/ How are your First Aid skills?

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The Lemming - on 31 Jan 2013
Just read this interesting article and it got me wondering, how good are our First Aid skill's on UKc?

http://uk.lifestyle.yahoo.com/emergency-first-aid-daniella-westbrook-cpr-what-to-do-160551797.html

Lets not get into a willy waving contest if you eat,sleep, breath First Aid or do it for a living, that's not what I'm trying to achieve.

But would you know how to do the basic stuff?
And what would you consider the basic stuff to be?
Al Evans on 31 Jan 2013
In reply to The Lemming: When I did my ML first aid, apart from resuccy Anne and minor treating of cuts and grazes the instructor told us that anything really serious should just be covered in cling film and gaffer tape and gotten to paramedics asap. It all depends on what you are dealing with, I guess a simple break could be splinted but a compound fracture or a serious head wound the best first aid is send some one to get proffesional help and try and stop the bleeding.
ice.solo - on 31 Jan 2013
In reply to The Lemming:

ive used em a fair bit, including resus once for real.
my wifes in ER so ive seen her deal with people havingg accidents in public and have actually learned more from that than the many courses, tho downtown is waaaay different to remote stuff.

i find i just click into gear and most of it comes to me. i always wondered if it would.
having had it applied to me also makes a difference..

the basics: bleeding, head/spinal injuries (real or suspected), breathing, shock, dislocations, loss of consciousness for regular stuff, then cold injuries and blunt wounds/crush stuff for climbing, altitude stuff for going high.
knowing a step-by-step process helps a lot.

als glad wrap method ive used in responder stuff but wouldnt carry it normally. otherwise im a big fan of lots of bandages and gaffers tape.
toad - on 31 Jan 2013
In reply to The Lemming: My first aid is out of date from a H&S perspective, but I'm fairly sure of the basics - ABC stuff and I'd be happy with minor injuries (probably not what A&E people regard as minor injuries - I'm strictly paper cuts material) Beyond that, it's time to call the professionals
Bimble on 31 Jan 2013
In reply to The Lemming:

Done the basic St Johns course a few years back, and a more advanced 'combat medic' course as part of my hostile environments/embed training. I'm confident with most things, but thankfully haven't had to use any of it apart stopping bleeding in day-to-day situations & one rather nasty head fracture during the student riots.
GridNorth - on 31 Jan 2013
In reply to The Lemming: I've done first aid courses at work and mountaineering first aid courses for ML etc. I know the basics but I'm not convinced that I could do much more than the basics of "Breathing, Bleeding and Bones" that we were taught to priorise. IMO the most valuable thing a first aider can do is reassure and comfort and having done the courses you can do this with a little more confidence.
iccy - on 31 Jan 2013
In reply to The Lemming:

Is it me or is the info on that link wrong?

Last first aid course I did (which I think was a St John's) said DR ABC was out of date - now just danger, response, airways, breathing.

Justification was that people couldn't always find a circulation due to lack of skill and could therefore act inappropriately.

Has it changed back?
spearing05 - on 31 Jan 2013
In reply to iccy: For basic first aid ie first responder at work, then I believe the current advice is as you say to ignore the C part if there is no breathing then start cpr without looking for a pulse. Even if it is present it wont be for long with no breathing.

However above this level circulation is important, certainly if the patient is breathing then the next step is a check of the circulation as this includes looking for and dealing with major bleeding. The pulse can also give a great deal of information.
spearing05 - on 31 Jan 2013
In reply to spearing05: Just read the artical and it says the same a bit further down.
climber david - on 31 Jan 2013
In reply to iccy:
> (In reply to The Lemming)
>
> Is it me or is the info on that link wrong?
>
> Last first aid course I did (which I think was a St John's) said DR ABC was out of date - now just danger, response, airways, breathing.

>
> Has it changed back?

When I did EFAW last week, it was DRS ABCD then. The C stood for CPR and the D was for defib

I did BASP outdoor first aid in November as well and they taught DRS ABC with the C also standing for CPR. Bleeding was covered in the 3 B's

One thing I didn't get taught was where burns would come in the 3 B's? I thought after bleeding but not sure

Thanks

David
Orgsm on 31 Jan 2013
In reply to The Lemming:

There's a first aid app for your smartphone by British Red Cross. Not the same as training but still a good prompter / lifesaver. It even has an emergency section.
I like climbing - on 01 Feb 2013
In reply to The Lemming:
A good reminder - I need to do a course.....
MtnGeekUK - on 01 Feb 2013
In reply to climber david:

Interesting you use S.

I have H in my head- help!

