Head and Neck Injuries

To move or not to move

One of the questions that always comes up on our Safe and Sound first aid courses is  --  "if you  think someone  may have broken their neck  should they be moved?"  Clearly the concern is that if you  move somebody with a supected broken neck then you  might paralyse them. But if they are not breathing or  are about to choke on their own vomit, then you have to move them, as it is your job as a first aid to help preserve life.

Reading Melanie Reid’s feature in the Saturday Times Magazine brought this question back to my mind. Melanie fell from her horse in 2010 and has been partially paralysed since the accident. Her weekly column in the Saturday Magazine is a ‘must read’. 

Melanie says, “I fell off my horse. The first job was to survive. And I managed that, thanks to the friends at the scene, paramedics, the crew of a Navy search and rescue Sea King, and the NHS at its most superb.” 

I don’t know if Melanie stopped breathing and yes she is paralysed, but alive and I also  don’t know whether she was glad that she was saved but  I suspect she is as she continues to fight for a recovery.

So what should you  do?

Suspect a spinal injury if someone has:

Had a blow to the head neck or back (especially resulting in unconsciousness).

Fallen from a height – like Melanie did from her horse

Dived into shallow water

Been in an accident involving speed – such as a car accident

Been involved in a ‘cave in’ accident – such as crushing or collapsed in a rugby scrum

Multiple injuries

Pain or tenderness in the neck or back after an accident - be careful not give pain killers before seeing a paramedic as they may mask other severe injuries

If in doubt treat the casualty as if they have a spinal injury.

What next?

If they are  conscious:

Reassure them and tell them not to move. Staying calm is so important in all first aid incidents. Because your anxiety ill transfer and even if you are  falling apart inside, the behaviour needs to show the opposite. 

Keep them in the position in which you find them. Don’t  allow them to move, unless they are in severe danger

Hold their head still with your hands. Keep the head and neck in line with the upper body.

Call 999/112 for emergency help. Keep them still and warm until help arrives.

 If they are unconscious

 If they are breathing normally this means the airway must be clear, so there is no need to tip the head back - you may have to gently tip it back and resuscitate if they are not!

Call 999/112 for emergency help

Hold the head still with your hands and keep the head and neck in line with the upper body.

If you have to leave the casualty, if they begin to vomit, or if you are concerned about their airway in any way, you should put them in the recovery position. KEEP THE HEAD AND NECK IN LINE WITH THE SPINE WHILY YOU TURN THE CASUALTY, Try to get help in doing this if you can.

Keep them warm and still. Constantly monitor breathing until help arrives. Only move them if they are in severe danger

I know this isn’t a very uplifting blog but I was reminded of the importance of knowing what to do when I read Melanie’s feature.  I hope you never have to use it – but at least should an emergency arise you will have some knowledge.  Better still come on one of our first aid courses and practice it yourself. www.safeandsound.uk.net

Heat Exhaustion and Heat Stroke - What To Do?

                                                                   

I am not complaining but..... It is hot hot hot. And this kind of heat can creep up on you so it is important to monitor your body's response to it.

We all know it’s important to drink water and slap on sun cream when the sun shines. But would you know what to do if someone had heat exhaustion or heat stroke?

So what is heat exhaustion?  It is when we sweat excessively and lose   water and body salts. Take a child that begins to feel poorly in the late afternoon or early evening after running around all day. 

Heat exhaustion occurs when the core body temperature rises above 38"C.   And if this is not treated it can quickly lead to heat stroke

So what are the signs and symptoms?

They include confusion, dizziness, and a loss of appetite, nausea, vomiting, stomach cramps and a pale and sweaty skin.   The child or adult may say they 'feel cold' but they will be hot to touch

How to treat this?

·        Move the adult or child to a cool shaded area. Remove excessive clothing and lay them down

·        Give them water to re-hydrate them. Oral rehydration solutions such as Dioralyte or isotonic drinks are best as they also replace lost body salts (if giving to someone else's children read the label and get consent from patents)  If a child does not want to drink then  try ice lollies. 

Always get medical advice, even if the child or adult recovers quickly.

Heat stroke is a much more serious condition and results in failure of the temperature control area of the brain.  Our sweating mechanism fails and the body is unable to cool down. The body temperature can reach dangerously high levels (over 40"C).

