How Massage Therapists Can Deal With Panic Attacks And Hyperventilating

It was 3:32 on a Tuesday afternoon in Myofascial II class and I was confused.

I couldn’t believe what the instructor was saying.

She was talking about people having an emotional response while having certain areas of the body treated.

Specifically she mentioned SCM (Sternocleidomastoid) and how it can sometimes be upsetting for people to have treated, and actually having people cry from treatment.

I didn’t believe her.

As we worked through our trades in class, I remember looking across the room and seeing it happen. People quickly wrapping sheets around their body and hopping off Massage tables.

Head down, tears rolling down their faces and heading to the bathroom to get away from the class.

I looked down at my buddy, with a dumb look on my face and said “What the hell are we going to do once we’re in clinic and someone starts crying on the table?”

I don’t want to see that, I hate seeing women cry.

Fortunately I went through the rest of college and the student clinic without ever having someone start crying. So glad, made it through never to have to deal with this again

When Someone Hyperventilates In Your Massage Clinic

Yeah, I wasn’t off that easy.

Years later I had a new patient come in to the clinic. In a recent car accident and she needed some work for limited range of motion and neck pain.

She had never had Massage before and was excited that treatments would help out with things after her car accident.

Starting with her face down on the table and things were going well. When she turned over and I started working through the neck, it all started to change.

She started getting a little agitated and couldn’t explain why she was feeling that way.

Her head lifted off the table in an attempt to breathe easier.

She wanted to continue with the treatment, but couldn’t quite catch her breath.  She started breathing faster and was getting a little light-headed, anxious and scared.

Her breathing increased. It was more difficult to catch her breath. Her previously calm demeanor shifted to fearful and agitated.

Now I’m starting to get worried.

What Is Hyperventilation?

Someone getting this anxious can turn into a medical emergency, right on your table.

When someone starts breathing this rapidly it’s called hyperventilating.

It becomes a medical emergency if they can’t calm down because if it goes on too long, it can render the person unconscious.

Because they are breathing so fast, it actually starts to change the pH levels in their blood. With too much oxygen coming in, the blood starts to become too alkaline (respiratory alkalosis) and proper nutrition is not making its way to the rest of the body.

This is also the reason that the persons fingers and toes can start becoming numb and tingling.

Having this happen will only compound the scared feelings the person was having initially, so we need to deal with it.

In this case we know that something is happening in our treatment that is causing the person to hyperventilate, but there are a few other causes that we should know about:

This is important to know, just in case you ever see this happening with a person and you don’t know the underlying cause that is making them hyperventilate.

If the underlying cause isn’t apparent, you need to dig deeper to see if you can find out. It may be the only way to actually deal with the problem at hand.

Remember your Secondary Survey? Great way to use the SAMPLE questions to dig deeper.

Photo by: Jaoie

Photo by: Jaoie

How To Treat Hyperventilation And Panic Attacks

The biggest thing we need to do is calm the person down.

Give them as much reassurance as possible, especially if they are becoming more anxious and scared.

You have to become their coach.

Coach them on their breathing.

Use whatever cues you find appropriate to begin calming them down. If you know them well, talk to them about whatever is important to them, or some memories/thoughts that would start to calm them down.

Have them mimic your breathing. If need be, take their hand and place it on your diaphragm. Breathe normally so they can feel it. Coach them to breathe with you, let them feel the rhythm and consistency of your breathing.

The more you can do to calm them down and get them back to normal breathing again, the better success you will have.

I used to think it was an old wives tale to get a person to breathe into a paper bag, but like so many other times…I was wrong.

I looked up hyperventilation in my Anatomy and Physiology textbook and it’s actually recommended as a method of treatment. As the person breathes into the bag, it helps to get more carbon dioxide back into their system to balance the pH level and help the person calm down.

Who knew a paper bag should be part of a First Aid kit?

Why Massage Therapists Should Not Fear Patients Who Hyperventilate

Fortunately knowing how to deal with someone hyperventilating helped in more ways than one with my patient. She was able to continue treatments after she understood why she was becoming upset and scared during that first treatment.

