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“Common things occur commonly” and so the first aider or emergency care provider would expect emergencies related to common conditions prevalent in the local community and therefore the workplace.
The common emergencies in South Africa would be related to:
- Heart disease (heart attack)
- Trauma (injury)
Every workplace should have a central point (operations centre in a big factory, switchboard in a small office) through which emergency action is co-ordinated.
In an emergency workers should have an internal emergency number to call through which they reach an operator who would respond first aiders, summon the Emergency Medical Services (EMS) and send someone out to meet the ambulance.
The operator would have clearly displayed at their station the emergency number for EMS. (e.g. 10177 is currently the National Medical Emergency Number, very soon 112 dialed on Telkom and cellular phones will replace all the emergency numbers)
Every office, factory, mall, shop etc. should have an Emergency Medical Response Team with training in first aid (including the use of Automatic External Defibrillation) and basic first aid equipment with which to respond.
Communication from the “shop floor” with the control point is essential (radio or cell phone).
The symptoms of a heart attack include:
- Severe central “crushing” chest pain
- Pain radiating into the neck or arms
- Shortness of breath
- Nausea and vomiting
The management is to rest the patient i.e. don”t let them walk anywhere; provide oxygen via mask if you have and offer them half a Disprin to drink voluntarily. Get the patient to the nearest hospital or hospital with a heart unit by ambulance (ambulances have all the right equipment to treat patients) as soon as possible.
If the patient collapses unconscious, their heart may have stopped and the emergency care providers will have to do Cardio-Pulmonary Resuscitation (CPR) and then provide defibrillation.
Asthma is a very common respiratory disease which causes the lung air passages to narrow due to inflammation, swelling, mucous production and spasm of the muscle in the walls of the air passages.
The patient will be short of breath and may exhibit wheezing (high-pitched sound on expiration). In severe asthma they may not be able to talk, will have a very fast pulse and may be confused. The asthma patient will want to sit up to facilitate breathing.
Provide oxygen if you can. If they have an asthma pump they can attempt use but don”t delay getting them to hospital if the symptoms are severe. Transport the patient to the nearest Emergency Centre in a sitting position or call an ambulance.
Diabetics rely on injected insulin or tablets to keep their blood sugar at normal levels.
Occasionally they can inject too much insulin or because they don”t eat at the right time the tablets or insulin lower the blood sugar too much, causing loss of consciousness.
The patient may complain of sweating, anxiety and heart palpitations before lapsing into unconsciousness. If they are diabetic they will usually know they are going “hypo” and will take some food.
If they are unconscious the first aider can smear glucose gel onto the gums and must get them to an Emergency Centre as soon as possible. Low blood glucose is life threatening.
Epilepsy is a very common condition (usually because the patient hasn”t taken their medication) in which the patient may experience a loss of consciousness with initial whole body spasm followed by rhythmic contraction of all the body muscles. The patient will usually have a loss of bladder control.
Management of a patient having a seizure is to turn them on their side and protect the head from injury. Allowing the patient to seize on their back may cause a severe head injury.
Allow the seizure to pass and then monitor the patient on their side while you wait for an ambulance.
The common consequence of trauma and injury is bleeding and fractures.
External bleeding is obvious and is best stopped by continuous external pressure with a wound dressing and or towel and elevation of the affected limb.
Blunt trauma to the chest or abdomen can cause internal bleeding which for the first aider may be difficult to detect.
Uncontrolled bleeding may lead to “shock” (insufficient blood and oxygen supply to the brain and major organs) and so the control of bleeding is very important.
Fractures are usually evident by the swelling over a bone at the site of injury, reluctance by the patient to move the bone, deformity, pain and grinding of the two ends of the bone on movement.
Fractures should be immobilized (splinted) in a position most comfortable for the patient, making sure that the circulation downstream from the injury is intact (pulse, good colour, capillary refill < 2 seconds). The best splints are wire splints covered by padding. The joint above and below the injury should be immobilised.
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