February 27, 2007

Health and Safety, First Aid


Health and SafetyNZQA Unit Standards 6400, 6401, 6402 - Safe T Works Taupo

I have passed this great safety training.

There were no written notes provided at the end of the course so I am going to summarise my own here as I took a notebook of notes. This is a longer post than usual.
The testing consisted of group tasks with use of manikins for CPR practise, adult and child, work with other team members for learning how to move patients as a team when injured and also two written questionnaires, I have not included these here but we handed these in at the conclusion. These memos are taken for my own benefit as the presenter spoke. This is to help me retain the information.

Topics included:
Scene assessment
Patient assessment
Adult CPR
Bleeding
Shock
Choking
Broken Bones
Child/Baby CPR


First we were asked to consider what factors we would have to think about in a Truck vs Car accident and brainstormed responses;

Language of people, English as a second language possible, hearing impaired
Type and size of vehicles
loads carried
fuel
fire/explosion
location
blood
weather/time of Day
debris
power poles

We were told first not to remove anything from the scene.
When you can't help then offer reassurance like, "Hang in there, how's the pain,
I'm not leaving you".
If the vehicle is unstable wait until stabilized
There could be an unstable load or a chemical load. The truck could be a decorators or cleaner courier or carry gas cylinders or other chemicals
For a chemical spill we could tell 111 the chemical identifying numbers on the back of the truck. There is a poison help line at 0800POISON

In the case of a cattle truck having a collision we learned how to stop the traffic flow a good distance away. The other common situation was when there is a dog in the car when it could be hard to assist an victim when a dog was out of control.

There is Fuel to consider - turn of the ignition in the car involved. Keys on the floor of the car.
No smoking. The two ignition sources are the car battery and smoking.

If there are flames you can use a fire extinguisher, or a blanket or dirt.

When you leave the scene to drive to help you can put your speedometer on zero and time distance to phone or help this gives you more information to give the Police/ambulance.
9 minutes is the average time to wait for an ambulance in a residential area and this time is increased in a rural area.

Debris: could be glass, toys, hot engine parts

Expect emotions: alcohol/drugs compound these
KEEP CALM, deep breathing, stop and don't move, go and get a coffee if appropriate.

If the vehicle has hit a power pole don't touch the lines. You must be at least 6 meters away from live lines.
Crowd control is important. Could shout "don't move, stay in your car, lives lines, help on the way", rubber tyres in car provide some protection.

We spoke about creating a road block using your car as a first measure. The process is that you park your car facing oncoming traffic in the centre of the road with the hazard light on. Engine off. If you are at risk, eg children in the car you don't do this but park at side hazard lights on get the next safe car to do this.

Blood: Aids/hepatitis - you need rubber gloves (good to carry in car. If no gloves a plastic bag, or condoms, one on each hand.
Also good to have in the car a blanket, pillow and pair of gloves.

D anger
R esponse
S end 4 help
A irway
B reathing
C irrculation

Hey, Oy, are you alright?
Establish status by verbalising
Yell at them
Give them a little bit of pain for example, Tap on collar bone, squeeze ear lobe, press fingernail between nostrils. Establish that they are conscious.

Tip the head of the person back to straighten breathing tubes (there are exceptions to this covered later)

Put your hand on the forehead and fingers under the chin.

Clear airway before checking pulse. Airway before pulse.
Put your ear up to the mouth to check if breathing.
Start chest compressions. 30 compression to 2 breaths. If adult two hands, depth of compression a third of the persons depth from the ground. Where do I apply the compression? chest centre, index finder over man's nipple or hand under arm pit and then about level with this...

Once you start the compression don't stop stick with it until the ambulance arrives or someone else takes over

Heart attack
:

The person will get central crushing chest pain
Short gaspy breath
Bad colour, lips blue indicates a lack of oxygen
Sweat
Pain in left arm

Action: Call 111
reassure.."hang in there mate, I'm not leaving"

Ask do they have any spray? If yes, two puffs under the tongue
Sit person down, loosen collar, tie, belts, bootlaces,
Give one aspirin, crushed under the tongue, this thins blood and may avoid a blockage. But never give this if you suspect a stroke!!
Note fit people have a resting pulse of 40-60 pulses per minute

http://www.myheart.co.za/ Hearts and Cardiovascular information

Choking: Colour changes
The person will likely want to leave the room, first reaction embarrassment wants to have space.
Follow them, Talk to them, Are you choking? I'm a first aider its alright.
Then five back blows first.
Then five Heinrik's. Come from behind go under the arms and give 5 thrusts. Where? Put your small fingers on the bellybutton and roll your hands up and where your thumb lands is the position. Hard to explain better to demonstrate!!

Wounds
*Pressure
*Elevation of the limb
*Indirect pressure above the site. We learnt how to do this practising on dummy legs and arms also with our team group.