If you ever have to deal with someone who’s going through this, remember these steps:

  1. Try to distract them from the fact that they are hyperventilating. Let them talk about whatever triggered this response.
  2. Reassure them, let them know that this type of response can be a reaction to the treatment.
  3. Coach him or her on their breathing.
  4. Have them look at you and try to mimic your slower breathing.
  5. If necessary have them place their hand on your diaphragm to get the feeling and rhythm of your breathing as a tactile response to relate to.

It can be a scary thing, but it doesn’t have to be. As long as you’re prepared and know how to deal with the situation you’ll be successful. Recognizing what’s happening and following the above steps will ensure your patients safety and their trust in you as their therapist.

Always be ready to coach and reassure your patients through whatever is happening in your treatment room. And again if you’re not sure of the cause, going through the SAMPLE questions will get you what you need to know.

While I’m not as scared of this happening anymore, I still can’t handle seeing a woman cry.

I may need to keep a paper bag handy the next time I watch “The Notebook”

Massage Therapists Guide To First Aid At Work


“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.

The ABCs


  • 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.

S – Signs and Symptoms?

A – Allergies?

M – Medications?

P – Past medical history? (Anything like this happen before, or family             history?)

L – Last meal? (Might be a hint of diabetic reactions)

E – Events leading up to the incident? (Do they remember what happened? Might be sign of altered level of consciousness)

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.

Photos by: Rocky Sun, Jill Hedler, Steve Jurveston and Melissa Johnson

Photos by: Rocky Sun, Jill Hedler, Steve Jurveston and Melissa Johnson

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:

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:

F – Face (numb, weak and drooping on one side)

A – Arm  (numbness and weakness on same side as the face)

S – Speech (slurred and confused)

T – Time (time to call 9-1-1, remember the quicker they get help, the less the consequences can be)

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:

  • Tablets.
  • Patches.
  • 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:

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:

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.

Diabetic Reaction

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:

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!

Treating Epilepsy And Seizures In Your Massage Therapy Clinic

The terrified voice over the radio screamed for help.

It took about a minute to get there after we had been called. Adrenaline pumping, no idea what we were running into, just hearing panicked screams for help.

I had an awesome first aid instructor who would simulate what a seizure looks like whenever I took a course with him. Fortunately he was pretty bang on with the way he re-enacted it. When I saw what was happening, I instantly knew what was going on.

As the tremors started to slow down, we could finally get access to him after we had cleared the area around his side.

He laid there unconscious, frothing at the mouth.

I tried to put an oral airway in, to help him breathe and maintain the airway. He wouldn’t accept it.

He was still breathing, so we did our best to support him. Called 9-1-1 to get an ambulance there and had no idea how this happened. Looking up at his co-workers they were all shaken and bewildered over the last couple of minutes, watching their friend go through something so traumatic.

I was at his side supporting his head when he started to regain consciousness. He looked at me confused and couldn’t sound out proper words. It just sounded like gibberish. Slowly, he started to come back, only to be confused by the multiple people standing around him wondering what the hell just happened.

Why Helping Someone Having A Seizure Can Be Scary

I’ve written about this story a couple of times now, but I wanted to write about it again because I think it bears repeating.

Dealing with someone having a seizure can be a pretty scary thing, especially if you’ve never seen it before. Even after watching my First Aid teacher re-enact a seizure, I was still pretty surprised that first time.

While it is depicted so often on TV and movies where the person is just flopping around on the floor, from my experience it doesn’t look like that. The person can also experience prolonged contractions through their whole body as opposed to actually shaking. There can also be incomprehensible sounds and cursing coming from the person while the contractions are happening.

The person can be frothing at the mouth and possibly have blood present in the area. I will admit that the first time I helped someone in this case the frothing from the mouth is what threw me off the most until I realized it was normal and part of the process.

