First Aid Courses?

[AntarcticPilot]

I respectfully disagree. As a Paramedic, I do an annual refresher in CPR (not least because the protocols change every few years based on new evidence) I also perform CPR on real patients regularly (often on several occasions in a week) I still find that I benefit from retraining to ensure that the rate and depth of my compressions are adequate. It is this that prolongs viability of life, rather than blowing air into the patient (which is of course important at a secondary level) Any attempt at CPR is a good thing, but the attempt will be much better if it is undertaken by someone who has had the opportunity to have properly supervised practice at regular intervals.

It isn't just things like CPR, either. For example, a First Aid course will certainly include not merely the recovery position, but how to put a someone into it. It isn't hard, but practical experience of man-handling an unresponsive person will be far more useful than a book. An intensive First-Aid course will also teach careful observation of the patient, to aid in diagnosis of the patient's condition; many life-threatening injuries may not have an obvious external indication (e.g. a broken rib penetrating a lung). Again, practical demonstration of what to look for is probably more helpful than book learning. Finally, again a First-Aid course will also teach how to manage a situation; how to split up responsibilities in the event of more than one person being available.

Another point is that while the human body doesn't change, our knowledge of the best way to handle it when it is damaged does. For example, the protocol for single-handed CPR when I did it was to use 13 chest compressions to one rescue breath. Recent research reported in the national press suggests that the outcomes are more positive if NO rescue breaths are used; that chest compression alone is more successful. And others have pointed out that advice on the use of tourniquets is changing.

 

[ghostlymoron]

The only caveat to this would be if the patient has stopped breathing. In this case I would advise even the untrained to attempt chest compressions

Why would you recommend chest compressions alone rather than coupled to mouth to mouth? I have done the four day red cross/st john's course a couple of times and consider it well worthwhile if only for the hands on practice at CPR (which fortunately I have never had to try for real).
I agree with the other points of your posting but am puzzled by that one.

 

[ghostlymoron]

Do an outdoor first aid course and read the booklet again each year.
This requirement to retrain all the time is cobblers.
The human body doesn't change all the time, the same skills that saved lives 20 years ago will save lives today.
All you need to do is follow the simple acronyms ABC (airway, breathing, circulation) and/or BBB (breathing,bleeding, bones) and then get the casualty attended to by someone who can progress the treatment.

First Aid is just that. Stabilising the casualty.

If you are 3 weeks from civilisation you need much more training, but it has become medical support by this time.

Refresher courses do have their value and are only 1 day provided your existing certificate is in date.
I've done a first aid course several times and the method of CPR has changed each time presumably as knowledge has advanced

 

[vertford]

We were given...

First Aid Made Easy by Nigel Barraclough, who is a paramedic and apparently it costs £6.99. Designed to be fairly bulletproof and easy to use with simple clear coloured charts/photos with plastic pages.

Attended a Defib course run by London Ambulance Service in March and trainer commented that is looked user friendly unlike some of the tomes he saw!

 

[Sniper]

Why would you recommend chest compressions alone rather than coupled to mouth to mouth? I have done the four day red cross/st john's course a couple of times and consider it well worthwhile if only for the hands on practice at CPR (which fortunately I have never had to try for real).
I agree with the other points of your posting but am puzzled by that one.

The Resuscitation Council regularly review the guidance they give to all, ranging from lay bystanders to advanced life support practitioners in hospitals. The latest guidelines recommend a ratio of 30 compressions to each two (brief) rescue breaths BUT they also allow that in a situation where a lay person is unwilling to engage in mouth to mouth (and frankly that may well be the case if you encounter an arrest in the street and you know nothing about the patient) then continuous chest compressions have been shown to be effective in maintaining perfusion in the initial stages. It is also very easy for ambulance control to 'teach' people compressions only over the phone. If you have been trained in correct BLS techniques and have some form of barrier mask available, then 30:2 is still recommended as the optimum intervention. Professional assistance will arrive with a range of airway adjuncts and a bag-valve-mask device which gets round the hygiene issues inherent in mouth to mouth.

