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This document is designed to provide information about Automated External Defibrillators (AEDs) and how they can be deployed in the community to help resuscitate an out of hospital cardiac arrest patient. It is based on A Guide to Automated External Defibrillators published by Resuscitation Council (UK) and British Heart Foundation (December 2013). Remember that completing a first aid course is also going to help you gain the skills required to help.

Summary

1. Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. In Australia, as many as 30,000 OHCAs occur every year – with fewer than 10% surviving (Ambulance Victoria, 2016). However, with immediate resuscitation more lives can be saved.

2. In cardiac arrest the heart is no longer pumping and the casualty loses consciousness and will not be breathing normally. This person is technically dead, but there is a limited period of time during which a normal heartbeat may be restored.

3. For a short period of time, the non-pumping heart may have a special rhythm (Ventricular Fibrillation or VF) which may be shocked back to a normal, effective pumping rhythm (defibrillation).

4. It is important to understand that the rescuer (professional, trained layperson or untrained person) cannot tell from observation or the casualty’s history whether the casualty has a “shockable” rhythm (where an effective heartbeat may be restored) or a “non-shockable” rhythm (where an electric shock will have no benefit for the casualty).

5. One of the functions of an AED is to determine whether the casualty has a “shockable” or “non-shockable” rhythm.

6. The time to defibrillation is a key factor that influences survival. For every minute defibrillation is delayed, there is approximately 10% reduction in survival if the patient is in cardiac arrest due to Ventricular Fibrillation (VF), also referred to as a shockable rhythm.

7. Cardiopulmonary resuscitation (CPR) alone will not save a person in VF. Hence a defibrillator should be applied to the person in need as soon as it becomes available so that a shock can be delivered if required.

8. The development of AEDs has made defibrillation part of basic life support. AEDs can accurately identify the cardiac rhythm as “shockable” or “non-shockable” and will then provide verbal prompts of the next steps (i.e. shock advised or no shock advised, continue with CPR).

9. Many OHCA patients can be saved if persons nearby immediately recognise they are in cardiac arrest, call Triple Zero (000) for an ambulance, perform CPR and use an AED. Each of these stages “is a link” and are links in a chain of events that provide the best chance of survival. Minutes count and members of the public along with first responders represent the front line in resuscitation from OHCA. More information in section 2 and section 3.

10. AEDs are easy to use, compact, portable and very effective. They are designed to be used by lay persons; the machines guide the rescuer through the process by verbal delete first “prompts” hearing prompts and visual prompts. They are safe for the casualty/victim and will not allow a shock to be given unless the casualty’s/victim’s heart’s rhythm requires it. They are designed to be stored for long periods without use and require very little routine maintenance. Many models are available directly from the manufacturers or through medical equipment companies. More information in Section 3 and section 13.

11. Right across Australia, AEDs have been installed in many busy public places, workplaces, or other areas where the public might have access. The intention is to improve early access to defibrillation to restore a normal beating heart rhythm as soon as possible. This strategy of placing AEDs in locations where they can be used by a lay person in the case of an OHCA is known as Public Access Defibrillation (PAD).

12. AED use should not be restricted to trained personnel only. Allowing the use of AEDs by members of the public without prior formal training can be beneficial and may be lifesaving. However, the use of an AED by trained members of the public and professional responders is encouraged. More information in section 4. Separate information is included about AEDs in the workplace (section 8) and schools (section 9). Information on training is contained in section 11.  Statement – A Guide to AED’s July 2017 Page 2 of 8

13. In Australia, there are very few legal barriers to PAD. A rescuer / person who has acted appropriately to help a patient who has suffered cardiac arrest would not be sued regardless of the outcome. More information in section 6.

14. There are a number of factors to consider when contemplating purchasing and installing an AED, some of these considerations are discussed in sections 5 and section 7. These decisions can also be made with the assistance and guidance of the state ambulance service who can provide advice relating to AED purchase, installation and other practical information.

