How to provide the emergency services operator with the exact location of a road incident? What are the benefits of taking a first aid course? The proper reaction of witnesses to an incident is a key element of any rescue operation. In the latest episode of AmberPodcast, together with an expert in first aid training and a paramedic with fire protection qualifications, Paweł Kwiatkowski from Kvadro, we discussed the most important principles of first aid. In addition to technical preparation, we also touched on the importance of participating in regular training that can help overcome the fear of providing emergency assistance.
Anna Kordecka: Welcome to the seventh episode of AmberPodcast. Today’s conversation is a continuation of the previous episode, which we devoted to the subject of first aid when traveling by car. As in the last episode, we invited Paweł Kwiatkowski from Kvadro, who is a paramedic with fire protection qualifications, to play the role of an expert with whom we will talk about first aid on the road.
Paweł Kwiatkowski: Hello.
AK: During the journey, various unforeseen situations can happen to us, such as fainting. What steps should be taken if someone experiences fainting during a journey?
PK: Ladies and Gentlemen, the most important element for us is the respiratory system. In the event of loss of consciousness, it may happen that the head is drooping towards the chest, which causes obstruction of the airways. Limiting the ability to absorb air from the outside into the lungs is a life-threatening condition. Hence, in resuscitation, the most important is the so-called ABC, i.e. A is the so-called airway patency. Unblocking can be easily performed by any person through the forehead-jaw manoeuvre, i.e. lifting the head and jaw upwards, which clears the airways and subsequently checks whether the person is breathing. Unfortunately, dear Ladies and Gentlemen, since we know that the hypoxic brain begins to die within a few minutes, we say in the rescue service that the rescuer should control his breathing in the case of unconscious people. And this breath control, checking whether a person is breathing, should take place every minute.
AK: And what should you do if someone has an asthma attack or other sudden allergic reaction?
PK: If we have a person and this person knows that he or she is ill with a given event, he or she will probably have medication with him/her. Our action is to help in the supply of these drugs. This person will tell us what to do, how to behave; most often she will need to be helped to extract, for example, an inhaled drug, whether it is Salbutamol or some other drugs. And in turn, help her with the aspiration of this inhaled drug into her mouth.
AK: Thank you for these answers. It is also worth remembering that staying calm is crucial in this type of situation.
PK: Of course, dear Ladies and Gentlemen, remember that there is always a paramedic at your disposal, who is an ambulance dispatcher. Your task will be to call 112, and depending on what you tell the dispatcher, he will tell you, lead you “by the hand” what to do with such an injured person. At the same time, a medical team will be sent to you with professional assistance. We also have a duality of conduct. On the one hand, we will tell you how to provide this help until qualified first aid comes to your rescue.
AK: Suppose there was an accident during our journey, we have already called 112, what is the basic information that should be provided when contacting the emergency services to enable them to properly assess the situation and prepare for the rescue operation?
PK: The most important element is one’s own safety. So even when calling for help, you must be in a safe place for you. We recommend, for example, securing the scene, evacuating from the vehicle, and observing the crash site from a safe distance and providing basic data. These basic data are; Introduction – name, surname and location where you are. For example, on motorways there are appropriate posts with position numbers, or you can specify the road number, location, town. If we are in buildings, we should provide a street, house, apartment, so that the services know where, if necessary, they should go. Then, the best elements are to state what happened in general, what the circumstances are and how many victims there are. Depending on this description, the dispatchers will ask further questions that you have to answer. Depending on the number of casualties in the situation, appropriate forces and resources will be adjusted. Please remember to never hang up the phone first. If the dispatcher ends the call, he will put it down. And otherwise, it may be considered a stupid joke and not a serious call for first aid.
AK: To sum up, at the beginning we secure the scene, call the emergency services, tell them where we are, what happened, and then follow the recommendations of the services.