Medical shock

Lack of oxygen to vital organs especially your brain
pale, cold clammy
Pulse is faster, the heart is racing
What to do? Keep person warm with blanket, towels, a car seat cover, a jacket.
By putting the head of the person between the knees if sitting you
increase their oxygen.

Fracture/Soft tissue injury
Sprained Ankle

R est
I ce
C ompression
E levation

Ice on the sprain stops the blood, decompresses
Please use a towel not ice directly on the skin. It should not be too tight
The colour of the skin will be black/blue

Broken Arm
Symptoms : A bone may be sticking out. There will be pain at the site, Swelling and
reluctance to move. Check for signs

If there is a Crack in Bone you can not elevate and you can not apply pressure. A thigh bone break is particularly dangerous because of bone marrow getting into the blood stream and causing a stroke. You must apply indirect pressure at thigh base to stop blood flow. You can also fold a piece of clothing into a circular donut shape to use as cushioning around the affected area. You could use the gladwrap.

If you must move, immobilise with splints before moving, We practised this in groups of four people.

CPR on a child is different.
1) We give five breaths before beginning the 30:2 compressions and breathing.
Children don't have cardiac arrests but have respiratory arrests.
You only use one hand not two when you are giving compressions. There is not as much tilt when clearing the airway passage by tilting the head. You put your mouth right around the nose and mouth.

The Recovery position

You roll the person towards you and put them on their side basically
You put their hand behind their head, their hand on their chest. You lift their knee upwards, then put your hands on their shoulder and roll toward you then reposition the bent leg and arm.

First Aid Kit
Gloves
Mouth shields (we practised using these)
Salve for eye injuries, cover for both eyes
Tape, scissors, pencil and paper,
Bandages
It was noted that sanitary pads were good for stopping bleeding (never a nappy though because these would absorb fluid too strongly).

There was a comment about creams in first aid kits and how they were often not there because of the chance of cross infection with reuse. To avoid this all cuts would be administered to with a cotton ball first but in communal first aid kits this is a problem so need small tubes and use once.
The discussion about first aid kits was not comprehensive and we were not introduced to a standard first aid kit that was recommended for purchase.

Head Injury

This was most common with motor bikes and with males ages 18-24.

This results in the patient presenting acting like they are drunk or on drugs, they may be drunk or on drugs, They may be on P. Watch your safety.

Treating bleeding heads
* There may be fluid out of the nose
Spinal fluid looks like olive oil

* Always get a knock to the head checked...

Bones in the back/vertebrae

The spinal chord is the central nervous system
A spinal injury is hard to diagnose.
If you suspect say "I don't want you to move your legs, I want you to stay really still. Leave them on their back .
You can do what is called a chin pull to minimise chance of neck trauma - we watched the tutor describe this.

If someone is on the ground with a motorbike then you do not remove the helmet. You leave the helmet on until they stop breathing, can see visor mist, She then showed us how to effectively remove. We were shown how to move a person with causing the least movement with a group roll using four people. One at the head with hands positioned carefully, one at the feet holding them firmly together and then two at the sides.

Next we moved on to Chemical spills. We noted that skin was the largest organ (2sqm of skin per adult approx). We would apply cool water or a cold nonflammable liquid.

Carbon dioxide poisoning was mentioned, you should open the car door

The tutor recalled the methane poisoning case in Auckland with three men poisoned consecutively as they went down a man hole one after another to help a first man out. With only the fourth man surviving. In this case the men did not use the right gear and equipment.
Butane and Nitrous oxide were the cheapest acid dangers which you could buy at a dairy.
If acid was swallowed you must call 111. They should drink milk.
If conscious try to get them to breathe

If someone overdoses on Pamol or Paracetamol they need to be taken to hospital.
If an alcohol/tablets overdose call 111.
Some more advice. The person should not walk around as this will put the tablets into the bloodstream. Always debrief with another person after this incident.

Asthma
Aggravators: aerosols, bee pollen, stress, overexercising, illness, hereditary component. Hawke's Bay has highest asthma rates.

Example given of a teacher who requested that her students do not wear 'links' deodorant body spray because of her asthma problem.

Asthma suffers need a blue Ventolin and a spacer. We were shown how to use a paper cup instead of a spacer if necessary. You can use another persons blue Ventolin in an emergency because they are standard. Ventolin makes the airway elastic. Other attendees spoke of putting their heads in fridges to help breathing.

Food allergies

Allergy reactions are on the rise.
eg. allergy to peanuts - in some schools no nuts and raisins bars, peanut butter or snickers. Allergy to eggs, dairy products more common.

Bees stings -

* Ask what happened last time.
They need a stringe of adrenalin, they get red, hot, have a fast pulse, abdominal cramps. The syringes cost about $160 NZ and need replacing each year. Wash with cold soap and water.

