Emergencies: what to do

First aid, as the term implies, is the first contact that a victim of an accident has with non-medical aid. Administered promptly and calmly, first aid can often mean the difference between life and death or partial and full recovery.

Needless to say, it is important for each one of us to know the basics of First Aid, whether we receive formal certification in it or not. Here’s an A-Z list of some of the most common emergency situations you might encounter and the basic first aid techniques to handle them.

Anaphylaxis

Anaphylaxis is a life threatening allergic reaction that needs immediate medical intervention. Symptoms include plummeting blood pressure, narrowed airways causing difficulty breathing, vomiting, rashes and nausea.

An epinephrine injection (typically from an easy-to-use EpiPen, which sufferers usually carry with them) can mean the difference between life and death and must be administered while waiting for emergency medical care to arrive.

Asthma attack

Severe asthma symptoms include wheezing and tightening of the chest. If someone you know is having an attack, move the victim away from anything that might have triggered the attack – like pollen, smoke or strong odours – and look for a rescue inhaler to use (most asthma victims have a inhaler – common trade names are Ventolin, Aerolin, Ventorlin, Asthalin, Proventil and ProAir).

If you can’t use an inhaler, help the victim inhale steam from a bowl of hot water through the nose and exhale through the mouth.

If there is no improvement, call 999 immediately.

Bleeding

Clean your hands (or wear synthetic gloves if you have them handy). Pick out any debris from the wound site and use absorbent gauze to apply pressure to the source of bleeding for at least 20 minutes. If the gauze gets soaked through with blood, add an extra layer and continue applying pressure.

If the bleeding does not stop, use flat fingers to put pressure on one of the main arteries supplying blood to the wound. These main arteries are located on the inside of the upper arm, behind the knees and in the groin area.

Keep the injured person warm; and make sure blood flow to the brain is adequate either by raising the legs, or by positioning the head lower than the trunk. Finally, depending on the extent of the injury, get the victim to the ER!

Bruises

With bruising, the best practice to follow is the RICE treatment – Rest, Ice, Compression and Elevation.

Ice will reduce the swelling and pain while promoting healing. Apply ice for 15 to 20 minutes three or more times a day. Wrap a towel around the bag of ice before applying it to the injury to prevent frostbite. (By the way, ice is preferable to a chemical cold pack because it stays cold for longer.) After about 48-72 hours, and if the swelling is gone, you could try applying heat in the form of a warm washcloth for 10 minutes two or three times a day; that may increase blood flow to the bruised area, allowing the skin to reabsorb the blood more quickly.

Compression, or wrapping the bruised area with an elastic bandage, will decrease swelling. Do not wrap the bandage too tightly, though, otherwise the person will experience numbness, tingling, increased pain, coolness or swelling in the area below the bandage.

Elevate the bruised area on pillows while applying ice and any time when sitting or lying down. Keep it above the level of the heart to minimise swelling.

Seek medical attention if the bruise is accompanied by swelling and extreme pain, if a bone is possibly broken, if the bruise is unusually painful, or if it’s under a toenail or fingernail. You should also be concerned if the bruising happens easily or for no apparent reason, or if it is on the head and the person cannot remember what happened or lost consciousness.

You should also seek advice if the injured person is on a blood-thinning medication.

Burns and scalds

Burns are caused by contact with dry heat, scalds by wet heat. They require different types of treatment depending on the area affected and depth of the injury.

If the victim’s clothing is on fire, drop them on the ground and wrap tightly with heavy- duty fabric like a coat or rug. Roll them on the ground until the flames have been doused.

First-degree burns affect only the topmost layer of the skin, making it appear red and painful. Run the affected area under cold water for at least 10-15 minutes or until the pain starts to recede. Remove any jewellery or clothing around the burn and cover it with a sterile dressing (a clean plastic bag or cling film can also be used if nothing else is available).

