How A Massage Therapist Can Handle An Allergic Reaction

The scary thing is, you never know how severe an allergic reaction is going to be.

When I showed up, I couldn’t believe the state she was in.

Mere steps away from the medication that could have saved her life, but she just didn’t get to it in time.

We cycled through CPR for 45 minutes but our efforts were in vain. We couldn’t bring her back.

It’s an issue everywhere these days.

Allergic reactions to so many foods, substances and insects. Such innocent things but enough for a person to lose their life.

At any given moment we could see this in our clinic, at an outreach or just in day-to-day life.  

The Signs and Symptoms You Need to Know

People who have this type of severe allergy (anaphylaxis) generally know they have it and will let you know if you need to deal with it.

There are a few different things that can cause anaphylaxis, the most common being food allergies and insect stings. Reactions can also be brought on with latex allergies, participating in exercise, medications and sometimes for no reason at all.

May is food allergy awareness month and if you’ve never seen someone having this kind of reaction, the Red Cross First Aid & CPR Manual highlights some signs to look for.

They may end up with:

  • Hives
  • Itching
  • Rash
  • Weakness
  • Nausea
  • Vomiting
  • Dizziness and
  • Breathing Difficulties

You may remember the Big Bang Theory episode where Wolowitz ate the granola bar to get Leonard out of the house?

Although it doesn’t look that extreme in real life, it gives you a bit of an idea what is happening when a person has a reaction.

If left too long the reaction can have dire consequences. In the story I told at the beginning, the person was ten feet from their medication which was the difference between life and death.  These allergies are so common now that schools are limiting whether kids can bring peanut butter sandwiches or other peanut ingredient snacks to school.

There has even been huge arguments over whether it is okay to use one student’s medication on another student having a reaction, to the point that schools are now having to carry their own supplies in case of emergency.

What Can Massage Therapists Do To Help?

Our biggest responsibility is to help the person breathe, so getting them sat down in a position of comfort to make breathing easier is the first step. This is usually going to be in a seated position leaning forward so that it takes some pressure off the diaphragm.

There are so many stories out there about how people panic when this type of thing happens.

They do their best to help but then get flustered. Time is of the essence here, the person needs that medication and they need it NOW.

Slow down, breathe and don’t panic. If the person sees you worked up it’s only going to cause them further stress that will worsen their condition.

The next step is to get that felt pen looking thing. It’s called an EpiPen and contains the hormone epinephrine.

Once delivered the epinephrine should start to relieve the swelling in a person’s airway and make breathing easier. But before they take the shot of medication there are a couple of things you should check.

  1. Make sure it is their EpiPen
  • This is important if it is not with them and you have to go get it. Always make sure you are giving a person THEIR medication with THEIR specified dose.
  • Ask them “is this yours?” and hold it up in front of them to confirm it.
  1. Check the expiry date.
  • If the medication is expired it should not be used (unless it’s your only option as a last resort), which means that calling 9-1-1 is a good idea at this point as the Ambulance will have medication with them.

Fortunately the design on new EpiPen’s are a lot easier to use than the older style ones and cause a lot less confusion.

Photo by: Greg Friese

Photo by: Greg Friese

If you’ve never seen or used one before they’re pretty simple to use. One end is blue and the other end is orange. The orange end is where the needle comes out to deliver the medication, so don’t get the two mixed up (you don’t want to have a person stick the needle into their thumb). All you have to do is get the pen out of the case and it’s ready to go.

  1. Pop the cap on the case and remove the EpiPen.
  2. Remove the blue cap at the top of the pen.
  3. The patient plunges the orange end into their thigh and holds for around 10 seconds.
  4. Monitor the person’s ABCs to make sure the medication is working.

It shouldn’t take too long for the person to start feeling the effects and make breathing a little easier. However they should still seek medical attention because sometimes the epinephrine can start to wear off, making breathing difficult again.

Remember that we cannot deliver the medication, the patient has to do it themselves.

Make sure to call 9-1-1 after to make sure they get needed medical attention.

Do not leave the person alone while you wait for paramedics to arrive. Your responsibility now shifts to making sure their ABCs are maintained in case their airway starts to swell.

As healthcare professionals you can contact www.epipen.ca and there is a wealth of information on the site about how to use an EpiPen, allergic risk factors, video tutorials and they will even send you an EpiPen training device for practice.