My be a shout, might be a whip your phone out?
Dax H - on 01 Feb 2013
In reply to The Lemming: In the training room my first aid skills are great and every time I have done the course through work over the last 20 or so years I have passed with flying colours but other than the odd minor cut I have never needed to use the training in anger and that is the true test of how good you are.
I hope I never need to find out.
Wainers44 - on 01 Feb 2013
In reply to Dax H:
> (In reply to The Lemming) In the training room my first aid skills are great and every time I have done the course through work over the last 20 or so years I have passed with flying colours but other than the odd minor cut I have never needed to use the training in anger and that is the true test of how good you are.
> I hope I never need to find out.

That is the real problem. Doing it all in the knowledge that its just a bunch of mates/people on the course is different from being unlucky enough to stumble across a real incident.

I have been in the wrong place at the wrong time twice, being the first to arrive at a couple of reasonably serious car accidents.

Just safely getting to someone who needs help is the first problem...in one the car had hit another head on and was smashed up. Airbags had all deployed which meant I couldnt even see the driver (my first aid kit now contains bigger and sharper scissors!). Other one the car was locked and the driver out cold with no conveniently broken windows!

After calming down a bit the biggest challenge was stopping others, or even the casualty from trying to drag themselves out of the vehicle (when both almost certainly had serious whiplash at the very least). The training all does help massively, but as others have said its at least as important to reassure and calm the casualty until the real cavalry arrive!

..and in both cases the usual ways to treat for shock advice wasnt that useful!!
Ireddek on 01 Feb 2013
In reply to The Lemming:

I've done the 1st Aid at Work course for about a decade now and there's always minor alterations when the refresher course comes round, but I found the main thing is to actually have some kind of an idea of what to do in any given situation. I've had to treat a fair amount of minor stuff and the odd more serious incident.

As mentioned shock is the really hard one to deal with as keeping someone focused & responding isn't always that easy! Also learned to keep a small notebook/sheet of paper & pen in my 1st aid kit, because when the chips are down & the adrenalin's surging it's harder to memorise their details, names and numbers of people the casualty wants notifying, response details & times of checking. I found in most cases people really want their next of kin to know where they're going/what has happened. Now I don't think it's my job as a 1st aider to do the notifying, but it does keep the other party talking (responding!) and the emergency response team are usually grateful to have the info!
captain paranoia - on 01 Feb 2013
In reply to climber david:

> One thing I didn't get taught was where burns would come in the 3 B's? I thought after bleeding but not sure

It depends...

A small burn from touching a hot pan is trivial. 50%, 1st degree burns aren't...

That's the problem with trying to use mnemonics too rigidly; they're simply to help you think about what to do. Beyond DR ABC (if you want to use that), everything else really comes under the category of 'you have a little more time to deal with this', obviously, depending on the severity. So, after ensuring you keep the patient breathing and beating, assess the other injuries and treat in order of severity/threat to life, not according to some rigid sequence defined by a mnemonic.
lone - on 01 Feb 2013
In reply to The Lemming:

From a Hill walkers point of view:

I had a serious incident on a walk I was leading in the Western Beacons last year where the first aid was essential, being trained in first aid made all the difference.

It would have been really difficult had I been there as a leader with no first aid knowledge or kit to hand. There are lots of walk leaders in that situation, its a time bomb waiting to go off for the individual leading the walk and the casualty.

The incident required professional treatment but the basic skills were enough to get though it until I could get him to a Hospital.

Basic, being knowledge of Shock, CPR, Hyperthermia/Hypothermia, broken bones, Burns, using the first aid kit, and also when you divide the line between walking someone off the hill and making the call for MRT.

Its only being exposed to situations that you really learn, the other important thing is if you have to get off the hill in poor conditions. It's quite a challenge with a group, an injured person and having to re-route your walk while keeping focused on lots of different things all going on at the same time.

Jason
Hillwalker - on 04 Feb 2013
In reply to iccy: Modern courses still use ABC system, and for some of us if its ABC then it is not logical to complicate it by using DRABC, the whole idea of ABC is that it starts with A.

A is for Assess for Danger
A is for Approach the casualty
A is for AVPU (level of consciousness)
A is for Assistance (shout for help)
A is for Airway check
B is for Breathing
C is for circulation, checking to see if its intact or any major bleeds.

We no longer teach taking pulses in this initial phase, it is kept for later when casualty monitoring is taught. Today we assume that if a casualty is breathing they have a pulse. Not being able to find it following trauma usually has nothing to do with the skills of the first aider, but lots to do with physiological changes in the casualty.

There will doubtless be lots of disagreement with the above process, but this is the modern approach, the items up to B being the sequence dictated by the EU and UK Resuscitation councils. But in the real world nobody cares if you want to teach ABC or DRABC, the end is the same.