15. AEDs should be placed or stored where they are most likely to be needed; they must be accessible with a minimum of delay. All persons working at the site need to be aware of their purpose and location, and the steps to be taken should someone suffer Sudden Cardiac Arrest (SCA). This will include calling Triple Zero (000) for an ambulance service and activating the organisation’s emergency response plan: ie, to commence CPR on any unconscious, non-breathing person and to get the AED as soon as possible, apply the pads and follow the AED’s prompts. More information in section 5 and section 12.

References ARC

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Children with mild to moderate asthma do not benefit from a common practice of increasing their inhaled steroids at the first signs of an asthma exacerbation, according to clinical trial results published in The New England Journal of Medicine. Researchers found short-term increases in inhaled steroids did not prevent attacks in children aged 5 to 11, and may even slow a child’s growth.

For one year, researchers measured benefits of quintupling inhaled steroid doses during the earliest signs of an asthma attack. This period-;known as the “yellow zone”-;is when wheezing, coughing, and shortness of breath first appear. “Increasing the dose of inhaled steroids at early signs of asthma worsening along with using quick relief medicines to relieve symptoms is a common practice,” says study author Kristie Ross, MD, assistant professor of pediatrics at Case Western Reserve University School of Medicine and clinical director of pediatric pulmonology, allergy and immunology at UH Rainbow Babies & Children’s Hospital. “Our study shows that this is no more effective at preventing progression to more serious asthma exacerbations than the use of quick relief medicines alone, such as albuterol inhalers.”

All 254 children in the randomized, double-blinded study used low dose controller inhalers-;”two puffs twice daily”-;for a standard maintenance dose of inhaled steroid medication. When parents noticed their child had yellow zone symptoms, the researchers instructed them to use a different inhaler for seven days. Half of the inhalers were the same low dose, and the other half contained five times the maintenance dose. Across 395 yellow zone episodes, the researchers did not find any significant difference in the number of asthma attacks that ultimately required systemic steroids. Despite a 16% increase in exposure to inhaled steroids, children in the high-dose group did not experience fewer attacks.

The researchers did find children in the high-dose group had slower growth rates-;averaging 0.23 centimeters per year less than children who maintained the low-dose regimen. Children with over two yellow zone episodes in a year, and children aged 5-7 were most affected. Over time, short-term increases in inhaled steroids could have cumulative effects, say the authors, but the slight difference is not enough to connect inhaled steroids to growth defects.

Ross cautions that the study did not include children with severe asthma who may be more prone to exacerbations, or children with uncontrolled asthma. It focused on preventing early, mild asthma symptoms from progressing to dangerous attacks. Parents should continue to work with their child’s asthma doctor to develop a personalized home management plan that includes yellow zone interventions, she says.

Rainbow Babies & Children’s Hospital at University Hospitals Cleveland Medical Center was one of 17 trial sites in the study. Other study authors from Case Western Reserve University School of Medicine included James Chmiel, MD, MPH, professor of pediatrics; and Ross Myers, MD, assistant professor of pediatrics. The National Heart, Lung, Blood Institute’s AsthmaNet clinical research network sponsored the study.

With the trial results in hand, the team must now look for new ways to manage yellow zone symptoms. “Our study suggests we need to find better ways to identify early signs of asthma worsening that are likely to lead to more serious asthma exacerbations,” Ross says. “We will be starting a study this summer on a way to do that using technology that collects information about the child and the environment with less burden on the family, that may help us better predict asthma flares.”​

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An “acupuncture” session using stings from living bees triggered a lethal allergic reaction in a 55-year-old woman at a clinic in Spain.

During the treatment, the woman was deliberately stung by live bees to treat her muscle contractions and stress, according to a recent case report. The blending of bees and acupuncture is a type of “apitherapy” — a term that describes an increasingly popular practice of treating various medical conditions with substances derived from honeybees.

