G’day everyone, hope you’re all doing well in the lead up to the silly season. This blog will be having a look at some of the weird and wonderful first aid myths that crop up from time to time in our courses and on the internet. Some are outdated, some are misguided, and some are just plain dangerous. So, in consultation with some other trainers and health care professionals, let’s right some wrongs. There is quite the list…
You don’t have to give breaths
You don’t, but it’s best if you do. The Australian Resuscitation Guidelines say that if you’re trained and willing you should. The blood in our body only contains so much oxygen, if we were to do compression only CPR, we’ll soon run out of oxygenated blood being pumped around. If you were to do compression only CPR on a casualty who has drowned, you would be pumping deoxygenated blood around and it’d be pointless. Same deal for a baby, who has a very high oxygen demand and very low blood volume. This will be the topic of a future blog as it seems to cause a lot of confusion.
Just a puff out of your cheeks for baby CPR
I challenge anyone to tell me exactly how much air is in your cheeks when you puff… It’s simple for this one, put just enough air in to make the chest rise. Works on adults, children and babies, no need to worry about how much air is in your cheeks.
Encircling the chest of the baby when doing compressions
Although using thumbs as an alternative method of providing chest compressions on an infant may be acceptable if the rescuer is unable to get the correct chest depth using their fingers, encircling the chest with the hands It’s not a technique that should be used by lay responders. Supporting the back with the fingers is reasonable but be mindful not to squeeze the infant from both sides. Problems that can occur when a lay rescuer performs this incorrect compression technique include squashing the chest cavity (rather than focussed pressure on the lower half of the sternum) and failing to allow the chest cavity to expand when breaths are given in two-person CPR. You may witness Health Care Professionals with appropriate Advanced Life Support training demonstrate this skill, but as a general rule in the first instance, attempt infant chest compressions with two fingers while supporting the head in a neutral position.
This is not a good technique for lay responders but may be demonstrated by Health Care Professionals with Advanced Life Support training or by may be used as an alternative method if lay responders are unable to depress the chest one third the depth using fingers. Remember to depress the sternum and not ‘squeeze’ the infant!
The poor baby is getting squished! Pressure should be applied to the sternum only with the infant on a firm surface. Aim for approximately one-third the depth of the chest.
Picking the baby up to do compressions on your arm
This one crops up a lot on courses and is not correct. By picking up a baby and doing compressions on your arm (or in your lap), you are unable to get the correct depth of compressions. You’re also unable to effectively support the baby’s head. Finally, when holding the baby in your arm doing CPR, you’re going to get a very tired and sore arm. The best technique is to place the baby on a firm surface (the ground or on a table/bench), hold the head of the baby in the neutral position and commence compressions using two fingers in the centre of the chest (lower half of the sternum).
This method is incorrect
Placing baby on a hard surface is the best
Use the patients fingers to scoop out what’s in their mouth
When you’re unconscious, all the muscles in your body relax. This is why we must position an unconscious patient on their side with their head back and face down, so as not to let the tongue and other upper airway anatomy block the airway. If all muscles are relaxed, the effectiveness of using a patients’ own fingers to clear their airway would be about as effective as shooting pool with a length of rope. It’s just not going to happen. Take the appropriate standard precautions for infection control (i.e. gloves), use your own fingers and scoop the goop or flick the sick. If it looks like they’re seizing, don’t put your fingers in there, just wait until the seizing is finished.
Use the Heimlich Manoeuvre
Taught in America and advocated in their guidelines, the Heimlich Manoeuvre (aka abdominal thrusts) has been deemed too high risk by the Australian Resuscitation Council and should therefore not be used and definitely not taught. There are too many highly vascularised organs under the lower ribs/upper abdominal region that could be damaged if performed incorrectly and there are in fact documented cases of life threatening complications when this technique has been used.