Causes Of Epilepsy And Seizures

Seizures can result from several different things, but the most common one is Epilepsy. Epilepsy only affects about 1% of the population and is characterized by short recurrent attacks of motor, sensory and physiological malfunction.The seizures start from abnormal electrical discharges in the brain that stimulate nerve impulses over their pathways.

Partial seizures have milder symptoms that begin on one side of the brain, while generalized seizures happen on larger areas on both sides of the brain resulting in loss of consciousness. 

Epilepsy is usually controlled by medication and there are surgeries that some people elect to have if the medications aren’t controlling the condition well. But people with Epilepsy can still have seizures from time to time even if using medication. The person in the story had epilepsy, but just forgot to take their medication that day. Unfortunately none of us knew he had epilepsy, so we had no idea why this seizure was happening.

There are several things that cause Epilepsy including:

  • Brain damage at birth.
  • Metabolic disturbances.
  • Infections.
  • Toxins (ie: drugs and alcohol).
  • Vascular issues.
  • Head injuries (happened to me when I was 18).
  • Abscess on the brain.

This is where a good Massage Therapy intake form is priceless. Making sure you look over an intake form to see if one of your new patients is on medication or lists Epilepsy as a medical condition, puts you a step ahead in preparation for dealing with this one day. Also making sure that each patient’s intake form is updated every so often, just in case someone develops a condition like this is just as important.

But Epilepsy isn’t the only cause of seizures. There are a few other things to consider (especially if Epilepsy isn’t listed on that intake form): (First Aid and CPR Manual)

  • Fever.
  • Heat Stroke.
  • Drug or alcohol withdrawal.
  • Video Games (some even come with a warning now before you start playing them).
  • Infants and young children with a high fever (febrile seizures).

While the causes may be different, most generalized seizures are going to look the same and providing care for the person is something we can all easily do.


The Signs Of A Seizure Massage Therapists Need To Recognize 

There are a few stages to a seizure that Massage Therapists need to recognize. In the case of someone with Epilepsy they will usually be able to recognize that a seizure is coming on. However with someone who has never experienced a seizure before, it’s less likely they would realize what’s going to happen.

In the case of a generalized seizure there are some warning signs that come on before the uncontrolled muscular contractions take place. The stages of the seizure will look like this:

  1. Aura phase – they sense something unusual is happening with a strange sound, taste or smell.
  2. Tonic phase – they go unconscious and experience tense muscles.
  3. Clonic phase – the seizure (which can range from blackout to convulsions lasting minutes).
  4. Postictal phase – the gradual recovery from the seizure.

Having the ability to recognize what’s about to happen goes a long way to being able to help a person if they are having a seizure.

What Massage Therapists Can To Do Help A Seizure

If you recognize that a seizure is about to happen (someone with Epilepsy will know what’s about to happen and may ask for help), get the person sat down on the floor in an open space.

Once the actual seizure starts, clear everything away from the person. We want to make sure there is an open area for them, so that they are not bumping into anything and causing an injury while the seizure happens.

  • Don’t try to suppress them, or stop the seizure from happening, just let it happen.
  • If they’re on your table when a seizure happens, try to prevent them from falling off the table.
  • Make some noise if you have to and get some of the other practitioners in your clinic to come in and stand at the side of the table to prevent the person falling off.
  • If they were face down on the table, grab some pillows and do your best to support their head coming off the face piece.

If they were face up when it happened, still do what you can to prevent falling off the table and support their head. DO NOT stick anything in their mouth. Biting the tongue enough to cause any injury isn’t common. However you can end up causing significant injury to yourself by trying to put something in the person’s mouth.

Your biggest responsibility now is to manage the person’s airway. Watch for any frothing at the mouth or possible vomiting. Once the seizure stops, get the person turned onto their side to help maintain the airway and keep it clear.

When the seizure is over and the airway is being maintained, go into your secondary survey. Check out the rest of the person’s body to see if there were any other injuries that occurred. Look for medical alert bracelets or necklaces to see if the person has a medical condition that would suggest this happening.