However, there’s scant clinical evidence that there are any benefits to these procedures, and in fact, they may be harmful. In this case, bee venom from the stings led to a severe allergic reaction that caused the woman’s death, researchers explained in the report. [Spider Bites and Bee Stings: Symptoms and Treatments]

Following a sting administered at a private clinic, the woman began to wheeze and then lost consciousness. She was transported to a local hospital, where she was diagnosed with a massive stroke that resulted in a permanent coma; she died several weeks later from multiple organ failure, the researchers noted in their report, which was recently published in the Journal of Investigational Allergology and Clinical Immunology.

Therapies using bee venom date back thousands of years, and can be traced to ancient civilizations in China, Greece and Egypt, according to a July 2012 study. Today, apitherapy is most commonly practiced in Asia, South America and Eastern Europe, and is used to treat immune-related diseases, some types of cancer, and conditions that affect the musculoskeletal system, such as rheumatism and arthritis, researchers reported in a study published in May 2015 in the journal PLOS ONE.

But bee venom therapies are often linked to adverse reactions, and there is little published research to support their safety and effectiveness, according to the new case report.

For people who are sensitive to bee venom, the venom’s compounds can trigger allergic reactions that range from mild to severe. In extreme cases, they cause anaphylaxis, an allergic reaction that can strike within moments after exposure to the allergen, and can be life-threatening. During anaphylaxis, the body floods with chemicals that induce a state of shock; blood pressure drops and the tongue and throat can swell, making it difficult to breathe, according to the Mayo Clinic.

The hormone epinephrine, also known as adrenaline, can ease anaphylaxis symptoms, but the apitherapy clinic in Spain did not have any on hand. And though the unconscious woman was given epinephrine once medical help arrived, the ambulance didn’t show up until about 30 minutes after the clinic workers placed the call, according to the case report.

Curiously, this wasn’t the woman’s first visit to the apitherapy clinic; in fact, she had been visiting the clinic and receiving bee acupuncture every four weeks for the past two years, with no adverse effects reported.

What likely happened is that she developed a sensitivity to honeybee venom over the course of her treatment, “and the last sting was the clinically relevant one that was fatal,” Dr. Andrew Murphy, an allergist with the Asthma Allergy and Sinus Center in Downingtown, Pennsylvania, told Live Science in an email. In other words, people can develop a sensitivity to allergens such as bee venom through regular exposure.

“What was even more galling and sad is that this clinic did not even have epinephrine available to treat the patient in case of a reaction,” Murphy added.

The study authors suggested that more rigorous measures should be taken by apitherapy clinics to identify people’s sensitivity to bee venom — particularly if they have been receiving stings over time — and that people should be informed of the inherent hazards in these largely untested procedures. In fact, those on the receiving end of a bee’s stinger should probably consider avoiding bee acupuncture entirely, the physicians added.

“The risks of undergoing apitherapy may exceed the presumed benefits, leading us to conclude that this practice is both unsafe and unadvisable,” the researchers wrote.

Original article on Live Science.

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Qatar Red Crescent Society’s (QRCS) health education section offered first-aid training for 1,050 beneficiaries at schools and social centres in the Al Shamal region during the first semester of the current academic year.
Sponsored by the Ras Laffan Community Outreach Programme (COP), QRCS’s ‘I Am a Paramedic’ programme is designed to promote first-aid and injury care skills among students, teachers and parents.
The programme has covered 750 trainees in 17 schools and academies, with health education and practical training sessions delivered by specialist medical trainers, QRCS has said in a statement.
During the Qatar Spring Festival, a first-aid workshop was held for 50 students at the Qatar Voluntary Centre. The event was attended by representatives from the Ministry of Education and Higher Education.
In co-operation with Al-Yarmouk Preparatory School for Boys, QRCS held a series of first-aid workshops over a week for the benefit of 250 students, staff and parents who participated in the festival.
The sessions introduce the theoretical and practical basics of first-aid, including cardiopulmonary resuscitation, suffocation, bleeding, fracture, nosebleed, burn, eye injury, epilepsy, asthma, poisoning, victim moving techniques, early trauma intervention, home safety and the health effects of cigarette smoking.
These activities fall under the blanket ‘QRCS School Programme’, which supports the educational system by capitalising on the capacity of the youth, raising awareness of social solidarity and responsibility, and preparing student leaders who contribute to school and community protection against disaster and environmental risks, the statement notes.
The components of the programme are as follows: the ‘I Am a Paramedic’ health programme involves first-aid training and health education on nutrition, hygiene, communicable diseases, home safety, oral health and other relevant topics; the ‘Safe School’ risk reduction programme seeks to improve community disaster preparedness and effective response; and the ‘Social Peace and Integration’ programme organises informative lectures to enrich positive values among school students, such as interactive communication, open-mindedness, behavioural discipline, psychological balance and mutual respect.

