First aid

[flaming]

Renewed my first aid certificate yesterday. All very useful stuff, and some interesting changes since I last did it 3 years ago.

However, it was noticeable that everyone on the course was there because they needed the certificate to be able to work. There were dinghy instructors, commercial yachtmasters and even a tug skipper. But no leisure sailors. The instructor said this wasn't unusual.

So how many people have ever done a 1st aid course, and how many have an up to date certificate?

 

[NealB]

I've done several over the years...and, yes, they always change a few things eg ratio of chest compressions to ventilations. Does it really make a difference?

 

[Seajet]

Unlike the first poster, I've found my club's First Aid courses, run by Paramedics & Nurses from local hospitals, RNLI etc, have a high attendance rate, all by leisure sailors.

I have noticed the change in compression / ventilation ratio too, but hope my impression is right, that it's pretty much a guideline; a Doctor said 'just do something, don't stand around !'

I have a bit of a thing about shock & dehydration - sometimes applicable to witnesses as much as casualties - after being present at a couple of nasty road accidents, so am a fan of Diorialyte and space blankets as well as ABC.

 

[sam_uk]

I have noticed the change in compression / ventilation ratio too,.

What is the new recommended ratio?

 

[Ubergeekian]

I've done several over the years...and, yes, they always change a few things eg ratio of chest compressions to ventilations.

A bit like university economists, then? They use the same exam questions all the time ... but the answers change every year.

 

[NealB]

A bit like university economists, then? They use the same exam questions all the time ... but the answers change every year.

Yes.....don't get me started on that!

 

[Seajet]

The last I was taught was 3 compressions, 5 breaths ( and don't forget a hygienic breather in the unlikely event one has one ) but I think it's changed again ?

 

[FullCircle]

I do mine with the local St Johns unit. I am not diligent, and go when I remember, as it happens only 2 years ago, because I just looked.

I did it first with the Army, then British Rail Engineering as they gave you an extra days leave if you had a Works Certificate.

 

[NorthUp]

two breaths, 30 compressions at a rate of 100/min. Repeat.
http://www.resus.org.uk/pages/bls.pdf

 

[tom_sail]

I have only got it for my dinghy instructor and when i update, its always other instructors.
Don't think i would bother i'd just read the book. But i need the piece of paper for work.

 

[fisherman]

Everyone on my boat has to have 1st aid, firefighting, sea survival, 'safety awareness' certs otherwise the boat may not go to sea.

 

[tom_sail]

Everyone on my boat has to have 1st aid, firefighting, sea survival, 'safety awareness' certs otherwise the boat may not go to sea.

Is that the same as STCW 95?

 

[Rigger Mortice]

I've never done a course; it's always one of those things I'll get around to.
I did get myself a copy of the St John's first aid book a couple of months ago, and I have even read it.

Better than that though is the MCA first aid guide http://www.dft.gov.uk/mca/mcga-shs_capt_guide_chap1.pdf
Somebody posted details of it here a few months ago. It's very good...and free. It's permanently on my Kindle.

 

[pendlecats]

I've been going with daughter no2 every 3yrs with British Red Cross, she needed it for her studies and now work.

I started doing it with her for no other reason than joining in was better than sitting in the car park waiting for her, very good thorough course.
Always included AED but that runs out after just one year.

I'm actually due this summer for the three year refresher.

 

[tudorsailor]

There is a change in the recommended protocol as noted in this extract from resus UK
You should note that two or three chest compressions followed by mouth to mouth is now not recommended. If there are several of you attending to someone who has collapsed it would be good to agree (very quickly) how often you are going to ventilate or give mouth to mouth.


Guideline changes
It is well documented that interruptions in chest compression are common and are associated with a reduced chance of survival. The ‘perfect’ solution is to deliver continuous compressions whilst giving ventilations independently. This is possible when the victim has an advanced airway in place, and is discussed in the adult advanced life support (ALS) chapter. Compression-only CPR is another way to increase the number of compressions given and will, by definition, eliminate pauses. It is effective for a limited period only (probably less than 5 min) and is not recommended as the standard management of out-of-hospital cardiac arrest.
It is also known that chest compressions, both in hospital and outside, are often undertaken with insufficient depth and at the wrong rate.
The following changes in the BLS guidelines have been made to reflect the importance placed on chest compression, particularly good quality compressions, and to attempt to reduce the number and duration of pauses in chest compression:
1. When obtaining help, ask for an automated external defibrillator (AED), if
one is available.
2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min-1.
3. Give each rescue breath over 1 s rather than 2 s.
4. Do not stop to check the victim or discontinue CPR unless the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes,
speaking, or moving purposefully AND starts to breathe normally.
5. Teach CPR to laypeople with an emphasis on chest compression, but
include ventilation as the standard, particularly for those with a duty of care.


