? Can you avoid it? What do you do if you see a person suffering from pain on the chest?

How do heart attacks occur?
Over time, plaque can build up along the course of an artery and narrow the channel through which blood flows.
Plaque is made up of cholesterol build-up and eventually may calcify or harden, with calcium deposits. If the artery becomes too narrow, it cannot supply enough blood to the heart muscle when it becomes stressed.

Just like arm muscles that begin to ache or hurt when heavy things are lifted, or legs that ache when you run too fast; the heart muscle will ache if it doesn’t get adequate blood supply.

This ache or pain is called angina. It is important to know that angina can manifest in many different ways and does not always need to be experienced as chest pain.

If the plaque ruptures, a small blood clot can form within the blood vessel, acting like a dam and acutely blocking the blood flow beyond the clot. When that part of the heart loses its blood supply completely, the muscle dies. This is called a heart attack, or an MI – a myocardial infarction (myo=muscle +cardial=heart; infarction=death due to lack of oxygen).

Signs and Symptoms of a heart attack
Any chest pain should be considered a medical emergency. A call to the emergency services should be your first action.

Warning signs include:

• Pain or pressure in the chest
• Discomfort spreading back, jaw, throat, or arms
• Nausea, intergestion or heartburn
• Weakness, anxiety, or shortness of breath
• Rapid wreak or irregular pulse
• Clammy skin

Heart attack Signs and Symptoms in women

Women do not always have the pain or heavy weight feeling in the chest.

Women are more likely than men to have:

• heartburn
• tiredness
• loss of appetite
• weakness
• Heart flutters.

None of these symptoms should be ignored the longer you leave treatment the greater the risk of damage to the heart and to the risk of death.

How do I help if they are having a heart attack??
If there is any pain on the chest, call 000 immediately, they will guide you through with instructions on how to manage this causality or if you are a first aider or did any of CPR courses or training you can help the casualty. Such type first aid courses help you very much in such crucial time as well as in your day to day life.

If they are conscious:
o Ask if they have any medical history/medications
o Keep them in a sitting position
o Loosen any tight clothing
o Try to reassure them
o Try to monitor their breathing and their pulse

If they are unconscious:
o Follow the Basic Life Support Flow Chart
o If there are bystanders have them assist by calling for help
o Begin CPR as soon as possible

Any attempt at CPR is better than no attempt at all.

What is sudden cardiac arrest?
A medical emergency with absent or inadequate contraction of the left ventricle of the heart that immediately causes body wide circulatory failure.

The signs and symptoms include:
o Loss of consciousness
o Rapid shallow breathing progressing to apnea (absence of breathing)
o Profoundly low blood pressure (hypotension) with no pulses that can be felt over major arteries
o And no heart sounds.

Cardiac arrest is one of the greatest of all medical emergencies. Within several minutes, there is lack of oxygen (tissue hypoxia), leading to multiple organ injury. Unless cardiac arrest is quickly corrected, it is fatal.

The most common causes of cardiac arrest are electrical problems in the heart with ventricular fibrillation representing the major type. In ventricular fibrillation, there is loss of coordinated ventricular contractions leading to immediate loss of effective output of blood by the heart, resulting in circulatory arrest.

How do I manage Sudden Cardiac arrest?
The Chain of Survival
The Chain of Survival is the term applied to a sequence of actions that, when put into motion, reduce the mortality associated with cardiac arrest.
While each action in the chain is unlikely on its own to revive a casualty, when all actions are effectively used together they can improve the outcome for the casualty.

Sudden cardiac arrest is the unexpected collapse of a casualty whose heart has stopped. Cardiac arrest occurs suddenly due to a disturbance in the electrical signals of the heart and is closely linked with sudden chest pain.

It is estimated that more than 95% of sudden cardiac arrest casualties die before reaching hospital as the casualty has only minutes from the time of collapse until death. If all four links in the Chain of Survival are strong the chance of survival for a sudden cardiac arrest casualty can rise from 5% to as high 49%.

How important are First aid courses?
First Aid courses and CPR courses give instructions on how to react to emergencies brought on by natural calamities, keeping your household safe in case there is such occurrence.

There are many programs to learn basic first aid course taught by schools, Fire Departments, hospitals, and community organizations that are a great tool for everyone. First Aid is usually administered under the premise of immediate care for an illness or injury. Members of the general public are taught to administer this care until the arrival of qualified medical personnel at the scene of a medical emergency.