SAF - on 04 Feb 2013
In reply to iccy:
> (In reply to The Lemming)
>
> Is it me or is the info on that link wrong?
>
> Last first aid course I did (which I think was a St John's) said DR ABC was out of date - now just danger, response, airways, breathing.
>

That's crazy since 'c' is not simply about assesing the circulation (ie taking a pulse' but about dealing with any circulatory problems. The problem with the way that it seems you have been taught is that it ignores that the vast majority of your patients will possibly be responsive, will have a clear airway and will most likely be breathing with some effect. Some first aid courses seemed to get overly focused on the unconcious/not breathing patient... these are the minority, and the outcome will normally already be out of your hands.

I have heard that the military are moving across to a slightly different algorithm/nmonic again, with trauma in mind, which puts, massive obvious external haemorrage above response, airway or breathing...on the basis that if you don't sort that out you may as well not bother with anything else. Will try and find out what it is.


SAF - on 04 Feb 2013
In reply to SAF: Found it...

CABC

The military frequently use CABC. With the first C standing for catastrophic haemorrhage. It is hypothesised that major bleeding will kill a casualty before an airway obstruction.
m0unt41n on 04 Feb 2013
In reply to The Lemming: Quite honestly it doesnt really matter what the Mnemonic is as long as you can remember it under stress and it covers all the basics. There are web sites devoted to Medical Mnemonics:
http://www.medicalmnemonics.com/cgi-bin/browse.cfm

Different people and organisations can get hung up on different versions. There is DRSABC where S is Shout for Help or Spine control. Stressing the importance of C-Spine control and protecting the Casualty but recent studies suggest that the overall risk of unstable injury in casualties found alive is less than 1%. S can also stand for Crime Scene, particularly if there is a fatality.

Maybe it should also include Protect Yourself / Protect the Group / Protect the Casualty and in that order.

SAF - on 04 Feb 2013
In reply to m0unt41n:
>
> Stressing the importance of C-Spine control and protecting the Casualty but recent studies suggest that the overall risk of unstable injury in casualties found alive is less than 1%. S can also stand for Crime Scene, particularly if there is a fatality.

Interetsing statistic...

Up until 2 yeats ago (I don't know if it still stands) in the time that they have been collecting data specifically on mountain incidents from snowdonia that came into Ysbyty Gwynedd (bangor hospital) there had never been a live patient brought in with a C-spine injury!! I was suprised and I don't think I was the only one!!
pandaling - on 08 Feb 2013
In reply to m0unt41n:
This:
>>Quite honestly it doesnt really matter what the Mnemonic is as long as you can remember it under stress and it covers all the basics. There are web sites devoted to Medical Mnemonics:
http://www.medicalmnemonics.com/cgi-bin/browse.cfm

Also (I suppose it might be tricky when there's only one trained person) but it's important to remember that whatever mnemonic you choose, you can work through more than one letter at a time. No reason why you can't shout instructions for your friend to stabilise the c-spine with another looking for catastrophic haemorrhage, whilst you get on with the rest of ABC etc:)
Minneconjou Sioux - on 08 Feb 2013
In reply to The Lemming:

Mine were fairly good having served in the military for a number of years. What I wasn't prepared for was having to make the decision NOT to go into CPR on someone who had just taken a major (500 ft) fall.

A major head trauma and probable broken neck, other fractures and internal injuries, a remote mountain location and no cell coverage made the immediate decision relatively straightforwards........

but that doesn't stop the constant questioning of that decision even now, years later.

What helps is that, at the time, I knew I would challenge myself on the decision and so confirmed over and over that it was the right one.
KellyKettle - on 08 Feb 2013
In reply to The Lemming:

My First Aid is OK, I can: deliver (and have delivered) CPR, spot the signs of and attempt to stop shock, act to stem heavy bleeding, protect the casualty from environmental (esp. thermal) hazards, have been trained how to properly move casualties with suspected spinal injuries (but personally would rather not do so unless absolutely neccessary) and I could probably splint a break but there's not much point as I'd not attempt to move a casualty who needed a splint to do so unless it was the direct advice of a 999 operator (or there was imminent danger, in which case splinting the break is way down the priorities).

I'd quite like to do AED (and possibly Oral Airway) training, as it would give improved odds of being able to save an unconscious patient...


I'd say that for someone who's actively doing outdoor pursuits; CPR, Major bleeding, Shock, Moving a patient safely and Preventing hypothermia are the bare minimum...

A lot of the things we think of as "first aid", is dealing with minor injuries that won't require medical attention unless they develop complications as they heal... don't really require formal training at all, and IMO are totally separate from the reason we all take time to train and practice first aid: that is to initially stabilise a casualty with serious or life threatening injuries/illnesses until they can receive medical attention.
climber david - on 08 Feb 2013
In reply to MtnGeekUK:

I just use the S because it fits in the mnemonic and is easy to remember. Also in the street, if you come across somebody who has collapsed and you shout for help, you then may get somebody to help you with CPR/get a defib/phone the ambulance

David

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