1st Aid Defence

| 8 April 2011 | 1 Comment

As an avid reader of articles on GunSite, I was interested to read several topics on “home defence”, “Get-out-of-jail goodie bags” and in general preparing for the worst case scenarios. I think you would all agree a basic understanding of 1st aid is essential and is worth taking the time to attend such a course. Anticipating and acting on medical emergencies will form part of your preparedness and awareness as shared by many readers on this site, which may encompass any number of scenario’s and situations. Lastly let me say that the purpose of this article is not to teach you 1st aid (as there would be no end to this article), but rather get you thinking in the right direction.

To start my credentials are as follows: I am a Paramedic in South Africa, trained in advance life support encompassing advanced cardiac, pediatric and trauma life support. I am not however trained in any form of combat or tactics and my knowledge I wish to share here is simply informative and my own anecdotal experience over several years of working the streets of South Africa as a Paramedic.

To start, having some basic equipment is essential for rendering 1st aid and without this you are better off not doing anything (ex no gloves to protect yourself from bodily fluids).

Gear Selection:

A good 1st aid kit doesn’t need to be large or expensive and most items can be bought at any pharmacy or even a supermarket.  Your main objectives when applying 1st aid is to stop bleeding and manage a person’s airways / breathing. Improvisation is often key when in a situation where 1st aid equipment is not available. This can include for example – towels or a person’s own clothing for controlling bleeding or a rope / cable ties to act as a tourniquet. Some good-to-have items should include, but not limited to:

  • Bandages of various sizes
  • Trauma pads or dressings (to be applied under the bandage)
  • Latex Gloves (thicker is better) & eye protection (your shooting glasses would work here).
  • CPR mouth piece / barrier (acts as a barrier between you and victim when performing CPR)
  • Personal prescription medications (how long until you can get new meds?)
  • Extra prescription glasses (you are lost without your eyes)
  • If you have severe allergies or Asthma, ask a Dr about an EpiPen?
  • Asthma Pump (asthma is a very common ailment)
  • Contact numbers of local EMS providers (memorize also store on your phone)
  • Medical Aid details (no card no entry)
  • Burn Shields (sterile aloe dressings used for burn wounds). These come in all sizes.
  • Rescue scissors (sturdy robust scissors with rounded point) – excellent for cutting through clothes, seat belts, etc.
  • Tourniquet – to be used in life threatening situations only (explained later)
  • Simple plasters, tweezers, ointments, sun block, tape.
  • Glucose Gel (as used by Sports people) – instant energy supply.
  • …continue list here

1st aid kits should be kept in your car, home and that “get-out-of-jail” bag. Each bag might be tailored according to weight, size and envisioned situations.

A-B-C’s of First Aid

The basis for all forms of emergencies remain the same, be it a Paramedic or a bystander. A simply acronym to remember is H-H-H…A-B-C. This stands for:

H – Hazards – as with any situation, sizing up the scene and making sure you too don’t become a victim is essential. This can include car accidents, shooting or simply no protective wear on a patient covered in blood.

“The chances of infection through blood into your eyes is FAR higher than with a direct needle stick into your hand…look after your eyes!

H – Hello – This covers several bases – it determines the patients LOC (level of consciousness) and ability to communicate. You want to at this stage introduce yourself and ask the person if they require your help. You now have explicit consent and the patient knows who you are and what you are doing.

“Imagine the security guard who has just been shot and you coming running up to them without identification…this might fall under Hazardous too if they are still armed

H – Help – Get assistance earlier then later. Where possible send someone else, ensuring they know your location (GPS co-ords, directions, landmarks), Ambulance number(s), patients priority, that they have a cell phone or money for a phone box. Lastly tell them to come to you with feedback.

Numbers to remember:

  • Metro Provincial Ambulance service – 10177
  • Police – 10111 (who can dispatch any number of services for you)
  • NetCare 911 Private Ambulance service – 082 911 (if you have medical aid)
  • ER24 Private Ambulance service – 084 124 (if you have medical aid)
  • Keep numbers of your local hospitals, Doctors on your phone and in 1st aid kit.

A – Airways – By protect, we mean the ability for air to move freely into their lungs without obstruction or allowing fluids to enter the lungs. An unconscious person loses the ability to protect their airways and should be of great concern. Ask the patient to stick out their tongue. If they can do this they are protecting their own airways. At the same time you can evaluate their mouth for blood, broken teeth, swelling, etc.

If they are not able to comply with your commands (ie they are unresponsive, confused, lethargic) we must assume they cannot protect their airways. Laying a person on their side (recovery position) with their face towards the ground will avoid aspiration of the person vomitus, blood. Having said this, any person involved in a trauma related incident may have spinal injuries and these needs to be considered before moving them. Where possible do not move a patient with suspected neck injuries.

C – Circulation – We need to stop all bleeding and if in cardiac arrest – perform CPR.

Bleeding is controlled by 1) Direct pressure 2) Indirect pressure on pressure points (in the groin, under the arm) and 3) elevation (lifting the bleeding limb higher than the heart). If bleeding in uncontrolled (ex bright arterial spurting blood causing patient to lose consciousness) and becomes life threatening, the use of a tourniquet may be advantageous. The rule-of-thumb here is Life over limb…wrap any form of rope / cable tie / belt tightly above the wound in a tourniquet manner until blood supply becomes cut off. Note: this will cause the limb to become deoxygenating and will result in the loss of that limb (after a period of time).

For both those who have and haven’t attended a 1st course, as of 2010 significant changes have be made by the AHA (American Heart Association) in CPR algorithms. Maybe it is time for that refresher?

The new protocols place a great emphasis on simple chest compressions (in a person who is pulseless) and less emphasis on breathing. Reasons for this include: blood in the body remains oxygenated for a period of time, even after arrest and during this time the bodies demand is relatively low (except where cardiac arrest is due to asphyxiation). Other reasons include wasting time between compressions causing inadequate perfusion to the brain and heart.

Ballistics

Lastly to make this article relevant to this website, here are some things to consider about GSW (gun shot wounds).

Often a GSW has a small entry hole and may be misleading as to the underlying injuries. A high velocity projectile such as a bullet causes massive hydrostatic forces that can significantly damage organs and major blood vessels, even if not in direct contact. Externally little or no bleeding may be noted but the patient may rapidly become shocked (they will appear pale, lethargic, fast “tachy” pulses). Also remember your hollow point rounds which are designed to break-up on impact and specifically designed to cause internal damage.

Secondly the path of a bullet through a human can be misleading. People have been shot in the foot and the bullet found in their chest. Also remember that anyone who has been shot can potential have a spinal injury and should be handled accordingly.

Questions you should be asking include: 1) Calibre of firearm(s) 2) Number of shots fired 3) Are any of the injuries in or around the spinal or neck region or may have crossed the midline.

Conclusion

With or without medical training the first person to assist in a medical emergency can directly influence the outcome of that person’s life or even your own. Remembering the basics of H-H-H-A-B-C, sizing up a scene, getting help and ensuring air goes in-and-out and blood round-and-round.

As part of your “Home Protection” or “Dooms day readiness” or even a mishap at your local range  – condition yourself not only in protection / defence scenario’s but also how to cope with the aftermath.

By Jacques Lourens
http://www.mediczone.co.za

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  1. Jacques says:

    Feel to pop a mail if there is anything further you wish to ask or visit our website http://www.mediczone.org for informative discussions on Paramedical debates.

    Jacques – jacques mediczone

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