I always assumed you had to have a prescription to get an EpiPen but I contacted Anaphylaxis Canada and they informed me you can get them behind the counter in all pharmacies in Canada (however in the U.S. it is still obtained by prescription only). If you’re doing much treatment outdoor, on site or even if you’re just worried about some of your patients in clinic, for the cost of around $85 it might be a good investment for your practice.

If you decide to keep some with you or in your clinic, make sure you only give it to someone who has used it before and has had it prescribed by their doctor. 

At least (if nothing else) Howard Wolowitz has taught us what an allergic reaction could look like, and maybe how not to be too creepy.

The FAST Way For Massage Therapists To Recognize A Stroke


 

 

It was around 1am Monday morning, when I realized there was an issue.

He was one of the guys that mentored me when I started working at the mill.

We were all standing around at work telling stories and joking around. (Yes I know 1am is an ungodly time to be working).

Tonight, something seemed different but nobody else really noticed. Standing with his arms crossed almost supporting one arm with the other, our conversation seemed confused as he constantly gazed at the floor.

I invited him to come and sit down for a coffee.

Walking him into First Aid shack, I sat him down and asked how he was feeling:

“not good”

How did your weekend go?

“I don’t remember, apparently I didn’t show up to work on Friday”

Did you leave the house to go to work that day?

“I remember dropping the kids off at school Friday morning, but that’s really the last thing I remember”

As we kept talking, his slurred speech became more noticeable. When he relaxed, those crossed arms became one crossed arm and one seemingly limp arm. Looking into the eyes and face of this normally strong, athletic man there was something missing. His left side was almost motionless, wilted.

Can you lift your arms above your head for me?

The right arm went up, left one didn’t move.

Can you kick your legs out for me?

The right one kicked out, left one stayed put.

We need to get you to the hospital.

“Just let me drive home and I’ll get the wife to take me in”

No, I’m calling an ambulance.

Later that morning I went to the hospital to check on him. As I walked in the room he looked at me and shouted to the nurse:

    “Hey nurse there’s the little jerk that sent me in here” (they had him on some pretty good stuff)

    “You should thank that little jerk, he saved your life”

The FAST Way To Stroke Recognition

Recognizing that someone suffered a stroke can be difficult depending on its severity.

Recognition is also one of the most important things in treating a stroke, since getting the person to advanced medical care increases the chance of limiting a strokes damage.

My friend in the story had gone three days without his family or friends noticing there was something wrong. He had no memory of the weekend and drove 45 minutes to work that night, with only the right side of his body working properly.

The Canadian Red Cross Emergency Care Manual gives the easiest way to recognize a stroke by using the mnemonic, F.A.S.T.

Here’s how you can use it to help figure out if the person has suffered a stroke:

Face

  • have a look at the persons face and check to see if there is weakness on one side
  • look and see if there is a noticeable droop around the eyes and mouth
  • have them smile and check if both sides are moving equal

Arm

  • check to see if there is any loss of sensation or weakness on one side
  • assess how one side moves compared to the other side (remember in the story how he could only lift one arm above his head)
  • this weakness can be present in the legs as well

Speech

  • difficulty speaking
  • slurred speech
  • remember that one side of the body is typically affected, so even motor control of the mouth and tongue will be difficult

Time

  • It is important to get them help ASAP to prevent things getting worse
  • even the person’s concept of time and memory can be affected

The patient could also have sudden headaches, dizziness, confusion and a temporary loss of consciousness.

There are three main causes to a stroke.

  • Tumors.
  • A clot in the brain that either develops within an artery, or a mass makes its way to the brain from somewhere else in the body.
  • An artery rupturing.

Although there is nothing we can do to help as far as the cause of the stroke, our ability to recognize the issue is key. If one of your patients is ever complaining of headaches, dizziness, confusion and in any way resembles the issues associated with F.A.S.T we need to get them to a hospital.

Photo: Mark Stedman/Photocall Ireland

Stroke Survivors Conference, Department of Health Ireland. Photo: Mark Stedman/Photocall Ireland

9-1-1 And What You Can Do

Your safety is always the top priority.

In this case we can assume it is a safe environment since we are talking about your clinic and also safe to assume there is no spinal injury associated with the patient.

If you remember your last first aid course we always do a Primary and then a Secondary Survey (if everything in the Primary is okay and we aren’t doing any kind of life safety interventions).  In the Primary Survey we are checking for ABCs (Airway, Breathing, Circulation).

Since the person is talking to us we already know that they have an airway, they’re breathing and of course have circulation, Primary done.

In the Secondary survey we want to do a head to toe check. This is where the F.A.S.T mnemonic will become more evident.

