First Aider Update Bulletin

This is our regular bulletin that contains articles and news from the world of First Aid, Health & Safety and Trauma Care.   We would be delighted to hear from anyone who has items of interest for inclusion in this section or any other comments or observations - please contact us.




The Top-to-Toe: 'You have to do it..' - February 2006

We are delighted at the amount of discussion our various comments on the Secondary Survey have prompted (see below). We would like to generate a groundswell of common-sense opinion in the first aid world in the hope that at some point this will get back to those who continue to promote and teach this legally unsafe and medically unsound routine.

Here is another: this week we held a defib update day for a group of pool lifeguards: they were keen, well-drilled first aiders who told us how they are required, every 6 months, to undergo full first aid refresher training. This includes adult and child resuscitation, full spinal management, a range of medical and trauma emergencies and - yes - a full, comprehensive, complete in all its glories - Top-to-Toe survey.. They told us how the presence of deformity means a person has a fracture, tracheal deviation means a person has a collapsed lung and puncture marks on the forearm means the casualty is a drug addict.. As a concession to safe practice, they conducted the examination using the backs of their hands.. For these lifeguards, a full practical demonstration with verbal explanation of this routine is an essential part of their first aid qualification - they HAVE to do it. What we found most interesting though is that everyone of them said that although they were required to do it on their training, they would never dream of actually touching someone in that way if there was a genuine injury or illness on poolside.

So yet another example of the difference between real-world first aid and Voluntary Socities first aid. Please keep them coming!


New Resus Guidelines - you heard it here first - again... - November 2005

The latest Resuscitation Guidelines have just been released by the Resuscitation Council UK, simultaneously with the American Heart Association and the European Resus Council. The full guidelines - which also include amendments to the Defib, Choking and ALS algorithims, amongst others - are available for viewing at the Resus Councils website - please see our Links page.

The most immediate changes at the Basic Life Support level are the reversion from 2 to 5 initial breaths for Paeds (back to pre-2000) and the binning of the 2 initial breaths completely from the Adult sequence - straight to chest compressions... The new ratios of 30 chest compressions to 2 ventilations will come as a shock to some but is only a logical culmination of research done over the last few years which has all been aimed towards improving cerebral and myocardial perfusion and which has also shown that the 16% expired oxygen we blow into the mouth doesn't make much difference in the early minutes of non-asyphxial collapse. We are pleased to say (ahem..) that if you scroll down this page to the entry of November 2001, you will see that we anticipated these changes and have been discussing the possibilities on our courses since then. I thank you...

We will be teaching the new Guidelines on a course for physiotherapists in the first weekend of December - probably amongst the first in the UK to do so. We are looking forward to seeing what the students think of the new ratios. The consensus was unanimous from the ABC elite staff (oh dear..) after 5 minutes beasting on the Skillmeter: Hard Graft..



NSMI RIP... - April 2004

We have just had it confirmed that the National Sports Medicine Institute have had their funding withdrawn by UK Sport. Their London HQ has been closed, with all staff being made redundant with 1 weeks notice. The staff we have spoken to have been tight-lipped and/or unaware as to the reasons for this sudden and surprising demise. The term 'Financial Irregularities' has been mentioned by several impeccable sources. We can only think that whatever it was, it must have been large scale and serious. NSMI was a centrally-funded organisation (what used to be called a 'quango') so we would have assumed the staff would have been entitled to a suitable notice period, likewise for contractors, tutors, etc. Perhaps this was naive of us.

We are saddened by this. We have worked with NSMI since the launch of their Sports First Aid course in 1998, indeed, we were the first NSMI training provider in England. We were pleased to support and help develop their mission because - from the first aid point of view - we felt it offered a truly national, sport-specific banner to further challenge the St John/ Red Cross axis, alongside HSE in commerce and industry. We had our differences with NSMI - we were often bemused at their various attempts to re-invent the wheel, copyright our material, not pay us, etc but overall we found them to be receptive and innovative, with excellent staff such as Kelly Goodwin always keen to develop new networks and links, promoting good practice in first aid, sports massage and other areas.

The loss of the 2 day, NSMI Sports First Aid course will not affect us - we always told them that the Appointed Persons course was preferred by the sport and therapy industry because it was shorter, cheaper and more flexible then theirs - but we have found over the last 6 years that there is definitely a need for a body such as NSMI and the work they do. They will be missed and it is hoped that whatever their failings, the good work they did can be continued by others.