Second-degree burns are more severe; they affect both the epidermis and dermis (top two layers of the skin) and typically involve red, painful, blistered and swollen skin. First aid for second- degree burns is the same as treatment for less severe burns, but with additional caution. Blisters must not be broken, and don’t touch any clothes or jewellery sticking to the burn site. After administering first aid, medical attention must be sought.

With the most severe type of burns – third-degree burns – all layers of the skin have been destroyed and there will be possible damage to underlying bone, muscle and tendons. The burn site is white, charred and without any sensation. First aid must be administered promptly by laying the victim down and dousing the affected area with generous amounts of cold water. Call emergency services immediately.

Check the victim’s pulse and breathing. Be prepared to resuscitate if necessary. Clothing, belts, jewellery or anything interfering with the burn site must be carefully removed – though anything stuck to the burn must be left untouched as it may cause further damage and infection. Cover the burn site with a sterile dressing, clean plastic bag or cling film. If the burn is on the face, it is best left uncovered.

No matter what the extent or depth of the burn, creams and ointments must not be applied without the specific recommendation of a health worker. Adhesive bandages must also be avoided.

Choking

Choking occurs when a foreign object becomes lodged in the wind pipe or throat. Common symptoms include hands clutching the throat, inability to breathe, or breathing forcefully and noisily, fingernails and skin becoming blue and/or an inability to talk. As choking cuts off oxygen supply to the brain, immediate action is required. A ‘five-and-five’ manoeuvre must be performed. Five blows to the back between the shoulder blades with the heel of your hand followed by the Heimlich manoeuvre five times should be executed alternately until the offending object is dislodged. Abdominal thrusts or Heimlich manoeuvre is performed by standing behind the choking person and wrapping your arms around his waist. A fist must then be made and placed just above the navel. With the other hand the fisted hand must be cupped and an inward and upward press must be performed.

On pregnant or obese people, the hand placement of the Heimlich manoeuvre should be slightly higher, near the breastbone. Children under the age of one must be placed upside down on your forearm and thumped firmly on the back until the object is dislodged.

If the victim is not breathing and / or the offending object is not getting dislodged, immediate medical attention must be sought.

Every year, thousands of children are treated in Emergency Rooms for choking episodes. Timely first aid given at home could easily halve this number.

Dehydration

Dehydration is a potentially dangerous condition where the body does not have adequate fluids and there is loss of body salts. Symptoms include dark urine, sticky and dry mouth, dizziness, fatigue, increased heart rate and possibly fever or loss of consciousness. Young children and older people are more susceptible to dehydration than others.

If symptoms are mild to moderate, encourage the patient to take in some fluid s, sports drinks and/or an oral rehydration solution should be undertaken. If you suspect more severe dehydration, it is best to seek medical intervention immediately.

Electrocution

Electrocution occurs when a person comes into contact with a live electricity source. Do not, under any circumstances, touch a person in contact with a live wire until contact is broken. If the victim is touching a high voltage wire like broken power lines, do not attempt any sort of intervention besides calling for immediate medical assistance.

Otherwise the first and most critical action you must take is to break contact either by turning off the power or by using a non-conductive object (like a wooden stick or a rope) to move the person away from danger.

Because of the rapid and severe muscle contractions that take place during electrocution, fractured bones and head trauma are possible; so moving the victim more than absolutely necessary is not advised.

Entry and exit burns also occur at points where electricity enters and leaves the body. They must be attended to by placing a sterile non-adhesive dressing on them.

Medical attention must be sought for any degree of electrocution.

Fainting

If you or someone you know experiences symptoms of fainting like dizziness, blurred vision, sweating and/or palpitation, make him sit or lie down. If sitting, position the head between the knees to improve blood supply to the brain. If lying down, elevate the feet above the head. Loosen any restrictive clothing or accessories. If normality does not return within a minute, seek medical intervention.

Food poisoning

Food poisoning happens when food is contaminated with bacteria or other pathogens. Bacteria may be present on food when you purchase it, or if it is handled improperly. Meats and seafood can become contaminated during slaughter or processing.

