At about 2am I was woken up to some revelry by the guys two flats down; I was a little upset but I got over it.
At about 3am I was woken up again by a dude roaming around drunk and calling for his ex-girlfriend to let him into her flat. This oke was making a helluva racket. I was ready to throw things at him, when I noticed a CHUBB vehicle pull up, and the guard kind of kept an eye on the guy and escorted him away. "Hooray for CHUBB" Kat exclaimed from the bed.
At about 330am I was woken up AGAIN by hooting. I looked outside and CHUBB was hooting and calling for our neighbour. I asked him what the heck he was on about and he explained that the dude had just jumped off the BP garage forecourt. Not usually a big deal except that the forecourt is about two or three stories above the parking area below. He said the guy was in a bad way, bleeding etc. I then saw my neighbour responding so I went back to bed.
In a moment I realised I had to go check the dude out since I knew first aid. Either I could allow myself to go back to sleep or I could go and examine the carnage and see what little my level 2 training could offer, so eventually I decided that even though my skills don't include "a fall from a height of seven metres", I could at the very least aid the guy if he had trouble breathing etc.
Off I went, with a few reassuring smses to my neighbour who had no idea how serious it was, if it was an attempt to win her sympathetic attention and get her outside, or whatever.
I met up with CHUBB outside, who was examining our now-newly-smashed front door. We went across to the Village Market where I found the dude lying in a heap and covered with a blanket. His dad and mom were already there, and I realised he was conscious by his colourful murmured expletives and his screaming.
I hesitated long enough for my instincts to kick in and I froze. I suddenly didn't want to see his brains on the side of the road, or to see the protruding ribs from the other side of his lungs, or the eyeball lying in his ear cavity, or anything. I had my basic kit, but his parents didn't look like they wanted a fumbling first aider to interfere with what is a really significant moment in a parent's life - there's not much one can do as a parent when your child is lying there like that. Did he jump? Did he fall? Is he paralysed? All those thoughts went through my mind but I wasn't the one being called out for in desperate panic. I wasn't the one looking helplessly into my son's eyes and lying that I knew everything was going to be okay. I was just a bystander, but I hated myself for not trying to offer any help - but what the heck can I do?
At that moment the paramedics arrived and we helped to eventually secure his neck in a cervical collar and log roll him onto his back, and onto the stretcher. The one thing I did manage to do was remind the paramedics to check his legs for injuries, which revealed a suspected broken femur. I also noted internal bleeding or bruising on his lower back. We splinted his leg, hoisted him onto the stretcher, and they took him off to hospital.
I don't believe he had medical aid and the gravest injustice was the decision they had to make about whether to pay a R30,000.00 down payment for his scans at St. Augustine's or to take him to a public clinic. I was willing to offer aid financially but it wasn't my place nor my call to do so.
I got WesFlash on the line because he works with the father, and told him to pray. That's about all we could really do.
In the end, based on the examinations, the guy must have landed feet-first, fractured his femur, then landed on his side. Bruised his lower back, strained his spine / neck, and grazed his elbow. Other than that he seemed to survive the fall, apart from the sorry hangover he'll have added to his woes come this afternoon.
Crazy times, but at least I know to get further training because I was an absolutely useless first aider. I've already asked my work to upgrade me to level 3 as a result of what happened.
Sorry Wendy; welcome to the life of The (new) Johnstons at Romax Court!
Until you get your further training I recommend you add the following to your basic kit (I'm surprised that they rarely include these items):
ReplyDelete1 large ziploc bag (sterile)
1 roll of duct tape/masking tape
1 sharp knife (preferably folding)
3 set of elbow length surgical gloves (the pathetic wrist length ones most kits include are pretty useless)
1 pair of glasses or goggles
In case of any abdominal injuries secure the plastic over the breach and tape it securely in place. Even if there's internal bleeding this buys you some time as it reseals the cavity and allows the person to breathe, and you can always unseal and reseal to vent excess blood thats pressing on the lungs.
The plastic bag can also be used to seal other bleeding. If someone is bleeding heavily and you can't locate the vein or artery to apply pressure then you can seal the exit wound and allow non-critical extremeties to fill with blood and normal blood circulation will resume, more or less. Not a long-term solution, but we're talking first aid here, and it sure beats watching someone bleed out if you don't know where the artery is or can't reach it.
Some kits have plastic bags, but generally they're tiny and most kits don't include tape with sufficient adhesive power to stop bleeding. The tape alone (if you use enough of it) can be a pretty darned effective splint (despite what movies would have you believe there is frequently not a handy stick around that is just the right size for the job), although I'd recommend plastic bagging the wound first to prevent the adhesive from making contact with live tissue (again the magic plastic bag!).
The knife is just common sense, although most kits don't have a decent one or give you a scapel, which is fine for an emergency tracheotomy, but just sucks if you need to cut a piece of stick down to size.
As for the gloves, well yeah, first aid is messy, and cuff-length gloves just don't cut it. Blood tends to splash (hence my recommendation of a pair of glasses, since eye-splash is a possible HIV transmission vector).
None of these items cost much, and they shouldn't add much to the weight of your first aid kit, but they're really indispensible pieces of equipment if you're actually interested in using your trainig to help someone.
For this particular case the checklist goes something like:
- check the area for dangers (your safety first)
- get someone to call for an ambulance
- put on gloves, etc (again, your saftey first)
- check cardio and respiration (might be the other way around, it doesn't much matter) [if he's screaming both are probably ok ;) ]
- check for bleeding and wounds (without moving the patient)-> if serious bleeding then stop it (pressure/bandage/plastic bag in roughly that order) -> if large volume of blood is lost and risk of hypovolemic shock then risk elevation of extremeties (you can check blood pressure using capillary refill in extremeties, basically you press down on a fingernail until the nail goes white, for people with sufficient blood flow the blood flows back in and the whiteness fades quickly... if it doesn't then there's a problem with blood flow to that area, check again on the other hand and if its the same the likely diagnosis is low blood pressure, possibly immiment hypovolemic shock, although there can be other causes)
- check for broken bones (if you touch it and they scream its probably broken) also checking for sub-dermal bleeding at the same time (bloated or rigidity where there shouldn't be)
- check pupil dilation and responsiveness. Fixed and dilated pupils (i.e. the pupils are BIG and when you shine a light into the eye and then remove it they don't constrict) means possible brain trauma, although it can be caused by certain drugs. Fixed and dilated is generally a very bad sign though, and there's nothing you can do but tell the paramedics first thing then they arrive (who will then administer tons of ice and at the hospital they'll artificially induce a coma and then pray).
- If you still have time you can check nerve responses in extremeties... yes, you get to pinch someone and ask if it hurts, and who says first aid isn't fun?
Basically the golden rule of first aid is that until the paramedics get there you're all the person has. You act only to stop death or to gather information to pass on to the paramedics, so you can't do any harm and any action you take to prevent death.. well, the person was going to die anyway without your help, so best case you save their life, and worst case you stuff up and they die.. which is what would have happened if you hadn't helped, so they're no worse off for your help.
Oh yeah, and just something to bear in mind, South Africa has a "Good Samaritan" Act, which means that if something does go wrong, provided that you weren't grossly neglegent, you're indemnified. However if someone finds out that you had training and walked on by then you can likewise be sued. Knowledge has its price, and the higher your medical training goes the more is expected of you.
... but seriously, plastic bag and duct tape. I'm not kidding. Without them there's nothing you can do for chest cavity injuries.