"Check for bleeding from orifices..." - February 2004

Our MD (or is it CEO these days?) Tony Bennison has had a most interesting discussion (well, he thinks it was) regarding our old friend 'The Secondary Survey' with someone who holds himself up as the resident legal adviser on the First Aid Cafe website (see Links page). Tony remains unconvinced by any of the opinion put forward - medical or legal - in support of this procedure and was saddened but not surprised at the naivete and lack of background knowledge of those who claim to be first aid training professionals. There seems to be a fundamental difference in how we define the role of the first aider, and what we expect from them. Until our industry can agree on these definitions there will always be differences in our message, which is unfortunate because it is the student first aider who is presented with the dilemma of who to believe. On our courses, we always feel moved to apologise to first aiders who have attended previous courses and been taught to do this stuff where we are now telling them not to. All we ask them is to question whether it is 'reasonable' or 'logical' to feel a persons body, is it 'reasonable' to exclude fracture on the basis of no swelling, etc, etc, etc.

The end result seems to be that there is disagreement in the first aid training world as to whether or not first aiders should be taught to examine casualties for swellings, deformities and bleeding from orifices.

We say they shouldn't, all the other training providers say they should.

Perhaps the last comment on this subject: we recently had some feedback from a karate coach on one of our First Aid for Sport and Exercise courses. He had previously done the 4 day First Aid at Work course and was taught the Top to Toe in detail. Delegates were expected to pair up and practice on fellow students. He felt a bit uncomfortable as he was partnered with a lady he had never met before. He expressed some reservation about this to the 'instructor' and also that as he trained extensively with children if this scenario ever occurred in the real world his likely casualty would be a minor: obviously from the Child Protection point of view he wasn't too happy about feeling a childs body. The instructor told him it was part of the course, he would be tested on it on Friday afternoon so if he wanted to be a qualified first aider he should get on with it. We rest our case.



Now remove those dressings... - December 2003

More queries concerning the first aid management of bleeding since the release of the 8th Edition. Yes, we know THAT manual says that if 2 dressings fails to control the bleeding, they should be removed and replaced. No, we dont know the medical basis behind this latest guidance. Prior to the release of the 8th Edition last year, the Voluntary Societies issued a small pamphlet entitled 'First Aid - updated 2002' in which they introduced such revolutionary pre-hospital emergency concepts as 'The Primary Survey' and 'The Jaw Thrust'...! They also gave as the rationale for their new Bleeding algorithim that if 2 dressings have failed to stem the bleed, it is not likely to stop because the pressure is not being applied in the right place (?). When asking around the 'profession' it was further justified to us that if the first aider has applied the first 2 dressings poorly, they will need to be removed in order to apply another! That, apparently, is it.

Our question on this (and indeed on the whole of the 8th Edition) is: EBM - Evidence Based Medicine - where is the Evidence in support of this new rule? Is there any? - we would be most interested to know, because we have done all the literature searches and cant find any ourselves. Yes we know that there is very little of what could be called Class 1 (definitely beneficial) evidence in the first aid field because, by definition, emergencies managed by minimally-trained personnel are not easy to arrange, control or test. So if this new guidance is issued without evidence and solely as an opinion of a Medical Adviser, then it counts - at best - as Class 2b (possibly helpful) but more likely as Indeterminate (unclassified due to lack of, or inconsistent, evidence).

Our concern with this new rule is as follows: good dressings applied to a wound immediately provide an ideal, fibrous, bulky medium for clotting factors to get hold of. Removing those dressings will remove clotting factors and thus could worsen bleeding. If this could be shown, this new rule would therefore constitute Class 3 evidence - Possibly Harmful! Also, if the first aider has applied 2 dressings incorrectly, why would he be anymore likely to apply the 3rd any better?? It doesn't stand logical assessment.

When dealing with major blood loss, the first aider has 1 job - STOP IT, by whatever means, because major blood loss presents an imminent threat to life. It is our experience, gained in many different roles - and therefore OUR opinion - that hard, direct pressure and packed dressings, at the site of the bleed, will stop even arterial blood loss. We will continue to teach this until evidence is produced which shows that removing 2 dressings and replacing them with 1 is better for the casualty.



"Check for swellings..." - September 2003

Update on the item below: The defendent was found Guilty of Assault and placed on the Sex Offenders Register for 2 years...

Our strong advice:

First aid students: when your course 'instructor' knowledgably informs you that a first aider has never been prosecuted, ask him about Regina vs Brooks.