What is the difference of being a first-aider or not?
It resumes being the same difference between saving a life and losing someone, especially if it is a loved one.

“So Do not hesitate to start CPR“

Australia adopted the new international guidelines for CPR Courses (cardiopulmonary resuscitation) in 2006. With these new guidelines we have seen an increase to survival rates for cardiac arrest victim’s increasing to about 10%.

We have been CPR training to follow the Emergency Action Plan of:

• Danger
• Response
• Airway
• Breathing
• Compressions
• Defibrillation

But may it be about to change!!

The ARC (Australian Resuscitation Council) has been reviewing data from America and Europe after a 5 year study.

We have always known that for CPR to be successful the operator had to deliver adequate compressions to the chest, this is often easier said than done. The current research has now shown that the focus really must be about the compressions.

The means compressions come first!  Remember the point of CPR is to move oxygen via the blood around the body; the body contains enough oxygen in the blood to last for at least 4 minutes without extra oxygen being supplied. Hence, by commencing compressions immediately the transport of blood continues and you then supply oxygen via 2 breaths following the first 30 compressions. To do all this first aider should have knowledge acquired in formal CPR Courses.

As of mid December our new Emergency Action Plan may look more like this:

• Danger
• Response
• Compressions
• Airway
• Breathing
• Defibrillation

So why change it again??

We know we can hold our breath for awhile without any brain damage or damage to other organs or cells, but what they do need is the blood that contains the oxygen moved around their body with the help of our compressions.

DONT delay the compressions. Now after checking for a response and calling for help if there are no signs of life we begin with the compressions, this ensures the rapid movement of what remains of the oxygen contained within the blood.

Often First Aiders are concerned about opening the airway, finding a mask lost in the glovebox or buried deep in the purse or even worse, that “ick”feeling when putting your lips on to those of a stranger, with or without vomit.

This all takes time, time the causality does not have. Remember between 3-5 minutes without O2 the cells will die, particularly the brain cells which are very sensitive to a lack of oxygen.

In summary it is best explained like this:

In the D-R-A-B-C-D sequence chest compressions are often delayed while the responder opens the airway to give mouth-to-mouth breaths or retrieves a barrier device or other ventilation equipment. By changing the sequence to D-R-C-A-B-D, chest compressions will be initiated sooner and ventilation only minimally delayed until completion of the first cycle of chest compressions (30 compressions should be accomplished in approximately 18 seconds).

Push a little harder. How deep you should push on the chest has changed for adult CPR. It was 4-5 cm, but now you should push at least 5cms deep on the chest of an adult.

• Push a little faster. Instead of pushing on the chest at about 100 compressions per minute, you should to push at least 100 compressions per minute. At that rate, 30 compressions should take you 18 seconds.
• Don’t stop pushing. Every interruption in chest compressions interrupts blood flow to the brain, which leads to brain death if the blood flow stops too long. It takes several chest compressions to get blood moving again. AHA wants you to keep pushing as long as you can. Push until the AED is in place and ready to analyse the heart. When it is time to do mouth to mouth, do it quick and get right back on the chest.

_{Never forget the simple motto of the ARC}

_{“Any attempt at resuscitation is better than no attempt at all”}

An infection is the entry and multiplication of an infectious agent in the tissues of the body. An infection may be due to bacteria, viruses, parasites or fungi and may be spread through cross-infection between a casualty and a first aider. To limit exposure to infectious agents first aiders must take precautions to avoid body fluids and other contaminants and he should follow the procedures of First Aid Training.

To minimize the risk of infection:

• Wash your hands with soap and water before and after assisting a casualty.
• Use protective barriers including disposable gloves, masks, CPR face shields and goggles.
• Change gloves before assisting another casualty.
• Ensure assistance is given in a clean and hygienic environment.
• Cover any open wounds you may have with a clean, waterproof, lint free dressing.
• Clean re-usable equipment hygienically after any use.
• Dispose of used gloves and other contaminated waste correctly. Place in a plastic bag, which is then placed inside another plastic bag and securely closed. Do not dispose of in a normal rubbish bin. Seek advice from your local Health Department on disposal options.
• Wash off any body fluids immediately with warm soapy water.
• Avoid coughing, breathing or speaking over wounds.

Signs of Infection

If a wound shows signs of an infection seek medical assistance.

