Author Topic: [LEL17] Cycling Specific 1st Aid Supplies - suggestions wanted  (Read 7695 times)

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #25 on: 09 August, 2017, 07:25:39 pm »
I've got my refresh on Friday, so I'll find out latest thinking then...

John

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #26 on: 09 August, 2017, 08:24:15 pm »
Quote
Continue with chest compressions and rescue breaths in a ratio of 30:2

If you are untrained or unable to do rescue breaths, give chest compression only CPR (i.e. continuous compressions at a rate of at least 100–120 min-1)

When I did my in hospital BLS for consultant surgeons training, a couple of months ago, the recommendation was to not bother with the rescue breaths.  There was an almost universal agreement that we were not giving rescue breaths to anybody except nearest and dearest.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #27 on: 09 August, 2017, 09:32:46 pm »
From the notes on the 2015 guidelines:

https://www.resus.org.uk/resuscitation-guidelines/adult-basic-life-support-and-automated-external-defibrillation/

Quote
Compression-only CPR

CPR providers trained and able to perform rescue breaths should perform chest compressions and rescue breaths as this may provide additional benefit for children and those who sustain an asphyxial cardiac arrest or where the EMS response interval is prolonged.54-57 Only if rescuers are unable to give rescue breaths should they do compression-only CPR.

The Resuscitation Council (UK) has carefully considered the balance between potential benefit and harm from compression-only CPR compared to standard CPR that includes ventilation. Our confidence in the equivalence between chest-compression-only and standard CPR is not sufficient to change current practice. The Resuscitation Council (UK), therefore, endorses the ILCOR and ERC recommendations that CPR providers should perform chest compressions for all patients in cardiac arrest. CPR providers trained and able to perform rescue breaths should perform chest compressions and rescue breaths as this may provide additional benefit for children and those who sustain an asphyxial cardiac arrest or where the EMS response interval is prolonged.

I  agree that for those not trained to provide rescue breaths the harms might outweigh the benefits. And even for those who are trained, if appropriate assistance is likely to arrive within a few minutes and a definitive airway is employed, it is arguable that CPR only might be best. But the situation I am envisaging, out on my bicycle, is when one is right out in the boonies (“where EMS response interval is prolonged”).

Anyway, that’s why I prefaced that addition to my list with “if it was me” ;-)

It weighs bugger all and keeps the option open. I’m not keen on direct mouth to mouth with strangers either.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #28 on: 09 August, 2017, 10:10:38 pm »
My understanding from my last resusc course is that chest compression gets enough oxygen in (remembering that exhaled gas is lower). Evrytime chest compression is interrupted cerebral and cardiac flow drops dramatically is my understanding.

Quote
Continue with chest compressions and rescue breaths in a ratio of 30:2

If you are untrained or unable to do rescue breaths, give chest compression only CPR (i.e. continuous compressions at a rate of at least 100–120 min-1)

When I did my in hospital BLS for consultant surgeons training, a couple of months ago, the recommendation was to not bother with the rescue breaths.  There was an almost universal agreement that we were not giving rescue breaths to anybody except nearest and dearest.

That's interesting. Certainly the first aid course I was on a month or two back didn't present compression-only CPR as anything other than a second choice - but I've got no doubt that your info is both more comprehensive and more up-to-date.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #29 on: 09 August, 2017, 10:28:48 pm »
Capsules of saline for flushing wounds.
UK tap water is more than adequate for cleaning dirty wounds - road rash, etc. It's what we use in ED. Or advise 'em to go and have a good shower!

On the resus front. Effective chest compressions with minimal interruptions are the way to go. I doubt there are many ED health care professionals who would bother with expired air resuscitation in an out of hospital setting. In a hospital we have other kit to manage the airway and deliver high percentage O2.
Started audax with LEL & SR in 2013. Currently working on fitness and trying for a RRtY in 2024. Event organiser, Arrivée photo contributor & LEL controller

mmmmartin

  • BPB 1/1: PBP 0/1
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Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #30 on: 09 August, 2017, 10:32:24 pm »
Surely more important is to have a trained first aider at the control, plus a method of calling 999 if necessary? (This may have been covered, obvs.)
As for kit, I'd say clingfilm and insulating tape is all you need. After that, it's best to call in the cavalry.
Besides, it wouldn't be audacious if success were guaranteed.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #31 on: 09 August, 2017, 11:33:02 pm »
Definitely large wound dressings for abrasions, and triangular bandages (a broken collarbone is quite likely). Ice packs would be good. Stuff for cleaning up gravel wounds and the like. Otherwise fairly standard stuff, I'd think.