Having the patient move limbs and using facial expressions will show you what part of the body, and to what extent the patient is having problems.

Now that we know what the problem is we want to get the patient into their most comfortable position (which will vary, but typically will be laying down) and if we haven’t done so already call 9-1-1

After calling 9-1-1 stay with the person and try to keep them as alert as possible. Our biggest responsibility is to stay with them in case they lose consciousness or require CPR intervention.

If a person loses consciousness (or prefers to lay down for comfort) but is still breathing, we need to get them laid down with their affected side up. The side that still has motor control and sensation must be on the ground. In case they begin to vomit, having gravity and motor control working together will help to keep their airway clear.

Since they still have sensation on that side, they will be able to know if anything is underneath them causing discomfort. This helps to prevent getting pressure sores as they could be in this position for a long time during transport to hospital.

I bumped into that friend about five years after his stroke. He wasn’t the man he used to be as the stroke had taken a toll on him. But he was still upright, walking and had his same old sense of humour.

I was sure glad to see him and even happier I was able to help him years before.

He didn’t call me a little jerk that day and even though he’s bigger than me, he could have at least called me a big jerk, I’m at least 5’10”!

Why First Aid Is The Most Important Course A Massage Therapist Can Take

 

“First Aid! First Aid!”

I’ve never heard so much distress in a man’s voice.

He was calling from the filing room (it’s where all the saws and blades are sharpened in a sawmill).

My heart sunk.

My mind raced with horrific images of what could be happening.

It was my responsibility to deal with it. Every employee looked at me as the expert to deal with these types of emergencies.

I was so scared to take responsibility.

After only a two week course, I was responsible for the health and safety of this man and 300 other employees in a sawmill. At any moment someone could be seriously injured and I was the guy relied on to fix the problem.

I raced through the mill and made it to the emergency scene.  As I rounded the corner I saw my friend laying on the floor.

For a second I froze, then all that First Aid training came back to me.

Thank God, everything was going to be okay.

First Aid Is Valuable Everywhere

As my career grew I got more involved in First Aid and joined the fire dept. Now I was one of the ones responding when the general public needed more help.

I was scared about the first time that pager would go off and I’d be responding to an emergency. But again, I would have senior people around to help  show me the ropes.

When the mill closed I decided it was time to go back to school for a better more stable career. I did some aptitude testing to see what would come up and Massage Therapy was one of the things listed. I jumped in with both feet and registered later that week.

While in college I was fortunate enough to start volunteering with the hockey team I still work with. One of the things that got me in with that team, was my experience and history working as a First Responder at the mill and fire dept.

Towards the end of my Massage College education, my fire chief asked if I would take the training to be a first responder instructor.

Of course!

Now as part of my career I’m fortunate to teach first aid to Massage students, Athletic Therapists and Registered Massage Therapist’s around the city.

Why First Aid Is Important

Recently the College of Massage Therapist’s of British Columbia made it mandatory for Registered Massage Therapist’s in BC to be certified in Standard First Aid.

I often disagree with some things the College does but I love this ruling. Here’s why.

1. Your Patients Safety Determines Your Success.

Whether working in an industrial environment or at an emergency scene, the rule is the same as in a clinical setting.

Strategic-Success-iStock_000009610569Medium1

Above anything else, your and your patients safety should be the number one priority.

Throughout professional development courses in college we learned so many things about making the clinic space a safe environment. Proper draping, boundaries, confidentiality, limb handling, professional attire and demeanour. This safe environment goes past just treating in a professional manner and respecting boundaries.

 

Within our code of ethical conduct it states that a registrant shall:

  1. Act in the best interests of the patient
  2. Use his/her knowledge and skill to improve the health and well-being of others;

Providing a safe place also means being prepared for the unexpected.

If someone is going through an emergency it is always scary. When a patient come to see you, you are the medical professional, patients know you have significant knowledge about the human body. They are depending on you to help resolve whatever issue they are having that day. One of those issues could be a stroke, a heart attack, an allergic reaction. YOU are their trusted medical person that should be able to help them.

I just looked at our clinic and one day this week saw 27 people come into the clinic. The odds are stacked against us that we may face an emergency one day. Granted you may be lucky and never see anything happen within your clinic, but why take that chance?

Don’t let your clinic be a statistic.

Provide each of your patients with as safe an environment as possible.

2. A First Aid Certification Improves Your Credibility.

Recently there was some anger when it was made mandatory for some Massage Therapists to have their Standard First Aid certificate to maintain their license. It was called into question since it’s not mandatory for Chiropractors, Physiotherapists and some other healthcare professionals.