• Skin is red and swollen around wound.
• Painful to touch.
• Skin surrounding the wound is hot to touch.
• Fluid discharge.

Avoid touching the infected area, ensure gloves are used and all equipment is cleaned after care is given.

Needle Stick Injuries

Some people, such as health care workers are at increased risk of needle stick injury, which occurs when the skin is accidentally punctured or scratched by a used needle or sharp object. Although the risk of transmission is low, blood-borne diseases that may be transmitted by such an injury include human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV).

Reducing the risk of needle stick injuries:

• It is generally recommended that workers who may come in contact with blood or body fluids should receive hepatitis B vaccinations.
• Follow all safety procedures in the workplace.
• Latex or nitrile gloves will not protect you against needle stick injuries.
• Never bend or snap used needles.
• Never re-cap a needle.
• Always place used needles into a clearly labelled and puncture-proof sharps approved container.

Immediately after the Injury

• Wash the wound with soap and water.
• If the eyes are contaminated, rinse eyes while open with water or saline.
• If blood gets into the mouth, spit it out and then repeatedly rinse with water.
• If soap and water are not available, use alcohol-based hand rubs or solutions.
• Ensure the safe disposal of the sharp.
• If you are at work, notify your supervisor or Occupational Health and Safety Officer – you will need to fill out an Accident Report Form.
• Go straight to your doctor, or to the nearest hospital emergency department.

At the Doctor’s Surgery or Emergency Department
Your general practitioner or emergency department doctor should:

• Take detailed information about the injury, including how long ago it happened, how deeply the skin was penetrated, whether or not the needle was visibly contaminated with blood, and any first aid measures used.
• Explain the transmission risks, which are small.
• Offer blood tests to check for pre-existing HIV, HBV and HCV. You should be offered counseling about these tests before the blood specimens are taken.
• Inform the original user of the needle about the needle stick injury – if they are known. They will be asked to consent to blood tests to check their HIV, HBV and HCV status. They should be provided with counseling before the tests are done.
• Advise you about reducing the risk of transmission until the test results are received. You should practice safe sex and avoid donating blood.
• Ask your doctor about additional counseling if you think that you will require it.

Always dispose of sharps in approved sharps disposal containers and in accordance with relevant workplace and local, state, territory and commonwealth legislation.

There is no legal obligation to assist an ill or injured person in the case of an emergency unless a “Duty of Care” has already been established. Duty of Care is the legal relationship owed by one individual or organisation to another. If you are the first aider in your work place then you owe a Duty of Care to your co-workers, if you are the career of minors then you owe a Duty of Care to those minors. The first aider should have knowledge acquired in formal first aid training.

If there is no Duty of Care owed and you provide first aid assistance you are considered to be a “Good Samaritan”. First aiders should not be concerned or delay giving assistance for fear of litigation. No Good Samaritan has been successfully sued for acting in a reasonable and responsible manner when rendering first aid.

A person that does have a Duty of Care to others when providing emergency first aid assistance must provide care that is:

• Prudent and reasonable in the circumstances.
• In the best interests of the casualty.
• Based on skills and knowledge acquired in formal first aid training.
• Unlikely to make the casualty’s condition worse.

Once you commence first aid treatment you have taken on a Duty of Care and you should continue to provide first aid until:

• Someone with more qualifications arrives to help e.g. ambulance personnel, medical professional.
• The casualty no longer requires treatment.
• You are no longer physically capable of providing first aid.
• The scene becomes unsafe.

Consent

Before providing first aid to a casualty you must obtain their consent. If the casualty is unconscious, or is unable to give consent due to their injuries then consent is assumed and you should commence first aid treatment. If the casualty is conscious and appears to be in sound mind then they have the right to refuse your offer of assistance and any first aid treatment.

If the casualty is less than 18 years of age consent should be obtained from a parent or guardian. However, if no parent or guardian is present then consent is assumed and you can commence emergency first aid treatment.

Always remember that a casualty’s consent only extends to their immediate illness or injury and you should not attempt to treat any condition beyond your knowledge of first aid. All rules and regulation regarding first aid are covered in  first aid training.

Negligence

For negligence of a first aider to be established a court must find:

• A Duty of Care existed between the first aider and the casualty.
• The first aider failed to exercise reasonable care and attention in applying emergency first aid.
• The casualty suffered additional damage.
• The additional damage resulted from the actions of the first aider’s standard of care.

