Based on what happened at the Boston Marathon and Texas Fertilizer Plant, you never know when you may be called upon to administer first aid. Both are rare occurrences but illustrate the need to know urgent emergency care and how it saves lives.
This article intends to educate you on the value to taking first aid classes. To do that I will be reviewing the fundamentals of first aid, review a couple first aid treatment modalities you will learn, and direct you toward resources to take first classes and review the levels of training available to you.
I personally have been at automobile accidents, disaster areas, and in remote locations around the world where emergency medical care needed to be implemented immediately and transportation to a medical facility was going to be challenging or require some time. Thus, having a good knowledge of what you can do in those environments is essential to treating an injured or wounded person.
One of the first hallmarks of rendering first aid is: “To Do No Harm”. This is one of the essential components of medicine and in particular first aid. A simple concern of moving the patient can result in serious negative consequences. Thus, it is so important that you do not do anything you are not trained to do and that you completely evaluate the situation before intervening. To reduce the likelihood of you doing harm while administering care, it is imperative that you take a first aid class so you can determine the extent of the injury and the required intervention.
There are multiple scenarios where one might be in a position to use their first aids skills. They include home, automobile accidents, in the wilderness, or in a combat or disaster environment. In each of these environments, it is important to understand the scope of actions you are taking and make informed decisions on your treatment approaches.
The four objectives of administering first aid are consistent across the spectrum of causality environments. So whether you are at home or in a remote environment the objectives are the same.
The four key objectives of first aid are; 1.) Preserve Life, 2.) Prevent further injury, 3.) Activate EMS ASAP, and 4) Facilitate transport to a medical facility.
Let’s address each one of these then move on to some of the treatment modalities you will learn when taking first aid courses.
This is clearly the most important first step in process of administering first aid. Since this aspect of the process includes not just the patient, but also you and any others in the surrounding area. So surveying the scene is exceedingly important as you approach an injured person. Here are a couple examples. First, I have been at automobile accidents where those trying to help were running across major four lane highways, almost getting hit themselves and causing additional accidents. Not only increasing the risk if injury to themselves but people driving the cars and the other rescuers. I have also been at accident scene where there was leakage of gasoline in large quantities. Thus, it as vital to get by standers away from the area and insure no one was smoking. Finally, I have seen scenes where rescuers with good intentions were pulling people from cars who may have had serious spinal injuries when there was not need to do so. All of these examples are automobile accidents which are one of the most common traumatic scenes and easy to relate too.
With these examples in mind, it is so important to survey the scene to determine any threats to safety before progressing to help the injured parties. It is of no value to injury or kill yourself or others by prematurely rushing to help an injured person. In particular, because until you reach that injured person you do not know if their injuries are even life threatening.
Prevent Further Injury
This aspect of first aid is of the utmost importance. There are many ways to exacerbate an injury by unnecessary intervention. So the very first step in all first aid processes is: Evaluation of the patient. This is an extensive process in general. I published an article in 1988 that established the foundation for an algorithmic approach to initial assessment of the trauma patient that was used by many organizations such as the Basic Trauma Life Support Training Program and the Initial Pediatric Assessment Tool used by the Illinois EMS for Children and several other trauma training organizations. I later expanded that publication to cover the differences between the initial evaluation of the trauma patient and the medical patient. Each has its own unique set of evaluations that are specific to whether it is a traumatic injury or a medical problem.
Using a systematic approach to examining and injured patient by starting at the head and working toward the lower body and extremities is essential to totally understanding the extent of the patient’s injuries and insuring that you do not miss an injury. Not all first aid classes teach this skill but it is a good one to read about and learn.
One of the best means to prevent further injury is to not move the patient until all treatments have been applied. Naturally, these are not always possible, but if you do not need to move the patient, then do not.
Activate the EMS System
The next priority in the sequence of events is to activate the EMS system as quickly as possible (if available). There are multiple benefits of this action. First and foremost, it reduces the time between injury and the application of advanced treatment modalities. Secondly and most importantly, it begins the process of getting the patient to medical facility. Once EMT’s and or paramedics arrive on the scene the ability to treat the injury party with more advanced tools can significantly contribute to the survival of the patient. There should never be hesitation in activating the EMS system.
Facilitate Transport to a Medical Facility
This is first accomplished by activating the EMS system. For seriously injured trauma patients reaching a medical facility is paramount to their survival. During the Korean and Vietnam Wars it was learned that if a seriously wounded soldier arrived at a MASH unit or hospital within one hour their survival rate was significantly higher than those who did not. This was later termed the “Golden Hour”, the time in which a patient was injured until they received definitive care. It is of extreme essence to get severely injured patients to a trauma facility as soon as possible to increase their chances of survival. Thus, activation of the EMS system is paramount of first aid assistance.