This is a good thing! Massage as a profession has been working to be more recognized within healthcare, being prepared to help patients in a state of emergency will only help solidify us as true healthcare providers.

We are privileged to see most  patients on a regular basis.

I know most Therapist’s have patients who make Massage part of their monthly and sometimes weekly routine. We see patients more often than most see their doctor.

As frontline healthcare professionals we need to have the ability to recognize when something is going wrong with patients in our clinic.

Being able to recognize a heart attack, stroke, breathing issue or any number of various medical emergencies proves our worth, not only to patients but to other practitioners within healthcare.

3. Being Unprepared Costs Money.

I have responded to hundreds of First Response calls over the years but that story at the beginning stands out.

It was ten years ago and I remember it like it was yesterday.

I was coming on shift at 5am and it happened.

I didn’t have any of my gear with me yet and there was a traumatic injury in progress.

I showed up to work unprepared that day.

This poor man was having a seizure surrounded by instruments that were sharp enough to turn logs into sawdust.

Although everything turned out fine, I will never forget the feeling of rushing to the scene unsure of what I was going to do without my proper equipment.  

There is nothing worse than seeing someone in distress and not being sure how to handle it. Everyday a therapist probably see’s five to six patients, sometimes more. That’s five to six times we need to be prepared to help should something go wrong.

I know most people take their first aid course, put the text-book on the shelf, scramble three years later when their certification expires, then groan because they have to take that damn first aid course AGAIN. I am begging you, review that book every once in a while. Even hold a little practice once in a while in your clinic to stay on top of things.

Don’t allow three years to go by without doing at least some review of protocols, signs and symptoms or techniques.

If you’re subscribing to this blog, I’ll do my best to make sure you’re getting a regular review of how to handle emergencies in your clinic.

4. You Will Be Required To Know First Aid Soon.

More and more Professional Practice Groups, Sport Massage and special needs environments are requiring Massage Therapist’s to have a higher level of certification when it comes to First Aid.

Advancing to a First Responder Certification is starting to become the norm if these are the types of specialties you want to get into (yes I know, we can’t say we specialize in something). In those cases, the groups or organizations recognize the need to give a higher level of patient care should something happen to someone on your team or within that environment.

Working in a sport environment it is often a requirement by leagues to have a dedicated number of First Responders at each game to provide emergency care for the home team and visiting team should a medical emergency or injury take place. In situations like this if you want to be on the medical and therapy crew for a team, you don’t have a choice but to advance your first aid training.

5. First Aid Will Be Mandatory For All Clinics.

You also owe it to your fellow practitioners.

At any one time in an average clinic there could be a couple of Massage Therapists, Acupuncturists, Chiropractors and Physiotherapists all working in one space.

In any other workplace Occupational Health and Safety would deem that at least one employee be trained in first aid to provide a safe work environment for all employees on site. Because most clinics have people working there that are considered sub-contractors the same rules don’t apply. However OSHA puts those rules in place for a reason, and its usually because someone was injured and uncared for or there was a fatality that led to that ruling.

According to WCB regulations your clinic may not be meeting standard regulations that are put on employers. Most clinics probably get around this because of the clause where each therapist is a contractor and not an employee, but the regulation states:

 

  1. Where a workplace creates a low risk of injury that is more than 20 minutes surface travel time away from a hospital
    • 2-5 employees (workers) there must be a standard first aid kit on site
    • 6-30 employees (workers) there must be a standard first aid kit and someone trained in Level 1 first aid.
  2. Where a workplace creates a low risk of injury and is 20 minutes or less surface travel time from a hospital
    • 2-10 employees (workers) there must be a standard first aid kit on site
    • 11-50 employees (workers) there must be a standard first aid kit and someone trained to a Level 1 first aid.

I don’t know if this could ever be enforced because of that contractor clause, but its important to know that these regulations are in place for a reason.

Companies like WCB don’t have a think tank of smart guys sitting around thinking things up just in case something should happen. Most regulations are in place because something happened that made laws change to prevent the same accident or occurrence from happening again.

The regulations of making sure someone is trained in first aid to cover a certain number of people is there as a protection for the people on any work site. In the case where all the therapists are trained in first aid, there isn’t a need to designate one person as the “attendant” but if you wanted you could just look to whoever has the most experience in that regard.

Some of us spend more time with our co-workers than we do with our families and friends. Could you handle it if something were to happen to one of them and you couldn’t deal with it?