If the person was naked or in their underwear on your table, make sure to cover them up with a blanket, not only to help prevent shock but also to show them respect and privacy. As the person begins to come out of a seizure they will be a little disoriented and possibly embarrassed. Try to give as much reassurance to them as possible.

10 Reasons A Seizure Can Be A Medical Emergency

Someone who has epilepsy or is known to have seizures doesn’t necessarily mean you have to call 9-1-1…yet.

In the story I told at the beginning, he was mad at me for calling the Ambulance (although I had no idea he had epilepsy). With individuals that are prone to having seizures, it is usually part of everyday life, and they manage the condition with directions from their Doctor. However there are some guidelines that show when it’s necessary to get more advanced help:

With any of the above instances make sure to call 9-1-1 and get some more advanced medical care. There is also something called “status epilepticus” where a person has continuous seizures and do not regain consciousness. This is a case where Ambulance must be called in to get the person to a hospital ASAP. They must get to advanced medical care.

In a case where a baby or child is having a seizure due to a fever, do what you can to cool the baby. Use room temperature water, give the baby a sponge bath and provide what care you can until Ambulance arrives.

While a seizure can be a scary thing to deal with, there are so many things we can do as healthcare professionals to assist our patients if it happens. Taking the time to recognize the events leading up to a seizure and how to properly handle what happens will help to make it not so scary.

“I feel so lucky that I met the love of my life. You know somebody’s in it to win it when…you’re having a seizure and they’re holding you…”  Kathleen Hanna

Why Massage Therapists Should Know CPR

The first time I gave CPR, it was nothing like I imagined.

I had practiced it, taken several courses on it and even taught others how to do it.

But looking down and seeing that blank face looking back while I pushed on his chest is an image I will never forget. The paramedics put a tracheotomy in, while several people cycled through compressions. We got a strong femoral pulse back but sadly that is the most success we would have.

The person went too long without CPR to for us to be able to resuscitate him.

We had no idea how long he had been lying there, but still gave every effort to try to bring him back.

Some may ask; was the effort worth it?

Why Massage Therapists Do CPR

An article circulated around recently that was written back in 2012. It was an opinion piece by a Dr entitled “Why do CPR?”.

In it he cited a Japanese study with several statistics that showed how survival rates after administering CPR were pretty minimal and those that did survive ended up with some sort of brain damage.

  • 18% of those who were administered CPR achieved spontaneous circulation.
  • less than 5% survived for a month afterward.
  • less than 2% survived a month with good cerebral performance.
  • 2% odds that the person will be healthy with a normally functioning brain.

He even went on to exclaim that if he were to collapse he would rather have a DNR (Do Not Resuscitate) order in place, rather than an attempt at CPR but please be obliged to call 911.

Sounds a little harsh I know and to some degree he’s right (I’ll get into why he’s wrong in a minute). The reality when it comes to CPR is that it is most effective if you witness the person collapse. There is an old saying in first aid circles that for the most part you only practice CPR because if you didn’t witness the collapse, there’s a good chance you’re not going to bring the person back.

The Red Cross gives some good statistics on this. Their research states that after 4-6 minutes of not breathing, brain damage is likely and after ten minutes major brain damage and death takes place. So we have a small window to have a great effect on someone who has collapsed if we weren’t there to see it.

Take a minute and imagine something for me:

You have a great weekend with your family celebrating some sort of very happy occasion. You decided to take Monday off because you just didn’t feel like going back to work yet and you want to just relax after such a great weekend.

You didn’t set the alarm, you can’t wait to put on a big breakfast for the family (whenever everyone decides to get out of bed) and hopefully the weather is good enough that you can get outside and do something fun.

You begin to wake up, the sun is shining in through the bedroom window and you stretch awake excited about the day ahead. You sneak out of bed so that you don’t wake your partner and get a jumpstart in the kitchen. Just before leaving the bedroom you look back but something doesn’t seem right.

Stepping closer to the bed, you reach out and shake your partner…no response. Diving to the other side of the bed you realize they’re not breathing.

