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Red Cross, AHA Release |
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New First Aid Guidelines have been released by the American Red
Cross and the American Heart Association as part of their 2006
Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The 2006 Guidelines are the results of a jointly sponsored and co-led review of first aid science in order to create new recommendations and guidelines comprised of the latest scientific data. The newly founded First Aid Science Advisory Board — another collaboration of the two organizations – spearheaded the study after the decision was made to review the existing Guidelines developed by the American Heart Association in 2000. “The creation of national first aid guidelines based upon scientific evidence and consensus will standardize the way people respond to many common first aid emergencies,” said David Markenson, M.D., chair of the American Red Cross Advisory Council on First Aid and Safety. “Utilizing its expertise in health and safety education, the American Red Cross will take the new information from the guidelines for first aid.” The 2006 Guidelines will ensure that, going forward, first aid being taught and administered in the field is the result of the latest statistical data and highest quality of research by two leaders in the field. When administering first aid, consider the following: Positioning the Victim As a general rule, a victim should not be moved, but there are times when you should do so: • If the area is unsafe for you or the victim, move the victim to a safe location. • If the victim is face down and needs CPR, turn the victim face up. • If the victim is unresponsive, has an open airway, and is breathing spontaneously, turn the victim onto his or her side (recovery position) with the victim’s hand in front. Be aware of the potential for nerve and vessel injury if the victim lies on one arm for a prolonged period; it may be necessary to roll the victim to the other side. • If you suspect that the victim might have a spinal injury, it is best not to move the victim. If the injured victim is unresponsive and has difficulty breathing because of copious secretions or vomiting, or if you are alone and have to leave the victim to get help, place the victim in a modified HAINES recovery position by extending one of the victim’s arms above the head and rolling the body to the side so that the victim’s head rests on the extended arm. Bend both legs to stabilize the victim. Oxygen There is insufficient evidence to recommend for or against the use of oxygen by a first aid provider, and concern exists that oxygen administration may delay other interventions. The incidence of acute asthma is increasing, especially in urban populations. Many victims with asthma have and can self-administer bronchodilator medication. Inhaled bronchodilator medications are safe with few untoward effects. First aid providers may assist the victim in using prescribed bronchodilator medication. They are not expected to make a diagnosis, but they can assist the victim under the following conditions: • The victim states that he or she is having an asthma attack and has medications or an inhaler. • The victim identifies the medication and is unable to administer it without assistance. Anaphylaxis Allergies are relatively common, but only a small proportion of people with allergies develop anaphylactic reactions. An anaphylactic reaction is characterized by swelling, especially of the face, breathing difficulty, shock and even death. Many people with a history of anaphylaxis carry a lifesaving epinephrine auto-injector. With proper training, parents can be taught to correctly use the auto-injector to administer epinephrine to their child. Unfortunately, all too often neither the victim nor family members know how to use an auto-injector correctly. First aid providers should be familiar with the epinephrine auto-injector so that they can help someone having an anaphylactic reaction self-administer the epinephrine. First aid providers should be able to administer the auto-injector if the victim is unable to do so, provided that the medication has been prescribed by a physician and state law permits. Seizures The general principles of first aid management of seizures are to (1) prevent injury, (2)ensure an open airway, and (3) ensure that the airway remains open after the seizure has ended. The victim of a seizure must be protected from injury. Protect the head with a pillow or other soft material. Do not restrain the victim during a seizure or place any object in the victim’s mouth. Restraining the victim may cause musculoskeletal or soft-tissue injury. Placing an object in the victim’s mouth is futile because most tongue biting occurs at the onset of seizure activity and attempts to insert an object may cause dental damage or aspiration or may injure the rescuer’s fingers. To prevent aspiration of secretions and maintain an open airway, place the victim in a recovery position after the seizure stops. It is not unusual for the victim to be unresponsive or confused for a short time after a seizure. Injury Emergencies Bleeding: Control of bleeding is one of the few actions by which you can critically influence outcome. Control external bleeding by applying pressure over the bleeding area until bleeding stops or EMS rescuers arrive. The important factors in successful control of bleeding are to apply pressure firmly and for a long time. Methods of applying pressure include: • Manual pressure on gauze or other cloth placed over the bleeding source. If bleeding continues, do not remove the gauze; add more gauze on top and apply more pressure. • An elastic bandage firmly wrapped over gauze to hold it in place with pressure. The effectiveness, feasibility, and safety of tourniquets to control bleeding by first aid providers are unknown, but the use of tourniquets is potentially dangerous. Tourniquets are routinely used in the operating room under controlled conditions and have been effective in controlling bleeding from an extremity, but potential undesired effects include temporary or permanent injury to the underlying nerves and muscles, as well as systemic complications resulting from limb ischemia, including acidemia, hyperkalemia, arrhythmias, shock, limb loss and death. Complications are related to tourniquet pressure