While not serious for most people, food poisoning can be more dangerous for babies and children, the elderly, pregnant women or those in otherwise poor health.

Symptoms of food poisoning may begin within 30 minutes of ingestion, or can start slowly and worsen over the course of several days.Symptoms generally last 24 to 48 hours. Symptoms, which can be mild or serious, include stomach cramps, nausea, green stool, vomiting, diarrhoea, fever and dehydration.

You can treat mild cases of food poisoning at home by avoiding solid foods and drinking plenty of fluids. Avoid alcohol, caffeine and sugary drinks – even full strength sports drinks – as sugar can exacerbate diarrhoea. Water is best, but you can give rehydration drinks to children or sports drinks mixed with water to adults.

The four Cs of food poisoning

To prevent food poisoning at home, remember the 4 Cs:

• Cleaning: Wash your hands regularly, especially after using the toilet, after handling raw foods and before touching readymade foods. Also, keep kitchen surfaces and cooking utensils clean.
• Cooking: Cooking foods properly – especially meats – should kill the bacteria responsible for food poisoning. Make sure meats are cooked thoroughly, and insure any food that is reheated is very hot all the way through.
• Chilling: Be sure to follow food storage instructions, especially if the label indicates a certain food should be refrigerated. When storing leftover food, cool the remains quickly in shallow containers and refrigerate as soon as possible.
• Cross-contamination: Cross-contamination occurs when bacteria is transferred from one food or surface to another. To prevent cross-contamination, make sure to wash your hands after handling raw meat, keep raw food separate from other foods, store raw meat in sealable containers on low shelves in the refrigerator to prevent it from dripping, use different chopping boards for meat and produce and clean knives, utensils and surfaces thoroughly after contact with raw meat.

Foreign objects in the eye, nose, ear, or skin

A foreign object lodged in the eye can be removed by opening the eye wide under a light source and using a wet cotton bud to gently remove the irritant. The eye must be washed out with saline water afterwards. If discomfort or itching continues, seek medical help.

If an object lodged in the ear is visible, a pair of tweezers can be used to gently pull it out. Insects can be flushed out using warm mineral oil. Simply tilting the head sideways can sometimes help dislodge an object using the force of gravity. If none of this works, and especially if there is any loss of hearing or pain, seek medical intervention.

If an object gets wedged in the nose, blow it out gently or use a pair of tweezers to pull it out if it is visible. Seek medical help if neither method succeeds.

Tweezers can be used to remove wooden splinters or glass projecting from the skin. If the object is completely embedded, wash the area thoroughly, sterilise a needle using alcohol, break the skin and pull out the offending object with a pair of tweezers. Wash the area thoroughly and apply an antibiotic ointment. If all fails, seek medical help.

Fractures

Typical symptoms of a broken bone include a combination of some or all of bruising, swelling, tenderness, severe pain, and an abnormally twisted limb.

If the fracture has an open wound, bring the bleeding under control and dress it. For any fracture, it is imperative to immobilise the broken bone and the areas directly above and below it; this can be done with wooden splints or even rolled-up newspapers tied with a string.

Ice-packs can be used to reduce swelling and pain, although do not place them directly above the broken bone.

If you suspect a fracture in the skull, spine or neck, it is not advisable to move the victim. Do not, under any circumstances, try to straighten the fracture or massage the affected area. And most importantly, call 999!

Head trauma

The skull is surprisingly tough and many head trauma cases require little professional help. But the reason it’s tough is because it needs to protect some very sensitive organs, and the victim should always be monitored for signs of a deeper injury.

Warning signs include discoloration in the area behind the ears or under the eyes, vomiting, slurred speech, unequal pupil size, bleeding from the ear or nose, disorientation and severe headache. Call 999 immediately if any of these symptoms develop.