First aid trainers: dont teach students to 'examine' casualties. The Voluntary Societies 'Secondary Survey' is not safe medically or legally and you now have proof of this.

First aiders: dont 'examine' your casualties, this examination has no medical validity but plenty of legal pitfalls.



"Feel with your whole hand..." - August 2003

For many years now we at ABC First Aid Ltd have been raving at some of the nonsense taught on traditional first aid courses under the guise of 'essential' skills and knowledge: the reef knot, the fist bandage, the collar made of newspaper and bandage (yes, really) are some of the classics. We have also become increasingly concerned with how some (the majority?) of training organisations are teaching Occupational and Lay First Aiders to conduct a Secondary Survey. It often seems to be referred to as a Top-to-Toe, Body Check or Head-to-Toe Check, with first aiders being taught to systematically 'examine' their casualty... Yes, the good ol' Voluntary Services Manual (current, 8th, Edition priced at £11.99) includes the following instructions: page 30 - "..a physical examination.", page 32 - "..your touch must be firm enough to detect any swelliing...", page 32 for a conscious casualty - "..confirm the symptoms by an examination..". Pages 34 and 35 describe in detail how to do the whole survey, including Step 8 - "Feel the ribcage...", Step 12 - "Feel the casualty's abdomen...", Step 13 - "Feel both sides of the hips..." The photo on page 35 says "Feel gently with your whole hand..." In fairness, on page 32 there is one reference to: "If appropriate..."

Well when is it 'appropriate' for a person with a very minimal, limited amount of medical training, gained during a 1, 2 or 4 day course, to 'feel' the body of an injured or ill person, possibly a minor, possibly of the opposite sex when they are incapable of giving informed consent?

We would suggest probably NEVER.

The standard rationale seems to be that the first aider is looking for broken bones (!) and bleeding. Well guys, checking for blood loss is part of the PRIMARY survey (C - Circulation) and how on earth is a first aider supposed to know whether or not a bone is broken when these are occasionally missed by Doctors and on x-ray?? The best clue as to occult injury will of course come from the Mechanism of Injury and the History - we have said for many years that teaching first aiders to 'examine' a casualty - along with plenty of these other apparently standard first aid 'skills' is medically unjustifiable and legally indefensible. We have said for many years that it would take a legal challenge in order to show how dangerous these things could be.

This has now happened and been brought to our attention in the case of Regina vs. Brooks which is taking place at Leicester Crown Court this month. The defendent is accused of indecent assault against a 19 year old girl outside the Barracuda bar in Loughborough. He is alleged to have put his hand into her clothing when she was unwell. He claims to have been checking her body for a Medic Alert bracelet. At this stage we dont know, but his defense may well hinge on having been trained to do this during first aid training - page 30 of the Manual says "if the casualty is unable to cooperate or unconscious, look for external clues about his condition..." along with all the other stuff about feeling their body.

We believe that under the principle of Bolitho (Bolitho vs City and Hackney Health Authority 1992) it is highly unlikely that such actions could be justified as being 'reasonable' or having 'logical basis' in the vast majority of first aid situations. We await the outcome of this trial with interest and will keep you informed as more details become available. We also invite comments from any training providers as to how they justify teaching this sort of thing and we will be delighted to publish these on this board.



Trust me I’m a paramedic… - April 2003

The Health Professions Council is now taking formal steps toward legal protection of a whole list of professional medical titles, including ‘paramedic’ and ‘physiotherapist’. From 1st April this year – it is claimed – anyone using the title ‘paramedic’ could be liable for prosecution if their name does not appear on the HPC Register. There is still much confusion within our industry regarding the actual scope of protection and the exact terms that should be used – some have claimed that the term ‘paramedic’ cannot be legally closed as it is a general descriptive term, in the same way that it is not illegal for an individual to claim to be a ‘nurse’ but is illegal to claim to be a ‘Registered or State Registered Nurse’…Some are worried that this may become a ‘closed-shop’ to anyone other than NHS paramedics, whilst others have shown that non-NHS personnel can meet the necessary criteria for registration, even though this seems to be a somewhat expensive and time consuming exercise at the moment.

It remains to be seen how much teeth the legislation actually has, but however the details and mechanisms pan out in future we feel that this is generally a positive move for the professionalism of the pre-hospital and remote medical industries. We believe that Laws will never completely remove the threat of bogus operators but we also know – from some of the CV’s that appear in our office and some of the dubious individuals we encounter on the First Aid training circuit - that the title ‘paramedic’ and the skills, experience and knowledge this implies, has been abused and used far too loosely for too many years.

