first aid question - Page 2

Some forum members choose to start their posts by saying things like "I'm a ski patroller". I presume they do this to try and add credibility to their post. If a post includes a sentence like that I assume that the forum member is a ski patroller.

This advice was offered to me by a ski patroller on this forum....

If your not trained on how to open an airway without moving the head than you may do more harm than good

Offering that advice to a random person on the internet would seem to undermine the American Heart Association BLS guidelines that a lay person should apply head tilt chin lift if they come across an unconscious casualty with head injuries.

First, about the gloves. We're told that ski gloves are not an adequate barrier, nobody I've heard ever specified gore-tex or not. Are your gore-tex gloves seam sealed? Is it the same Gore-Tex quality and weight as those gowns? I've had old gore-tex clothing rip, and was amazed how shredded the membrane was, whether from through the wash a few times, or from stretching over and over again. Those Gore-Tex gowns claim to stand up to 60 steamings. Would you bet your life on those gloves?
second, sorry to hear your concerned. different patrols train to different standards, but we are all trained. We are not trained as medical researchers, but are trained to stabilize and transport without causing further injury and get the patient to a higher level of care. I wouldn't ask an internist the intracacies of how to prevent infection, and wouldn't ask an epedemiologist about my abdominal pain if I wanted an absolutely correct answer. I hope a couple of off the cuff comments on a message board doesn't sour your impression of Ski patrol in general.

[quote=2-turn;876590]

I think you make some really valid points about gloves there, ofcourse I've seen medical gloves rip while treating a patient as well, but I guess at least with medical gloves (unlike ski gloves) you can look at them and tell that they haven't been compromised. It's great to read a well thought out answer to my original question about whether Goretex gloves provide protection.

I have no problem at all with being wrong, I just wasn't impressed by ill informed answers like "Goretex is permeable it provides no protection whatsoever"

I have every confidence that if I hurt myself on the hill over easter i will be very well looked after. My beef was that ski patrollers are experts in providing care on the mountain, not in giving advice on things that are beyond their training.

If your not trained on how to open an airway without moving the head than you may do more harm than good

Offering that advice to a random person on the internet would seem to undermine the American Heart Association BLS guidelines that a lay person should apply head tilt chin lift if they come across an unconscious casualty with head injuries.

OK.
I guess I see your point...there's some fairly subtle stuff implied in this. If you come across an unconscious person who IS breathing, best not to do any manipulation if you can possibly avoid it...monitor the breathing and leave it to the professionals. If they are NOT breathing, anything you can do to open their airway and restore breathing would be proper...else they will die. Even at risk to the cervical spine...better paralyzed than dead.

However, a properly trained patroller or EMT stands a very good chance of opening the airway (hopefully restoring breathing) without doing C-spine damage...which sort of relates back to that comment about "doing more harm than good". This is a pro level CPR skill, usually not taught in the most basic AHA/ARC CPR classes. The AHA/ARC is trying to teach the masses how to save the greatest number of lives possible while keeping it as simple as possible. EMTs and patrol is expected to operate at a higher skill level.

Hope this helps...

[quote=nypatroller;876663]

quote]

Firstly... I completely agree with you that a trained professsional coming across an unconsious casualty with a head injury should assess if the patient is breathing, and carefully apply a jaw thrust if necessary.

But.... My point was that I was challenged (by skier j) to give an example of a ski patroller on this forum giving dubious medical advice. A patroller on this thread suggested that a person who had not been trained to open an airway without moving the head should not open the airway of an unconsious casualty with a head injury. That advice is out of step with AHA guidelines, so it is imho an example of dubious medical advice.

I'm pretty sure that the AHA guidelines say that a lay person coming across an unconscious casualty with a head injury should apply head tilt chin lift before checking for breathing! As this is a thread about what a recreational skiier could do with a casualty until expert help arrives, surely advice should be in line with AHA layman's guidelines?

[quote=Oceanic Steve;876684] That was no challenge, just a simple request for an example.

It is not a great example, IMHO. As it implies at least a BLS level of education---or familairity with Am Heart's standards. That is certainly more than your average uneducated (in first aid that is) bystander would have.

I smell someone with one heck of a lot more knowledge than he (or she) is letting on trying to fish for the result they wish to elicit.

Perhaps with an ulterior motive.

I'd be real careful engaging in any debate.

so

I'm out of this one

[quote=skier_j;876693] Ahh, don't frown!

No ulterior motive, except that provided by me thinking that some people dismissed my question about gloves without really thinking it through.

Unfortunately I don't have a heck of a lot of knowledge, I'm training to work as a nurse in an OR.

I'm out of here too. I've been on this thread far too much so I'm going to go and get some exercise

[quote=Oceanic Steve;876684] I forget where I get information from, be it layman's CPR class I took a long time ago, the First Responder's class I take every year, or my OEC training a few years ago, so give me a little leeway on what I attribute to what.
Actually, checking for normal breathing is the first thing you should do. If there is no breathing, or it is shallow, then perform the head tilt/chin lift, check for breathing, then give 2 breaths. Prior to 2005, they were teaching the jaw thrust method if trauma is involved.
We don't want to scare people away from giving CPR, but it is what it is.....


From the American Health website concerning changes to CPR protocol in 2005
http://www.americanheart.org/downloa...Winter2005.pdf




should give 2 rescue breaths.