In a panic you dial 911, the dispatcher takes your information and dispatches Ambulance, Fire and Police to your address. Keeping you on the line the dispatcher tries to get more information from you and attempts to coach you through doing some CPR but you’re so shaken you can’t do it.

Fortunately there was an Ambulance not too far from your address and within five minutes they’re at your house (although to you it feels like 20), then Fire Department arrives, then Police. They all stand there and look, asking you how long your loved one has been in this condition. You explain you woke up ten minutes ago and found them like this.

Looking down they cite several statistics as to why it’s not really worth it to do CPR since the outcome isn’t in their favour. Then they pack up their things and go on their way, wishing you their best as they leave your house.

A Better Ending, Peace Of Mind And What Would Really Happen

Fortunately there was an ambulance not too far from your address and within five minutes they’re at your house (although to you it feels like 20), then Fire Department arrives, then Police. You meet them at the front door and they start by asking you how long your loved one has been in this condition. You explain you woke up ten minutes ago and found them like this.

The Paramedics and First Responders go to work immediately upon entering the room while they are asking as many questions as they can to get a clearer picture of what happened. The police escort you out to your living room and gather up any other members of your family that might be there.

Sitting you down they tell you that it might be a good idea to start calling other family members to get as much support as possible. As time passes by, more Firefighters and advanced life support Paramedics show up. There are now between eight and ten people in your bedroom working on your loved one.

Using every bit of training, every medication and every last bit of knowledge they have, they work until getting a pulse again. At that point they transfer your partner to the hospital, however sadly their efforts are unsuccessful.

In the meantime more family members show up and you grieve with loved ones in your living room, having faith that these people are helping out.

Photo by: Greg Clarke

Photo by: Greg Clarke

What About Someone In Your Massage Clinic?

Imagine this is one of your patients in your clinic. You’ve had to call 911 because they have collapsed after your initial assessment and you find them this way coming back in the room. Are you confident in your CPR training that you took two and a half years ago? Can you do everything possible to help them out before the ambulance gets there?

The reality is, we’re not always going to be able to resuscitate everyone who has a cardiac arrest.

Here’s what some of the statistics say:

  • 88% of Cardiac Arrest’s happen at home
  • The life you save will most likely be a loved one (and I think we all care about our patients)
  • Effective CPR delivered immediately after sudden arrest will double or triple the likely hood of survival

What we can do is give each person’s family peace of mind that everything possible was done in order to help their family member.

Would you want your family member treated like the one in the first story?

Or would you want them treated like the one in the second story?

Even though there was little chance of bringing that family member back, we still make every effort to save them, so the family will spend the rest of their lives knowing someone tried to help.

The Reason Massage Therapists Need CPR And First Aid

Two weeks after this person collapses in your clinic and you helped them by calling 911 and doing CPR . The entire family shows up, eyes welled up with tears and pulls you in for the tightest hug you’ve ever felt because you did everything you could to help.

Every year after that at Christmas you get a card and a gift from the family saying: “thank you for trying to save our loved one”. You get to spend the rest of your life knowing that nothing else could have been done to help this person because YOU did everything possible to help them.

So yeah, the statistics may not be in favour of being able to bring everyone back to life. What I’d really like to see is the statistics that show how much their families appreciated the fact that someone gave a damn enough to try and rescue their loved one so they are in their lives another week, month, year or the rest of their lives.

While the Dr who wrote that article may rather have a DNR, how’s his family going to feel. Who knows maybe they’ve already filled out the DNR!?

Emergency Preparedness For Environmental Issues That Massage Therapists Face

It was so hot out you could fry an egg on your massage table.

Out of the blue a volunteer walks up supporting a guy with one arm draped over his shoulder and says “I don’t know what,s wrong with him, but he’s acting funny, you need to deal with this”, flops him on the table and walks away.

Umm okay, never seen this person before but I’ll see what I can do, thanks for the help by the way.  

He didn’t look too good.

He looked flush, he was dizzy, lethargic and had a headache. He had no idea what was going on or how he even got to my massage table.

Unfortunately athletes will sometimes ignore the warning signs that something is wrong and just try to push through a problem, which can sometimes lead to more serious issues.