The symptoms for this can include severe confusion and restlessness, a lowered level of consciousness and a possibility of fitting. Flushed, hot dry skin (no sweating), a throbbing headache, dizziness, nausea, vomiting.

So how to treat this? 

·   Move the child or adult  to a cool, shaded area

·    Call 999/112 for emergency help

·    Cool rapidly. Remove outer clothing and wrap in a cold, wet sheet, Keep it wed and cold until the temperature falls to normal levels, then replace with a dry sheet. Take care not to cool down too quickly

    

I hope this isn't too scary but really so much better to be forwarned

You can also always attend one of our first aid courses www.safeandsound.uk.net

Registering Nannies and Au Pairs with Ofsted

 

                                                                

"Why do I need to register with Ofsted?" asked a nanny on the phone today. 

 "You don't need to register however if you are looking for work then you will stand a better chance of finding a job if you are registered." I amswered

 "Why?" she asked

"Because a family can only claim back their tax credits if they employ an Ofsted registered nanny.”

"But then surely they should pay for me to be registered" was her retort.

 Of course there might be some truth in this but with the economy in decline and families thinking twice about employing nannies, I explained that it might be sensible for her to take the initiative and pay to get herself registered.

She sighed "So how do I do it?" 

Luckily Safe and Sound has written a guide for nannies and parents.  We did this  after  many many calls  from confused nannies, au pairs and parents who had called Ofsted and been directed to their site - but find the site muddled and confusing.  And when they tried to talk to someone at Ofsted they still did not understand.  I am not sure Ofsted really understand themselves.

So here is our Safe and Sound Guide to the Voluntary Ofsted Registration for child carers looking after children in other people's homes. 

Parents who employ an Ofsted registered nanny can receive some financial contributions towards their childcare costs. There are two types of financial support available: employer-supported childcare vouchers and working tax credits.

You can find out more about what this means for you financially by going to: www.taxcredits.inlandrevenue.gov.uk

The Registration Process

Step 1

Nannies and Au Pairs complete the initial online application form (CR1) available at http://www.ofsted.gov.uk/resources/application-forms-for-childcare-register-forms-cr1-and-cr2Ofsted.gov.uk

You can also apply by phone (0300 123 1231) or post. 

Step 2

Ofsted will send out an invoice and a request for further information including the following documents:

1.    A valid paediatric first aid certificate

2.      Evidence of an appropriate childcare qualification covering the Common core skills and knowledge (for further info go to http://www.ofsted.gov.uk/resources/factsheet-childcare-common-core-skills-and-knowledge)

3.    A valid nanny insurance certificate

4.      A completed CRB application form (Ofsted will carry out the CRB check as part of the registration process)

Step 3

Submit the documents at a local post office where the applicant’s identity will be verified. Once Ofsted has checked all documentation, carried out the CRB check, and is satisfied the applicant meets their criteria; they will issue a certificate of registration with a unique registration number.

How much does it cost to register?

Ofsted registration fee (includes CRB check)                        £103

Safe and Sound Paediatric First Aid course                  £114 (£100*)

Safe and Sound Common Core Skills course                £135 (£120*)

*If both courses are booked together the discounted rates apply

Nanny Insurance                                                                     Approximately £65

Who should be expected to cover the cost?

Whilst parents benefit financially, Ofsted registration may enhance a nanny or au pair’s professional qualifications and employability and so both parties benefit from registration. There are no hard and fast rules as to who should pay for what but as a professional childcarer it is not unreasonable to expect nannies to pay for their first aid training and insurance. It is worth mentioning that if the parents do pay for the registration it is considered a benefit in kind and should be declared as such.

How long does it take to get registered?

Once your application and supporting documents have been submitted, you need to allow approximately 12 weeks to get your registration certificate through.

Good Luck

Only female bees and wasps sting

Just another gloomy summer day in London and sitting in the garden with a friend,sipping good old english tea - menondade on a hot sunny day would have been preferred - we suddenly get visited by a bee.  "not seen many of these this summer," says my friend and hardly had she got the words out of her month when she gets stung!!! 

The poor bee had landed on her hand for a wee rest and she, not knowing it was there was describing an event to me and slapped her hand on the table - with the bee underneath.