PK: Once again, ladies and gentlemen, if we are dealing with a road incident on a ring road or motorway, please remember that your own safety is the most important. A good rescuer is a living rescuer. That is why we stop in a safe place for us, for example on the side of the road. Before getting out of the vehicle, of course, turn on the hazard lights. When leaving, we put on reflective vests. When getting out of a motor vehicle, make sure in the mirrors that no UFO is flying in our direction, because leaving the vehicle is at risk of being hit by moving vehicles. Then, immediately after getting out of the car, we go to a safe place. The driver, in accordance with the provisions of the road traffic law, takes out the elements that he will need, i.e. the warning triangle. The triangle, if we are outside built-up areas, should be placed only 30 to 50 meters from the vehicle, but on expressways, it should be placed even 100 meters from our vehicle. If we have additional elements such as warning flares, especially when these are night positions, it is worth placing them at an even greater distance. Another person, wearing a warning vest, can also additionally signal about danger. However, under no circumstances can this person be on the road lane. It should be on the side of the road, marked, wearing a vest and then when it waves, for example, a flare, it will be sufficiently visible to drivers. It is supposed to be safe.
AK: A good habit when traveling on expressways is also getting out through the right door. This is the safest place to get off, especially if you are standing in the emergency lane. It may not be comfortable, but safety is paramount. Let’s move on to the principles of first aid in the event of an accident. What are the key steps to providing first aid to people injured in a road accident?
PK: From the general point of view, we repeat once again, securing the scene of an accident. For the good of the injured person, the most important thing is that he or she breathes. Therefore, the injured person, usually alone, takes the best position that causes him the least pain. For his better comfort, we improve everything we can. If, as a result of an accident, for example, the equipment from the vehicle is lying on the injured person – on the head, torso, and we can safely without interfering, because it is not stuck in the body, we will take it off at this point, of course, we evacuate. We give it access to fresh air; By opening the doors and windows, we are able to provide air. And if the patient wants to take some medication that he has, we can help him. But we do not administer any medication ourselves. Dear Ladies and Gentlemen, a very important rule, drugs that are painkillers, such drugs should not be given to the injured person. Even if the injured person has such drugs, we do not administer any painkillers.
AK: This is very important information, thank you for it. And how does the first aid procedure affect a situation in which the victim is unconscious?
PK: We consider unconsciousness to be a state of immediate threat to life. Returning to the previous question, the standard procedure is not to unjustifiably evacuate the injured person in a traffic accident who is at risk of spinal injury. In this case, we should secure the scene. It is preferable to secure it with a car and mark the place at a considerable distance to reduce the possibility of other vehicles running over our motor vehicle. In addition, at this point, we should stabilize the cervical spine and clear the airways. And in this position, we should be waiting for a specialist medical team, firefighters, who will safely evacuate the injured person. If the victim is not breathing or it is not safe for the victim to stay in the vehicle for any longer, they should be evacuated. Such a situation occurs, for example, when the car starts to burn, fluids leak out of the car, leaking onto the hot asphalt, when more vehicles are involved in the collision, when it is slippery, it is snowing, or there is fog that obscures visibility for several meters. Not to mention the situation when the car hangs with one wheel on a cliff. In such a case, it is not safe for the patient to stay inside the vehicle. During this time, we evacuate the patient. Of course, we expose his health to a deterioration of his health, but during the evacuation, we try to maintain the greatest possible comfort of the cervical spine. Stabilization is performed by handcuffing: with one hand we stabilize the victim from the front, and with our face, hugging the face of the injured person, we stabilize him from the other side. In addition, with our shoulder, which we slide behind the injured person’s back, we stabilize him from the third side. Remember not to lift the victim by the head, by the neck up. This is a place of potential injury. Lifting should take place under the armpits. In this way, we lift and carry the patient out of the car to a safe place.
AK: If we are dealing with a conscious person who needs help, how should we talk to him/her? What information about the condition of the injured person is the most important?
