“To be prepared is half the victory” – Miguel de Cervantes
I used to cringe every two years when my First Aid certificate expired.
Great, another two-week course with a bunch of people I don’t know teaching me the same thing I learned the last time. Total crap.
It would drive me nuts that I had to go sit through the exact same course, same textbook, same information, but at least I always got two weeks off work to do it.
Then it happened. Fresh off of taking a re-cert course, we had a major incident at work where someone was seriously injured. I hadn’t dealt with this kind of traumatic head injury before.
As I made my way to the scene, other workers who were First Responders outside of work were helping out. However, the way they handled the person was wrong.
When I questioned them, they simply said “that’s how we were taught the last time we did the course”.
Then it dawned on me, that the new way of handling this person was an update that had come through recently. The type of spinal immobilization they were doing was an old way, but new research had changed and upgraded how to do it.
If I had not just recently done the course again I wouldn’t have known any better.
That’s why it’s important to keep on top of your license and re-certify when it expires.
And yes, I know I’m probably the only Massage Therapist out there that gets excited about First Aid, but I truly believe it contributes to our recognition as healthcare professionals. As I’ve promised before I’ll do my best to keep you up to date on First Aid info, so with this post I’ll review some of the more important points you need to remember.
The Primary Survey In First Aid
Remember back when you did your last course and the instructor was adamant about you checking the scene for safety?
Well this is the first part in your Primary Survey when helping someone in need. Hopefully you remember some mnemonics used as reminders of what to do, but if not here’s what you need to know.
The three C’s. Check, Call, Care. This is the first thing you need to do whenever trying to help someone, but remember it can be modified to fit the situation.
- Check the scene, is it safe for you to help out? This is where things can be modified, if this is happening in your clinic, chances are it’s a safe environment, so just make sure it’s safe enough that your patient isn’t going to cause you harm.
- If the environment isn’t safe, back away and call 9-1-1
- Check the person. Get down beside them and see if they are conscious and breathing.
- If they are not conscious go through and check the ABCs.
- If they are conscious ask them what’s happening, let them know you are trained in First Aid and want to help (hopefully they’ll let you)
- Once you’ve checked the person, determine if this is a medical emergency.
- If they respond, try and figure out if they need a 9-1-1 call. (however you may find something in the Secondary Survey that requires you call for emergency help)
- If they’re unconscious, don’t waste time, call 9-1-1 and get the other people in your clinic to come and help.
- Provide whatever immediate care is necessary for any life threatening injuries.
- Make sure the persons airway is open.
- Get down beside them, put your ear as close as possible above their mouth while looking at their chest. Listen for breathing and see if you feel their breath on your ear.
- Put one hand on the chest, watch for it to rise.
- This is called look-listen-and feel. Do it for 10 seconds
- If there is no rise in the chest or signs of breathing we have to try and open the airway.
- Use the head-tilt-chin lift technique that you learned in your course. This technique moves the tongue out-of-the-way from blocking the airway.
- If no breathing occurs, attempt to give two breaths and see if air passes through.
- If air passes through, begin CPR.
- If you do the head-tilt-chin lift and they start breathing, maintain the position to keep the airway open.
- Assess their breathing to make sure it is adequate.
- Make sure they are taking a normal amount of breaths, it’s not just an occasional gasp.
- If the breathing is not adequate you will need to start CPR soon.
- With a Standard First Aid course all we do for checking circulation is assess the skin.
- Do they have pale skin? Or is it full in color?
- If their skin is pale it’s showing signs of shock and decreased circulation.
- Take a quick scan of the body to see if there is any deadly bleeding happening.
The Secondary Survey In First Aid
Remember, you cannot move on to the Secondary Survey if the ABCs aren’t adequate or being maintained by another person.
The Secondary Survey is where you find out what else is possibly happening with this person. Its your chance gather as much information possible. Let’s assume you’ve completed your Primary Survey and the person has their ABCs in place.
There are two portions to the Secondary Survey, one is the interview and the other is the head to toe check where you look for other injuries.
