First Things to Be Done in Emergencies – Providing First Aid for Health Professionals First Things to Be Done This publication has been published by the following project: in Emergencies – Providing First Aid TÁMOP-4.1.2-08/1/A-2009-0061 for Health Professionals © József Betlehem PhD, 2012 by József Betlehem Authors: József Betlehem Ph.D. Krisztina Deutsch M.Ed. Nikolett Gál M.Sc in PT. Tamás Köcse M.Ed. József Marton-Simora M.NS. András Oláh Ph.D. Gábor Nagy M.D. Proofread by Zsigmond Göndöcs M.D James Garvey Ph.D. Medicina Responsible for Edition: Director of Medicina Publishing House Co. Published by: Commissioning Editor: Katalin Benjámin Medicina Könyvkiadó Zrt. ● Budapest, 2012 Technical Editor: Imre Dóczi Number of figures: 119 db © József Betlehem, 2012 illustrations: Zoltán Bodor © Authors, 2012 Identification number: 3587 ’Anyone can have an accident Contents anywhere any time.’ Dr. Bán S. István Foreword / 7 1. The Significance of Administering First Aid in Today’s Society / 9 (by Krisztina Deutsch) 2. Recognition of Status in Case of Emergencies / 20 (by József Betlehem and Krisztina Deutsch) 3. Patients’ Examinations and Making Decisions / 30 (by Gábor Nagy) 4. Asking for Help, Calling an Ambulance / 63 (by József Betlehem and József Marton-Simora) 5. Basic Life Functions / 73 (by András Oláh and Nikolett Gál) 6. Immediate Interventions Supporting Life Functions with or without Appliances / 80 (by József Betlehem and József Marton-Simora) 7. Automated External Defibrillator / 102 (by Gábor Nagy) 8. Primary Care of Unconscious Patients / 107 (by József Marton-Simora and Gábor Nagy) 9. Care of Patients with Foreign-body Airway Obstruction / 119 (by József Marton-Simora and Gábor Nagy) 10. Further Care of Conscious Patients / 126 (by József Marton-Simora) 11. Accident Occurences / 136 (by József Betlehem, Tamás Köcse, József Marton-Simora and Gábor Nagy) 12. Sicknesses of Internistic Nature by Nature / 181 (by József Betlehem, Tamás Köcse and József Marton-Simora) 13. Assisting Childbirth / 210 (by Gábor Nagy) 14. Relatively Common Paediatric Occurrences Requiring First Aid / 221 (by József Betlehem) Tests / 227 Answers to the tests / 263 — 5 — Foreword — 7 — First Things to Be Done in Emergencies – Providing First Aid for Health Professionals 1. The Significance of Administering First Aid in Today’s Society Krisztina Deutsch The content of chapter The social i.e. legal and moral requirements for rendering assistance The relationship between the health care system and first aid The psychological effects, motivation or apathy towards first aid assistance Bibliography — 8 — — 9 — First Things to Be Done in Emergencies – Providing First Aid for Health Professionals 1. The Significance of Administering First Aid in Today’s Society The social i.e. legal and moral requirements for rendering assistance Administering first aid and being prepared to do so and consequently its quality is an organic part of every nation’s health culture. The international epidemiological data show that the most common situations that require first aid, namely accidents, in the world appear as the third most common Household School Sport reason for death after vascular and tumorous diseases. That is why the fast recognition of the given actualities and performing the first basic life saving primary activities get a special emphasis since they fundementally define the further life of the person in trouble by decreasing the chances for premature death on one hand and improving the quality of life after survival on the other hand. Teaching the basic phases of first aid is not only important for professionals in the developed countries of west Europe but it acquires a significant role in the education of non-professionals and it is attached to the shaping of a helpful attitude from a very young age on. This bears a special signifi- cance because the first witnesses of accidents or sudden health impairments are usually members of the family, friends, acquaintances or co-workers. Consequently the responsibility is theirs to try to help the one in trouble as best as they can. The knowledge of the basic principles of first aid is indis- ticlopidine pensable for administering proper help and it ought to be continuously updated. Work Vehicular traffic Consequently during the education of the health care professional staff the practical knowledge of basic life support interventions require special attention irrespective of their specialist areas or Illustration 1/1 The most common accident locations disciplines. The legal and moral obligation to be able to perform life saving interventions in case of emergencies can be expected from professionals graduating at degree level in health science edu- cation in disciplines such as education in the area of nursing, medical attendance, health care, pre- themselves in and the objective environment in question and to prevent the development