So next time your first aid tutor tells you he is a ‘paramedic’, ask him if he is ‘State Registered’ and watch his face carefully for the reaction…



Press Release - Touchline Emergency Care course - March 2003

ABC First Aid Limited have announced the release of a range of Touchline Emergency Care courses designed specifically for the needs of Healthcare Professionals working in sport and exercise. Tony Bennison, ABC Managing Director, said today "Sports clubs who utilise the services of a touchline 'physio' usually expect this person to deal with all injuries on the field of play, regardless of severity. This often means that a therapy and rehab practitioner finds themselves having to make clinical decisions in areas outside their professional scope or training. The legal implications of this could be very serious for all parties."

Most touchline responders address the skills deficit by attending traditional First Aid courses - this at least gives a certificate necessary for insurance purposes. A common complaint though is that these courses are not pitched at an appropriate level and do not cover the extended skills often expected of the Healthcare Professional. In launching these new courses, ABC has addressed this problem, says Tony Bennison: "We work with many elite clubs, clinics and governing bodies and the touchline physios always have the same questions regarding airway adjuncts, c-spine immobilisation, suturing, reduction and splinting, etc. We have based these courses around their needs." He goes on: "It is not our intention to turn 'physios' into 'paramedics' but the touchline practitioner who is routinely expected to make critical decisions regarding, for example, head and neck trauma should have the background knowledge, skills and awareness necessary to cope with this - we are all professionally accountable..."

Each course is taught by experts in the field of emergency pre-hospital care and sport injury. They are run over 2 evenings so as not to clash with weekend or daytime jobs and are available at a variety of locations in the south and midlands - with more venues to follow soon. They can also be operated on-site at the clients' club if required. All delegates receive comprehensive handouts and a certificate of attendance, invaluable for CPD and PREP.

If you would like details of the above or other courses, or if you would be interested in hosting a course, please contact Tony Bennison straight away.



Don't blow...just pump? - November 2001

We have just attended a Resuscitation Council seminar at the Hammersmith Hospital in west London. Some papers were presented which may have important implications for the training of Basic Life Support, particularly to Occupational and Lay First Aiders. There is some interesting research taking place with regard to maximising cerebral blood flow during resuscitation. It seems that the main reason that the old ratio of 5 compressions : 1 ventilation for 2 rescuers has been dropped under Guidelines 2000 is because 5 compressions has been shown to develop too little 'perfusion pressure' - i.e the rescuer starts to build up an outward pressure within the vessels in the thoracic cavity, but by stopping after the 5th compression the blood pressure drops off immediately and the blood settles back within the chest, giving only a very poor circulation to the brain. 15 chest compressions has been shown to develop better blood delivery to the brain but - and maybe this is a pointer to the future - the graph showing the continuum of cerebral oxygenation is still rising at 15 compressions... in other words we dont know what the optimal number of chest compressions is but a higher number seems to offer a better blood supply to the brain...

Allied to this is the ongoing debate over the reluctance of bystanders to initiate Basic Life Support and the perennial issues surrounding mouth-to-mouth ventilation. This first came to light formally with the release of a scientific paper in 1998 in the U.S by Doctor Lance Becker. He produced evidence showing that in the first 6 minutes of induced Ventricular Fibrillation (the commonest cardiac arrest arrythmia) in pigs, cerebral oxygenation was identical between groups which received compressions and ventilations combined and groups which received compressions only, due to residual oxygen within the brain at the time of the arrest. He put forward the case that due to his findings and the traditional problems of mouth-to-mouth (training retention, cross-contamination concerns, etc) would it not be better to dispense with mouth-to-mouth completely and encourage Lay Rescuers to concentrate on delivering effective chest compressions. Doctor Beckers conclusions were challenged at the time by Doctor Peter Safar (the Father of Resuscitation) but it seems that we may now be moving in this direction anyway.

The next guideline changes are probably due in late 2005 and we at ABC First Aid Ltd believe this may well herald the introduction of 'graded' levels of resuscitation training, possibly along the following lines: 'Bronze': 50 chest compressions, no breaths; 'Silver':continuous compressions, breaths asynchronous via adjunct; 'Gold': continuous compressions, oxygen asynchronous via ET tube/LMA/Combitube.