The last first aid course I did also said don't bother with breaths in CPR.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #32 on: 10 August, 2017, 07:44:12 am »
MAC, I agree with the copious water.  We also regularly use standard soap and water on hand injuries before we examine them.  Sometimes we put the local in first!


I am not sure about the first aider.

This is an audax run under the auspices of Audax UK and is clearly a self sufficient ride with some food and bedding for purely logistical reasons of keeping the ride away from 24 hour Tescos (centres of population and traffic).  We do not provide first aid at BCM check points, etc. 

I had a scare with my heart.  I decided for myself to seek medical help and found a GP open.  otherwise I would probably have sat their until my wife came to collect me or phoned 999. 

As soon as we provide a first aider we have to provide first aid at every 100km ride (as that was the maximum distance between controls)

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #33 on: 10 August, 2017, 09:11:53 am »
Hydrocolloid dressing such as Granuflex? Expensive.

(I always carry my own on long rides... if my bum plays up again, this stuff is what works.)
(Haven't tried Clingfilm though.)

https://en.wikipedia.org/wiki/Hydrocolloid_dressing

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #34 on: 10 August, 2017, 02:04:21 pm »
On the resus front. Effective chest compressions with minimal interruptions are the way to go.

Out of hospital, solo, bike situation out in the country (let's face it, that's unlikely to end well anyway) rescue breaths wouldn't be worth even considering unless an additional trained person happened along. Even then, that help would be best employed in chest compressions.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #35 on: 10 August, 2017, 02:11:04 pm »
I agree. Help can arrive surprisingly quickly.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #36 on: 10 August, 2017, 02:22:03 pm »
Thankfully the reality is that basic first aid stuff for minor injuries etc. is much more likely to be useful.

Unless it's a shockable rhythm and a defib is made available quickly with rapid onward transport to a suitable hospital, outcomes are woeful.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #37 on: 10 August, 2017, 03:00:04 pm »
I was given the clingfilm tip by people who have done advanced mountaineering first aid training for expeditions. They put in their first aid kits.
An A&E nurse stated that they love people who use clingfilm - it doesn't put foreign bodies in the wound, you can see the wound site through the clingfilm, presents a nice sterile barrier, stops loss of fluid from very large grazes. In short, it does everything you need a dressing to do and it's likely you can find it in any kitchen.

If you have to use some, they recommended unwrapping a couple of turns and discarding (or placing these off the wound).

If someone has a burn, the clingfilm can be applied and you can carry on pouring water over the burn for the cooling effect.
<i>Marmite slave</i>

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #38 on: 10 August, 2017, 08:20:34 pm »
I was given the clingfilm tip by people who have done advanced mountaineering first aid training for expeditions.

I think it is an excellent tip. I was vaguely aware of its usefulness but the knowledge had receded. Thanks for the reminder.

hellymedic

  • Just do it!
Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #39 on: 11 August, 2017, 11:01:01 am »
Given varied location of AUK rides, expertise & teamwork is needed most for medical and other emergencies.

This is very dependent on the number of people on scene:
#1) Stay with casualty/team leader chest compression A
#2) Summon help/direct traffic
#3) Chest compression B/attend to peripheral injuries

Situations are very variable!

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #40 on: 11 August, 2017, 04:10:45 pm »
For what it's worth, today's first aid refresh is stil teaching 30 compressions then 2 breaths unless serious facial injuries etc mean you can't get to the mouth.