vention, management, medical laboratory and visual diagnostical analyst and also on some other of further damages. majors resulting in a Bachelor’s degree. Out of these the most important point of view has to be to save the human life and to stop During the last decades the techniques that can be applied in such situations have been simpli- or delay the damage to health. fied a great deal on the basis of the newer scientific achievements on one hand and for the sake of In a narrower sense first aid can be defined as the application and treatment of the in- easier acquirement and implementation on the other. Besides the technical simplification there has jured person within the context of first aid knowledge. been another very important point of view, namely taking into consideration the degree of scien- tific data that underpins the interventions that we perform in case of emergencies. With the flare of The basic book noted by the St. John (the Johannitas) Ambulance Service and the British Red Cross professional medical knowledge more and more scientifically based practical knowledge evolves, a says ’ first aid means the first help or medical attendance given to the injured or people who became sud- substantial amount of which can be used in non-professional education as well. A good example to denly ill’. the latter is the application of the automatic external defibrillator (AED). According to Aurél Gábor ’We call first aid the health attendance that is performed either by a (Illustration 1: Most common accident locations) medical professional or a non-professional before starting the final medical attendance in order to delay Before the exposition of the chain of survival and the factors influencing the first aid process it is the direct consequencies of an accident or of some sudden health damage and also to keep off further subservient to define what first aid application is. decline of health and eliminate newer or secondary damage. Róbert Almási says that ’administering first aid is not only a skill or ability but it is also the unity and In a complex interpretation first aid application expresses all the primary activities around harmony of intention, knowledge and action.’ the person in trouble that are aimed at the elimination of the dangers that people might find — 10 — — 11 — First Things to Be Done in Emergencies – Providing First Aid for Health Professionals 1. The Significance of Administering First Aid in Today’s Society Two new concepts have been introduced in the last decades which interpret first aid in a less The relationship between the health care system and first aid wide sense. They characterize those situations from the point of view of health care when immediate help really might be necessary. The injured or health damaged patient gets medical assistance within the frames of the chain of Urgent need is ’a change in the state of health as a result of which the patient’s life would either be survival from the first level of non-professional first aid to the highest level of hospital treatment directly threatened or badly or permanently damaged in lack of immediate medical attendance.’ while each medical level is built on each other, being connected as chain links. Consequently the Endangering state is ’the state when the lack of immediate arrangements would either result in efficiency of each medical assistance level fully depends on the efficiency of the previous medical a situation that would endanger the patient’s or another person’s life, body integrity or health or would assistance level, thus determining the further outcome of the patient. (Illustration 4: The units of the mean direct danger to the surroundings. ’ saving chain in Hungary In Hungary helping a person in trouble is a citizen’s obligation even at a non-professional level and it is specified in Act CLIV of 1997 on Health. ’It is everyone’s obligation to help in a way which The chain of survival includes the following medical assistance levels and activities: can be expected from him/her and notify the authorized health care server in case an urgent need or an 1. non-professional first aid endangering state is noticed or heard about. 2. notification of professional aid providers The above statement is even better understandable if we put ourselves into the position of 3. ambulance assistance someone who is in trouble, who expects help, since according to the previously mentioned law 4. hospital treatment ’Every patient is entitled to get life saving medical attendance or attendance that ensures the preven- tion of bad or permanent health damage and also his pain to be soothed and his suffering to be lessened.’ The non-professional first aid provider usually does not possess professional health care knowledge People working in the health care system are especially obliged in this respect to administer and reliable practical experience consequently a difficult job awaits him at the location of the ac- help in an urgent need. ’In case of urgent need people working in the health care system provide first aid cident.2 Naturally, depending on the situation, first aid can be given by a qualified first aid provider to the person in need of it among the given circumstances as it can be expected of them and depending who bears the knowledge of first aid and specific professional medical assistance. Other than this on the equipments available. They are to take the proper action. In case of doubt the occurence of urgent first aid without appliances and medication can also be applied by a doctor. need has to be opinionated. If the expected first aid is cancelled then, according to the law, ’The person who does not help H an injured one or someone whose life or body integrity is directly endangered in a way he can be expected to do, commits a misdemeanor and can be inprisoned for two years’. 1 (Illustration 2., 3.) INSTITUONAL CARE Emergency rooms, wards, centres AMBULANCE CARE Units of ambulance on land and in the air, extended care, transportation PROFESSIONAL AID Professionals with health care qualifications NON-PROFESSIONAL HELP Co-workers, friends, relatives, strangers Illustration 1/2 A non-professional is Illustration 1/3 A healthcare worker is helping the helping the person in trouble person in trouble Illustration 1/4 The units of the saving chain in Hungary — 12 — — 13 — First Things to Be Done in Emergencies – Providing First Aid for Health Professionals 1. The Significance of Administering First Aid in Today’s Society The first thing to be done after having noticed the incident is to request professional help by The psychological effects, motivation or apathy towards calling an ambulance (see in more details in a later chapter). The further first aid assistance car- first aid assistance ries out the necessary immediate actions and stabilizes the patient’s status until the professional health care givers get there. Then the professional staff and appliances of the ambulance allow the Providing first aid, as an activity, is built up of several psychological and physiological ele- professional specialist’s higher level assistance on the spot. During transportation the medical ments. Action happens only after perceiving the stimuli of the environment which are structured staff of the ambulance (the ambulance driver, ambulance nurse, ambulance officer or an oxyologist into meaningful units i.e. they are sensed and recognized. The extraordinary circumstances, the rec- - emergency medical doctor) monitors the status of the patient and performs the proper medical ognition of a situation that demands an immediate intervention evoke strong pressure and a height- applications according to the changes in status. This is the control during transportation. The re- ened emotional state in the first aid provider. Experiencing the given stressful situation and then the ceiving institutions are health care institutions that are apt for some level of emergency assistance alarm reaction that appears as the response of the human body evoke an increased activity of the (emergency room, emergency ward) where the patient’s status is tested based on newer and wider sympathetic nervous system. All of this result in the rise of the pulse, the number of breaths and a scaled diagnostic opportunities first and the patient is either given final assistance or the required higher blood pressure besides the increased functioning of the digestive system. further specialized treatment is taken care of afterwards. Numerous, psychologically and sociologically based, explanations exist about why we should All in all the first aid provider plays a key role in emergency care since the first minutes fol- help or why we do not help our injured fellow-men or women in trouble. lowing an accident are critical from the point of view of the further chances for survival. His ability Psychology assumes altruism i.e. the kind of unselfish behaviour in the background of adminis- to recognize the given situation, his actions and calling for help are of crucial importance in terms of tering help in case of emergencies that does not serve one’s own interests but that of his fellow-man the further process of the subject needing help. His psychological support can have a calming and or woman. In other words, empathy is emphasized. Consequently the higher the empathic skill, the reassuring effect. higher the drive to be helpful. It has been observed that altruistic behaviour is more common with Taking the directives of the European Resuscitation Council into consideration the graduates of acquaintances, friends than with strangers or less carismatic individuals. Since this behaviour goes health sciences education, as qualified first aid providers, have to be competent in performing with advantages both for the helper and for the helped person, it is called reciprocal altruism by the following activities no