and occlusion time. Pressure has been found to be superior to tourniquets in controlling bleeding, although tourniquets may be useful under some unique conditions. The method of application and the best design of tourniquets are under investigation. There is insufficient evidence to recommend for or against the first aid use of pressure points or extremity elevation to control hemorrhage. The efficacy, feasibility, and safety of pressure points to control bleeding have never been subjected to study, and there have been no published studies to determine if elevation of a bleeding extremity helps in bleeding control or causes harm. Using these unproven procedures has the potential to compromise the proven intervention of direct pressure. Wounds and Abrasions Irrigate wounds and abrasions with clean running tap water for five minutes or until there appears to be no foreign matter in the wound. If running water is unavailable, use any source of clean water. Wounds heal better and with less infection if an antibiotic ointment or cream is used; triple antibiotic ointment appears to be superior to single antibiotic ointment or cream. Apply antibiotic ointment or cream only if the victim’s wound is an abrasion or is superficial. Burns Cool thermal burns with cold water as soon as possible, and continue at least until pain is relieved. Cooling reduces the injury and relieves pain. There is some evidence that brief cooling of small burns with ice water may be effective but direct application of ice to a burn may produce tissue ischemia, and prolonged cold exposure even of small burns can lead to further injury. Avoid cooling of burns with ice or ice water for longer than 10 minutes, especially if the burn is large (20 percent of body surface area). Loosely cover burn blisters with a sterile dressing but leave them intact. Electrocution and Electrical Burns The severity of electrical injuries can vary widely, from an unpleasant tingling sensation caused by low-intensity current to thermal burns, cardiopulmonary arrest and death. Thermal burns may result from burning clothing that is in contact with the skin or from electric current traversing a portion of the body. When current transverses the body, thermal burns may be present at the points where the current entered and exited the body and internally along its pathway. Cardiopulmonary arrest is the primary cause of immediate death from electrocution. Cardiac arrhythmias, including ventricular fibrillation, ventricular asystole, and ventricular tachycardia that progresses to ventricular fibrillation, may result from exposure to low- or high-voltage current. Respiratory arrest may result from electrical injury to the respiratory center in the brain or from tetanic contractions or paralysis of respiratory muscles. Do not place yourself in danger by touching an electrocuted victim while the power is on. Turn off the power at its source; at home the switch is usually near the fuse box. In case of high-voltage electrocution, such as that caused by fallen power lines, immediately notify the appropriate authorities (i.e., 911, fire department, etc). All materials will conduct electricity if the voltage is high enough, so do not enter the area around the victim or try to remove wires or other materials with any object, including wooden ones, until the power has been turned off by knowledgeable personnel. Once the power is off, assess the victim, who may need CPR, defibrillation, and treatment for shock and thermal burns. All victims of electric shock require medical assessment because the extent of injury may not be apparent. Spine Stabilization There is an approximately 2 percent risk of injury to the cervical spine after blunt trauma that is serious enough to require spinal imaging in an emergency department, and this risk is tripled in patients with craniofacial injury. Most victims with spinal injuries are males between the ages of 10 and 30 years. Motor vehicles cause approximately half of the injuries; the remainder are caused by falls (especially from a height or diving), sports, and assaults. A victim with a spinal injury has an increased risk of permanent neurologic damage, including quadriplegia from a secondary spinal cord injury. First aid rescuers maynot be able to conclusively identify a victim with a spinal injury, but they should suspect spinal injury if an injured victim: • Is involved in a motor vehicle, motorized cycle, or bicycle crash as an occupant, rider, or pedestrian; • Is injured as a result of a fall from greater than a standing height; • Complains of neck or back pain, tingling in the extremities, or weakness; • Is not fully alert; • Appears to be intoxicated; • Appears frail or 65 years of age; • Has a head or neck injury. In these situations or any situation in which you suspect a possible spinal injury, manually stabilize the head so that the head, neck and spine do not move and are kept in line. Do not use any immobilization devices because their benefit in first aid has not been proven and may be harmful. Immobilization devices may be needed in special circumstances when immediate extrication (i.e., rescue of drowning victim) is required. First aid providers should be trained in the proper use of these devices before using them. Musculoskeletal Trauma Soft-tissue injuries include joint sprains and muscle contusions. Apply cold to soft-tissue injuries. Cold application decreases hemorrhage, edema, pain, and disability. Cooling is best accomplished with a plastic bag or damp cloth filled with a cooling modality that undergoes a phase change (e.g., ice). Refreezable gel packs are not as good as ice. To prevent cold injury, limit each application of cold to periods of 20 minutes and place a barrier, such as a thin towel, between the cold container and the skin. There is insufficient evidence to recommend for or against the use of a compression bandage to reduce edema following a closed soft-tissue injury such as a joint sprain. Assume that any injury to an extremity includes a bone fracture. Cover open wounds with a dressing if one is available. Do not move or straighten an injured extremity. If you are far from definitive
health care, you may stabilize the extremity in the position found.
If an injured extremity is blue or extremely pale, activate EMS
immediately because this could be |
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