Whether this will improve survival rates and neurological status will be the next debate...watch this space...



"You're protected by the The Good Samaritan Act..." - September 2001

We have recently heard of yet another example of a first aid trainer knowledgeably informing his course students that they cannot be held accountable for their first aid actions because they are protected by the above mentioned legislation. We have heard this nonsense many times down the years so will take this opportunity to put the record straight in the hope that some of the ignorant and misinformed individuals who pass on this rubbish might visit these pages.

Firstly, there is no 'Good Samaritan' statute in this country, no such Law exists, there is NO legal duty to treat. This also applies to Doctors and Nurses. The difference for a Healthcare Professional is that although they do not have a LEGAL duty to treat they do have a PROFESSIONAL duty. In other words, a nurse failing to attend an accident could not be taken to court for not doing so but could be held accountable by their professional body, the Nursing and Midwifery Council.

First Aiders, of course, are not Healthcare Professionals and are not bound by professional obligations. They are, however, still potentially legally accountable for their actions. Whether acting in or out of the workplace, the volunteer who provides first aid has assumed a Duty of Care. Once the Duty of Care is taken on, an appropriate Standard of Care must desmonstrably be adhered to - the first aider must be able to justify their actions as being reasonable and in accordance with an informed body of expert medical opinion i.e what they were taught on their first aid course. If the first aider can prove that they acted in accordance with their training, they will be safe legally. If they have acted outside their training and it is proved that these actions have worsened the casualty's condition, then they will certainly be legally liable and could be deemed negligent.

An example: a first aider dealing with a foreign body upper airway obstruction carries out backslaps followed by abdominal thrusts. Failing to clear the obstruction and forgetting what to do next, the first aider instead grabs a handy penknife, wrestles the struggling casualty to the floor and stabs an incision into the hapless victims cricothyroid membrane, as remembered from a recent episode of 'Casualty'...the ensuing bleeding completely occludes the airway and the person asphyxiates....

Appropriate Standard of Care?? protection under The Good Samaritan Act?? - hmmm...



Guidelines 2000 Reviewed! - June 2001

We have now had a chance to assess the impact that the new resuscitation guidelines have had on our training and can report that implementation has in general proceded without problems. Our trainers felt initially that abandonment of the pulse checks for lay rescuers and occupational first aiders was a negative move, although all of us who have worked in emergency care have experienced and understand the problems of inaccuracy and risk of 'false-positive' readings.

The identity and status of 'Health-Care Professionals' has prompted much debate amongst course delegates, particularly on sports first aid courses where we often have a mix of Physiotherapists, Sports Therapists, Nurses and Sports Coaches....Those working full-time in a medical environment are undeniably Health-Care Professionals. However, do their general duties regularly require the assessment of vital signs in a stressful, emergency situation? If not, would they be any more accurate then a Lay First Aider in checking for a carotid pulse? We would be very interested in your comments.



"Pull it straight..." - March 2001

We recently did a basic 1 day course for the touchline staff at an elite London rugby club. One of the delegates was kind enough to make us aware of a situation which had occurred where her son played mini-rugby on Sunday mornings. A scrum had collapsed and one of the young lads had sustained a broken leg. The game stopped and he lay still, in considerable pain, his leg badly twisted and deformed. One of the spectators approached, announced herself as being a trained first aider and proceded to pull the injured leg straight so that she could apply the triangular bandages she was carrying. The screaming that followed brought others running from far and wide....

This is not the first time we have heard of certain training organisations who are still teaching first aiders to manipulate suspected limb fractures. Indeed, the application of traction is still shown on pages 131 and 150 of the current Voluntary Societies First Aid Manual. To re-state: if the casualty is conscious it is THEY who dictate the position of any injured limb, not a First Aid Manual. The conscious casualty will naturally adopt the position which causes them least pain, they will tend to guard the injury and will resist unnecessary movement. If the limb is already immobile, why apply a sling?

In the case of traction, if there are no circulatory implications and a short hospital transport time, the chances are that the limb will be supported in a vacuum splint only. If the casualty has a fractured pelvis rather than (or as well as) a broken leg, traction is absolutely contra-indicated!! An ambulance crew or a BASICS Doctor may be able to tell the difference between a broken leg or a broken pelvis - can the first aider? Even when traction is indicated, it requires a specific type of splint to exert and maintain the necessary force. It also requires some form of pain relief for the casualty as the initial pull of the splint always increases their pain. Does a first aider carry such drugs and kit?