Assuming the person is conscious you can start with the interview. If they are not conscious, but have their ABCs you can ask bystanders, friends or loved ones as they may have the answer to some of these questions. The mnemonic to remember for the interview is SAMPLE.
Once you document the answers to the SAMPLE questions then you can do a head-to-toe check. Start at the head and work your way down the body, palpating each area as you go. Look for any bleeding, bruising, or signs of further injury as you go. As Massage Therapists we should be pro’s at this.
Make sure you never drag your hands down a person while checking them in case there is anything sharp sticking off their body (broken bone, syringes, other objects) as you don’t want to cut yourself, always pat and compress areas as you go.
A very important part of doing a head-to-toe check is looking for medical alert bracelets. They can inform you of conditions like asthma, angina, diabetes and allergic reactions.
If they are conscious but don’t want you touching them, you can do a hands off head-to-toe check by getting them to move for you. Shrugging shoulders, moving limbs and shoulders can tell you a lot about what’s happening with a person.
The Most Common Conditions, What Massage Therapists Should Know
Choking is classified into two categories:
- Mild – this is where the person is still having some air exchange happening and are just coughing but maybe a little distressed.
- Severe – when this happens there is a full obstruction of the airway preventing any air exchange from happening. It’s usually recognized by the classic sign of someone putting their hands up to their neck and of course…not breathing.
If someone is experiencing mild choking, all we do for them is encourage coughing and stay with them to make sure they clear whatever they are choking on. You’re staying with them and making sure they don’t suffer a full airway obstruction.
When someone is severely choking we have to step in to help. Make sure you stand in front of the person and tell them you’re trained in First Aid and going to help before you just jump behind them and go to work.
Get behind the person and wedge your knee/leg between their legs so that you have a solid base to support them in case they collapse. Doing this makes it so they won’t pull you down with them and cause an injury in case they do pass out.
Now here is where things may have changed since the last time you took a First Aid course. We don’t go right into abdominal thrusts now. Here are the new steps to take:
- Wrap one arm across the persons chest and bend them forward.
- Deliver five back blows between the shoulder blades with the heel of your hand.
- Then place one fist above the belly button and support it with your other hand.
- Deliver five abdominal thrusts with your fist in a “J” motion pushing up towards the diaphragm.
- Keep repeating five back blows to five abdominal thrusts until whatever they are choking on comes out, or they go unconscious.
- If they go unconscious, help them to the ground, go to CPR protocols and call 9-1-1.
If what they are choking on becomes dislodged, accept the hug from the person and go on about your day knowing you just did something awesome.
No, not Massage strokes, a medical stroke. I posted an article on here recently about how to deal with someone having a stroke in your clinic which you can read here, as well as a video to help out which you can watch here.
As it is with so many other things in First Aid, recognition is key. When it comes to someone who has had or is having a stroke, the biggest help you can give is to simply recognize that something is wrong, then get help.
The Red Cross has a great mnemonic to help out with this. If you can do your best to remember it, your chances of helping the person recover increase greatly. If someone has had a stroke, the quicker they get medical help the less damaging the stroke can be. So try to remember this:
Once you recognize that the person has had a stroke, call 9-1-1 and stay with them. The biggest thing you are going to do now is monitor their ABCs and provide appropriate care if they lose consciousness.
Get the person into a position that they are comfortable with until Ambulance arrives. They are probably best laying on their side, make sure to position them affected side up. This helps them maintain motor control of their mouth and airway should they begin to vomit, remember to keep that airway clear.
Angina And Heart Attack
This is another one of those cases where your intake form can give you a heads up on a potential issue. Someone who has angina typically knows they have it and is taking a medication called nitroglycerin to deal with it. Angina is essentially chest pain a person experiences that comes and goes. The medication for it comes in a few forms:
- Oral Spray.
- Skin Ointment.
If someone in your clinic has Angina and is complaining of chest pain, this isn’t a medical emergency yet. If they are having chest pain it should feel how it usually feels, they take their nitroglycerin and with rest the pain goes away.
