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Its your worst nightmare as a First Responder. You hear a loud crash, followed by a scream. You race over to the where the noise was, and you find your colleague on the floor, unconscious, with laboured breathing. He is lying flat on his back, his chest moving rapidly in and out. You can see a small amount of blood on the top of his head, and the large amount of debris that has fallen down upon him is lying in a pile next to him. You look up and see that more debris may fall down, and will cause more injury to him, or to you if approach to assist. Another colleague arrives, he is also First Aid trained, and is clearly distressed at seeing his mate in such a condition. You take some deep breaths, you need to engage your frontal cortex rather than your amygdala (emotional centre), and you get to it. You’re in charge now. What are your priorities? Of course, safety is your number one priority. But how do you move him? You want to move your patient away from the falling debris, but do you need to be concerned about spinal precautions? You have one person to assist you, so can move him easily enough away from the imminent danger. And then what about Airway management? He is unconscious, but clearly breathing. You know that unconscious patients need to be on their side, or in the recovery position, but are concerned that this is a traumatic injury, and that there may be a spinal injury involved. Your assistant is getting more concerned, you think you want to pull him away from the danger, and roll him onto his side, but he feels you may cause a spinal injury. “What if he ends up in a wheelchair?” These are the sort of high pressure, high acuity situations we aim to prepare you for, so you can approach them with confidence, backed with years of research and scientific evidence. Danger takes precedence over everything! There is no point treating a patient if there is a risk of you becoming injured, or your bystanders. You will only create more patients to treat, and may become useless to the situation. Not only that, if you don’t mitigate the danger, your patient may be at risk of becoming further injured, possibly even fatally. Spinal precautions do not take more importance than safety. Let’s talk about Airway Vs Spinal. For too long, there has been a misperception in the pre-hospital setting about spinal injuries, spinal immobilization and the possible worsening of spinal injuries during treatment and movement. AIRWAY TAKES PRECEDENCE OVER SPINAL The evidence is clear. The management of this patient’s Airway by either rolling him onto his side, or by placing him into the recovery position is far more important than worrying about worsening a spinal injury. The following are direct extracts from the Spinal injury treatment guidelines, according to the Australian Resuscitation Council. Airway management takes precedence over any suspected spinal injury. It is acceptable to gently move the head into a neutral position to obtain a clear airway. If the victim is breathing but remains unconscious, it is preferable that they be placed in the recovery position. The clinical importance of pre-hospital immobilisation in spinal trauma remains unproven. Pre-hospital spinal immobilisation has never been shown to affect outcome and the estimates in the literature regarding the incidence of neurological deterioration due to inadequate immobilisation may be exaggerated. At RR+R, we teach you the correct method to perform a log roll, or spinal roll, so you can place this patient onto his side, maintain spinal alignment, and keep his airway open. So you can be assured that you can cover all bases in keeping this patient safe. Ambulance Services across the world are recognizing that we need to think differently when it comes to the treatment of Spinal patients. In fact, it has been found that the young, fit and healthy patient rarely injures their spine, and it is far more likely to occur in elderly, frail casualties who fall from standing height. Of course, this does not remove the need to take spinal precautions, or change good habits when it comes to treating your suspected spinal injury patients. Keep them still, use good technique when moving them, and maintain spinal alignment as best you can. At RR+R, we teach you all these methods so you can be confident and sure of yourself. But we also want to remind you that you can feel safe that you won’t worsen or exaggerate an injury with simple movements, and airway management. We teach you to be an advocate for your patient, and prioritize treatment in the order in which would best suit them. Following is a short video from SEC Ambulance in the UK who are radically changing how they do business when it comes to Spinal injuries: https://www.youtube.com/watch?v=aBfYi9clnH0
The sniffing position—only in the absence of cervical spine injury
If cervical spine injury is a possibility
Learn the first aid method of DRSABCDFirst aid is as easy as ABC – airway, breathing and CPR (cardiopulmonary resuscitation). In any situation, apply the DRSABCD Action Plan. DRSABCD stands for:
Where to learn first aid and CPRYou can attend a CPR training course or first aid course with a non-profit organisation such as St John Ambulance Australia (Victoria), Australian Red Cross and Life Saving Victoria. St John also runs awareness programs in schools and the community. There is no age limit to learning CPR. The ability to carry out CPR is only limited by the physical capabilities of the person carrying out the procedure. In some schools, CPR is a module of the first aid course taught to Year 9 students. CPR is a life skill that everyone should learn. Remember that doing some CPR in an emergency is better than doing nothing. Infection control when performing CPRTo avoid contact with potentially infectious bodily fluids such as blood or saliva, everyone with training in resuscitation is advised to carry a resuscitation mask in their purse, wallet or first aid kit. This helps take the worry of infection out of helping someone in a life-threatening situation. These masks are available from first aid providers or from your pharmacy. First aid for a person chokingMaintaining a clear airway is always the priority to make sure the person can keep breathing. You might need to roll them onto their side, but spinal injury is always a possibility in anyone involved in an accident. There are ways of placing an injured person on their side so that there is very little movement to their spine. You can learn these skills in a first aid course. First aid for a medication or drug overdoseMedications are very unpredictable. Many medications or illicit drugs have dangerous side effects, particularly if they are mixed together or taken with alcohol. If you are aware or suspect that someone you have found has overdosed on drugs or medications, do not leave them to ‘sleep it off’. A doctor or ambulance paramedic should assess any person who overdoses on any medication. It is very important that you call triple zero (000) if you are aware or suspect that someone you have found has overdosed on drugs or medications, as many overdoses cause death. First aid kitAs well as knowing some basic first aid techniques, it is important that households and workplaces have a first aid kit that meets their needs and is well organised, fully stocked and readily available at all times. The contents should be appropriate to cope with a range of emergency situations, depending on the setting. It’s a good idea to have a number of kits handy in different places, such as in the home, car or office. First aid kits are available for purchase from a variety of providers, including St John Ambulance Australia (Victoria) or your local pharmacy. Specialty kits are also available to meet specific needs. Reducing the risk of infected wounds during first aidOpen wounds are prone to infection. Suggestions to reduce the risk of infection include:
In an emergency, these suggestions may not be practical. If the injured person is bleeding heavily, don’t waste time. For example, cleaning the wound might dislodge a blood clot and make the wound bleed again or bleed more. Immediately apply pressure to a heavily bleeding wound (or around the wound if there is an embedded object), and apply a bandage when the bleeding has slowed down or stopped. Call triple zero (000) immediately. Using bandages during first aidThis information is of a general nature only and should not be considered a replacement for proper first aid training. General suggestions include:
Making an arm slingAfter being bandaged, an injured forearm or wrist may require an arm sling to lift the arm and keep it from moving. Steps include:
Where to get help
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This page has been produced in consultation with and approved by:
This page has been produced in consultation with and approved by:
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