You can’t use a tourniquet
A hangover from older first aid courses, I remember being taught this years ago. However, much research and hard-won experience on the battlefields of Iraq and Afghanistan, not to mention mass casualty events such as the Boston Marathon bombings and the Sandy Hook Massacre in the USA, have proven the effectiveness of the tourniquet. A recent study in Texas, USA showed that the civilian application of the tourniquet for dangerous vascular bleeding gave almost a six times greater chance of survival than for those who didn’t get one applied. Quite simply, they save lives. Read up on my previous blog introducing the ‘Stop the Bleed’ workshop that we run – https://www.paradisefirstaid.com.au/stopping-the-bleed/
If you use a tourniquet, you have to take it off after x amount of time
Again, another hangover from older first aid courses. This is a technique taught at higher levels of pre-hospital care when there is an extended transportation time. This is not something that we do at our level.
You need to elevate the limb
For an arterial bleed, this technique is ineffective. Let’s face it, the blood pumps uphill from our heart to our brain. Stands to reason that if we held an arm that had an arterial bleed above our heart, it’s going to pump all the way up there too. There is no evidence to say it works, in fact it has shown to cause further injury. The correct techniques are taught in our first aid courses, the ‘Stop the Bleed’ workshops or in the same blog as mentioned above in tourniquets.
Use a donut bandage
An antiquated technique that simply doesn’t work. For starters, it takes a long time to make (and if you’ve pre-made them, it takes up a hell of a lot of room in your first aid kit). Secondly, they only go on a nice and straight embedded object. Thirdly, you’d have to be pretty damn lucky (or unlucky?) to have the embedded object the perfect size of the pre-made donut bandage. Fourthly, it won’t go on if it’s an uneven shaped object that has embedded into you (say a pair of scissors for example). Finally, it doesn’t provide the pressure at the base of the embedded object, the whole point of the exercise.
Donut too small, doesn’t fit
Donut too large, does nothing
A triangle bandage wrapped around the base of the embedded object and bandaged in place is very quick and does the job. Even quicker, two rolled bandages either side of the embedded object and bandaged in place is effective.
One correct technique for dealing with embedded objects.
Use butter/pawpaw cream/egg white/toothpaste
Please. Don’t. Cool running water for 20 minutes. Follow that up by placing cling wrap, or a wet absorbent dressing, or a burnaid dressing on the burn. You can read a whole lot more about burns here – https://www.paradisefirstaid.com.au/first-aid-for-burns/
Don’t move what’s on them/Don’t move it after x amount of time
Another hang up from older first aid courses where there was no definitive guideline. Current best practice is to remove the crushing force ASAP, regardless of how long it has been there. Treat any external bleeding, reassure whilst waiting for ambulance to arrive. Due to a number of factors, such as potential hypothermia, hidden dangerous bleeding as well as the standard airways and breathing, the patient should be exposed from under the crushing force as soon as possible, regardless of how long they have been subjected to the crushing force.
You can’t move them
If the patient is conscious, breathing and lying on their back, then sure, leave them be. However, if they’re unconscious and breathing, they must be placed on their side in the recovery position. It’s all about life over limb, and the guidelines clearly state that airway has precedence over everything else (with the exception of dangerous bleeding). Because when we’re lying on our back unconscious, all muscles, including the tongue and other upper airway anatomy, actually drop back and block the airway. So we’d die. Do your best to roll the patient safely using the spinal log roll. But if you are on your own with your patient, roll them the best way you can.
The research I’ve done basically says that you’ll have an initial injury that may not produce paraplegia. However, secondary spinal cord injury does occur in the hours to days following the initial injury. This can be attributed to processes at a cellular level, such as hypoxia, inflammation and cell death. Nothing of which we can control at a first aider level. So please, if you come across an unconscious and breathing patient, place them in the recovery position. Or if they are still in a car following a crash, support their head in an upright position to maintain a clear and open airway.