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FORMER Australian fast bowler Mitchell Johnson came off second best when taking on gym equipment. Warning: Graphic

This isn’t what you want out of a gym session.Source:Instagram

WARNING: Graphic

Australian cricket legend Mitchell Johnson shows off his gruesome head injury — after having a fight with a chin-up bar.

The left-arm fast bowler, 36, needed 16 stitches in his scalp after being rushed to hospital with a nasty cut.

A series of four photos posted to Johnson’s Instagram page showed the initial laceration, him lying on a bed receiving treatment and the stitches.

A final snap revealed a smiling Johnson, indicating all was OK after his procedure.

“If you don’t like blood and cuts then don’t look through these pics!” He captioned the images.

“Not the best thing I’ve ever done to myself but I’m am [sic] fine #toohardtoexplain #dontfightchinupbar #stilldontknowhowitspossible.”

At least he was met with a barrage of well wishes following his mishap

“Oh goodness me … Horrific to see a wonderful person getting injured like this. Can’t digest that injury, is a big and a massive one. Our prayers will be with you to get well soon sir,” one user posted.

“What. I can’t believe this,” another added.

“How the heck could this have happened?” an intrigued fan commented.

Johnson is best known for utterly dominating England’s batting order in the 2013-14 Ashes series in which the hosts won 5-0.

He mustered a 37-wicket haul and was awarded Man of the Match in three of the five Tests, as well as being named Player of the Series.

The man known as ‘Midge’ was also a crucial cog in the machinery when Australia won the World Cup for a fifth time in 2015, beating New Zealand by seven wickets in the final.

Hopefully Mitch had someone around who had been to a first aid courses. Im sure a few stitches would have done the trick.

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“It’s really important to learn first aid, we are not asking people to make things complicated or become doctors or paramedics,” Tracey Taylor, from the British Red Cross told The Sun Online.

“It’s about learning a few simple skills so you can act in that situation and know that you have done the best possible thing to help.

“Nobody knows when they might need first aid, a lot of situations are very quick and very sudden and you need to be able to think on your feet and act quickly and calmly.”

Here we reveal what you need to know, in the case of seven different types of emergency…

1. Bleeding heavily

If someone has had an accident or cut themselves badly, the first thing you need to do is apply pressure to the wound to help stop the bleeding.

You can use whatever is around, a jumper, a blanket, a towel, to apply firm pressure to create a plug to slow the bleeding.

The next step is to call 999 and continue holding pressure on the wound until help arrives.

“Whatever you’ve got to hand, whether that is a T-shirt or a scarf or a towel can be used to apply really firm pressure on the wound to stop the bleeding,” Tracey said.

“It is really important to stop them losing too much blood.

“It is a life-threatening injury and if people don’t apply pressure then someone could die.”

2. Collapsed and not breathing

If someone is unresponsive and not breathing you need to call 999 as soon as possible and begin CPR.

The most likely cause of this is a cardiac arrest.

A cardiac arrest, also known as cardiopulmonary arrest, happens when your heart suddenly stops pumping blood around your body – and is different from a heart attack.

