Who knew that First Aid involved so much clingwrap?

There’s been a car accident. You’re the first person at the site. The driver of the car is upright, in a seated position in the car, experiencing pain in the ribs and difficulty breathing. What do you do?

My friends, let’s hope that I am never the first person at an accident site. Having done a first aid course last week, where I was confronted with a massive amount of things that, as a holder of a level 1 First Aid certificate, I’m expected to remember and, what’s more, calmly triage before attending to, it’s possible that from here on, if I witness any kind of accident happening in the distance I’ll select answer D, below:

a. Call an ambulance

b. wrap Gladwrap around the casualty

c. run cold water over the injured area

d. turn and run the other way, preferably without knocking anyone over and requiring that they need First Aid too.

This was a beginner’s First Aid course. I attended for my workplace. We work in a low risk environment, but the company is a National Disability Enterprise, with employees and clients/workshop participants who have disabilities and sometimes other complicating health issues, so we have a duty of care to make sure that as many staff as possible are equipped to attend to an incident if needed.

For this course – Level 1 First Aid – you have to do “pre-reading” at home the day before, and sit an online test at the end of it. The test was given in the form of multiple choice questions with 4 possible answers. Together, the reading and test took me about 1.5 hours, and covered everything from running a burnt finger under cool water for 20 minutes, through to what to do if someone’s internal organs are protruding from their stomach.

Now, I admire the optimism here, but as a Level 1 First Aider, what I will do, if ever confronted by the sight of someone’s internal organs protruding from their stomach is answer D, below.

a.gag

b. dry retch

c. faint.

d. All of the above, although not necessarily in that order.

This answer was not available to me in the test however, so I probably selected whatever I felt was the correct procedure. Whatever that was, I have now forgotten, so please, if you ever find your internal organs hanging out, don’t come to me.

While sitting the online test, I was frequently tempted to select the “trick answer”: C. Call for an ambulance and then leave the site of the accident; however, annoying, when I attended the onsite course the next day this was never an option for a First Aider.

Each time we were presented with a scenario, we had to work through the DRSABC steps devised by St John’s Ambulance:

assess for Danger, check for a Response, Send for help, check the Airway, check for Breathing, start CPR, use Defibrillation,

This course was a challenge for me in many ways.

First and foremost, like most people who don’t voluntarily go into the medical professions or choose to work as paramedics, the idea of having to deal with serious blood loss, burns, internal organs spilling out, or someone with a sharp object embedded in their eyeball, creates anxiety for me. On the other hand it’s also too surreal for me to contemplate. I never want to encounter such a thing and I fear that a one-day course will not help me to remain calm if I ever do.

Secondly, it’s difficult to memorise all the correct procedures, but the main challenge is that in a real situation, ideally your understanding has gone beyond rote learning, so that you can also apply common sense, something I fear I am lacking in when it comes to First Aid (if not in all areas of life.)

Common sense is needed in order to triage – ie, work out what needs to be addressed first and which of the standard “procedures” might not apply because of another factor. For example, by the time I ended the day, I was confused about when you should move a suspected spinal injury and when you shouldn’t. Common sense tells me that you would move them if they were in danger – eg near a car that was likely to blow up – or if you needed to move them into the CPR position, and would not move them in any other circumstance, but I feel as if I was told something different during the day.

Common sense is a tool – to be able to use it, you must have a good understanding of the basic principles behind what you’re doing – something that is hard to learn in one day of training.

The third way in which a course like this is challenging is all the acting and “pretending” that is involved, for someone as self-conscious as myself.

All day long we had to work with partners (who were total strangers at the start of the day), and pretend either that we were injured, or that we were attending an injured person and talking them through what we were doing. This was difficult in itself. Since there we were “pretending,” I was always hopeful that we could just pretend at step 1 (assess the Danger) that it was dangerous to approach the casualty, and then sit that one out. Unfortunately, despite the fantasy element, everything remained pretty scripted, and every scenario seemed to take place in the pretend-but-real environment of a safe, small, carpeted, corporate training room in King St Melbourne, where due to some unaccountable disaster, half the class were lying all over the floor, having just almost drowned, broken their legs, accidentally injected themselves with someone else’s insulin, or spilled bleach all over themselves.

Similarly, it was no use hoping that as I worked through DRSABCD, that my partner, pretending to be the casualty, would decide to mix it up by acting as if she was responsive, breathing and able to sit up – she never chose to take that arguably more creative route, so I was left trying to remember which way to turn her to clean out her airway and what the next step was. Was it…

a. sit the casualty upright and tilt her head back

b. do nothing because you don’t have the casualty’s permission

c.lie the casualty on her back with her head and legs slightly elevated

d. wrap the casualty’s abdomen in Gladwrap

(*none of the above are correct, unless there are other complications)

When we had a scenario thrown at us with no pre-preparation, my “casualty” said she’d just been in a car accident, was still strapped into the car, had pain in the ribs and was having trouble breathing. I pretended to call an ambulance, started working through DRSABC and then panicked, as I couldn’t work out which of her pretend symptoms (sore ribs, breathing difficulties) was the main thing to address. She was still responsive and breathing so clearly there was no point doing CPR, I was fairly clear on that point (also, she reminded me). It was apparent that I was unable to move beyond rote learning and work out what steps to take. I felt as if the symptoms were clues I should be following. What if her “difficulty breathing” turns into “stops breathing”?! Should I get her out of the car in case I need to do CPR? But she probably has broken ribs – I don’t know if I should move her.

I think I was overthinking it.

At the same time, my triage skills were affected by the fact that – we were acting, right, and I’m no good at that, as I’ve acknowledged.

Maybe in the heat of a real scenario, I might have decided to move the casualty from the car, but honestly, in this scenario, she looked like she was fine, and pretend-moving her was going to be more trouble than it was worth.

So my options were:

a. ramp up the acting, move casualty from the car, put her into the recovery position

b. slightly less acting required, leave casualty in the car, monitor her breathing

c. give up altogether, run out of the training course, go home early, and tell my workplace tomorrow that I passed the course with flying colors

d. wrap the casualty in Gladwrap

I was very tempted by c, but ended up choosing an answer that was very like b, although regrettably, I didn’t choose it for the right reasons but because I was frozen stiff with indecision. The good news is that she survived.

I’m not criticising the idea of a First Aid course, and I certainly did come away with a little more knowledge about first aid. If ever faced with heavy bleeding now – assuming I’m able to retain consciousness (my own) – I know to put pressure on it, ideally with gauze, then bandage it, and, if the blood comes through, to put another bandage over the first – and never change the first bandage. I know bites from the most creepy creatures – Funnel Web Spiders and snakes – should be treated by immobilising the casualty to stop any muscle movement.

That information stuck in my mind because in the class, the person who volunteered to be the “snakebite victim” had the most dramatic role, as he ended up literally lying on the floor with his arms tied to his body and his legs tied together with bandages, to ensure he could not move. Since he was lying in the middle of a carpeted training room with 15 other people looking on, all it needed was some blood slowly seeping from his ear and it would have been just like something out of a Coen Brothers film.

Of course, in a real snake-bite situation, common sense and a calm temperament would still be needed, in order to decide whether it was better to go for help and leave someone lying alone and tied up, or to stay with them.

I’d definitely need a multiple choice questionnaire to work that one out.

*

**Disclaimer – none of the content above is intended to educate on correct First Aid procedures. If you are searching for a First Aid procedure I’d recommend you try here instead: St John’s Ambulance NZ 

*Wrapping the casualty in Gladwrap was actually a First Aid procedure, I think it may have been for the protruding internal organs. Again, best not to test me on that for real.