Not really. The emphasis was on "not trained" as in NO training. Notice I did not provide ANY advice on what to do or what not to do. I only provided information. Again I think its great that people would want to help. Hopefully what will come out of this thread is people will get properly trained. Hopefully they will ask some more interesting questions during that training.
H'mmm Are they really NOT breathing. I have had 1000s of hours of training and have experienced working on about 40 unconscious patients. Even with all that training and experience it can be difficult to tell if a person is breathing or not breathing. Yes I know look, listen and feel. It sounds real easy. Then there is compromised breathing. Patient is breathing 32 breaths per minute or Cheyenstokes respirations. When must you compromise the spine to assist the patients breathing. BTW forcing a patient to breath deeper at a slower rate takes a lot of skill.
Good points. More people trained the better we can all help one another.

Huh? Not sure I understand this assertion. If they have no airway they presumably aren't breathing. Non-breathing people generally don't live very long. Any damage a lay person might do trying to open an airway can't possibly do more harm than letting the victim die, can it? In my book death is worse than an injured neck or spine.

Sinecure, good points. You sound confident. That is a good thing. Again the idea here is to be trained in the highest level of first aid you have time for and to help others whenever possible.

Old thread and age old topic - unless you saw the person go down - you need to assess for the mechanism of injury "second" - example could have sucked thier gum/candy down the airway causing blockage. But "first" you need to get help coming. 
If you at least lay trained in CPR and saw the person go down, establish or at least attempt to establish an airway per your training - then get help. But get help coming in all cases - the quickest way possible.
And if not least lay trained - get help.

You actually contradict yourself here. You say that "breathing should be checked first", then you quote AHA guidelines which state that you must open the airway before you check for breathing. I am not a patroller, but I was a lifeguard/aquatics director for 12 years, and I am still an ARC CPR/FA/LGT Instructor. I was always taught, and now teach my students to always go with the "ABC's" after they establish scene safety and state of consciousness. If the person is unconscious, you must establish an airway before checking breathing. It's absolutely true that an entirely untrained individual would not know how to properly open an airway, using any method. And its also true that an untrained person who 'got some advice' from a forum like this could very likely cause more damage if there is any spinal injury.

As a trained first responder and somebody who trains first responders, my advice to a layperson is to get or send for help. Also, it's crucially important that your first priority is that you not make yourself another victim. There are many people who happen upon accidents, and start thinking about being a hero. When they do that, they stop thinking about their own safety. Keep in mind that a person is injured for a reason, and frequently the reason has a lot to do with where they are. Is there ice above them? Are they in a blind spot? Are they near a trail junction? Did a power line fall from a lift tower? Those of us who are trained are trained to survey the scene for safety. If it's unsafe, we can't provide care. That being said, you can do things to make an unsafe scene safer. On a ski slope, having people/ equipment markers uphill to let people know there is a problem downhill is the first thing to do. Once your safety is assured, as an untrained bystander, you're just waiting for patrol to arrive. If the victim is conscious, talk to them. That's about all you can or should do.


Oh, and TAKE A CPR/FIRST AID CLASS!!! I'm not yelling, I'm highlighting for emphasis. A little training really can help you save a life. And that life could be your wife, your child... or your own.
Edited by freeski919 - 11/3/09 at 8:18pm

 The way it was explained to me was "If you don't have an airway, You don't have shit"  It doesn't get more basic than that.  ABC...  Airway, Bleeding, Consciousness.  The only exception I can think of is for a hazardous environment, where you move out of that environment before doing anything else.

Just a quick comment on all this ABC stuff.  Different people use ABCs to mean different things, but the most commonly understood meaning (thanks to Dr. Peter Safar, the father of modern CPR) is:

Airway
Breathing
Circulation

The ABC mnemonic generally assumes that the rescuer has already established a lack of consciousness, and is designed to remind you what to do next.  Also, bleeding is most commonly considered part of Circulation, not the "B" step.

Most people are taught that Airway comes before Breathing, which comes before Circulation (this is where tetonpwdrjunkie's learning comes from).  It's taught that way because it's easy to learn and remember, and because, all else being equal, Airway problems usually need to be fixed faster than most Breathing or Circulation problems.   However, in reality, every step is just as important as every other step.  Your patient won't be Breathing or have Circulation for long without an Airway.  And, a patient who has bled out can't Circulate, and all the Airway and Breathing in the world won't help him. 

So, do the steps in order because that's how you learned it, and that's the best way to make sure you don't forget something.  But just remember that the ABC mnemonic is just a learning technique.  You always have to treat your patient, not a textbook.

Heh.  Right you are.  I was about to correct eblackwelder's correction of tetonpowderjunkie, but you beat me to it.  

Folks, it's Airway, Breathing, Circulation:
http://en.wikipedia.org/wiki/ABC_(medicine)

 That's embarrassing!  Of course it's Airway, Breathing, Circulation.  I'm not sure how I posted that wrong, but I did.  Thanks for catching it.  I better get my poop in a group before the refresher this weekend... and patrolling this season.

Too funny.  When I saw the original ABC mnemonic spelled out by tetonpowderjunkie, the C was what stuck out in my mind, so I basically glossed over the B.  Oops.  Hey tetonpowderjunkie, I guess we both owe MikeN2UZU  a beer after our refreshers.   

 I would be happy to buy him a beer for the correction and another for being gracious about it.

 

There's been  a lot of people saying that stevescho did what he was suppose to do; which is exactly true.  Without Gloves on, theres no reason to actually treat him yourself.  Especially with blood.  I am apart of the NSP; not a trained in anything but OEC (so take with a grain of salt), however, facial injuries usually are a lot more grusome than they actually are.  The face and scalp are very vascular.  So injuries to the face and head bleed a lot.  Hypothetically that you had gloves to protect yourself and the patient was competent, then the patient could help stop the bleeding with soiled clothes, if available.  The first thing to check though is to make sure that his airway and is breathing is not compromised; thats what can really get the patient with facial bleeding.