Emergency care: Vital signs

First aid is a vital life skill yet not enough members of the public have the confidence to deal with injuries or other emergencies, mainly due to a lack of training.

According to new research commissioned by the British Red Cross and conducted by the University of Manchester, over half of bystanders are failing to intervene in an emergency. Although 93 per cent of people will call for an ambulance if they find someone with an injury, around half wouldn’t attempt any first aid while waiting for the emergency medical services to arrive.

This is often a missed opportunity to save a life. The research findings, published in September 2016, revealed that up to 59 per cent of ‘pre-hospital’ deaths from injury could potentially be prevented if more people stepped in with some simple first aid.

“The good news is that most people are calling 999,” says Joe Mulligan, British Red Cross head of first aid education, “but after calling 999, we want people to then do something in those crucial minutes before the ambulance arrives. Every person needs to recognise that in an emergency, they are part of the ‘chain of survival’.”

Mind the gap

This lack of basic first aid knowledge could be putting extra strain on NHS services if people are seeking help for minor injuries that could have been treated at home. “A lot of first aid knowledge involves dealing with the acute situation,” says Jason Bland, director at Stockwood Consulting Ltd, which offers first aid training for pharmacists and workplaces.

“A lack of skills could affect walk-in centres or A&E departments if people don’t need to be there, putting increased demand on NHS services. There’s often a lack of willingness to use first aid knowledge, with people reluctant to intervene in case they get it wrong – a fear of leaving themselves open to some kind of legal action afterwards.”

St John Ambulance research in 2014 looked at the reasons why people might be put off helping in an emergency situation. The results revealed that 63 per cent of people were likely not to help because of a lack of confidence in their first aid knowledge, and 34 per cent were worried about the legal consequences. The survey also showed that 57 per cent of those who were first aid trained would immediately step forward in the case of a life-threatening injury, whereas 32 per cent of those without any training would not give any first aid at all.

The British Red Cross is calling for everyone in the UK to learn two basic first aid skills that could help to prevent the number of people who die from injuries, such as those resulting from falls or road traffic accidents, before reaching hospital. These are:

• Opening a person’s airways so they can continue to breathe if they are unresponsive and breathing

• Stopping bleeding to death by putting pressure on wounds.

“Sadly, in the majority of deaths we looked at, the simplest interventions could have helped keep someone alive until they got to hospital,” says Joe Mulligan. “For example, something as simple as turning someone on their side and tilting their head back to keep their airway open could be all it takes to make that difference between life and death in certain situations.”

In October 2016, the British Heart Foundation launched an initiative to encourage more people to learn how to do life-saving CPR on cardiac arrest patients. Research from the University of Warwick, published in the journal Resuscitation, revealed that one in eight cardiac arrest patients could not be saved by the emergency services when they arrived because rates of bystander CPR were so low. The BHF estimates this could be leading to around 10,000 deaths every year across the UK.

A separate poll of UK adults by the BHF found that 62 per cent would be worried about knowing what to do if someone suffered a cardiac arrest in front of them, and 53 per cent said they had never received any CPR training.


First aid for the elderly

The UK’s population is ageing rapidly. According to the British Red Cross, more than one in 12 of the population is projected to be aged 80 or over by mid-2039, and a large elderly population means an increase in the number of accidental injuries from slips, trips and falls.

“Older people, particularly those who are frail, are the most vulnerable to accidents, as their failing health can often lead to failure or slowness to spot and avoid risks, especially in and around the home,” says Clive James, national training officer at St John Ambulance. “Those over 65 years of age are most at risk, suffering the highest mortality rate and the most severe injuries.”

When administering first aid to older people, several factors need to be taken into account. As people get older, wound healing slows down, especially if they have certain chronic conditions, such as diabetes, or are taking medication such as anticoagulants. If they have any cognitive impairment or problems with their eyesight or dexterity, they may be less able to look after a wound effectively, increasing the risk of infection and other complications.

“Cuts and grazes may not seem like serious injuries but, due to the thinning of the skin in elderly individuals, the risk of developing skin infection is higher than usual,” says Clive James. “It is therefore important to make sure that you clean the cut or graze thoroughly to reduce the risk of infection. Cuts and grazes can easily be treated at home, but be aware that due to the frailty of the casualty, the wound may take longer than usual to heal.

“Signs of infection include red skin around the wound, discharge containing pus, swelling, warmth, foul odour and fever.”


Training opportunities

The British Red Cross would like to see more opportunities to learn first aid throughout a person’s lifetime, starting at school, but also through the driving test and public health initiatives. First aid training isn’t currently mandatory in state-funded secondary schools.

According to the British Red Cross report, only 24 per cent of secondary schools teach the topic. In England, it does feature in the Personal, Social, Health and Economic (PSHE) education curriculum, but this is not a statutory subject and is not widely taught to a high standard.

