First Aid?

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simonsays

Forager
Sep 9, 2004
126
0
56
sunderland
Martyn said:
Successful CPR depends on a number of things, but probably most significant, is why the person arrested in the first place. If they had an EMD arrest (PEA for the old timers) with correctable causes and thier downtime is minimal, you stand a half decent chance of getting an output, but if they infarcted, your chances are much slimmer. I've forgotten how many (in-hospital) arrests I've been involved in, but it's more than a few, I've led probably half of those and outcomes are generally poor unless there is a clear and correctable cause. The problem with resus in the field, is you have very limited means of identifying cause. You can treat hypoxia effectively, but I doubt many arrests are caused by hypoxia alone. Hypothermia is another which actually has good outcomes, with a good long term prognosis. But most of the other causes are much harder (or impossible) to identify in the field, with limited or no equipment. If you have IV siting skills and have the eqipment, you could treat hypovolaemia, but that's pushing reality. As others have mentioned, the awkwardness of in the field resus, also compounds it's effectiveness. The longest I've done is 40 minutes, taking turns with 1 other bloke. We failed to get an output and the team called it. But after 40 minutes of "ideal situation" CPR, I was utterly b***ered! I felt like I'd don 5 hours in the gym and could feel the ache in my shoulders for days afterwards - and my technique is practiced and pretty good. If you're trying to do CPR on your own, in less than ideal circumstances, I'd bet you'd give up long before then - I know I would.

However, those people that come into hospital, that have had effective bystander CPR with minimal downtime, stand a massively improved chance of survival. Sometimes you question whether it's all worth it, when outcomes are generally so poor - it can get depressing, but you only have to see the face of one little girl, after you've given her dad back to her, to make it all worthwhile.


40 minutes of CPR shared between two is REAL hard work Martyn, you deserve a medal... How often did you swap places? At work we try and keep it down to turns of about a minute, I know my own technique gets a bit 'ragged at the edges' as I start to get tired. :1244:

Just to add a little to the general discussion... I do feel sometimes that the difficulty many people encounter with first aid is not always a lack of training (I'm a senior nurse in a trauma theatre and in 17 years have NEVER been offered formal first aid training. Go figure....) but a difficulty in applying that training in a real life situation.
As I'm sure Martyn will confirm, spending hours cheerfully pounding the living daylights out of resussi annie (Its a traditional name for the cpr practice kit) cannot -really- prepare you for the somewhat stark reality of actually having to do it for real where the outcome isnt a passing or failing grade but life and death to some poor soul. Even folk who carry out CPR on a fairly frequent basis are a little thrown by a change of environment. I well remember how much more stressful it was on the one occasion I had to perform CPR whilst not at work (I was in Asda's carpark :yikes: ). It felt scarier by far and was pretty disconcerting to cynical old 'seen-it-all-done-it-all' me. I really do have the greatest respect for any non-clinician who attempts any sort of heroic first aid at all. I just wish I had the time to spare to get some formal FA qualifications, It bugs me because I really feel like I should be better qualified.

cheers,
simon
 

Martyn

Bushcrafter through and through
Aug 7, 2003
5,252
33
58
staffordshire
www.britishblades.com
simonsays said:
40 minutes of CPR shared between two is REAL hard work Martyn, you deserve a medal... How often did you swap places? At work we try and keep it down to turns of about a minute, I know my own technique gets a bit 'ragged at the edges' as I start to get tired. :1244:

Just to add a little to the general discussion... I do feel sometimes that the difficulty many people encounter with first aid is not always a lack of training (I'm a senior nurse in a trauma theatre and in 17 years have NEVER been offered formal first aid training. Go figure....) but a difficulty in applying that training in a real life situation.
As I'm sure Martyn will confirm, spending hours cheerfully pounding the living daylights out of resussi annie (Its a traditional name for the cpr practice kit) cannot -really- prepare you for the somewhat stark reality of actually having to do it for real where the outcome isnt a passing or failing grade but life and death to some poor soul. Even folk who carry out CPR on a fairly frequent basis are a little thrown by a change of environment. I well remember how much more stressful it was on the one occasion I had to perform CPR whilst not at work (I was in Asda's carpark :yikes: ). It felt scarier by far and was pretty disconcerting to cynical old 'seen-it-all-done-it-all' me. I really do have the greatest respect for any non-clinician who attempts any sort of heroic first aid at all. I just wish I had the time to spare to get some formal FA qualifications, It bugs me because I really feel like I should be better qualified.

