Talk:First Aid/Emergency First Aid & Initial Action Steps

BLS Chapter
In my opinion, D for Deadly bleeding has no real place here in a chapter fundamentally about resucitation. It would be far better to cover D for Defribrillation here - even if it's only about how to work with someone operating a defibrillator and a seperate chapter later for how to actually use (although i'd prefer to cover it all here).

Leave bleeding in it's own place. In reality nobody is likely to come to the section on resus to find a section on bleeding. Let's move it.

I've also moved AVPU here (as part of the larger mnemonic) as its very imporatnt to knwo how to check response before commencing ABC checks.

Owain.davies 14:31, 3 July 2007 (UTC)


 * The point is that Deadly bleeding is an ABC emergency. If you're a lone rescuer it might not make a difference since you'll be busy doing CPR, but a wet check should definitely be done as a precursor to the head-to-toe of a secondary survey if you have access to a bystander or another trained rescuer. As for treatment of deadly bleeding, I'm fine to move it over to First Aid/External Bleeding. Getting an AED (and AED-trained responder)? That's part of calling EMS. When you do one, you do the other. That's why I proposed the above changes. – Mike.lifeguard | talk 13:57, 5 July 2007 (UTC)

Here i think that Defibrillation is definately the priority over bleeding, so probably deserves the space more. Especially as AED now forms part of many standard first aid courses.


 * It does get priority over bleeding - that's why getting an AED comes before Deadly bleeding. Compressions also take priority over Deadly bleeding. Perhaps that should be made more clear, but that's what's intended there. If you want operation of the AED to take the priority over CPR (as is proper), then that should be included in First Aid/Automated External Defibrillation and reinforced in First Aid/C for Compressions.
 * Getting an AED is already included in Ambulance (which still needs to be created). Getting an AED is part of that step. Operation of AEDs is not part of Standard first aid, but is included as an advanced topic here. As for putting "get an AED" into D for Defib... that's not where it should happen in the sequence of things - it's at the same time as activating EMS.
 * Area (hazards, MOI, barriers...)
 * Awake (LOC)
 * Ambulance (get EMS and an AED)
 * Airway
 * Breathing
 * Compressions (getting an AED comes earlier; deadly bleeding comes later; using the AED takes priority over BLS)
 * Deadly bleeding (AED has already been summoned. Putting it here is out-of-order. Operation of an AED is covered elsewhere, and is not part of BLS.


 * – Mike.lifeguard | talk 21:23, 5 July 2007 (UTC)


 * I think that AED is now so firmly routed in BLS (it's part of most basic courses over here now) that it should be part of the basic protocols, rather than deadly bleeding. I'd even go so far as to move the AED operation up to BLS section.  I'm not sure its responsible to bring deadly bleeding in to the BLS protocol for first aiders lest they neglect the important parts.  In terms of EMS treatment, we are going to resus and defib first then look for the Hs and Ts (which includes 'deadly bleeding' as Hypovolaemia).  Thinking about that, deadly bleeding is only one of 15 reversible causes of cardiac arrest, and in honesty probably the one with the lowest chance of survival (trauma related cardiac arrest ROSC rates are a tiny fraction of 1%, far lower than the other causes)  It seems strange to give it such prominence when its unlikely to help. Owain.davies 06:13, 6 July 2007 (UTC)


 * It's more likely to help than nothing, which is what you're proposing. Someone trained in CPR but not AED (which, unfortunately, is more likely than having both) should be doing defib? No! If they're not trained to use an AED then they're not going to be using an AED! So what would have them do? Nothing seems like a bad idea, and this sounds at least marginally better.
 * For rescuers with AED training on top of their CPR, they'll obtain an AED in Ambulance (again, this section doesn't exist because my proposal hasn't been adopted) and then use it (the operation of defib is an advanced topic, and is located there).
 * Feel free to make it clearer that defib takes priority, but putting a skill requiring additional training with a skill that doesn't is not ok.  – Mike.lifeguard  | talk 20:03, 15 July 2007 (UTC)


 * I can agree with Mike here, only rescuers trained in using an AED should use one. I did make the point about it being easy, but the stresses of using an AED to shock someone may be too much for someone who isn't trained in it. --Nugger 00:30, 16 July 2007 (UTC)

Ambulance before Airway - Disagree
You shouldn't call an ambulance before checking airway and breathing as the call may be incorrectly categorised at the control centre.

