Dr. Safina Jan
The recent tragic road traffic accident which took place in Gojal, Upper Hunza, resulting in the loss of nine precious lives made us realize that how significant role Pre-hospital care(First Aid and CPR) at the scene of accident can play in saving lives.
Pre-hospital care is very well established in the developed world, where the facility of trained medical professionals with well-equipped ambulances is easily accessible for emergency medical treatment at the scene of accidents as compared to our part of the world where even well-equipped ambulance is not available. But we cannot deny the importance of the First aid offered by any one on the site of accident in both the developing and developed worlds. As 55% of deaths caused by road accident occur in the first few minutes after a crash and up to 85% of these deaths could be prevented if first aid was given (Ref: BBC Health).
In road traffic accidents the time between injury and arrival at the hospital may be prolonged, the victim may be trapped and require extrication by the emergency services or in rural environments, the distance from hospital may be considerable and the need for rapid
intervention at the roadside may be life-saving.(Ref: The college of emergency medicine, Uk).
So, how to provide First aid at the scene of accident?
If you are the first person to witness the accident, you have to remain calm and assess the scene and seriousness of the collision. Call for help and you can call the emergency services (112 or 999) for ambulance, if available. Make safe, make sure you stay safe and that you
and the casualty are not in any danger and if you need to stop or warn approaching cars, signal to them from the pavement. if there is no phone nearby, recruit help and send two people in opposite directions, do not use mobile phones if there is a danger from petrol-spillage or fumes, consider the safety of others, look out for hazards like leaking fuel, chemicals, broken glass or shed loads, guide uninjured passengers to a place of safety. Remain calm, reassure the victims and donot allow smoking or offer food or drinks to casualities as this could hamper urgent medical treatment.
Call the emergency service as soon as possible or get some one else to do it while you deal with an injured person.
Now carry out basic First Aid.(Ref:NHS choices)
1) Assess the ABC of the victims i.e
-If someone is unconscious and breathing and has no other life threatening conditions, they should be placed in recovery position.
-If someone is unconscious and not breathing, if a person is not breathing or his breathing is abnormal after an accident, call for an ambulance and then, if you can, start CPR straight away.
Recovery position: Putting someone in the recovery position will ensure their airway remains clear and open. It also ensures that any vomit or fluid will not cause them to choke.
i) To place someone in recovery position, ROLL A PERSON ON THEIR SIDE with their arms and upper leg at right angles to the body to support them.
ii) Tuck their upper hand under the side of their head so that their head is on the back of the hand.
iii) Open their airway by tilting the head back and lifting the chin.
iv) Monitor their breathing and pulse continuously
v) If their injuries allow you to, turn the person on to their other side after 30 minutes.
BUT IF YOU THINK A PERSON HAS SPINAL INJURY,DONOT ATTEMPT TO MOVE THEM
until the emergency services reach you and unless their airway is obstructed.
You should suspect a spinal injury if the person has a head injury especially one where there has been a large blow on the back of the head and is or has been unconscious. Complains of severe pain in their neck or back, won’t move their neck, feels weak, numb or paralysed, has
lost control of their limbs, bladder or bowels, has a twisted neck or back.
If you must move the person (for example, because they are vomiting, choking or in danger of further injury), you need someone else to help you roll them.
One person should be at the head and another along the side of the injured person. Work together to keep the person’s head, neck and back aligned while gently rolling the person onto one side.
The recovery position for babies
For babies less than a year old, a different recovery position is needed. Cradle the infant in your arms with their head tilted downwards to make sure they do not choke on their tongue or vomit.
Until help arrives, keep checking the baby’s vital signs, such as their temperature, pulse and whether they are breathing.
. Cardiopulmonary resuscitation (CPR) is a first aid technique that can be used if someone is not breathing properly or if their heart has stopped.
Chest compressions and rescue breaths keep blood and oxygen circulating in the body. Hands-only CPR If you have not been trained in CPR or are worried about giving mouth-to-mouth resuscitation to a stranger, you can do chest compression-only (or hands-only) CPR.
To carry out a chest compression:
1. Place the heel of your hand on the breastbone at the centre of the person’s chest. Place your other hand on top of your first hand and interlock your fingers.
2. Using your body weight (not just your arms), press straight down by 5–6cm on their chest.
3. Repeat this until an ambulance arrives. Try to give 100 chest compressions a minute. Children over one year old
1. Open their airway by placing one hand on the child’s forehead and gently tilting their head back and lifting the chin. Remove any visible obstructions from the mouth and nose.
2. Pinch their nose. Seal your mouth over their mouth and blow steadily and firmly into their mouth, checking that their chest rises. Give five initial rescue breaths.
3. Place your hands on the centre of their chest and, with the heel of your hand, press down by one-third of the depth of the chest using one or two hands.
4. After every 30 chest compressions at a steady rate (slightly faster than one compression a second), give two breaths.
5. Continue with cycles of 30 chest compressions and two rescue breaths until they begin to recover or emergency help arrives.
Source for the article: http://www.bbc.co.uk/health/treatments/first_aid/procedures/