Three Most Important Treatments
There are three vital treatment modalities that one must be prepared to evaluate and treat in an emergency situation. Those are Airway, Breathing and Circulation, known as the ABC’s of first aid. Correctly identifying a crisis and properly treating any of these three problems can and will save a person’s life. Let’s review some techniques you will learn in first aid classes to treat these problems.
An open patent airway is essential for one to breathe. There are two primary airway obstructions: soft tissue and foreign object. In either case, intervention will most likely be needed in order for the patient to properly and easily breathe.
The first step is to determine if the patient is breathing. If so then the best next step may be to do nothing and allow the patient to breathe on their own. However, if the patient is not breathing then it is essential to open the airway. The best means of doing this is by using the jaw thrust technique. It allows the rescuer to open the airway without moving the head and spine. This is particularity important when the patient is a victim of trauma and there may be a spinal injury. If there is a foreign object in the patient’s mouth it must be removed and if the vomit the patient must be rolled onto their side to allow the vomit to drain.
This technique alone can save a person’s life. It is one of the vital shills you will learn in a first aid class.
The second step is to verify the patient is breathing. Even though you open the airway does not necessary mean the patient will start breathing. There are several methods to determine if the patient is breathing and they include: observing the patients color, watching for the rise and fall of the chest and placing your ear close to the patient’s mouth and listening for air movement. The treatment for a non breathing patient is mouth to mouth or mouth to mask if you have one. To deliver a breath you must place your mouth over the patient’s mouth and or to the mask, and then blow slowly and with good volume. Blowing fast and hard will increase the likelihood that the air will go into the patient’s stomach rather than their lungs. You continue to do this until help arrives with more advanced means of ventilating the patient or the patient starts breathing on their own.
The third step in assessing the patient is to determine their circulatory status. There are three primary methods for evaluating a patient circulatory status. First color, if their skin and mucus membranes are pink that is good. Blue or purple is bad. Second pulse, if the pulse is between 80 and 100 that is good. Above 100 is of concern. However, it must be taken into consideration that the person may be very scared and that will affect heart rate too. Finally is capillary refill. This is measured by squeezing the tip of the patient’s finger and watching the underside go from white to pink. If this takes less than 3 seconds then the patient is fine. The longer this takes the worst the patient’s circulatory condition is and this is a sign of impending shock or shock.
Trauma is the number one cause of death between the ages of 1 and 44. Bleeding is one of the top causes of death in trauma. So in most cases, the treatment of choice in a trauma situation is to stop the bleeding. Some of the treatment modalities are direct pressure on the affected area, followed by a pressure bandage and then if needed a tourniquet. Venous bleeding is easily controlled by direct pressure. Some arterial bleeding can be control with direct pressure as well. Direct pressure can the applied using pressure dressings and in more severe cases such as amputations, a tourniquet is needed to control the bleeding.
Clearly there are other emergency situations such as fractures, medical illnesses and bites and stings that require some form of first aid. The treatment modalities for these types of emergency are covered in the classes listed below.
Basic first aid classes are excellent and will help you understand the very basic skills needed. But if you are planning on hiking or camping, then I recommend a wilderness first aid course. If you are preparing to be more isolated for an extended period of time, then I strongly recommend an emergency medical responder (EMR) or emergency medical technician (EMT) course. These courses offer more in depth training and the ability to understand medical problems as well as trauma. They can usually be taken one to two nights per week over a three month period. Finally, depending on your plan, I feel taking a paramedic course is the very best program to learn emergency skills and advanced techniques that can be invaluable in remote areas or very isolated areas or in the time of disaster. This course is about 14 months long, two to three nights per week.
There are a number of resources where you can take these classes. The American Red Cross and the American heart Association are both nationwide organizations that provide first aid classes. In addition, in many locations the Boy Scouts and Girl Scouts of America teach first aid classes. For the EMT and paramedic programs you can contact your local vocational tech school or Jr. College.
In summary, first aid is an essential skill you should know and can be valuable in a broad spectrum of environments. The classes are usually only several hours long and you learn so much. I highly recommend you take classes based on your expected need. You can play a vital role in saving a life when properly trained.
About Dan C: Dan has lectured in over 250 American Heart Association Advanced Cardiac Life Support Provider Courses (ACLS) and over 40 ACLS Instructor Courses, over 50 American College of Emergency Physician Basic Trauma Life Support Provider (BTLS) Courses and 20 BTLS Instructor courses and in over 30 American College of Surgeons Advanced Trauma Life Support Provider (ATLS) Courses, 5 ATLS Instructor courses, 40 American Heart Association Pediatric Advanced Life Support (PALS) Provider and Instructor Courses and 30 American College of Emergency Physicians Advanced Pediatric Life Support (APALS) Provider and Instructor Courses. He has also lectured nationally at several national medical meetings on Trauma verses Medical Patient Assessment, Emergency Airway Management, Pediatric Resuscitation, Emergency Trauma Patient Assessment and Management, Emergency Cardiac Care, and Critical Care Aeromedical Transport.