The correct procedure is:


 * Check response
 * If Unresponsive then call for help ("Help! Help!")
 * Check Airway
 * Check Breathing
 * NOW summon ambulance ("patient not breathing")

This avoids calls being passed as 'Unconscious' when it should be passed as "Not Breathing" and ensures that the most timely resposne it recieved. It is best practice to give the 15 seconds maximum to ascertain this important fact, which avoids a potentially more deadly delay of having a call misgraded.

We should stick to this protocol at all times, to avoid the risk of badly passed calls

Owain.davies 14:36, 3 July 2007 (UTC)


 * ILCOR disagrees:
 * And so does the Lifesaving Society: PDF
 * And so does the AHA: PDF
 * I hate to bring it up again, but notice that ILCOR and the AHA both use 'victim' primarily (I'll leave out the LSS since you think they're biased towards doing that anyway), and 'patient' for sections directed towards healthcare providers. – Mike.lifeguard | talk 13:52, 5 July 2007 (UTC)

Fair enough, i'll give you that one. As to victim, you probably can be a victim of a heart attack, but still not of a cut finger!... Owain.davies 16:02, 5 July 2007 (UTC)


 * I'm fine to alternate between victim and patient just as the 3 organizations above do... victim for most stuff, and patient/casualty in First Aid/Advanced Topics. Using patient for everything is not ok though. – Mike.lifeguard | talk 20:30, 5 July 2007 (UTC)

Using alpha-echo, a delta unconscious is lights and sirens just like an echo cardiac arrest is. Only thing different is that you might run to the truck for an echo and drive a wee bit faster for a cardiac arrest. Once the dispatcher beings collecting the information, she can always advise EMS to upgrade to a cardiac/respiratory arrest. Mike6271 02:54, 6 July 2007 (UTC)


 * I've found it! - The ILCOR protocol is NOT to call for EMS until you have assessed breathing, although you should shout for help when you see they are unconscious - which is what i said originally. I will consequently change this information around.  This is shown at Part I: Introduction of the ILCOR protocol, under "The Universal Algorithm".


 * What if they are breathing... Do they still require EMS? Yes. So? Call earlier - that's the foundation of the chain of survival: early access.  – Mike.lifeguard  | talk 20:05, 15 July 2007 (UTC)


 * Allow me to throw another wrench in here, but don't forget about children and infants when you do make the change as they require immediate assistance if you're alone. (I know it's stated somewhere but just a friendly reminder.) --Nugger 00:21, 16 July 2007 (UTC)


 * Mike- you can't be so sanctimonious about following ILCOR protocols throughout, and then just ignore one the most fundamental parts, just because it doesn't suit your preferred protocol! The link I posted above from ILCOR unambiguously states that calling the ambulance comes after airway and breathing - we either follow it all (and i'm happy to relent on the breathing issue because that is their guideline) or we follow none of it, and turn this in to a bun fight over regional variations.  I say we follow the ILCOR guidelines to the letter, which will make this book unambiguous and clear. (this will also mean changing things like D for defibrillation, which ILCOR list as a BLS skill.  Owain.davies 17:05, 16 July 2007 (UTC)


 * I'll have to agree with Owain on this one, although Mike posted a link from the AHA which stated "An Immediate call to 9-1-1" it didn't specify WHO had to call 9-1-1. ILCOR states that YOU should "shout for help" then assess breathing. A patient who is dead from a blocked airway won't appreciate your immediate 9-1-1 call. But a person who may be able to breathe from a simple head tilt will thank you later. 9-1-1 can be called by ANYONE, it doesn't have to be the rescuer.--Nugger 03:24, 5 August 2007 (UTC)

AVPU or ALVPU
I know that Owain.davies (who is mostly responsible for writing this module) only uses a four-point scale for assessing consciousness, but I use a 5-point scale. The module as it currently stands explains why I use an additional level of consciousness: Lowered.