cheers,
simon

Hi Simon, yep it was torture. We were both shattered, but i think to start with, we sort of pushed ourselves a bit too hard (an ego thing maybe), doing a few minutes each, but you pretty quickly get tired and it soon drops to a couple of minutes or less for each swap round. We had a couple of pauses as we got a meagre output following the 1mg adrenaline bolus' but it didnt last long and we were back at it (I think we pushed so hard and for so long because the guy was only 38, it shouldn't make a difference in theory, but it seems to in practice.). We didn't actually time our swaps or anything, to be honest, I usually find it's hard enough keeping track of the cycles - I dunno about you, but I generally feel we are doing well if we can keep a rough approximation of the algorithm in the "heat of battle". We dont really see enough arrests in ITU to be "slick", enough to keep a decent level of competance but that's about it. Generally, I think A&E staff are much better than we are. We do six monthly ALS updates and as a very rough estimate, most of us probably see 2 or 3 arrests between each one. ...and you're spot on, pounding seven bells out of annie, doesnt come close to the real thing - invaluable training as it is, it doesnt really prepare you fopr the real thing. I dont envy your ASDA experience, it hasn't happened to me yet, thankfully.
 

Andy

Native
Dec 31, 2003
1,867
11
38
sheffield
www.freewebs.com
thought you might like to know. The world record for time of CPR on a dummy was by a team of for (think they were St Johns) who did 24hrs without stopping.
The team I was involved in for CPR was at the time a success. we got him back until the ambulance came and took him away. I was 14 and first on the scene for that one. I think that was the first time I didn't get anyone complaining that a kid was talking over. My dad was working in A & E that day and led the team that tried in A&E. Sadly he died (think he came back once)
I don't talk about the chances people have with a number of injuries as it's easier for us if people around them don't know.
 

bambodoggy

Bushcrafter (boy, I've got a lot to say!)
Nov 10, 2004
3,062
50
49
Surrey
www.stumpandgrind.co.uk
Gary....any chance of a copy of the booklet you got or do you know where I can buy one?

I've been a four-day first aider for the last 12 years but as you say we can't remember everything and particulary at a time of great stress.

Cheers,

Phil.
 

dchinell

Tenderfoot
Oct 11, 2004
62
0
Sarasota, Florida, USA
I like the Fast Aid guide from Moore Medical.

http://www2.mooremedical.com/index.cfm?PG=Homepage&CS=HOM

Here's their description.

Fast Aid First-Aid Guide
The Fast Aid First-Aid Guide provides instructions for treating 31 different medical emergencies until help arrives. The 5 1/2" x 3 3/4" guide unfolds to a large 11" x 15" size. It is laminated for easy cleaning and water-resistant.

It seems a handy size and fairly comprehensive. If you carry and use a pocket PC or Palm device, you may be able to find someone who has already transcribed the text and is willing to email it to you. dchinell[AT]msn.com.

Here's another likely-looking prospect:

http://www.wildernessmedical.com/flashcards.htm

I also have the fold-out booklet from Wilderness Medical Associates, but wouldn't recommend it. It's too much a summary of their system, filled with too many acronyms. It's probably fine for graduates of their course, but not for a layman.

Bear
 
G

Ginja

Guest
Colins also do quite a handy guide as part of their 'Mini Gem' series. Available from most bookshops/outdoor retailers (I know Millets have got 'em in stock).

Or here ...

http://www.amazon.co.uk/exec/obidos...4451/sr=1-1/ref=sr_1_24_1/026-5842504-3362023

Have always been told not to rely (or even carry) first aid guides, and instead to trust expertise, or failing that, common sense - the argument being that the latter is much quicker, more effective an less likely to cause panic than leafing through a guide book in an emergency. That said, I personally disagree with this thinking - I always carry some kind of quick reminder/guide - either the above book, or a laminated tips sheet I picked up from St John Ambulance (but would be interested to hear any opinion on this).