We dont know why the 7th Edition of the First Aid Manual still shows traction. We believe strongly that this is something which could lead to litigation against the first aider if it went wrong and that it also flies in the face of simple common sense. As always, we welcome your own thoughts and experiences.



You heard it here first! - new Resuscitation guidelines announced - January 2001

The Resuscitation Council have finally confirmed the new 'Guidelines 2000' for use in the UK. These cover the whole spectrum of Basic and Advanced Life Support for Children and Adults, Defibrillation programmes, the ethics of Resuscitation and many other related subjects. There are some small but important modifications to the 1997/1998 Basic Life Support algorithim:

- 15 compressions: 2 ventilations in both single and dual rescuer CPR.

- The carotid pulse check should no longer be taught to lay rescuers because it has been shown to be so inaccurate. Instead, the Circulatory assessment is made on the basis of obvious signs such as coughing and movement.

- The 'Child/Trauma/Drowning' interventions (where the primary mechanism is deemed to be Respiratory rather then Cardiac in origin) have been widened to include Drugs or Alcohol intoxication.

The changes will come into effect with the release of the new Resuscitation Council Advanced Life Support manual on 1st February 2001.



Health and Safety (Fees) Regulations 2000 - October 2000

We have been notified by the Health and Safety Executive that the Health and Safety (Fees) Regulations will come into effect on 10 October 2000. From this date, we at ABC First Aid Ltd and all other HSE approved training providers will have to pay the HSE for maintenence of our training approvals. This is not an entirely unexpected development - we have expected a move in this direction ever since HSE out-sourced the monitoring and approvals service in 1996. We believe this to be a positive move on the part of HSE - the approvals system is a good one which requires high standards and commitment from training providers. We support any move that ensures these standards are maintained. It is too early to say what impact these charges will have on our costs but at the moment we see no need to increase our prices which have remained the same since 1997.



Beware!  'CITB approved' - September 2000

We have been made aware that several of our competitors are claiming something called 'CITB approval' and we have been asked if this is some higher or extra level of qualification for training providers. We would advise as follows: the Construction Industry Training Board assist employers by providing financial subsidies against the cost of certain, essential training courses. First Aid at Work is one such CITB subsidised course - this is a funding scheme only; training providers who offer this have not undergone any CITB validation or quality control process. The CITB are quite explicit in their instructions to training providers: in any advertising they should always use the full term 'CITB approved for grant purposes only' and should not use the abbreviated term or the name of the CITB to imply any endorsement of course content or quality. Training providers who use this scheme for the wrong purposes are in breach of their agreement with CITB. These issues are made clear to all providers when they join the scheme. As we have been shown repeated examples of this misuse by the same providers, we can only conclude these are deliberate attempts to deceive. Please let us know if you come across any similar examples, we are delighted to pass the names of these providers to the CITB for action.



Resuscitation Guidelines - July 2000

Contrary to all expectations, the new resuscitation guidelines were not released at the European Resuscitation Council conference in Antwerp last month. This was apparently due to the desire of the International Liaison Committee on Resuscitation that European changes should be announced to coincide with those of the American Heart Association. Although frustrating for those of us who went to Belgium, this is a sensible decision which marks the establishment of a true international consensus in resuscitation practice. We are told that there will be no changes in the current guidelines until the end of this year. You can rely on ABC First Aid Limited to implement and make you aware of any new recommendations immediately. Watch this space.



Press Release - Workout magazine - July 2000

First Aid - a matter of life and death?

Picture this: The class is buzzing, your music is good, everybody is working hard and enjoying themselves. Then you notice the middle-aged guy at the back, one of your new members - his face is screwed up in pain, he is clutching his chest. Without any further warning he collapses to the floor. Although you don't know it yet, he has just suffered a massive heart attack. As he hits the floor his heart has stopped beating and his breathing is tailing off into agonised, ragged gasps. The class comes to a stop as people notice, most look concerned, several look alarmed - all eyes turn to you.

What are you going to do? - Call 999, of course.

Yes, calling the ambulance is essential. However, the average ambulance response time in most metropolitan areas is 14 minutes. With no breathing or heart beat of his own your class member will suffer serious, irreversible brain damage after approximately 3 minutes. After 6 minutes his chances of successful revival are extremely poor.

So what else can you do?? - You can apply Resuscitation techniques.