This wasn’t just a case of an athlete trying to push through fatigue.

There was something bigger going on. He needed help and needed it quickly.

How To Handle Environmental Issues

It happens every year.

Organizers email, call and generally canvas looking for Massage Therapists to give treatments at their events.

Each summer charity events like runs, walks and marathons that are participated in where the people participating aren’t always prepared the best. A lack of proper preparation combined with the heat of summer can lead into some serious emergency situations that we should be able to deal with.

Here are three emergencies you should be prepared for…

  1. Heat Cramps

This is the initial sign that someone is having a heat related issue. The person will have severe and painful muscle cramps most likely caused by the salt that is lost during profuse sweating. Recognizing this and treating the condition properly is the best way to prevent things from getting progressively worse.

If we don’t deal with this the persons condition will continue to get worse and can lead into more serious problems that can become a medical emergency.

Fortunately, we are pro’s at dealing with this. Since heat cramps are involuntary muscle contractions, helping the person stretch and massaging the area is one of the things we can do to help them out. The biggest thing we need to do in order to prevent things getting worse is cooling the person down and getting fluids in them. At this point they have lost about 4% of their body water. 

  1. Heat Exhaustion

This is the first sign that the person’s body is losing the ability to control its temperature. Watch for the person to feel dizzy, nauseous and exhausted along with possible vomiting.

The ability to recognize this will be our biggest tool in preventing a medical emergency. There is a fine line between Heat Exhaustion and Heat Stroke (which is a medical emergency).

Heat Exhaustion is not a medical emergency…yet. Again just like with Heat Cramps, we want to cool the person down and get fluids into them. Do your best to get them out of the hot environment and get water or sports drinks of some sort into them to help balance out their electrolytes. This represents a loss of about 5% of their body water. 

Usually with treatment the person will begin to feel better.

Here is a detailed list of some actions you can take to properly cool the person and some guidelines for fluid intake.

  • strip off any excess clothing
  • get the person out of the heat and into some shade
  • use something to fan the person, getting cooler air around them
  • pour water down the back of their neck
  • put ice packs around their groin, armpits and neck
  • wet down one of the sheets you brought and wrap it around them
  • gradually give them something to drink, water is good but so are sports drinks to help get some salt back in their system. Give them 1/2 a glass every 15 minutes.
  • Continually monitor their ABCs
  • Do not let them return to competition, they need to rest
  1. Heat Stroke

This is the point where we have a medical emergency on our hands.

If we don’t treat someone having heat exhaustion and cool the body down it will lead into heat stroke, which is fatal if not dealt with promptly. The person has now lost 2% more body water compared to heat cramps for a total of 6%.  That percentage isn’t a huge number and it can happen pretty quickly. If the person gets to the point of a 10-20% loss of body water it can lead to death. So we need to act fast.

The signs and symptoms between heat exhaustion and heat stroke are similar with a couple of warning signs that things are getting worse.

  • The person stops sweating. This is important to know because it is the warning sign that their body is beginning to shut down and has lost the ability to cool itself.
  • A gradual loss of consciousness. This is not typical if someone has heat exhaustion and it is dealt with appropriately. It will only happen if the condition continues to worsen.

If you realize that things are progressing to heat stroke and this has become a medical emergency:

  • call for more help from other people around
  • call 911
  • send somebody to the main event entrance to wait for the ambulance so that they can guide the paramedics to your exact location.
  • stay with the person and monitor them in case they lose consciousness  and you have to help them breathe or CPR protocols need to be started.
Photo By: bark

Photo By: bark


Emergency Preparedness

Keep an eye out for things like this during your summer activities. If you are doing any massage outreaches in the heat try to be as prepared as possible before you go. Bring some extra water, sports drinks and ice or ice packs with you just in case.

And if anyone tries that whole frying an egg with coconut oil on your table, let me know how it goes. I love eggs.



How To Pick The First Aid Course That’s Right For You

There was an opportunity for a great job opening.