PK: For the injured person, as well as for you, the most important element is the element of safety. So the thermal, mental and physical comfort of the patient is the most important. Hence, access to fresh air, our calming tone in the voice, talking to him is the first element that causes the patient to calm down even at the time when he or she has experienced an injury. If the patient affects us even in a slightly aggressive tone, remember not to shock with further aggression. Aggression arouses aggression, of course, but the patient must be understood and tried to tone him down. Do not say that everything will be fine, because the patient is not always fine. But to calm him down in a tone that “I’m already helping you, the services are already called, which will arrive in a moment”, ask “what else can I do for you to make it better for you? Can I give you something or should I let someone know?” Remember that for paramedics and when you talk to the medical dispatcher, the most important thing is the so-called medical interview. It is a SAMPLE interview, which from the first letters of its name includes: symptoms, allergies, medications, past illnesses and the last meal before the event. These are important elements, because if the patient loses consciousness, having knowledge of these basic things, we know how to guide the treatment procedure towards the patient. Which may simply be the reason for the patient’s condition. Let me repeat once again, symptoms, or what we are about: What ailments? What symptoms does the victim have? Does the injured person have allergies? Is the victim allergic to something; for some food, medicines? Collecting the interview during a conversation with the medical dispatcher will be a great convenience for paramedics. Questions about medication: Is the injured person using any medication at the moment? When did he take these medications, just in case? Does he remember that the medications he has to take constantly? What diseases does he have at the moment or comorbidities? Even if they were six months ago. Didn’t he leave the hospital a month ago after undergoing surgery? It is also worth asking what and when he ate recently. Why might this be important? Because the patient, for example, may say that he has a stomachache, that he feels sick. It can be motion sickness, of course, but suddenly he can also say that he ate scrambled eggs with mushrooms this morning. And where did he get these mushrooms from? Yesterday he was collecting. So the question is whether he has properly collected them. This may be the team of medics to indicate that the source of the problem will be the liver and elements related to food poisoning. What happened? Here, in this element, it is the so-called SAMPLE “E” from the interview, we are mainly concerned with what circumstances, what the victim remembers. We want us to know whether the patient is fully aware of the entire event or whether there has been a loss of consciousness or fainting. Fainting, loss of consciousness may be associated with the fact that there is something negative in the patient’s head. Without a reason, a person does not lose consciousness, does not remember the preceding event. This may be the result of trauma, e.g. a strong blow, an emotional pathogenic event that is located in the patient’s head.
AK: At what point can you stop providing first aid to the injured?
PK: There are three elements related to first aid. The most important thing is that we provide first aid until qualified uniformed services arrive to take over the action for us. However, we must be aware that if we are not able to provide help by force, sometimes we need to let go and rest at least for a moment. For example, when we perform cardiopulmonary resuscitation and if there are no substitutes to replace us, then from our point of view it is better, to let go for half a minute, a minute, two and after relaxation proceed to cardiopulmonary resuscitation again. Providing first aid is an element of effort, and a temporary rest is more beneficial for us from the point of view of our safety. If we bring ourselves to extreme exhaustion, we can lose consciousness, and as I said, our loss of consciousness is a direct threat. In such a case, we will not help the patient better, because no one helps him anymore, and we are a threat ourselves, because we are also a potential patient with a threat of cessation. Therefore, this is the second element. The place of occurrence is also a threat. If we are not able to help the patient ourselves, because he is e.g. stuck in the vehicle, we limit ourselves to securing the accident site. On the other hand, if we have a safe opportunity to help the patient, we proceed to action. We approach him, from the side of the legs, but at a safe distance from the patient. We approach from the side of the head and if he does not respond vocally, we lower ourselves to the running position and nudge him by the shoulder, asking “Hello, can you hear me? Hello, what happened?” If the patient does not respond to this, it is our duty under ABC to check whether the airway is unobstructed and whether breathing is preserved. For this purpose, we perform the so-called forehead-mandibular manoeuvre, which causes the jaw to be lifted upwards and the airways to be opened. When approaching the victim’s mouth, we analyse the state with our heads, namely whether we hear the exhaled air or feel it on our cheek, and with our eyes, directed towards the plane of the victim’s torso, whether we can see the rising chest of the victim from this horizontal plane. If we feel 2-3 breaths within 10 seconds, this is normal. If the injured person would breathe a little faster, we may suspect an element related to the patient’s trauma management. If you do not know how to behave, call for help and medical dispatchers will instruct you on what to do, how to cause, for example, a shock position with your legs raised. If the patient is not breathing, in this time, dear Ladies and Gentlemen, we must proceed with cardiopulmonary resuscitation. Before starting cardiopulmonary resuscitation, remember that maximum safety conditions should be provided for an adult. The possibilities of saving human life, which you have limited. These sources are medicines or electricity, which is used by an AED device, a defibrillator, and medics have them, unless there is such a source in the immediate vicinity. So your primary responsibility when you find out that a person is not breathing is to make sure that someone has not already started making an emergency call. If we call for help, we provide the most important elements that the dispatcher will ask us for. If we are alone, we turn on the speakerphone and talk to the dispatcher. But if we have other people around, this other person informs. We, on the other hand, proceed to cardiopulmonary resuscitation. Remember that the place is also important, a hard, even surface. So if you happen to meet me in the car, this is not a good position in which you can perform cardiopulmonary resuscitation. So such a patient must be evacuated from the car as soon as possible to a level surface and to such a place that other cars do not accidentally come to both of us. Therefore, sometimes you have to move away from the vehicle because the vehicle itself is exposed, for example, to explosions. Therefore, this distance should be safe for us and during this time we proceed to the cardiopulmonary restaurant, performing 30 chest compressions. I would just like to point out that if you listened to our previous podcast, I said that it is good if there is a mouthpiece for artificial ventilation in the first aid kit. Then we can perform cardiopulmonary resuscitation in a way that is safe for us. If we do not have this mask, we perform cardiopulmonary resuscitation through chest compressions only. We limit ourselves to oppression until someone provides us with this element. We continue resuscitation until the uniformed services arrive or until we lose strength, because if we don’t have the strength, we have to rest for a while.