By blowing air into his lungs and compressing his chest you can supply his brain and heart with a limited amount of life-giving oxygen in order to buy time until the ambulance arrives. Your application of some basic but vital skills might literally make the difference between life and death.

If you thought that First Aid was just bandages and slings, speak to us at ABC First Aid Limited or visit our website at www.abcfirstaid.co.uk. We are approved by the Health and Safety Executive and the National Sports Medicine Institute. We operate a range of courses for all areas of risk and for all skill levels. Whichever course you choose, we will teach you skills that can save life and minimise injury and you will learn the crucial health and safety role fulfilled by today's First Aider.

Press release - March 2000

ABC First Aid Limited have announced the latest addition to their range of training courses - the National Sports Medicine Institute 'Sports First Aid' course - the only nationally recognised, sport-specific First Aid qualification in the UK.

Tony Bennison, ABC Managing Director, said today "It has long been recognised that traditional First Aid training does not properly address the needs of those dealing with the injuries and illnesses that are encountered in sport and exercise. In launching this new course, the NSMI has acted to fill this gap and we at ABC are proud to be the only NSMI approved provider in the south of England. We have already trained physiotherapists, coaches, personal trainers, school nurses and teachers - the amount of interest has shown just how much a course of this type is needed"

The course is 2 days duration and ABC operates a course per month at its training centre near Heathrow. It can also be operated at the clients' premises if required. Students are independently assessed and if successful receive the NSMI Sports First Aid certificate.

"Anyone who is required to act in an emergency at a sporting or exercise event will find that this course gives them all the skills necessary to act confidently and appropriately." says Tony Bennison.

Resuscitation - agonal respirations - March 2000

We recently received a call from one of our First Aiders who attended a collapsed colleague at work. Finding no breathing or pulse and having called for an ambulance, he commenced CPR. After several cycles of ventilations and compressions, he was surprised and gratified to hear what seemed to be gasping and breathing efforts from the casualty. However, having placed the casualty into the recovery position he found that breathing and pulse were, in fact, still absent - no 'resuscitation' had occurred. CPR was re-started and continued until the ambulance crew arrived. The apparently spontaneous breathing efforts that the First Aider reported are called Agonal Respirations - irregular gasping or wheezing noises that may be made even by casualties who are in full cardiac arrest. As was seen, the appearance of these signs can be confusing for the rescuer and, if misinterpreted, could have lead to a wrong course of action. We wholeheartedly commend the First Aider - by following the ABC of Resuscitation he ensured that a proper re-assessment was made and the correct procedure carried out - no easy thing to do in such very sad, distressing circumstances. ALWAYS REMEMBER THE A B C'S...

Antiseptic wipes - March 2000

Many of our clients have asked us to clarify the situation regarding antiseptic wipes within statutory First Aid kits and we are aware that many of you buy 'HSE compliant' kits that contain these items. We would ask you to carefully check the packaging of the wipes - if they are 'medicated' or 'antiseptic' they will contain substances such as Cetrimide or Chlorhexidine Gluconate. These are medications. Paragraph 30 of the HSE Approved Code of Practice states "...MEDICATIONS SHOULD NOT BE KEPT." Further, wipes are not included in the kit list recommended by the HSE. As mentioned on a previous Update, we do not believe that this is wilful mis-selling on the part of most product suppliers but rather ignorance of the official guidelines.

"The Regulations say we must have 1 First Aider for each 50 staff" - March 2000

False. The Regulation DOES NOT specify set ratios of First Aiders to staff. Paragraph 6 of the Approved Code of Practice states "NO FIXED LEVEL EXISTS BUT EACH EMPLOYER NEEDS TO ASSESS WHAT FACILITIES AND PERSONNEL ARE APPROPRIATE." Paragraph 14 goes on to say "...EMPLOYEE NUMBERS SHOULD NEVER BE THE SOLE BASIS FOR DETERMINING FIRST AID NEEDS." It is the employers Risk Assessment that decides. If you need any assistance with your assessment, please do not hesitate to give us a call.

"The Regulations say we must have at least 1 litre of eyewash" - March 2000

False. The Regulation makes no such stipulation. Paragraph 36 of the Approved Code of Practice says that at least 1 litre of sterile water or sterile saline should be provided "WHERE MAINS TAP WATER IS NOT READILY AVAILABLE." The First Aid reps often neglect to mention this and we see the signs of many a successful sale where an eyewash station has been bought and positioned above a sink! Please call us first whenever you receive new information claiming "The Regulation says..."