John

IJL

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #41 on: 11 August, 2017, 04:38:55 pm »
Quote
That's interesting. Certainly the first aid course I was on a month or two back didn't present compression-only CPR as anything other than a second choice - but I've got no doubt that your info is both more comprehensive and more up-to-date.

compression only is a poor substitute for proper CPR.  However when it comes to real life situations people are not keen to get that up close and personal, there's often vomit involved!! compression only is better than nothing and hopefully help will arrive soon.  If a genuine arrest occurs in the middle of nowhere on a ride, the CPR will keep you warm until the ambulance arrives, its unlikely to achieve much else.   

For gravel rash, there are a hole range of suitable dressings, the brand we use in the surgery changes as the prices changes but hydrofilm e is a film dressing with a non adherent patch and comes in a huge range of sizes, clean with water, volume is the important factor, it doesn't need to be sterile

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #42 on: 11 August, 2017, 04:53:41 pm »
As above, the guidelines for trained personnel do still include rescue breaths,  but - also as above - the are other considerations such as the cause of the cardiac arrest, reversible causes, hospital vs out of hospital, who is available and their level of training, the situation as regards the likelihood of emergency services arriving soon, how long the resus attempt has been going on for etc. etc..

Regardless of the situation (assuming a defib is not immediately available or the rhythm is not shockable) the prompt start and quality of chest compressions is the prime factor in improving outcomes. Rescue breaths are of secondary importance, particularly as chest compressions are all too often started late, not at all, or carried out poorly.

Hence the content of the recent Vinnie Jones ads.

I had a chat to one of our resus team earlier about the situation I am envisaging (that is, remote location, possibly at night, first trained person on scene, and ambulance a long way away). That's a pretty hopeless situation, of course. A pocket mask remains something I'd carry if I, personally, was doing any ride that involved possibly being further away than I'd like from emergency services.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #43 on: 11 August, 2017, 09:30:06 pm »
Regardless of the situation (assuming a defib is not immediately available or the rhythm is not shockable) the prompt start and quality of chest compressions is the prime factor in improving outcomes. Rescue breaths are of secondary importance, particularly as chest compressions are all too often started late, not at all, or carried out poorly.

If there is a heartbeat (pulse) then I assume the patient is conscious so why carry out CPR? Surely 999 and monitoring is all that is required.  Also, the public style AED will not start a heart that has stopped (cardiac arrest) and might shock a fibrillating heart into normal rhythm, or it might not.  Quite of few of 'well ard' elderly cyclist I know suffer from arryhythmia and simply monitor the situation with HRM and effort.  Last thing we would want to do if someone had a 'wobbly' would be to start CPR.

Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #44 on: 11 August, 2017, 11:59:38 pm »
No defib restarts a completely still heart or corrects a problem where the muscle is working but there is a limiting factor such as massive blood loss. They ALL work by hopefully forcing muscle cells contracting out of sync (fibrillating) to contract at once. The intention being the normal cardiac 'wiring' can then resume control. Arrhythmias come in various forms and many may even go unnoticed until a routine test or some other issue reveals a problem. A cardiac arrest rhythm, or absence of any rhythm, is a very different beast. AEDs can be highly effective for public use and have saved many people around the world. Public training is available via St John's Ambulance or similar bodies.

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Re: Cycling Specific 1st Aid Supplies - suggestions wanted
« Reply #45 on: 12 August, 2017, 12:19:10 am »
If there is a heartbeat (pulse) then I assume the patient is conscious so why carry out CPR?

Well, no. An unconscious patient can have a pulse, and be breathing of course, so then it isn’t a cardiac arrest. Initial assessments aim to determine whether the person is in fact in cardiac arrest or not. If the person is unresponsive and not breathing normally, then it is straight to CPR and call for help.

If there is no pulse the heart can be in a shockable rhythm (VF or pulseless VT) in which case prompt defibrillation is required. Alternatively the heart may be in asystole or pulseless electrical activity, in which case adrenaline and treatment of reversible causes is appropriate.

Either way, you are not going to know until a defibrillator or monitor are available. In both cases, calling for help and prompt CPR are the initial steps.

So you are out in the boonies on a ride, in the dead of night, and there is no public AED. Yes, you can call 999, but if it is an arrest, until a defibrillator is available, CPR is the appropriate action.

One reason why outcomes are poor for out of hospital cardiac arrests is that sometimes they are not recognised for what they are.