And it was painful and there sitting in the middle of her hand was the Bee sting.  "Do you think the bee will die now," she ask worried. More important was to get the sting out immediately. "tweezers," she shouts. Putting on my Safe and sound hat, and remembering what our paramedics always teach on our first aid courses,  I explain, tweezer should never be used. You don't want to snap the sting or push it further in - I grab a credit card and gently edge the sting  off her hand.  I check her out for any signs of swelling or anaphylactic shock but all is good. Once the sting is removed it is important to use a cold compress or cold water to reduce the swelling.

Some people can have a severe allergic reaction to being bitten or stung and the whole body can react within minutes which can lead to anaphylactic shock. Anaphylactic shock is very serious and can be fatal.

So do bees really  die after they have stung you?  I search for answers.  Apparently it depends on which kind of bee stung you.  Honey bees do die after they sting but other bees and of course those horrible wasps, don't.  and another interesting fact I found out is that only female bees  and wasps sting.  Venom, pumped from attached venom sacs, is injected into the unfortunate victim through the stylus, the needle-like portion of the sting apparatus. The stylus is enclosed between a pair of lancets. When a    bees or wasp  stings you, the lancets become embedded in your skin. They alternately pull the stylus into your flesh, and then the venom sacs pump venom into your body.

My friend is fine and hopefully so is the bee.

WHAT TO DO  - First Aid for bites and Stings

Bee, wasp and Hornet stings cause localised pain and swelling but are not usually serious.

•        If the sting is still visible in the wound, carefully scrape it away with your fingernail or  a card such as a credit card ad ensure that the poison stored in the poison sac attached to the sting is not     squeezed into the bloodstream.

 

•        Place a cold compress on the area stung to relieve pain and reduce swelling and if possible raise the affected area.

•        If the sting is in the mouth, remove if possible and get the child to sip cool water or suck on a piece of ice.

•        TAKE THE CHILD TO HOSPITAL OR DIAL 999 IMMEDIATLEY IF THE LIPS, TONGUE OR THROAT BEGIN TO SWELL

Choking Baby - know what to do

On yesterdays  Safe and Sound  Paediatric First Aid Course for new parents the two questions that most parents asked us were: what to do if my baby starts choking? and what to do if he stops breathing?  This is not uncommon - we are alway getting asked this questions.  And of course parents are anxious and are always going to be worried about this.

Lucikly the latter -- stopping breathing is rare - but you do need to know what to do and we cover this very very thoroughly on all  Safe and Sound first aid  courses.  The former, choking, is not rare and will happen many times, most times it will pass without an issue - that said you still do need to know what to do.

Most important in both of these scenarios is keeping clam. A baby or child who is choking is going to be anxious and scared as they won't understand what is happening and the more they panic the worse it will become.   Your job, however upset and scared you are, is to remain calm. Your anxiety will transfer to the baby or child.  I know, not easy and this is where the correct training comes in. Because if you know what to do at least you can do something about it.

So below are some instructions:

If a baby is choking, you need to assess the situation quickly to see how best you can help.

 

 

This information applies to babies aged under one year old. For information relating to adults and older children, see

 

What should I do if someone is choking?

 

Choking happens when a person’s airway suddenly gets blocked so they cannot breathe. Their airway can be partly or fully blocked. In babies, choking is often caused if they put small objects in their mouths, which then get stuck. It can also be caused by food getting stuck.

Choking in babies under one year old

A baby who is choking will be distressed and may be unable to cry, cough or breathe.

• Lie the baby face down along your forearm or thigh, with their head low. Support their head.
• Give up to five firm slaps to the baby’s back between the shoulder blades with the heel of your hand. (The heel is between the palm of your hand and your wrist.)
• Stop after each slap to check if the blockage has cleared. Look inside the baby’s mouth and remove any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage. You may push it further in.
• If the airway is still blocked, give up to five chest thrusts (see below).
• Stop after each thrust to check if the blockage has cleared.

If the baby’s airway is still blocked after three cycles of back slaps and chest thrusts, you should:.

• dial 999 (or 112) for an ambulance immediately. Do not leave the baby. Take him or her with you to the phone 
• continue with the cycles of back slaps and chest thrusts until help arrives

Chest thrusts for babies under one year old

In babies under one year old, chest thrusts are used in an emergency to clear a blockage from their airway. Important: do not use abdominal thrusts with babies under one year old.