Recovery Position - you heard it here first! - Sept 99

The new Voluntary Societies First Aid Manual is now available - it costs a pound more (£10.95) and is still referred to as the 7th Edition but has been revised to show the 'old' Recovery Position which has now become the 'new' Recovery Position again (déjà vu 1992…).  Once again then - the position that you were taught on your ABC course is the correct one and we are delighted that St John and Red Cross have followed our lead in teaching this.   Aside from the technicalities - by supporting an unconscious person on their side and positioning their head so that nose and mouth are visible, accessible and facing downwards so as to allow drainage, you will have achieved an acceptable position. It is a simple action and a proven life saver.   We believe that the debate of the last two and a half years has been a shameful waste of time.

Defibrillation - Sept 99

British Airways, Asda, Virgin, Qantas, Nestles, Lakeside Thurrock - the list of organisations acquiring Automated External Defibrillators continues to grow across the commercial, industrial, leisure and public sectors.  The Resuscitation Council (UK) have issued training guidelines, the British Heart Foundation offers financial grants to those considering this move and all our First Aid at Work and Refresher courses now include full demonstrations of this equipment.  The reason for all these initiatives is that when a person suffers a heart stoppage, the optimal time for delivery of the first defibrillatory shock is 90 seconds after the arrest.  No ambulance in the world will arrive this quickly but the first aider often can.  Please call if you would like more information.

Beware - 1 - Sept 99

Please take care if you buy your workplace First Aid kits from the large office supplies catalogue companies.  We have recently seen several examples that gave cause for concern - cetrimide antiseptic cream in one first aid kit and a reference to the COP42 as being the 'current Regulations' in another.   We often still encounter supposedly 'HSE compliant' kits that contain antiseptic wipes.  We believe that suppliers do not set out to deliberately dupe their clients but rather that they themselves are often unaware of the details of the current Code of Practice and Guidance.  Contact us if you would like to check your own arrangements.

Beware - 2 - Sept 99

One of our paramedics recently attended a known diabetic who had collapsed - a classic hypoglycaemic episode that was witnessed and carefully described by relatives and bystanders.  No doubt about it, quite clear-cut.  But a whiff of oxygen caused the casualty to perk up and a BM test showed a normal blood sugar level (??).  After being placed on a cardiac monitor it transpired that this obvious 'hypo' was in fact a heart problem - nothing at all to do with the blood sugar.  And the moral of this tale - DO NOT DIAGNOSE, things are rarely as simple as they seem.

Recovery Position - Feb 99

We still receive queries regarding the position shown in the current (7th) edition of the First Aid Manual. To reiterate - that position was discarded by St John London District barely three months after it first appeared in April 1997.   The Health and Safety Executive formally affirmed this in a national newsletter dated September 1998. The next edition of the First Aid Manual will show the position you were taught and is due to be published later in 1999. I am pleased to say that by adhering to European Resus Council guidelines, our organisation remained aloof from the chaos caused by the Manual and we have avoided the embarrassing U-turn that has faced most of our competitors and the Voluntary Societies.

Defibrillation - Feb 99

At last years Resus Council conference in Copenhagen, several papers were presented that showed the way forward for First Responder Defibrillation. The American Heart Association, the British Heart Foundation and all Resus Councils are unanimous in pressing for wider access to Advisory External Defibrillation training and equipment. Advances in technology, simplicity of use and falling prices have resulted in an increasing number of employers, public and private organisations investing in this equipment. If your organisation ever considers such a move, please remember that we are ideally placed to provide independent, no-obligation advice and service.

Safety Signs - Feb 99

Stage 2 of the Health and Safety (Safety Signs and Signals) Regulations 1996 came into effect on 24 December 1998. This requires that any safety signs displayed in the workplace contain a pictogram – text only signs will no longer comply. Any signs that mention ‘First Aid’ must be accompanied by a white cross on a green background.

Beware! - Feb 99

Several of our clients have received mail-shots from a First Aid product supply company alerting them to the ‘New Eyewash Regulations’. We spoke to this supplier for clarification and their representative proceeded to quote extracts from the old Health and Safety COP42! After we had pointed out that the COP42 was superseded in March 1997 by the ACOP L74 and that their publicity photo (an eyewash station containing 3 x 300ml bottles) was non-compliant, this ‘consultant’ admitted that he wasn’t actually aware of any new Regulations and received his information from a third party. We wonder how many have been duped by these ‘experts’.


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