Recording

A first aider should always make notes or fill out a first aid report on all events of an incident no matter how minor the incident or emergency first aid provided. This will help them to remember the incident at a future time if required. If you are a first aider in a workplace your reporting obligations are greater under your State or Territories Occupational Health and Safety legislation. Any notes or reports can be used in a court of law. Ensure all documentation is accurate and factual, based on observations and not opinion.

General guidelines for first aiders completing a report for a first aid incident include:

• Use ink and not pencil.
• Amend any errors by drawing a single line through the error and initialing.
• Never use correction fluid/tape to correct mistakes.
• Include date and time of incident.
• Brief personal details – name, address, date of birth.
• History of illness or injury.
• Observations – signs, symptoms, vital signs.
• All notes should be legible.

Privacy and Confidentiality

All personal information regarding a casualty is considered to be confidential, including details of the illness or injury, treatment and medical history. In a workplace environment disclosure of personal information without the individual’s prior consent is unethical and in many cases illegal.



Occupational Health and Safety requirements in the provision of First Aid Training certification are guided by the First Aid Code of Practice (2004) which provides practical advice to employers and employees. It covers first aid personnel, first aid kits, first aid rooms, first aid signs, accident response plans, risk management and accident response plans. All States and Territories within Australia are required to follow their relevant legislation.

It is the responsibility of employers to have procedures in place to deal with major and minor accidents in the workplace. It is the employees responsibility to follow these procedures of First Aid Training certification.

The fundamentals of Occupational Health and Safety include:

• State the primacy principles of Occupational Health and Safety.
• List the role and responsibilities of employers and employees.
• State the functions of health and safety committees.
• List the powers of Workplace Health and Safety inspectors.
• Describe the principles of risk management.
• Explain why personal protective equipment is used.

Within the Work Environment

First Aid Training Courses Describe possible hazards.

• Recognize various safety signs.
• Define an ‘emergency situation’.
• Identify a range of fire extinguishers suitable for a specific type of fire.
• Recognize chemicals as hazardous substances.
• Identify hazards, equipment and precautions with respect to working at heights.
• Define a ‘confined space’ and its potential hazards.

Manual Handling

• Define manual handling.
• Describe correct lifting procedures.
• List typical manual handling injuries.

Each state and territory has legislation in place regarding the relevant requirements for workplaces; these requirements will give recommendations on items such as the required size of first aid kits and equipment needed for the level of risk as well as the number of first aiders required within that workplace.

The team at Immediate Response First Aid training are privileged to have the chance to provide people with our First Aid courses. Our aim is assisting others.

Our goal is to raise awareness and on how to manage medical emergencies like:

• Anaphylaxis
• Diabetes
• Heart attack

And to teach people the skills to act with injuries like:

• Choking
• Fractures
• Head injuries
• Amputations

First Aid is about knowing simple, lifesaving skills. Each week I am going to discuss ways these issues can be managed.

The information I provide is in accordance with the Australian Resuscitation Council guidelines, but is intended as tip for emergency assistance only.

To ensure you too can assist others you should begin a First Aid Training Course.

The 1^st tip I will pass on to you is this:

If the injury/situation looks bad, call for emergency help, trust me Paramedics would prefer to arrive at a job where the casualty is now recovering then to get there too late, use and trust your own instincts.

This week’s management

Managing a suspected Spinal Injury:

The vertebrae is in 5 sections and contains 28 bones (some of these are fused to create a “joined bone”) and of course supports and protects the spinal cord which is carrying signals from the brain to different parts of the body.

If the injured person is conscious and can give symptoms of the pain eg: tingling in the hands, feet, or worse no sense of felling at all leave them on their back or in the position you have found them, avoid any movement of their vertebrae assisting with immobilization if possible. If you are trained to do so and the equipment is available apply a neck brace or collar for support, constantly monitor their A.B.C and treat for shock while you are waiting for the professionals.

If the injured person is unconscious we should still be concerned about the movement of the vertebrae and must manage the causality with as much care as possible but in this case the causality must be rolled onto their side into the lateral position ensuring spinal alignment as this is done.

The reason the unconscious causality must be moved is that there is a greater risk of blocking of the airway by their tongue or aspirating (choking on their vomit) when left on their back which will result in suffocation of the causality. The A.R.C (Australian Resuscitation Council) states that “airway management must take precedence over ever other condition including spinal damage”.

I look forward to giving more tips and information and how to assist others who may be in trouble.