PSHE is not the only possible route, as first aid could also be taught in a variety of other ways across the curriculum, including physical education and as an after-school activity. The British Red Cross, St John Ambulance and British Heart Foundation launched a campaign to get first aid taught in schools through the Emergency First Aid Education Bill but, in November 2015, the Private Members’ Bill did not get through to the next stage of parliamentary scrutiny.

Both the British Red Cross and St John Ambulance offer a variety of training courses and resources, so help is readily available if pharmacy customers want to improve their skills and knowledge. “Pharmacists have the opportunity to demonstrate how easy first aid is and encourage the public to learn more themselves,” says Clive James, national training officer at St John Ambulance. “They could use the contact they have with the public to encourage attendance on first aid courses and for people to look at online learning and first aid phone apps.”

One way to promote the importance of first aid training would be to include it in more Department of Health initiatives, such as national campaigns and awareness weeks. Primary healthcare professionals are ideally placed to get involved with these, especially pharmacists who have regular contact with the local community.

“Pharmacists are involved in supporting self-care and public health campaigns as part of their contractual arrangements,” says Jason Bland. “As part of this activity they could help to ensure customers know how to look after themselves and have essential life skills. They could arrange drop-in sessions teaching CPR, if appropriately trained, or show CPR videos in the pharmacy (available from the British Heart Foundation and other charities), as well as distributing information leaflets on simple first aid for minor issues, such as bites, stings, cuts and burns.”


Wound and scar management: some basic advice

People with scars can be upset about the appearance of their skin and often need support from a healthcare professional, says Julie Van Onselen, dermatology specialist nurse.

“As with anything, the healing process can be very individual and depends on the actual type and size of scar, age of the patient and general health,” she says. “Saying that, most scars go through four distinct stages of healing, with immediate healing taking up to two to three weeks, but the final formation of a scar can take up to two years. If a person is very distressed, a referral to a psychologist, dermatologist or plastic surgeon may be considered.”

Scar management is not an area extensively covered by core education, and some would not readily associate it with the key activity of supporting the safe supply and effective use of medicines, says pharmacy training expert Steve Riley.

“However, pharmacists are taking on and delivering more clinically focused roles and there is a need, particularly in the community setting, to support self-care, health promotion and wellbeing. Pharmacists are one of the healthcare professionals most likely to have regular contact with patients concerned about scars. As they supply the products used to support the management of scars, they are ideally placed to give self-care guidance.”

Consultant dermatologist Justine Hextall says that the longer a wound takes to heal, the worse the scar. “Keeping the wound clean, avoiding stretching and stopping infection are key in preventing healing delays,” she says. “Once a wound has healed, there will almost always be a scar that may be red, raised, stretched or continually active – as we sometimes see in a keloid scar. Massaging a scar will soften it and reduce redness. Sometimes, though, despite these steps, the scar remains active and/or raised.”

Newer scars are the easiest to treat but it is important to wait until the wound has fully healed and allow four weeks after any stitches have been removed before commencing scar massage. “The best opportunity to treat a scar is when it is new,” says Justine Hextall.

“Keeping it hydrated, for example with oil, not going in the sun and not stretching it, will reduce its appearance. Once scars become old, they can be more difficult to treat unless abnormal, such as with keloid scars, and surgical remoulding may be necessary to encourage new collagen.”

Pharmacies can stock various products to help minimise the appearance of scarring, says Steve Riley, including moisturising oils, creams and ointments, silicone gel sheets or gel and camouflage products, helping patients to regain self-confidence. Pharmacists can also offer practical advice on sunscreens and sun protection and other long-term support.


Pharmacy skills

According to Sultan ‘Sid’ Dajani, independent community pharmacist and member of the RPS English Pharmacy Board, first aid is one of the most important skills for community pharmacists to learn, from treating splinters in fingers to dealing with falls and strokes. “People will head to their nearest healthcare professional when an accident or emergency occurs,” he says, “so pharmacists and pharmacy staff should know how to deal with minor and major incidents.”

Pharmacists may never need to deal with an acute emergency, but they should still make sure their first aid skills are up-to-date. They can attend a refresher first aid course once every year during the three-year period that their first aid certificate is valid. “There’s no official requirement for pharmacists to be first aid trained beyond their pre-reg year,” says Jason Bland. “However, they do need to ensure that they are trained adequately to deliver services, such as flu vaccinations, and to be able to act appropriately in the case of an emergency.

“Pharmacy businesses also need to ensure that they comply with the health and safety law. Having wide-ranging, current first aid skills would enable pharmacy staff to help customers if they come in-store for help.”

Key facts

  • A lack of basic first aid knowledge could be putting extra strain on the NHS
  • The British Red Cross is calling for everyone in the UK to learn two basic first aid skills
  • Pharmacists are one of the healthcare professionals most likely to have regular contact with patients concerned about scars

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