matter what area they had specialized in: psychology. • recognition of the situation in case of an emergency Prosocial behaviour is a sort of behaviour that is aimed at helping others and it always goes • fast patient’s examination and decision making with social rewards. This is mostly a demeanour that appears in the family among relatives. Conse- • calling for help (ambulance) quently the stranger the person who needs help is, the smaller the chances are for the help that the • immediate interventions for supporting life functions helped one would benefit more from than the helper. • resuscitation without appliances According to the exchange theory model the person giving help receives symbolic resources • primary care of unconscious patients in return. This model claims that the person undergoing trouble, being in an emergency situation ex- • further care of conscious patients periences a feeling of pressure which is based on the grounds of empathy. The more we are capable • further care of choking patients of empathizing with the position of the other one, the stronger the feeling of pressure and also the • the application of an Automated External Defibrillator (AED) desire to act are. In pursuance of the altruistic model our self-confidence grows by providing help. Giving help can also be the consequence of embroilment when assisting with help means a smaller Employers are required to employ a qualified first aid provider whose job is to recognize sudden loss than its omission and then the subsequent negative condemnation from the society’s part. It is health damages related to work and to perform primary care using the first aid kit supplied by the put into words by György Csepeli the following way: workplaces. ‘The motif of providing help derives from the negative feelings originating from the violation of norms, the avoidance of a sense of guilt and a twinge of conscience.’ 3 There have also been research done concerning how the mood of people, the type of settlement, the differences in gender and the relationship factors influence help providing attitudes. John Darley and Bibb Latané reported the following results: — 14 — — 15 — First Things to Be Done in Emergencies – Providing First Aid for Health Professionals 1. The Significance of Administering First Aid in Today’s Society The momentary positive mood increases the inclination to give help in several ways but the In every culture people are more likely to help a member of their own group than a stranger in negative mood is not necessarily a decreasing factor since giving help can improve negative mood the group. 80% of all heart attacks occur in the home, hence the casualty is going to be a loved one, and sadness. This was named a negative state relief hypothesis (Cialdini and co-workers, negatív - state a relative, a person for whom we care about. reliefe hypothesis, 1987). In the context of differences in gender and providing first aid it turned out that women help In relation to the type of settlement several case studies and experiments have proved that the more often and more in simple routine situations than in real emergencies whereas in trems of stran- more people are present at the spot of the accident or the emergency, the smaller the chances are gers men tend to be more helpful. In cases when the person who needs help is female or if others for giving help. are also present at the location of the emergency the differences between the genders is even more We have already known for a long time from socio-psychological research that people tend to obvious. wait for each other in first aid assistance. Sándor Márai, the Hungarian writer, also recorded an inci- The ensurance or rejection of giving help is the result of human decisions in which the per- dent of the sort: ‘In a New York district a young woman was stabbed to death in the early morning hours. sonal value system and habits, family or institutional upbringing, moral points of view, the knowl- Hearing the screaming of the victim the neighbours hurried to the windows but nobody called the police. edge and skills at hand, further more, the state of mind and the social expectations are tightly con- The police questioned the tenants of the area who confessed that thirty-seven! of them were watching nected. Lendvai (1986) sums up the the motivating and inhibiting psychological, cognitive and from their windows as the murderer killed the screaming victim but they did not make telephone calls social factors as they are listed below. because they were afraid of getting involved.’ It is known as ‘by-stander apathy’. According to what they According to this the driving factors of providing first aid are as follow: said each eyewitness thought that somebody else would notify the police. Then a hypothesis was • wanting to help created in pursuance of which paradoxically giving help is obstructed by a lot of people present. • being sorry for the person in need of help According to a sociological explanation belonging together is less characteristic of big cities and • proving worthiness to oneself and to others this situation alienates the individual from the group. Withdrawal from the accident and the need • pressure of conscience to satisfy potential unconscious sadistic instincts were traced as possible reasons by psychologists. • sympathy towards the patient • being related to or acquainted to the patient Concerning relationships the seemingly almost evident thought was confirmed that the closer a • helpful mentality relationship is, the higher the probability rate of giving help is. In this case the nature of the relation- • family and/or school example ship is also a determining factor (Illustration 5.) • highly developed emphatic skills • acceptance of life • being against death • searching for new things, curiousity • interest in extraordinary things • prior practical exercises done during education • success or failure during earlier first aid assistance • the request and encouragement of the people present • feeling of dutifulness The obstructive factors of providing first aid are listed as follow: • feeling of fear and uncertainty • lack of professional knowledge and practice • sensing blood, smells, seeing vomiting • passivity as a habitual factor • family relationships Illustration 1/5 The ones who provide help sometimes work in the presence • lack of earlier positive examples of a large group of people — 16 — — 17 — First Things to Be Done in Emergencies – Providing First Aid for Health Professionals 1. The Significance of Administering First Aid in Today’s Society • pitifulness Jogszabály: az 1978. évi IV. törvény a Büntető Törvénykönyvről 172.§ 1. • repulsion of death Larsson, E. M., Martensson N. L., Alexandersson, K. A. (2002) First-aid training and bystander actions at • inability to make decisions traffic crashes - a population study. Prehospital and Disaster Medicine, 17;3: pp. 134-141. • the effect of the atmosphere of panic Lendvai, R., Hesztera, A. Birosz, B., Kiss, B., Pojbics, E., Puskás, T. (1986) Az elsősegélynyújtó „modell alak” • lack of confidence and/or faith in success pszichológiai vizsgálatok tükrében. Magyar Mentésügy, 6;4: pp.163-166. • lack of initiative skills and perseverance Lendvai, R. (1998) Az elsősegélynyújtás lelki tényezői. In.: Lendvai R. (ed.): Elsősegélynyújtás. Magyar • fear of difficulties and/or infection4 Máltai Szeretetszolgálat. Budapest, .II.1.-II.22. Mauritz, W., Pelinka, LE., Kaff, A., Segall, B., Fridrich, P. (2003) First aid measures by bystanders at the place In Hungary ’barely 10 % of road accidents are accompanied by any kind of first aid assistance not to men- of accident. A prospective, epidemiologic study in the Vienna area. Wien Klinische Wochenschrift, tion their poor quality. However the 60 % rate of the same kind of activity in Germany evoke a high degree 115: pp. 698-704. of dissatisfaction there.’ (Árki, 2002)5 Nagy, L.. (1995) Az emberi motiváció. In.: Bernáth, L, Révész, G. (ed.): A pszichológia alapjai. Tertia Kiadó. Budapest, p.194. Therefore there is much to be done in the area of first aid in Hungary both in the establishment of Paterson, G. J., Newman, L., Crawford, R., Lee, T., Armstrong, J.V.(2003) Az elsősegély alapkönyve. Mérték the first aid providing attitude and in the transmission of theoretical and practical knowledge Kiadó. Budapest,. p. 11. about first aid. Families, educational institutions, workplaces, professional and civil organizations have emphasised tasks to be done in this area.as well as health science educational institutions Bibliography Almási, R. (2007) Az életmentés alapjai. AN-IN-TER Bt. Kaposvár, pp. 5-12. an de Velde, S. et al. (2007) European First Aid Guideline. Resuscitation, 72;2: pp.240-251. Árki, I. (2002) ’Egészséges Nemzetért’ népegészségügyi program: beszélgetés Gőbl Gáborral az Országos Mentőszolgálat főigazgatójával Családorvosi Fórum, 7: pp.48-49. Bán, S. I. (1947) Első segély. Budapesti Önkéntes Mentőegyesület, p.1. Csepeli, G. (2003) A segítségnyújtás. In.: Csepeli G. (ed): Szociálpszichológia. Osiris Kiadó. Budapest, pp. 327-333. Darley, J. G.(1983) Latane, B.: Mikor segítenek az emberek egy válsághelyzetben. In: Szilágyi V. (ed) (1983):Együttérzés, önzetlenség, felelősség: A proszociális magatartás vizsgálata. Tankönyvkiadó, Bu- dapest pp. 20-36. Gábor, A. (1972) Korszerű elsősegélynyújtás. Budapest, Medicina Könyvkiadó Gőbl, G. (2001). A sürgősségi betegellátás rendszere és jogi háttere. In: Gőbl G. (ed): Oxiológia. Medicina Kiadó. Budapest, pp. 75-105 Jogszabály: A 1997. évi CLIV. törvény az egészségügyről, 125. §. Jogszabály: A 1997. évi CLIV. törvény az egészségügyről, 3. § i). Jogszabály: A 1997. évi CLIV. törvény az egészségügyről, 3. § j). Jogszabály: A 1997. évi CLIV. törvény az egészségügyről, 5. § e). Jogszabály: A 1997. évi CLIV. törvény az egészségügyről, 6. §. — 18 — — 19 —