You need to pee on it
This little chestnut crops up on almost every single first aid course! Please don’t do this, especially to me!!! For tropical jellyfish (box jellyfish and Irukandji), you’ll want to apply copious amounts of vinegar. For non-tropical jellyfish, hot water as hot as the casualty can tolerate, or ice packs if you don’t have hot water. For all other marine stings, hot water as hot as the patient can tolerate is the treatment. Peeing on people just makes for a very awkward situation that can easily be avoided…
This is a Box Jellyfish envenomation. Casualty wouldn’t appreciate getting peed on…
Cut the bite and suck the venom out
I think we have Hollywood to thank for this one. Australian snakebite venom reaches the bloodstream via the lymphatic system. This system works off muscle movement and is just below the skin. Hence the treatment for all Australian snakebites (as well as the Funnel Web, Blue Ring Octopus and Cone Shell) is the Pressure Immobilisation Technique and not cutting and sucking. See correct snake bite first aid treatment here.
Coughing if you’re on your own so you don’t need to do CPR
I believe this one did the rounds (or is still going) on social media. The message delivered was that, if you were alone and thought you were having a heart attack, by coughing vigorously, you would stay conscious longer and therefore prolong the negative effects of said heart attack. Quite simply, there is no evidence to support this.
It’s not a bad idea firstly to understand actually why a person is having a heart attack. For the most part, it’s because the heart is no longer getting a suitable amount of oxygenated blood, likely due to a clot or restriction of the coronary artery (the blood vessels that keep the heart muscle supplied). When this occurs, the patient may experience pain, shortness of breath, pale, cool clammy skin, nausea and vomiting. Coughing then won’t really do anything to reverse this. The patient needs the chain of survival – early access to help, early CPR, early AED and early Advance Life Support. So it’s better to recognise the signs and symptoms and know how to do effective CPR. If you’re on your own, phone Triple Zero ASAP!
The green EpiPen is for kids
This one admittedly caught me by surprise, as I had always taught that it was by age that the different EpiPen’s were administered. But reviewing the ASCIA frequently asked questions web page, it clearly says that it’s by weight. Green EpiPen Jr is for under 20kg and yellow EpiPen is for kids and adults over 20kg. Always learning, love it!
The age of consent in Qld is 16 years old
Strictly speaking, in Queensland, a person under the age of 18 is deemed a minor. However, when it comes to consent for first aid procedures, younger people can give consent. Michael Eburn discusses this very topic in his excellent emergency law blog, found here – https://emergencylaw.wordpress.com/2016/10/13/consent-first-aid-and-minors-in-queensland/
So there you have it folks, a wrap up of some of the myths that are out there in the realm of first aid training and delivery. The best thing you can do when it comes to this sort of mis-information is to come visit us and sit in our CPR and/or provide first aid course. We run these daily at three awesome locations on the Gold Coast, or we can come to you. Check out our website for more information. Folks, this will probably be the last blog for the year, so be sure to have a very merry Christmas and a safe and happy New Year. Thanks for reading and see you in 2019!
ARC Guideline 6 – Compressions
ARC Guideline 9.1.1 – First Aid for Management of Bleeding
ARC Guideline 9.1.6 – Management of Suspected Spinal Injury
ARC Guideline 9.1.7 – Emergency Management of a Crushed Victim
ARC Guideline 9.4.1 – Australian Snake Bite
ARC Guideline 9.4.5 – Jellyfish Stings
ARC Guideline 9.4.7 – Envenomation – Fish Stings
ARC Guideline 12.2 – ALS for Infants and Children: Diagnosis and Initial Management
ARC Guideline 13.6 – Chest Compressions during Resuscitation of the Newborn Infant
Queensland Ambulance Service Clinical Practice Procedures: Trauma/Arterial Tourniquet
American Heart Association Guidelines for CPR and Emergency Cardiovascular Care, Part 5, section 10.5
Greaves, I., Porter, K., & Smith, J. (2003). Consensus Statement On The Early Management Of Crush Injury And Prevention Of Crush Syndrome. Journal Of The Royal Army Medical Corps, 149(4), 255-259. doi: 10.1136/jramc-149-04-02
Curtis, K. and Ramsden, C. (2014). Emergency and Trauma Care for Nurses and Paramedics.