All I had to do was get my Occupational First Aid Level 3 (OFA 3) certification. It was  daunting because I’d have to use two weeks holidays from work to take the course and I had no idea what I was getting into but I wanted that job.

Didn’t matter, I was in.

I registered for the course with a local community college and was scared to death the first day as I had no idea what I’d be learning. There were all these new terms, mnemonics, and stress that I wasn’t expecting.

A full two weeks of practicing emergency scenario after emergency scenario and then came the practical exam. It was intense.

I watched a couple of students around me fail because they didn’t follow certain protocols. That only made me more nervous.

But I passed it and got the job I was hoping for.

It can get pretty confusing which First Aid course is the best one for Massage Therapists to take.

There are a variety of different levels, descriptions and requirements for each one.

In some places where it’s mandated to have your certificate, the companies to use may be specified by your College.

However courses can be offered by independent companies working under bigger national organizations, community colleges, private education institute’s, the national companies themselves and also by individual trainers.

So which one is the right course and who’s the best provider?

Here are the top four courses for a Massage Therapist to take and some ways to find the best providers to use.

How to Determine Which First Aid Course To Take

Standard First Aid CPR-C     

This course is a great starting point for Massage Therapists.

There are different levels of CPR instruction ranging as CPR-A, B, C and HCP (healthcare provider).

With each level of CPR you are introduced to a greater range of the population and given more responsibility. A CPR-A certification allows you to perform Cardiopulmonary Resuscitation on adults as well as learning how to use an AED (Automated External Defibrillator).

As you move up to a CPR-C it gets you into doing CPR on children and infants as well as learning how to use an AED.

With greater range in population and responsibility in CPR also comes more range and responsibility in delivering first aid. An Emergency First Aid Course (where typically CPR-A & B would be taught) only covers minor emergencies and wounds in addition to the CPR component.

With a Standard First Aid CPR-C you learn to deal with life threatening emergencies as well as how to deal with different injuries to prevent them from becoming a life threatening emergency. Various topics covered would include:

  • Airway, Breathing and Circulation Emergencies
  • Wounds
  • Head and Spine Injuries
  • Injuries involving Bones, Muscles, Joints
  • Sudden medical emergencies
  • Heat and Cold related Emergencies
  • Poisonings

All of the above are things that we as Massage Therapists could deal with in practice, at outreaches, on-site massage or even in day-to-day life with our families.

If you want to get just a little more advanced than a Standard First Aid, then the HCP (Health Care Professional) course would be a good starting point. It teaches you how to use devices other than your body to help people breathe as well as how to do Rescue Breathing, 2 person CPR and pulse checks (which you already know).

Workplace Emergency First Aid (W.E.F.A)

This course used to be called OFA 1 and was meant for use in various workplaces.

Much of the First Aid component to the course is very similar to Standard First Aid CPR-C. However since its intent is for employees in a workplace there is a far more legal aspect to it. There are entire components in the course regarding documentation of injuries and the First Aid that was performed on a worker. It also covers topics relating to:

  • Occupational Health and Safety
  • Workplace Written Procedures.
  • First Aid Records
  • Emergency Procedures.

While this course isn’t a typical First Aid course for most Massage Therapy clinics, I could see it being used in cases where a spa or larger clinic has employees instead of contractors.

Usually with this course one employee is designated as the First Aid person and any First Aid treatment, record keeping and First Aid room protocols are that employees responsibility.

First Responder

This is the course that Massage Therapists who want to be involved with sports teams should look into. More often it is becoming the standard course required by Sport Massage organizations and Sport Professional Practice Groups.

In some sport leagues and organizations it is a requirement for team therapists to have this certification. For instance within the BCHL the league has requirements that each team must live up to for game day operations. Their regulations stipulate that there must be:

  • A team trainer that is: A doctor or no less than; a licensed Ambulance Paramedic; Occupational First Aid level 2 or 3; a Registered Nurse; Certified Athletic Therapist (they graduate their program with a First Responder license) or a Licensed First Responder Level 3 with AED, Spinal Management and basic airway management endorsements.
  • An alternate medical person that must be at each home game to look after the treatment of players with all the same qualifications as listed for the team trainer.

