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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.

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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.

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”!