Emergency Care

  Emergencies

• Being faced with a collapsed person or stumbling into an accident scene is a frightening experience
• However you can help with a minimal amount of training
• The following information shows what can be achieved by a person competent in Basic Life Support (BLS)

REMEMBER: resuscitation skills require frequent practice on a specially designed training manikin
No amount of written information can substitute for a properly organised training course
The basic skills can be learned in as little as two hours and once trained you need to keep your skills up to date.

  Basic Life Support (BLS)

• Approach
• Airway
• Breathing
• Circulation
• Rescue breathing
• Chest compression
• Summary

Approach

• Approach with care and be sure that there is no continuing danger either to yourself or the casualty
• Be aware of hazards from electricity, gas, traffic, masonry, etc
• Assess whether or not the casualty is conscious: carefully shake his shoulders and ask loudly "Are you all right?"
• If there is no response and someone else is nearby ask them to wait as you might need his assistance
• If you are alone, shout loudly to try and attract attention but do not leave the casualty

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Airway

• In an unconscious casualty the tongue may fall back to block the airway
• By tilting the head back and lifting the chin forward the tongue can be moved away from the back of the throat
• If possible with the casualty in the position you found him, place one hand on his forehead and gently tilt his head back. (Keep your thumb and index finger free to close the nose if rescue breathing is required)
• At the same time lift the chin using two fingertips of your other hand under the point of the chin. This will open the airway
• If you have any difficulty, turn the casualty onto his back and then open the airway as described
• In casualties with suspected neck injuries, try and avoid head tilt, using chin lift to clear the airway
• The first priority, however, is to obtain a clear airway and some degree of head tilt may be unavoidable
• Neck injuries can result from: head injury, road accidents, falls fron height, dives into shallow water and horse riding accidents

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Breathing

• Keeping the airway open check whether the casualty is breathing:
• Look for chest movement
• Listen at the mouth for breath sounds
• Feel for breath on your cheek
• Look, listen and feel for 10 seconds before deciding that breathing is absent
• There may be several reasons why the casualty has stopped breathing:
• Lying unconscious on his back with a blocked airway, heart attack, injury to the head or chest, poisoning, drowning and choking
• If the casualty is not breathing and you have someone else with you, send him to call an ambulance immediately, while you give 2 rescue breaths
• If you are alone and think the cause of the casualty's unconsciousness is a serious injury or he has been drowned, or if the casualty is a child, perform resuscitation for about a minute before leaving the casualty to telephone for an ambulance
• If you are alone with an adult casualty who has not been drowned or suffered a serious injury, leave him immediately you realise he is not breathing and go to telephone for an ambulance. Then return and give 2 rescue breaths

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Circulation

• Once you have given 2 rescue breaths, assess the casualty for signs of a circulation by looking for any movement, including swallowing or breathing (more than an occasional gasp), and by checking the pulse down the side of the neck (carotid pulse)
• Check for signs of a circulation for no more than 10 seconds
• If there are no signs of a circulation, or you are at all unsure, assume that the heart has stopped (cardiac arrest)
• The casualty will be unconscious and may appear very pale, grey or bluish in colour
• An artificial circulation will have to be provided by chest compressions
• If the circulation stops then breathing will stop also; casualties with cardiac arrest will need both rescue breathing and chest compression, a combination known as cardiopulmonary resuscitation (CPR)
• CPR will "buy time" for the casualty by allowing blood containing oxygen to be circulated around the body preventing damage to vital organs such as the brain
• CPR will not "bring the casualty back to life" which is why it is important that the ambulance is called as quickly as possible. Ambulance personnel will be able to use a machine called a "defibrillator" designed to deliver an electric shock to the heart, which may be able to start it beating again

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Rescue Breathing

• This is usually given by the "mouth to mouth" method
• Turn the casualty onto his back, if he is not already in this position, and kneel by him
• Remove any visible obstruction from his mouth (leave well-fitting dentures in place)
• Keep the airway clear (head tilt and chin lift) and pinch his nose closed
• With your other hand keep the chin lifted and allow his mouth to open
• Take a breath, place your mouth completely over the mouth of the casualty, making a firm seal, and breathe steadily into the casualty
• Each breath should be sufficient to cause the chest to rise as in normal breathing; take about 2 seconds
• Maintaining head tilt and chin lift, take your mouth away from the casualty and allow the chest to fall fully as the air comes out
• Take another breath and repeat to give 2 effective rescue breaths in all
• Check for signs of a circulation - swallowing, breathing, or a carotid pulse - if there are none, start chest compressions
• If you are sure there is a circulation, continue rescue breathing until the casualty starts to breathe again or the emergency services arrive
• About once a minute (every 10 breaths) recheck for signs of a circulation
• If the casualty starts to breathe again he should be turned onto his side into the recovery position
• Vomiting often occurs when breathing returns and the recovery position will help to prevent blockage of the airway if this happens

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Chest Compressions

• Chest compression is performed with the casualty lying flat on his back on a firm surface
• By rhythmically depressing the breastbone towards the backbone, blood is made to flow out of the heart and around the body
• Kneeling by the side of the casualty find the lower half of the breastbone by running the index and middle fingers of one hand up the lower margin of the ribcage and finding the notch where the ribs join
• With your middle finger in this notch place your index finger on the breastbone above
• Slide the heel of your other hand down the breastbone until it reaches your index finger
• It will then be in the middle of the lower half of the breastbone
• Place the heel of your first hand on top of the other and interlock the fingers
• With your elbows straight, bring your shoulders up until they are directly over the casualty's chest
• Depress and release the breastbone 5 centimetres. The recommended rate is approximately 100 chest compressions per minute
• Chest compression must always be combined with rescue breathing so after 15 compressions give 2 more effective rescue breaths
• Continue to alternate 2 breaths with 15 compressions
• It is unlikely that the casualty's pulse will return spontaneously without other more advanced techniques (especially defibrillation)
• Do not waste time by stopping CPR to recheck the circulation, only stop and recheck if the casualty shows signs of life (movement or breathing)
• Carry on until the emergency services arrive, another rescuer can take over, or you are too exhausted to keep going

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Summary

• Look for danger - approach with care
• Assess responsiveness - shake and shout
• Shout for help - ask someone to assist you

• Open the airway by head tilt and chin lift (if you suspect a neck injury, try chin lift only)
• Check for breathing - look, listen and feel for up to 10 seconds

Responsive and breathing:

• Leave the casualty in the position you found them (unless this is dangerous)
• Get help if necessary and keep checking their condition

Unconscious but breathing normally:

• Turn them into the recovery position
• Dial 999 for an ambulance and check for continued breathing

Unconscious and not breathing:

• Go to dial 999, or send someone else to do it for you
• If you are alone with a casualty who has serious injuries, or has been drowned, perform resuscitation for one minute before making the call yourself
• Give 2 effective rescue breaths and check for signs of a circulation for no more than 10 seconds
• If no signs of a circulation give 15 chest compressions and continue in cycles of 2 breaths to 15 compressions until the emergency services arrive
• If you are sure there is a circulation continue rescue breathing and recheck for signs of a circulation once a minute
• If breathing restarts, place casualty in recovery position and continue to check his condition
• Continue resuscitation until: circulation and breathing are restored, a doctor or qualified professional assumes responsibility for the casualty, another rescuer takes over from you or you are completely exhausted and unable to continue

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