Before help arrives, you can make the victim lie down with the head and shoulders elevated, apply firm pressure to any bleeding injury with clean gauze and monitor the victim’s pulse. As in other emergency situations, be prepared to resuscitate.

Heart attacks

Heart attacks are tricky for laymen to diagnose; the symptoms are often similar to those of indigestion. Typical signs include a tightness or pressure in the chest, nausea, dizziness, sweating, pain in the arm, upper back, or jaw, and general weakness. All these symptoms may last for up to 12 hours.

If you suspect you are having a heart attack, sit or lie down. Chew and shallow an Aspirin followed by a glass of water; if you have access to nitro-glycerine tablets, take three at five- minute intervals. If the pain does not subside, seek medical help immediately – delay could result in permanent heart damage.

If someone you know might be having a heart attack, make the victim sit or lie down and call emergency services immediately. If they have no pulse and are not breathing, start performing CPR and artificial respiration in a 15:2 ratio until help arrives.

Heat stroke

This is a potentially fatal condition resulting from an inability of the body to cool itself through sweating. Symptoms include very high body temperature, convulsions, hallucinations, no sweating and, in severe cases, loss of consciousness.

The victim must immediately be taken to a shady cool place. Remove their clothing and lower the body temperature using cool wet towels to sponge them off or spray with water.

To prevent the heat stroke victim from going into shock, get them to lie down with the feet placed higher than the head.

CPR

When a person is not breathing, CPR (Cardiopulmonary Resuscitation, or chest compression) is the technique commonly used to try to get the lungs to work again. It involves laying the victim on the floor and using the heel of your hand to compress the middle of their abdomen; wait for his chest to rise, then repeat the compression. This is performed 15 to 30 times before going on to rescue breathing.

Rescue breathing is performed by pinching shut the nose of the victim, tilting the head backwards with the chin up, making a seal over their mouth with yours, and blowing until the victim’s chest rises. Wait for the chest to fall and repeat.

CPR and rescue breathing are performed alternately till normal breathing is restored or until professional help arrives.

Hypoglycaemia

Hypoglycaemia occurs as a result of sudden and rapid drop in blood sugar levels. Although those suffering from diabetics have a much higher incidence of hypoglycaemia, others are at risk too.

Symptoms include uncontrollable hunger, dizziness, vomiting, clamminess, headaches, sweating and in severe cases seizures and a diabetic coma. In case of mild symptoms, the best remedy is to drink a glass of sugar-rich soda or juice.

If the victim is too disoriented to do so, or is experiencing light-headedness, emergency medical help must be sought and an injection of glucagon must be administered.

Even if normality returns, the sufferer should see their doctor – a more severe episode of hypoglycaemia could result in diabetic coma and possibly death.

Insect bites and stings

Allergic reactions resulting from insect bites and stings can produce swelling in the face, symptoms of shock, abdominal cramps, diarrhoea and nausea. Take anti histamine tablets, use cold packs on the affected area to reduce pain and swelling, and/or apply hydrocortisone cream to the site of the sting site.

If there is difficulty breathing, vomiting, swelling of the lips and throat, rapid heart rate, disorientation, hives, faintness or dizziness, seek immediate medical intervention. If you have epinephrine available, perhaps as an EpiPen, inject it in the thigh and follow up with a dose of anti histamines if the victim is in a position to swallow without choking. (Have the victim lie on their side or on their back with feet raised if there is any fear of choking.) Loosen tight or restrictive clothing. Monitor the victim’s breathing and pulse. Be prepared to administer CPR if necessary.

Near-drowning

If someone you know has had a distressing experience in water – characterised by pale skin, low body temperature, blue ears and lips, disorientation and/or inability to breathe, and possible a bloated abdomen – it is important to administer first aid immediately.

