First Aid - The future


Thirteenth annual scientific symposium of the Resuscitation Council

Introduction First Aid Training is a mammoth task, considering how many people there are who yet still do not know how to save a life! The efforts of training organisations are commendable, for few lessons are greater than that of stopping to help your neighbour (and in the case of first aid at work, your colleague). The responsibility of teaching lies heavily on their shoulders especially in terms of teaching protocols. There are often grey areas, as emergencies do not pose set-work book scenarios. As a result, instructors are confronted with questions that challenge these protocols. The First Aid Café website (www.firstaidcafe.co.uk) is certainly an effective forum through which instructors can get together to discuss, to give or receive advice, to clear issues or just simply lay their case.

Trainers all know and definitely advocate in their training, that in the treatment of casualties it is important to adhere to protocols. That sticking to these protocols is what is going to save the first aider in an event of any law suite being brought forward. Yet in terms of first aid and the law it seems not to be a very tried and tested field. Which may be a good thing for the first aider, does any ‘good Samaritan’really want to be sued for stopping and helping someone in need? But as any instructor knows this now gives rise to the question of protocols?

It is not uncommon to hear instructors discuss the protocols they teach and realise that there are more than just a few out there. The issue at this point is not to debate which protocols are the better ones to teach. It is generally accepted that most follow the guidelines as set up by the Resuscitation Council (UK). The point is that there are disputes and that instructors often need to discuss these. The first aid café seems to be an avenue for many instructors to do this. The question is, are any of the institutions regulating the protocols aware of the views expressed on this website. Many students expect black and white answers, therefore instructors knowing their legal responsibility also seek simple answers. Sometimes the answer is ‘wait – issue still under discussion’. This poses difficulties, since students who are undertaking training usually expect answers straight away.
Thirteenth annual scientific symposium of the Resuscitation Council Last month (November 02) saw the presentation of the thirteenth annual scientific symposium of the Resuscitation Council (UK). It certainly was true, that the symposium was suitable for healthcare and non-medical personnel. The papers presented were put across simply in clear understandable concepts. For some they created an excitement to be part of organisations that promote Resuscitation Training on a daily basis. Some subjects discussed that day touched on issues facing first aid instructors.
Dr. Jerry Nolan Dr. Jerry Nolan spoke on the subject that directly involves each one of us, ‘ILCOR: Process for Development of New Guidelines’. He discussed all the roles that the various organisations played. He also encouraged us to watch out for 2004, when the new guidelines from the Resuscitation Council (UK) are due to be released. The fact that he did not discuss the changes may have left some just a little disappointed but it is understandable that the symposium was not the forum for such matters but mainly to reveal new research and findings. Now instructors may have something to look forward to, new changes to the guidelines.

It may be that the Resuscitation Council will be looking at making the protocols simpler and easier to remember for the lay person. Could we be facing changes linked to the DR’S ABC such as;
  • the combining of the checking of breathing and circulation into one 10 second operation
  • simplifying the land-marking technique

the list goes on, as many will notice if they manage to spend time on the First Aid Café website.
‘The Brain – The Forgotten Organ in CPR?’ given by Dr. Carl Gwinnutt

The presentation ‘The Brain – The Forgotten Organ in CPR?’ given by Dr. Carl Gwinnutt, left many with the impression that more research will most probably change the way we view resuscitate in the future. To highlight the main points discussed in this session:

  • Low Blood Volume is as destructive as Low Oxygen when it comes to the Brain. Low Blood Volume causes the brain to release chemicals that causes rapid brain destruction. Full Blood Volume is needed when Resuscitating (how would this effect trainers in first aid training – probably to encourage students to get bystanders to hold both legs and arms in the air while performing CPR. Although this has not been made official through the Council, it certainly is seen as being beneficial to the patient. )
  • A Drug Cocktail required for both the heart and the brain in resuscitation – The benefits of adrenalin were recognised in the role that it played in resuscitating the heart, but research shows that it may not be so effective in resuscitating the brain. In actual fact that it may be speeding up the release of chemicals in the brain that cause brain destruction. Although Adrenalin was not being ruled-out as a drug of choice in resuscitation Dr. Carl Gwinnutt was advocating his research findings showing that a drug cocktail (drugs that would be good for both the heart the brain) was needed to resuscitate effectively. Due to this factor it was suggested that we may have to return to the terminology and practise of CCPR, Cerebral Cardio Pulmonary Resuscitation in the future.
  • Dr. Carl Gwinnutt also discussed the benefits of HYPOTHERMIA in resuscitation. He showed us comparative graphs of his research findings advocating the benefits of hypothermia (lowering the patients core body temperature) in resuscitation, especially in achieving survival without permanent damage. The tests were performed on dogs. The results showed that a higher percentage of dogs survived with no permanent damage using hypothermic therapy than dogs resuscitated without. He did point out however that more research was needed to determine exactly how we were to implement hypothermia practically with regard to resuscitating humans (e.g. do we surround the head, neck, groin, underarms with ice while resuscitating etc.)
Dr. Anna Forrest-Hay Another speaker Dr. Anna Forrest-Hay brought a new insight into the treatment of Anaphylaxis. She pointed out the importance of longer observation times being practised at AE’s due to what she called Bi-Phasic Anaphylaxis. This is the re-occurance of the Anaphylactic reaction within a 12 to 48 hour time period after the initial exposure, without re-exposure to the specific substance that caused the anaphylaxis in the first place. She stated that AE’s should keep the patient under observation for at least 8 to 12 hours before sending them home. If patient was being discharged, that relatives should be informed to keep an eye on the redevelopment of the Bi-Phasic Anaphylaxis for at least up to 72 hours after the initial contact. Although this, as yet, has not been introduced by the Resuscitation Council in first aid instructor guidelines, it is new research, a new finding and is being suggested as being beneficial to the patient.
Dr. Sam Parnia Dr. Sam Parnia kept delegates fascinated with the esoteric subject of ‘Near Death Experiences’. He discussed his research of scientifically trying to prove ‘the real and shared experiences’ of those who have been successfully resuscitated. One of the shared experiences of patients is that they speak of being aware of what goes on during the resuscitation process, although to the resuscitators they are showing signs of clinical death. Interesting point, that instructors may want to convey to their students.
Overall Overall the symposium made it clear that as an organisation, the Resuscitation Council (UK) was certainly involved in forging ahead in scientific research regarding Resuscitation. This should make training organisations look forward to the introduction of new guidelines in 2004.
In conclusion In conclusion, there is no denying that we are living in exciting times with regard to resuscitation. When protocols will continually be updated as they are tried and tested in the training world. The development of more effective protocols will probably include easier teaching techniques which would benefit the lay person. Making first aid easier to implement in times of emergencies by increasing the retention period with simpler protocols. The advancement of technology is an added bonus, making information accessible. There is no doubt that having a website like www.firstaidcafe.co.uk creates a forum where instructors from various training organisations can freely inter-react with each other, allowing them to constantly keep abreast of new ideas, keeping first aid in the public domain within everyone’s reach.
BIG thanks

Big thanks goes out to Rose Mary Labuschagne Pereira Training Officer,
Safety First Aid Group for writing the article.

Safety First Aid Group
www.SafetyFirstAid.co.uk

Safety First Aid Group Ltd. Is a leading provider of first aid products and training. Based in London they provide of a wide range of HSE approved courses and deliver custom courses to suit individual requirements. Contact Tel: 0208 203 7447 for details.

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