At a minimum each team is required to have two First Responder Level 3’s at each game. So having this certification is not only a requirement to get involved, but may be a good stepping stone for those Massage Therapists who want to go this route with their career.

This course teaches you some more advanced care for medical emergencies and injuries in preparation to transfer the patient to Paramedics when they arrive on scene.

In the course you will learn:

  • More advanced CPR
  • Treating acute Soft Tissue, Musculoskeletal, Head, Spine, Chest, Abdominal and Pelvic injuries
  • Sudden Illness
  • Dealing with special populations, Childbirth (hope I never have to), Reaching and Moving People, Transport and Multiple Casualty Incidents

The closest equivalent course I could find for the U.S. is the Red Cross’ program “Basic Life Support For Healthcare Providers” (at least what I could find). Having this type of certification is important for working in these types of environments because the risk for injury is so much greater than a typical clinical setting. You are there to provide support to your athlete until ambulance arrives and the work you have done provides a base for the paramedics to work off of.

First Responder certifications also have limitations, they are meant to be used within certain distances from a hospital (typically under 20min travel time). This is the same certification most fire department personnel are trained to, as they are usually on scene to assist ambulance paramedics with medical calls.

With that in mind, the course is taught with the idea and assumption that you will be working with other trained responders and you would work together as a team providing care.

OFA 3 (Occupational First Aid)

This certification is the next step up from the First Responder program.

Although you learn many of the same techniques and protocols as the First Responder, you learn more about educating untrained people how to help. The course was intended for helping injured workers in industrial settings (logging, sawmills, heavy industry) with the assumption that you are the designated first aid person with untrained workers around you to help.

Where the First Responder program is designed to be within 20 minutes of a hospital, the OFA 3 is focused on providing advanced first aid for those more than 20 minutes from hospital, so you are also trained in transport. Learning how to position patients for loading on an emergency helicopter and how to provide care while transporting someone to either a hospital or an ambulance meeting you at a designated place.

For Massage Therapists this course would be good one for those who want to work in fishing lodges, heli-ski resorts, some tourism lodges and back country resorts. While it is probably not a requirement to get a job in these places it definitely wouldn’t hurt to have on your resume.

One of my friends who worked at a fishing resort said there were no other healthcare professionals on-site, so one of the guides was trained in first aid. We as healthcare professionals have a duty to help should something happen and our patients should have the confidence that we can help them in an emergency.

Photo by: Lyndsay Esson

Photo by: Lyndsay Esson


How To Determine Which Provider To Use 

The first time I did my OFA 3, I was registered with a local company and excited to start the course.

I talked to one of the First Aid attendants at work and told him I was proudly registered and ready to go. When I told him who I was taking the course with he instantly looked at me and said “cancel it, DO NOT take it with them”. Then he told me the best place and instructor to use.

This is a valuable lesson.

If you’re taking any level of First Aid training, talk to some of the local people in your community that are in the industry. Get advice on who the best teachers and providers are. When teaching courses I’m shocked when people tell me that they didn’t learn some of the basics the last time they took First Aid.

In the US the Occupational Safety and Health Administration (OSHA) identifies American Heart Association, American Red Cross, National Safety Council (NSC), and private institutions as the main providers for training.

In Canada some of the bigger providers are the Heart and Stroke Foundation, Canadian Red Cross, St. John Ambulance and Canadian Ski Patrol.

Many of the independent instructors work under a license to teach first aid from one of the above companies. Look for a provider offering courses that are nationally recognized. Each Province or State may have their own standard that you must meet, try to find the courses that are nationally recognized or easily transferable in case you decide to move, it will save you having to re-certify before your license expires.

With so many courses out there take your time to decide which one is right for you and your practice. Whether you’re in a clinic, a sports team or working in an outback resort having the right certification will be a benefit to you, your career and your patients.

Hopefully after you’ll do a better job than these guys.