It is a condition they manage and know what to handle. If they take their nitroglycerin and the pain doesn’t subside within five minutes, have them take another dose. This is one case where its okay for a Massage Therapist to ask if someone has taken erectile dysfunction drugs. They should not take their Nitroglycerin in this case as they are both vasodilators and can cause further problems.
If after three cycles of Nitroglycerin (spaced five minutes apart) the pain doesn’t subside, or is worse than usual, it is a medical emergency and you must get them to the hospital because their condition has progressed to a heart attack.
If someone is having a heart attack in your clinic it is because of a blockage in an artery feeding the heart. Some of the signs and symptoms of a heart attack are:
- Squeezing chest pain.
- Difficulty breathing.
- Cold, bluish sweaty skin.
- Nausea and Vomiting.
- Denial (no one wants to confront their own mortality).
- Jaw pain.
- Abdominal or back pain (most common with women).
There are also some “soft” signs to watch for that occur most commonly with the elderly, women and people with diabetes (another important intake form question). They will have more mild and broad chest pain that:
- Comes and goes.
- Is better with rest.
- Worsens with activity.
- Doesn’t feel painful.
- Starts mild but worsens with time.
If someone is having a heart attack, have them rest and call 9-1-1. If they have a predisposed heart condition they may have Aspirin recommended by their doctor, if they have it with them get it for them. Stay with them and monitor ABCs in case they lose consciousness.
As mentioned above, this is another one of those questions that should be reviewed on your intake form.
Always be aware when one of your patients who has diabetes comes in just in case they haven’t eaten in a while. Once the person goes long enough without food their body begins to shut down until finally losing consciousness if not dealt with properly.
If you know someone coming in for a treatment has diabetes and don’t seem like themselves, it may be your first hint that something is going on.
Once the person has gone long enough without food, the excess intake of insulin has taken up too much of their blood glucose. Their brain is now deprived of the necessary sugar it needs to function effectively, which in turn can cause unconsciousness and shock.
Once you recognize that the person is not acting like themselves there are some signs you want to look for to confirm a diabetic reaction:
- Changes in level of consciousness
- Confused aggressive behaviour
- Rapid breathing
- Pale skin
- Seem intoxicated
- Look and feel ill
- Cool, sweaty skin
We have to act fast.
Getting some sugar in their system is the biggest thing we can do. Always make sure you keep fruit juice, soda or some kind of sugary drink in your clinic (can’t be diet, they need real sugar). Get it to them as quick as possible.
If this happens and you get sugar in them fast enough, it doesn’t mean you have to call 9-1-1. This is a condition they deal with on a regular basis and should know how to manage. However it does mean that you cannot proceed with your treatment they came in for. They need to get carbohydrates in their system by eating a proper meal.
If they progress to the point of unconsciousness, it is now a medical emergency, make sure you call for help. Stay with the person until help arrives monitoring their ABCs as their condition will progressively get worse. Roll them over into the recovery position to help maintain their airway and continually check on them.
You cannot give them anything orally once they are unconscious, however the paramedics responding will have something to give them to help the condition.
The Common Theme For Massage Therapists
I wanted to outline choking, strokes, angina, heart attack and diabetic reactions because they are some of the more common things that you can see with patients that come to see you on a daily basis. The common theme with all of them is recognition. Recognizing that there is a possible emergency is the number one thing you can do to help someone in each of these cases.
Secondly, staying with them to monitor their ABCs until help arrives is the next step. As long as you do a proper Primary and Secondary Survey you should be able to figure out what is happening in any case and deal with it appropriately.
If you’re ever unsure what is going on with someone, that Secondary Survey is your key to investigating what’s happening. As healthcare professionals knowing how to interpret the signs and symptoms of different First Aid emergencies is key to providing excellent care to our patients.
Whether it’s a stroke, choking, diabetic reaction or angina following the appropriate steps will give you the best chance of success when you’re providing First Aid at work.
So don’t get too upset the next time you have to re-cert your first aid license, there is a reason for it.
And try not to take too much aggression out on the instructor!