G
 

jamesraykenney

Forager
Aug 16, 2004
145
0
Beaumont, TX
ripley said:
It is true that is very rare that a person get's revived with cpr, but the goal is to provide crucial organs with oxygen and keep him that way alive till professional rescue arrives. I think cpr SHOULD be learned by everyone.
Once the heart stops beating you only have about 3 minutes and there is no way that professinal help can be there in such a short time. This is a crucial me.
(I'm a first aid worker in my freetime)
I think what he meant was that the new theory was that CPR has hardly any value, because does not do enough good to make any real difference in the overall survival rate of the people it is used on.
I have been reading the same thing for a few years now.
I think the figures said that something like 2-3% of CPR recipients ended up surviving after they got to the hospital.
That would mean that by doing CPR and not letting the person die right there, that you were just going to cost the family tens of thousands of dollars in 'resuscitation' costs from the hospital, that were useless anyway.
Of course those 2-3% of people would probably disagree.:D
 

ripley

Member
Sep 2, 2004
19
0
Switzerland
jamesraykenney said:
I think what he meant was that the new theory was that CPR has hardly any value, because does not do enough good to make any real difference in the overall survival rate of the people it is used on.
I have been reading the same thing for a few years now.
I think the figures said that something like 2-3% of CPR recipients ended up surviving after they got to the hospital.
That would mean that by doing CPR and not letting the person die right there, that you were just going to cost the family tens of thousands of dollars in 'resuscitation' costs from the hospital, that were useless anyway.
Of course those 2-3% of people would probably disagree.:D

Mmmm, I think you are mixing up a few things here, jamesraykenney.
With revival I ment coming back to live while performing CPR. You need schock before the heart would start beating again by itself and it's very rare that this would happen with just heart massage.
And I'm sure that CPR is usefull, even when the numbers speak against it. You say 2-3%, which is very low. Last week we had a lesson on the human heart from a specialist in our monthly first aid sessions. He himself, has worked for several years in the E.R. and told us that 1 on 10 walk out fully recovered, which is 10% and not 2-3%. And I was schocked (and astonished, but I'll come back to that later) that the rate was so low. But you have to get a right angle on these numbers. Of the 90% that didn't make it or had severe lasting damage, a big part of them could have been saved if the CPR had been performed correctly, but more important... on time! Stats in the states show that the average intervention time is 6 minutes! Waaaaay to late for CPR cases! So the problem here is not that CPR wouldn't be effective, but the problem is in the application: it has to be done correctly and on time. These two go together anyway because if there would be more people who would know CPR the higher the chances get that someone reacts quickly enough (time factor) and would perform CPR in a correct manner (or at least good enuogh). There comes the reason that such a low percent leave the hospital in good conditions. It's not the CPR itself.
With the 15:2 system the stats should show slight improvements for the future as this has more margin for errrors then the 5:1 system (I'm talking here about performing CPR correctly).

And why was I not only schocked but also astonished hearing these low survival figures?
Because I now 4 CPR cases from our first aid group and all four victims are still alive today. Which gives a succes rate of 100%, but then again, CPR was performed here correctly in all cases... and on time. :nana:
 

bambodoggy

Bushcrafter (boy, I've got a lot to say!)
Nov 10, 2004
3,062
50
49
Surrey
www.stumpandgrind.co.uk
Hey Gary...many thanks, mini 1st aid mountain book arrived safely today with all the other bits.... I've only glanced through the book but it looks very good, I'll find a place for it in my possibles bag.
Cheers.... :eek:):
 

Andy

Native
Dec 31, 2003
1,867
11
38
sheffield
www.freewebs.com
the confusion in CPR success comes frmo diffeent ways they count as a success. Niether of the figures above are ones I use. If there is a first aider on hand as soon as the person goes into arest the success rate is better then either above stated for first revival. Some will crash again later. This goes down with other complications. I don't like to put statistics on the net as it could cause upset for relitives. Statistics don't really work well anyway as it all depends why the person went into arrest, age and health will of course play a part.
 

ripley

Member
Sep 2, 2004
19
0
Switzerland
Andy said:
the confusion in CPR success comes frmo diffeent ways they count as a success. Niether of the figures above are ones I use. If there is a first aider on hand as soon as the person goes into arest the success rate is better then either above stated for first revival. Some will crash again later. This goes down with other complications. I don't like to put statistics on the net as it could cause upset for relitives. Statistics don't really work well anyway as it all depends why the person went into arrest, age and health will of course play a part.

I fully agree with you. Stats surely don't tell everything but if there is a first aider at hand chances for survival will improve. That's why I suggested previously that more people should learn it.
 
Nov 8, 2004
1
0
Chester, UK
Totaly know what you mean.

