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I'm interested to know what peoples' opinions are regarding
administration by first aiders of aspirin to those suspected of
suffering a heart attack.
I've had a couple of cases brought into my dept recently who've
actually suffered a dissection of the aorta or a blown aortic aneurysm,
and of course because the signs and symptoms are identical to heart
attack as far as the first aider was concerned, they've been
administered aspirin.
I've always been aware of this possibility, and for that reason do not
teach first aiders to administer aspirin (I believe the VAS take a
similar stance?), but I understand that some first aid instructors are
still teaching this.
Recent events however, have just brought this home to me, and I can't
help feeling that the risks associated with aspirin far outweigh the
potential benefits, particularly as so many ambulances are now meeting
the 8 minute target for chest pain.
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Within my field of training, I DO NOT ALLOW the administration of an asprin. The people we care for may be on , for example, warfarin. I am concerned that first aiders will feel they can openly give medicines, when this is certainly not the case. I advocate that the only time asprin can be given is if the service user is written up for it as it was prescribed by the GP I seem to recall research that indicated the asparin could be given within the first 10 min and would be successful, so therefore why not wait for the ambulance? Hope this assists
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Yes, I agree with you. Administration of medicines in any case is not
really a good idea for the first aider, but this one inparticular seems
particularly frought with difficulties.
The patients I mentioned both had classic heart attack signs &
symptoms (chest pain, pale face, sweating, weak irregular pulse etc.),
but their cause was an internal bleed from the aorta. Adminstration of
aspirin just made them bleed out even more, and one of them very nearly
died.
Aspirin of course does have a use in treatment of
heart attack, but I think it should be used with as much caution as
thrombolysis - ie only after definitive diagnosis. I don't see how it
is in anybody's interests for the first aider to do it.
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There is nothing stopping a first aider in administering aspirin for heart attacks providing they follow the instructions/guidelines laid out within a well researched first aid manual. The 8th edition and nearly all other FA manuals advocate its use in this situation. That said, I agree with Mr Dog and 24601. I suggest to my students that they should not administer it for the following reasons: 1. There are people out there who are highly allergic to aspirin 2. There are asthmatics who are triggered by aspirin 3. There are people with gastric bleeds which can be excacerbated by aspirin 4. There is research suggesting that whilst the beneficial effects of aspirin are well documented and agreed, the administration of aspirin could be given within 24hrs - so let the hospital give it! 5. Aspirin is not on the Emergency list iaw Medicines Act 68 (Article 7) and as such is not regarded as a life saving medication. Of course the exception to all of the above being if it is the casualties aspirin, we can assist any casualty in taking their own aspirin. Hope this helps Paul
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I am no medicines expert but the part of the medicines act you are ferfering to Scedual 7 refers specficaly to prescribtion ony medication not genrals sale list medication.
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I'm not sure exactly of the finer details mountainman, but there are also clauses within either that or another act (I'm no legal expert) which state that a person may not administer a substance other than to himself unless prescribed by a doctor (or obviously a nurse/paramedic/midwife etc.). Therefore all medications (no matter what list they're on) should be treated as prescription only unless you're giving them to yourself.
I'm not sure if there is provision under the act for administration of aspirin contrary to that rule in an emergency, but even if there is that doesn't necessarily mean it's right to do so (after all, the law says I can shoot a welshman from 12 foot on the english-welsh border, but it doesn't mean I should!)
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I personaly support the giveing of asprin by first aiders. Like anything it needs clearly defined protcols but if done within thease protcols i relitfly safe.
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the law says I can shoot a welshman from 12 foot on the english-welsh borderIs this true? I know you can shoot a dog that is worrying sheep, but I didn't know you could shoot a Welshman! 
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But the point is thought that it ISN'T safe. All of the signs & symptoms of heart attack turn out to be that in maybe 7 or 8 out or 10 cases, and giving aspirin is beneficial; however in the other 2 or 3 it is lethal. In the first aid setting, there is no way of distinguishing. Given that aspirin administration can safely wait for an ambulance to confirm diagnosis, I don't see how it is in anybodys best interests for the first aider to give it.
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I said relitfly. Asprin if given within protocls ie to consiouse people, over 16 not on anti coags no history of cloting disorders no history of gastric bleeding not asthmatics not allergic. There is a risk with evrything so nothing is safe but with risk reduction and in an environment where first aiders recive update traing the it is possible.
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Jonacc What about jocks? are we to be shot for worrying sheep? It`s well, I`m a jock and I worry the beasts of the wool! Indeed I am banned from Dartmoor for my behaviour
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Scotty You like the ponies there, do you? 
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But WHY? If we can eliminate that risk altogether by waiting 10 minutes for the paramedics to do an ECG and then give it?
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As i understand it asprin should be given befor an ECG. Certainly this has been the case at events I have been up. asprin first ECG later.
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Yes, I know - and that's what I'm trying to challenge! There's no need to give it before the ambulance comes and does the ECG
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yep but what I am saying is the ambulance crew are going to give asprin first and then do an ECG. I can apretaite your arguments and like many things it is going to come down to the people useing the drug are the first aiders in a shop who may treat 2 paper cuts in 3 years or are they part of a structured organisation reguly seeing patients with medical oversight and clearly defined protcols eg VAS MR teams the better PAS. If it is the later group the asprin is sensible.
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The ambulance crew shouldn't be giving aspirin before ECG (or some other confirmation that the patient isn't bleeding), round here that's almost a sacking offence.
And it's nothing to do with the setting the first aider works in, or how skilled and well practiced they are, the point is that I don't see how aspirin can be a justified first aid measure.
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JRCALC guidlines state that the indications for asprin are : Adults with central chest pain, Possibly of cardiac orgin. Unless asprin is contra indicated. Asprin should be administerd to any patient with chest pain unless the diognosis is clearly non cardiac. I take that to mean no need for an ECG.
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I am well aware of that but there is a growing body of opinion against such use of aspirin. See http://bmj.bmjjournals.c...nt/full/308/6945/1713/a , for example. Furthermore, almost all of the evidence for early administration of aspirin is based on a 4 hour wait to thrombolysis. Nowadays, most patients receive thrombolysis within 30 minutes of entering A&E (some even in the ambulance), and others will even receive primary angioplasty. There is also much disagreement regarding when exactly aspirin should be given. This study (http://emj.bmjjournals.com/cgi/content/full/18/6/478?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=aspirin+chest+pain&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT) seems to be the most thorough, and suggests that it can safely be given within 24 hours. It does make the recommendation for a health professional to give it prehospital for chest pain suggestive of ischaemic heart disease. This is not the same as a first aider giving it to anybody with chest pain. The guidelines are simply outdated!
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Further to the ECG comments which you now seam to have changed your tune on the second article you gave me (Woolard M et al 2001) specificaly states that Asprin should be given befor an ECG and that one service does ask for an ECG and that this os of some concern as ECG changes may not be present till later (Adams J et al 1993). The article goes on to descourgae a rigid approch in the administartion of asprin to people with confirmed MI. It does however as you have pointed out raise questions about the importance of the time scale with which it is given but lake of evidence is not the same as it can be given later. Arguably many areas such as spinal imobilsation lack a strong evidence base. Terry and Davies (2001) also state the benifit of asprin within the first hour for maximum effect although they do comment that other facotrs may need to be taken into account. In my opinion this could be done through good medical control and protcols. No doubt we can keep going on the articles but I belive there is a case for some first aiders to administer asprin
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