TudorSailor

 

[flaming]

Some interesting replies - Looks like about 1/5 of people have never done one, and about 2/5 keep theirs in date.
Which I suppose leads to the follow up question - has anyone actually had to call on their first aid skills at sea?

 

[FullCircle]

Some interesting replies - Looks like about 1/5 of people have never done one, and about 2/5 keep theirs in date.
Which I suppose leads to the follow up question - has anyone actually had to call on their first aid skills at sea?

Only for cuts and abrasions.
As SWMBO is a Community Matron, our First Aid Kit is ready and waiting for our first Caesarean section at sea.

 

[Lakesailor]

5. Teach CPR to laypeople with an emphasis on chest compression, but
include ventilation as the standard, particularly for those with a duty of care.

Fantastic. So the casualty stands more chance if the First Aider has a Duty of Care.

Covering and backs springs to mind.

CPR is a moveable feast. Truth is probably that it isn't a particularly succesful procedure, but you have to try.
Science Daily

The success rate for CPR ranges from 5 percent to 10 percent, depending on how quickly it is administered after a person's heart stops. "This is important because every minute lost in applying CPR results in a 10 percent decrease in successful resuscitation," Geddes said. "Time is the enemy. After 10 minutes, very few are

They also found that

The findings showed that 60 percent of the CPR-trained rescue personnel pushed with more than 125 pounds, whereas more than 60 percent of those not trained in CPR failed to push with more than 125 pounds of force.

That seems to be the required force to have an effect although it virtually guarantees rib fractures.


Recognising and dealing with bleeding can have a far more effective outcome, but CPR seems to be the headline act of First Aid Courses.
ABC is still the priority, but as the figures show CPR is not a sure-fire winner. Often just attention to the airway will spontaneously restart breathing. Determining that the heart has stopped in a real-life situation is a hell of a lot more difficult than in the make-believe situation of a class room. It is known that many casualties receiving CPR still had a heartbeat, so the apparent success rate is better than the real one.

Compression Only CPR is seen as a better option for survival by laypeople with nearly 3 times as many surviving.

Bentley J. Bobrow, M.D., of the Arizona Department of Health Services, Phoenix, and colleagues evaluated whether widespread endorsement of COCPR for adult sudden cardiac arrest would be associated with an increased likelihood that lay rescuers would perform CPR and an increased likelihood of survival to hospital discharge compared with no bystander CPR and conventional CPR. The study included patients at least 18 years old with out-of-hospital cardiac arrest between January 2005 and December 2009 in Arizona. A total of 4,415 adults with out-of-hospital cardiac arrest met all inclusion criteria for analysis, including 2,900 who received no bystander CPR, 666 who received conventional CPR (15.1 percent), and 849 who received COCPR (19.2 percent).

The researchers found that rates of survival to hospital discharge were 5.2 percent for the no bystander CPR group, 7.8 percent for conventional CPR, and 13.3 percent for COCPR. The annual rate for lay rescuers providing any type of bystander CPR increased significantly over time, from 28.2 percent in 2005 to 39.9 percent in 2009. "Among patients who received bystander CPR, the proportion with COCPR increased significantly over time, from 19.6 percent in 2005 to 75.9 percent in 2009. Overall survival also increased significantly over time: from 3.7 percent in 2005 to 9.8 percent in 2009." Further analysis indicated that COCPR was associated with an approximately 60 percent improved odds of survival compared with no bystander CPR or conventional CPR.

Note that is not a 60% chance of survival, but a 60% increase in the rather low chance of survival.

That is not a figure recognised by Professor Hillman in his book

Only about 15 per cent of patients requiring CPR in a hospital and approximately 1 per cent of patients who have arrested in the community and had CPR survive to leave hospital. And this dismal figure hasn’t changed since CPR was first introduced in about 1960. Moreover, these figures do not give any indication of what state the survivors are in. Many are in a coma or have severe brain damage.

 

[Downsman]

100-120 per minute!! Looking round our boatyard I would say that most of this lot would snuff it themselves if they tried giving 100-120 compressions to a jelly, let alone a casualty..Some of 'em have a struggle opening a tin of antifouling...

 

[Twister_Ken]

100-120 per minute!! Looking round our boatyard I would say that most of this lot would snuff it themselves if they tried giving 100-120 compressions to a jelly, let alone a casualty..Some of 'em have a struggle opening a tin of antifouling...

The doc who took my course (a sailor and ex A&E consultant) did mention that for most people doing CPR at the recommended speed would knacker them pretty quickly, but not to worry, because if the victim hadn't recovered by the time the first-aider was shagged, they weren't going recover anyway. He too quoted the dismal success rate of CPR and said its main function was to make sure the first aider felt that they had done everything they could to save a life. I seem to remember we're also supposed to hum 'Nellie the Elephant' to ourselves while doing it, to keep the right pace.