Under "Alert" it says "The victim looks at you spontaneously, can communicate (even if it doesn't make sense) and seems to have control of their body." In the 5-point scale, Alert is for victims who make coherent sentences, can communicate effectively and have no issues with responsiveness. Lowered covers those victims who take longer to respond, have heavy eyelids because they feel tired, they may have shaky hands due to shock or an "adrenaline rush."

I think the 5-point scale is more accurate than the 4-point, particularly because the grey area referred to here deals with those people who fall into the Lowered category. I find that tying those 2 concepts together helps candidates make better judgment calls when dealing with issues of implied consent that aren't straightforward.

Keep 4 levels or introduce the 5th?  – Mike.lifeguard  | talk 02:00, 16 July 2007 (UTC)


 * This is a primary assessment, and LOC comes later. AVPU is also recognised worldwide, with numberous published papers i can give you links to (or just google it if you feel like it), whereas ALVPU seems to be a variation.  I can see why you use it, but i don't think its relevant here. Owain.davies 16:58, 16 July 2007 (UTC)


 * AVPU is the international scale for responsiveness. Descriptions of how alert a person is are given later in the reports.--Nugger 03:26, 5 August 2007 (UTC)

AAA vs GO DR SHAVPU
I don't see how you AAA system is an improvement on the GO DR SHAVPU system I laid down for initial assessments. Whilst your system does have an alliterative advantage in initial memory making, it is actually harder because it relies on the rescuer remembering a whole sub-set of parts which make up the As, whereas the GO DR SHAVPU system is far more comprehensive. Also, as I said the ILCOR guidelines state that ambulance comes after airway and breathing - read your own posted link!!!! Owain.davies 17:01, 16 July 2007 (UTC)


 * Please don't yell at me. I've copied the relevant text; feel free to change the module to match this:


 *  – Mike.lifeguard  | talk 01:56, 17 July 2007 (UTC)


 * Yes your memory aid is comprehensive, but I can't see teaching any kid to remember that successfully. AAAABC works very well for me. If you'd like to include both, let's remove memory aids from the text proper, and include them in a textbox for memory aids. I can create another template similar to these for memory aids. I think if we do that throughout the text it might alleviate a lot of the bickering.  – Mike.lifeguard  | talk 19:54, 16 July 2007 (UTC)


 * Of course, this book is not 'First aid for kids'. First aid for kids is something I only teach occasionally, and you're right, i wouldn't do GO Dr SHAVPU with them, and it that case i would emphasise calling EMS more highly, because they are likely to be more efficient doing that than attempting to treat, but most competent adult rescuers can understand and remember the GO DR.  Maybe a separate 'First aid for kids' book is not a bad idea though.  As per my other discussion with you, i have reread the ILCOR document in detail, and still believe that ambulance comes after airway and breathing. Owain.davies 06:42, 17 July 2007 (UTC)


 * My point is that this textbook should be useful for any first aid or CPR course, and the advanced topics chapter should be useful for the appropriate courses. First aid doesn't have an age prerequisite, so why shouldn't a 12-year old take standard first aid? I do community CPR courses all the time, and I suspect that even adults are going to prefer AAAABC because they'll be able to remember it.
 * I think using AAA as an organizational method for the text of this module and highlighting GO DR SHAVPU in a box to the side would be most effective though. AAA creates a very nice section hierarchy that your mnemonic doesn't. And (according to you, though I don't agree), GO DR SHAVPU is a wonderful memory aid that your candidates will remember forever, so let's give it a box to the side to give it more prominence.
 * Please read my reply here regarding EMS and AED in the CoSTR.  – Mike.lifeguard  | talk 14:36, 17 July 2007 (UTC)


 * Which is all very well, but having ambulance in there is still in contravention of the ILCOR protocol. Owain.davies 17:22, 17 July 2007 (UTC)