Remove wet clothing to prevent hypothermia and provide first aid for any injuries; perform CPR if the victim is not breathing, using chest compressions and rescue breaths in 15:2 ratio until the victim is revived

Poisoning

Unless the victim tells you that they have inhaled or ingested poison, watch out for signs of poison consumption – breath that smells of chemicals, chemical burns around the mouth, chemical staining on clothes or furniture, nausea, vomiting, difficulty breathing, confusion, seizures or abnormal skin colour and general malaise are all possible indications. Call the emergency services immediately.

You could check the poison control number listed on some household chemical cleaner bottles, if that seems to be the culprit.

While waiting for help to arrive, thoroughly clean out the mouth of the victim to remove trace amounts of poison if it has been ingested. If you suspect inhalation of carbon monoxide or other noxious fumes, flush out the victim’s eyes and nose with tepid water and get them into fresh air.

Start CPR if the victim stops breathing. Do not give the victim any medication to induce vomiting.

When the ambulance arrives collect the poison container, substance and any stomach contents that the person has vomited to help doctors determine the best treatment.

According to the Health Authority Abu Dhabi (HAAD), more than 90 percent of poisonings occur at home, and more than 53 percent involve children younger than six years.

Poison and Drug Information

HAAD has set up a Poison and Drug Information Centre in Abu Dhabi. From 7am to 3pm, the medical professionals at PDIC can give you information about medications and what to do in an emergency.

There’s a toll-free number – 800 424. And there’s lots of information and advice on website at http://PDIC.HAAD.AE.

After hours, dial 999 for an ambulance, or call HAAD anytime day or night on 800.

Seizures

Seizures occur when a person’s muscles contract and relax quickly. Although they are generally harmless, care should be taken to remove any furniture in the surroundings that may injure the person; and have the victim lie down with the head cushioned to prevent accidental damage to head.

Do not try to place anything between the victim’s teeth or try to make them stop convulsing.

In some situations, emergency medical intervention is required. Call 999 immediately if the victim starts another seizure soon after the previous one has ended, if the seizure lasts more than three to five minutes, the victim does not return to normality after the episode ends, or if this is the first time a seizure has occurred. You should also call 999 if the victim is pregnant or diabetic.

Shock

Shock, or more accurately circulatory shock, occurs when the blood circulation becomes inadequate due to loss of body fluids (including possibly blood or water) or a heart attack. If not treated immediately, it can result in death or permanent brain damage.

Symptoms include a rapid pulse that gradually weakens, shallow breathing that gradually becomes more laboured, nausea, thirst and paleness. Immediate medical intervention must be sought. In the meantime lay the victim down and raise the legs slightly; keep them warm but loosen any tight clothing. Be prepared to resuscitate in case breathing stops before help arrives.

Strains and sprains

When the body is forced to perform functions outside its capacity or range of normal motion, particularly in sports, sprains and strains can occur. Pain, swelling and possible muscle spasms may result. Your immediate plan of action must be to rest the injury, apply ice or a compress to reduce swelling and keep the injured area elevated. If discoloration or tingling occur in the affected area, it is best to seek medical help.

Tooth loss

Teeth that have been knocked out can sometimes be fitted back into their sockets if proper steps are taken before a visit to the dentist. Handle your tooth gently and rinse it in a bowl of water. Put the tooth in the socket and bite into either a piece of gauze or a moist tea bag to ensure it goes all the way in. In case it does not, you can temporarily preserve the tooth by placing it in a weak saline solution or some milk. Visit your dentist immediately.

Unused medicines

Once you have finished a course of medication as prescribed by your doctor, you should dispose of any leftover medicine immediately.

Follow the instructions for disposal included on the information leaflet that comes with the medicine. Due to environmental concerns, you should not flush medicine down the toilet or pour it down the sink unless the information leaflet specifically instructs you to do so.

If disposal instructions are not included, throw out unused drugs with the household trash. Pills should be removed from their containers and mixed with undesirable substances, like used coffee grounds. Liquids should be poured into paper towels.

When disposing of medicine bottles, scratch out identifying information on the label to protect your own privacy. Never give leftover prescription drugs to another person.