Isnt related to bushcraft specificaly, but my mum used to be a nurse (27 years) when I was a young lad, I worked in IT (which I do now) I used to listen to her talk, but being young, I always knew better than her (well I would wouldnt I ) one night, I asked her if she had actualy saved anyones life. She said that she had brought nearly 90 people back from death.

I was speachless. This year I did a rec course at pyb and I gained a lot from it. Its ironic. lots of the people I socialise with, smoke and say they might be hit by a bus in the morningl. How many of us could bring them around if that did happen ?.

John
 

SARHound

Member
Jan 28, 2005
19
0
Canada
CPR stats are missleading.

CPR is not meant to bring a person back form the afterlife. CPR is meant to keep the brain alive with latent blood/O2 flow long enough to keep the heart in fibrilation so it can be reset with a shock from an AED.

Hollywood has CPR characterized as this lifesaving action that brings people around sputtering and ok which is absolutley untrue.

The facts are the sooner CPR is applied in combination with quickly applied defibrilating shock the better the chances. If either aspect is late in arriving the odds are very grim. After 15-20 mins of CPR there is not enough O2 left in the blood steam to keep the brain alive long enough to fibrilate the heart and death is certain.

This is why CPR in an emergency room is so effective as it is started quickly and the shock comes soon after thus producing good results.

The only exception to this rule is children under the age of 6 who have had a rapid temperature reduction which in essence perserves the brain because of so called brown fat deposits in the brain that cease to exist beyond 6-7 ys of age.

Rapid temp loss in adults helps in some cases but the time to restart he heart is nowhere near that of children.

Hound
 

greg2935

Nomad
Oct 27, 2004
257
1
55
Exeter
Interesting thread, however one thing that has not been addressed here is:

There seems to be a move in the UK from first aid to minimal aid. What I mean by this is that paramedics are well trained, and because, say I did a 6 week course a year ago, (and am panicing because I have never seen something like this), I would easily do more damage trying to do some good than rather leaving well enough alone. I guess this is obvious considering most of us are less than one hour away from a hospital (and therefore less than 20 mins from people who would have less chance of making a mistake). Consequently much of what has been taken out either because medical understanding has moved on, or because the probability of administering the procedure correctly is smaller than the chance of a trained paramedic getting there fast enough to administer it correctly.

What I would like to know then, from a bushcraft point of view, and in light of the fact that we go out of our way to get away from people (and therefore away from timely help should we need it), what courses would you all recommend and why?


Greg
 

SARHound

Member
Jan 28, 2005
19
0
Canada
Greg,

I realy don't understand this concept. I mean most first aid organizations train people to do what they know and only up to their level of training. This also protects them legally.

If a subject has no pulse and is not breathing how can you screw up CPR honestly? What is the worst that can happen? In the case of CPR and massive bleeding there is no time to wait for paramedics to arrive so this minimum first aid thing is missguided.

As far as courses go any is better than none. I recommend a wilderness course if possible as its more comprehensive and is VERY different than urban first aid. It also plays perfectly with this forums ideals.

Hound
 

greg2935

Nomad
Oct 27, 2004
257
1
55
Exeter
Oops, sorry, seem to have caused a misunderstanding here, I wasn't actually thinking of CPR, maybe I should write down what I'm thinking and not expect everyone to work it out for themselves, sorry! I was thinking of the sort of problem you can get on an expedition like snake bite/tropical ulcers etc.

My reasoning went thus: the first 1st aid course I did was in Zimbabwe, it included learning the treatment for snakebite, including type and quantity of serum for size/species, which I guess makes sense for the country/area. In the UK I redid the course and was horrified to find that so much had changed or was left out (snakebite being one of those subjects left out, which is not surprising as you dont have many poisonous snakes here). I did question the reason for taking out so much of the syllabus though, to give you an idea the Zimbabwe course was 6 months two evenings a week, the UK one was 2 months once a week, I was told that it is all a matter of probabilities and that the number of people who were injured by "first aiders" was high enough for the relevant authorities to take "dangerous proceedures" out of the course. I have since redone the UK red cross 1st aid course 6-7 times and each time, something has gone, or changed.

This is okay if you are within a few miles of a hospital where you can get good care. But what if you are not? In particular, I want to update my wilderness skills as I want to go back to africa for a wander round again sometime next year and a red cross course simply will not do.

Sorry for the confusion.

Greg
 

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