AK: 67% of Poles surveyed by CBOS declare that they would be able to provide first aid in the event of an accident, but only 19% are completely confident in their skills in this area. First aid training could be a solution. Is first aid training necessary to properly provide assistance and what are the benefits of participating in such training?
PK: Of course, each knowledge improves abilities in various areas of our lives. That is why many medics encourage first aid education among children from an early age. Children are at the age when they absorb knowledge most easily. In primary schools, there is plenty of time to expand this knowledge, starting with basic skills and then adding more elements. I recommend that you, as the Parents’ Council, strive to ensure that these elements of first aid are as present as possible in educational life. The more people are educated, the more of them will no longer be afraid of first aid. Vocational education is treated very neglected by some workplaces. Even if training courses are organized, because of their periodicity, we do not feel comfortable, we do not feel confident in this acquired knowledge. These trainings are also in different time mechanisms. We prefer such all-day trainings, but we know perfectly well that usually such trainings are in the form of two-hour lectures. Some of them are conducted only by people with health and safety service qualifications, and not by professional paramedics or people who have completed medical studies in the field of emergency medical services. This is also a different level of knowledge and experience related to medicine. In medicine, there are some standard solutions, but in most cases, unfortunately, this experience in patient management is important. The more you exercise, the better you can prevent the consequences of accidents. There is no other way to explain and show cardiopulmonary resuscitation than by exercising on phantoms. On a living organism, this cannot be practiced. In addition, the strength of the pressures, the strength of the grips depends on our patient and our condition. After accidents, the chest will very often be flaccid, so for this reason alone we will have lighter compressions. We will behave differently towards an adult and a child. Pressures will also be performed with different intensity. The inhalations will also have to be tailored to our patient. A one-second peak in an adult, in children we even talk about “puffs” not breaths. So education, education and more education. Remember that, just like in your professional life, when you enter any new workplace, you undergo the so-called health and safety training, i.e. on-the-job training. Why is it so important, this on-the-job training? Because it implements, it will inform you what to do, when to do it and how to do it. Most studies show that most of us are visual learners, sensory learners. He has to see, feel, touch something to be able to multiply it. And the same, unfortunately, is with first aid. If we don’t see something, we don’t feel it, we won’t know how to do it. If we have this knowledge repeated for many years, it becomes a habit. Like us medics, we also had difficulties with cardiopulmonary resuscitation the first time. Through many years of practice in the field of cardiopulmonary resuscitation exercises, it is a habit that for us is not a mystery or novelty and we do not feel fear of it. Of course, this is always an uncomfortable situation, because it is related to the patient. But, dear Ladies and Gentlemen, we already have some experience and we know how to do certain things. Hence education, the more people are aware of first aid, the fewer of us will be afraid of first aid, the more lives we will save. There will simply be more of us, Poles. And this is probably what everyone cares about.
AK: Thank you very much. This is a very valuable point. Regular repetition of training is a great practice that is worth using. Thanks to it, we will be able to help others without fear. Thank you very much for today’s conversation with lots of valuable comments and tips on first aid. My and your guest expert in first aid was Paweł Kwiatkowski from Kvadro. I hope that thanks to this conversation you have found out why it is worth training in first aid and that the cyclical nature of training allows us to overcome the fear of providing help to the injured. See you in the next episode of AmberPodcast.