• Lie the baby along your forearm on their back, with their head low. Support their back and head.
• Give up to five chest thrusts. Using two fingers, push inwards and upwards (towards the head) against the baby’s breastbone, one finger's breadth below the nipple line.
• Check if the blockage has cleared after each thrust, by looking inside the baby’s mouth and removing any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage as you may push it further in. 

Complications

Once the baby’s airway is cleared, some of the material that caused the blockage can sometimes remain and cause complications later. If the baby still has a persistent cough or difficulty swallowing, they need to see a health professional urgently. You should take the baby to A&E, an NHS Walk-in Centre or your GP if it’s during GP hours.

 

For more inforamtion about paediatric first aid courses go to :

http://www.safeandsound.uk.net/catalogue_main.php?catID=4428

 

Heart Attacks

I have a new question that I pose to everybody I meet. "Would you know what to do if I had a heart attack?"  The scary thing is that almost everybody has either said 'no' or given me the wrong answers. The most common response is ”I would put you in the recovery position" which is not correct.    

This doesn't make me feel very comfortable, especially as last year I was rushed to hospital with a suspected heart attack. How reassuring it would be to know that if I did collapse in the street, started choking or stopped breathing somebody near to me would know what to do. Now you might well say 'well she would say that wouldn’t she because she runs Safe and Sound which is a First Aid Training Company. '  But it isn't just about getting more business - it has to be the most important skill that we will ever learn. Why wouldn't we want to learn first aid? 

For some reasons we Brits are really bad at this and I am not sure why. Maybe because it is scary and easier to hope that it will just never happen.  But it happened to Heather who was only 48.

Last year she, a receptionist at Highgate Dental Practice in London had a heart attack just after she arrived at work in the morning. She was fit and healthy and only 48.  Her heart stopped three times and she was in a coma for four days. She survived because the surgery, had she finished their training with us and it was fresh in their minds. Everyone  knew exactly what to do. It is these crucial moments before the ambulance arrives that are so important and it stopped heather from suffering brain damage or dying.

“Had we not had the training, we would have been at a loss,” Dr Hagan explained. “At the early stages, the most important thing is to keep the oxygen circulating around the body. We all worked like clockwork."

 

Here are some interesting heart attack facts.

Overall cardiac arrest survival rate

259 out of 3,246 cardiac arrest patients who ambulance staff attempted to resuscitate survived to be discharged from hospital (8%).

In 2009/10, 237 out of 2,973 cardiac arrest patients treated by ambulances staff survived (also around 8%).

 Around two thirds of cardiac arrests in London occurred in the home (67.7%)

·         Just over a fifth of cardiac arrests occurred in public (20.8%)

·         Between a third and a half of all cardiac arrests were witnessed by bystanders (44.1%)

·         However, bystanders only gave cardio-pulmonary resuscitation (CPR) in just over a third of all cardiac arrests (36.7%)

·         The average age of a cardiac arrest patient was 68

·         The majority of patients (64%) were male

·         Female patients were on average six years older than males (72 compared with 66)

·         Cardiac arrests occurred most frequently on a Monday

·         The highest number in a single month occurred in December (10.8%) and the fewest in July (6.9%)

Chain of survival and defibrillation

For every minute that a person in cardiac arrest must wait to be defibrillated, their chance of survival decreases by approx 10%.  If a cardiac arrest happens in the home and there is no defibrillator it is important that good quality CPR is carried out to keep the brain oxygenated and the heart pumping.

 It is not rocket science so common guys do yourself a favour and make sure you are prepared.

 

Drinking Enough Water

Just a reminder about the importance of drinking lots of water in this wonderful hot weather which hopefully will stay with us for a while.  It is  very easy to become dehydrated and if you wait to drink water when you feel thirsty you are probably already dehydrated.

A good general recommendation is to drink enough fluid so that you're not thirsty for long periods of time, and to steadily increase your intake during exercise or hot weather.

Some of the early warning signs that you're dehydrated include:

•feeling thirsty and light headed
•having dark coloured, strong-smelling urine
•passing urine less often than usual

A baby may be dehydrated if they have:

•a sunken soft spot (fontanelle) on their head
•few or no tears when they cry
•fewer wet nappies
•drowsiness

The body is affected even when you lose a small amount of fluid. Read more about the symptoms of dehydration www.nhs.uk