There was a short discussion on people taking drugs. This was why the public toilets in Australia had blue lights to stop people finding a vein to shoot up. If you get a nail or syringe in your foot then you must get to a GP (general practitioner).

Burns

Chemical ----==> affected area goes in water for 10 minutes. You can use a bucket , there is no ice in the bucket, a bathtub is fine, or pool. Still water is better than running water. Try not to let them look at it.

Electrical ----==>Turn off the mains, throw a book at it, or piece of wood. 10 mins water
Thermal burns (burns from steam, water) apply 10 minutes water

ANY BURN ON THE FACE OR HANDS MUST BE PROFESSIONALLY ATTENDED TO, ALSO ANY BIGGER THAN A NZ$2 COIN.

You can use clingfilm/glad wrap after cooling to stop the air reaching the burnt skin this helps with pain. It is also a material that peels easily off when you get to hospital unlike other materials which can stick and cause problems.

Frost nip/frostbite/
Hypothermia

Hypothermia occurs when your body tissue freezes below 35 degrees c

Frost nip affects cheeks nose fingers
A way to warm up is to put the frozen fingers under your armpits or your groin these are your warmest areas

The Hypothermic person is tired. They will think they are alright. Get them out of wet and cold and call for help.

You gradually warm them up. They will be in shock. Don't put a hot water bottle on their feet as this would take body fluid away from the brain.

Get into a sleeping bag with them. When you get cold get out and let other first aider to get in. Reassure them.

If you have chocolate, Milo, jellybeans or biscuits give these to the hypothermic person.

Heat Cramps

Give salt. With heat cramps body salts are taken from your body, you sweat, its like a hang over, dehydration is a safety issue. Be aware of the colour of your urine, it should be the colour of L&P (Lemon and Paeroa, NZ drink).

Major Injuries - Some discussion followed...

Gunshot in the ribs
Patient will be blue no oxygen.
Use glad wrap tape it at three sides. This lets out air but none in.

If there is a knife in a body leave it in there.

you must debrief in this situation always.
In the case of someone trapped under a tractor or fallen tree you have 2-3 minutes to remove an
object like a tractor. If under for a longer period of time there needs to be an expert to lift off the heavy object gradually and then to stabilise with IV fluids otherwise the shock of the blood flow will kill the person.

If a limb is lost, find the limb, put it in glad wrap first, then in a chilly bin or on ice.

Seizure

Seizures affect epileptic sufferers. You can also get one if intoxicated.
Babies can get "feberal convulsions" (check spelling here)
The epilectic person can get an aura or a tingle and they know if they are going to seizure.
You will see the whites of their eyes.
They can be moving violently.
There can be grunting, squeezing noised
They can loose bladder control.

You can:
1) remove any objects that can harm them and then let them go (seizure).
2) you can put a blanket or towel under their head to stop them banging their head
3) don't stick anything in their mouth
4) don't hold them down
5) Cover their jeans; legs, for dignity in case they get wet from bladder control loss
6) Time the seizure. If the seizure lasts for more than five minutes they need help from a hospital or if it is their first time.


Wake them up, Hi , I'm a first aider. Help them arrange transport home.
Blue flashy lights set them off.
Also sunlight in the car window going past a row of trees.

Diabetes

This medical condition is to do with blood sugar levels.
4-8 mmol/L is the average
The Pancrease increases insulin. Insulin takes sugar out of the blood. Diabetics do not have enough insulin. As sugar travels around the body without insulin, the sugar levels get higher and higher without passing out of the body. People with diabetes often have eye problems, and it can lead to kidney disease, heart disease and stroke.
The diabetic may have low sugar reading say 1.2 or a high reading at 23 ( the average is 4.8. We were told to give sugar if high or low, often jellybeans. The diabetic should drink lots of water.

Visit: www.diabetes.org.nz or www.diabetesaustralia.com.au.
Cut and paste to your browser.

Or to obtain a handy brochure, please contact:
Diabetes New Zealand
Telephone toll-free: 0800 DIABETES (0800 342 238)
Email: info@diabetes.org.nz

We then tested each others groups with mock situations using test cards and reported back our responses verbally. Our correct answers were then confirmed, added to, self and peer checked.

So to conclude the training was a simple introduction and provided a list of situations and conditons that more detailed information is avaliable for and easily accessable via a medical professional or one of many medical guides to better looking after your body. These informal notes supplement my own learning, my actual submissions in the form of the written questionnaires are not included.

Best,

Helena

Health and Safety


See also the Health and Safety in Employment Act 1992 in Brookers databases.

I've read and reviewed Library Emergency Policies and Procedures and Policies and Procedures for Incidents
 _______________________ _ _ ________________

End of February 2010 First Aid Course Attended. Certificate updated.

Good to refocus on CPR with practise on the dummies. First Aid Manual Given with comprehensive written notes provided this time. Good to review material, though different emphasis and provider meant some new topics covered etc.

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