 

[pteron]

Why would you recommend chest compressions alone rather than coupled to mouth to mouth? I have done the four day red cross/st john's course a couple of times and consider it well worthwhile if only for the hands on practice at CPR (which fortunately I have never had to try for real).
I agree with the other points of your posting but am puzzled by that one.

The protocol was recently updated to be 30 compressions to 2 breaths, but the teaching now is that the breaths are not "essential". This is for two reasons:

1. People were put off doing anything because they didn't want mouth to mouth contact with a stranger. Compressions alone are way better than nothing and

2. There is a fair amount of oxygen dissolved in the blood which is still useful to the brain as long as the blood is being moved.

Also, the act of compressing does cause a bit of oxygen interchange in the lungs.

Studies show that the effectiveness of CPR without the breaths is higher for those most likely to benefit from CPR.

My favourite CPR teaching aid: http://supersexycpr.com/cpr.html

 

[nickfabbri]

I think, the previous two posts sum things up perfectly, although I must add that mouth to mouth done incorrectly ie without the head tilt chin lift simply fills the stomach with air, resulting in the stomach contents being vomited back into the mouth of the first aider

 

[Seajet]

There's some very good info' on this thread, a big thankyou to all who have posted.

Pteron, it's amazing what one can learn; I am grateful on several levels for the link you posted !

 

[pteron]

Pteron, it's amazing what one can learn; I am grateful on several levels for the link you posted !

My pleasure... It is a rather pleasant teaching aid. I'm wondering what other applications could benefit from a similar treatment.

 

[Ubergeekian]

Studies show that the effectiveness of CPR without the breaths is higher for those most likely to benefit from CPR.

Did I not read recently that the effectiveness of CPR is almost negligible? Something like 1% when carried out by amateurs in the street, 5% when the pros do it in a hospital. Mind you, if it was my crew I'd take that 1% chance...

 

[pteron]

Did I not read recently that the effectiveness of CPR is almost negligible? Something like 1% when carried out by amateurs in the street, 5% when the pros do it in a hospital. Mind you, if it was my crew I'd take that 1% chance...

I don't know the figures, but each time I've been taught it the instructor has said that it doesn't usually work, especially if there is no defib available. But even at 1%, I'd keep going 'til
exhaustion.

 

[Sniper]

It depends on what you mean by effective. In terms of maintaining perfusion of vital organs, good CPR is highly effective and there are many studies to support this. In my own experience, good CPR will keep a body without a working heart looking relatively normal (i.e. without central or peripheral cyanosis) for quite some time.

On the other hand, CPR alone will very rarely restore spontaneous circulation. It can happen, but normally it is early defibrillation (and occasionally perhaps adrenaline) which does this. Hence my earlier suggestion that an AED on board a cruising boat (especially one which sails with elderly people and/or people with known cardiac conditions) would not be out of place.

The other point worth making is that a hypothermic body can survive long periods without proper circulation and still be revived. There is a well-known saying in pre-hospital circles (attributed to the late Nancy Caroline, an American doctor) that: 'they aren't dead until they are warm and dead'. This means that if you pull someone from the water in cardiac arrest it may well be worth continuing CPR efforts for a long time.

 

[Anne Hulbert]

To go back to the original question - it all depends on what you are doing:

Coastal within easy reach of assistance (includes cross Channel) - 1-day first aid slanted towards sailing, run by your local sailing club, sea school or RYA

Long distance out of reach of help for days or weeks - you may wish to consider the courses you quote, the second being what used to be known as "Ship's Captain's" course. We did these and they are very intensive and exhausting, but very interesting and allow us to carry antibiotics etc. We have only made use of what we learned twice - both times in harbour - (1) self-diagnosed (with telephone assistance from nurse relative) bronchitis on v. small Canaries island, (2) in Las Palmas marina stopped bleeding on another sailor who had a stanchion go through his mouth, ambulance got him to hospital.