KNOW THE DIFFERENCE What is the difference between cardiac arrest and a heart attack? The definitions, symptoms, signs and what to do

Someone who has had a cardiac arrest will collapse unconscious.

Their breathing will be irregular, and may stop, and they will be unresponsive.

To begin CPR place the heel of your hand in the centre of the person’s chest, then place your other hand on top and interlock your fingers.

Make sure you have positioned your body so your shoulders are directly above your hands.

Begin compression using your body weight, pushing about 2 – 2.5 inches into their chest.

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Repeat at a rate of 100 to 120 times per minute.

If you have trouble keeping pace, do the compressions to the tune of the Bee Gee’s song Stayin’ Alive to keep time in your head.

If you know how to, and are comfortable doing so, you can also perform rescue breaths at the rate of two breaths to every 30 compressions.

You should keep going until help arrives.

“You need to get help on its way as quickly as possible and you can start doing chest compressions,” Tracey said.

“And if you are in a public place you could find the automated external defibrillator (AED) to help the person.

“AEDs are becoming much more common in public places like leisure centres, train stations, shopping centres and places like the hospital.

3. Suspected heart attack

In contrast to a cardiac arrest, a heart attack is when one of the coronary arteries becomes blocked.

The heart muscle is then robbed of vital oxygenated blood, which if left untreated, can cause the heart muscle to begin to die.

Like a cardiac arrest, a heart attack is a life-threatening emergency.

You need to call 999 immediately.

You should also make sure the person is comfortable and try to keep them calm while the ambulance arrives.

“A lot of people get mixed up between a heart attack and a cardiac arrest,” Tracey said.

“If someone is having a heart attack then that can lead to cardiac arrest but in the first stages they will be presenting as someone who is still awake and still talking.

“But they may have really severe chest pain that can go up into their jaw, down their and into their stomach, they might also be very pale and sweaty.

“If you suspect someone is having a heart attack get them to sit down and rest while you call for an ambulance.

“While help is on it’s way try to keep them calm.”

4. Choking

If someone is choking they may clutch their throat or chest while gasping for air.

They won’t be able to speak to tell you what is wrong, so you have to act quickly.

Stand behind them and bend them forward before giving them five firm blows between the shoulder blades, known as back blows, to try and dislodge whatever is choking them.

If this doesn’t work you need to try the Heimlich manoeuvre.

HARD TO SWALLOW How to perform the Heimlich manoeuvre on YOURSELF to save your own life

Place your arms around the choking person from behind, and pull upwards and inwards on the abdomen below the rib cage.

The pressure from this movement can force out whatever is blocking the airway, allowing the patient to breathe again.

Recent research has also suggested that a person can perform the Heimlich manoeuvre on themselves.

Call 999 if the object doesn’t shift and continue using back blows and the Heimlich manoeuvre until an ambulance arrives.

“Back blows create a vibration within their airway which will hopefully push the object that they are choking on out,” Tracey explained.

“The back blows need to be firm so there is enough force to generate that vibration within the airway.

“If it is a small child, you would moderate the amount of force you are using.”

5. Unresponsive but breathing

If someone passes out in front of you, the first thing you should do is check to see if they are still breathing.

You can do this by tilting their head back and feeling for breaths.

If they are breathing you need to move them onto their side and tilt their head back to open their airways.

You should also check that nothing is obstructing their airways.

Call 999 as soon as you can and wait with them while help arrives.

“It is really important to get them in a position where their airway is clear, on their side is perfect because their tongue will fall forward and anything in their mouth will drain out,” Tracey said.

“While they are in that position you should be reassuring them and talking to them, even if they can’t hear you and keep checking their breathing until help gets to you.”

6. Taken a fall

If you or a loved one trip over, and suffer a sprain or strain, first things first – apply an ice pack.

This could even be just a bag of frozen veggies,but  just remember to wrap it in a tea towel.  This will help reduce the swelling and pain.

If you suspect it’s more than a strain or sprain, and could be broken, it’s important to seek medical advice.

“Falls are a very common reason why over 65s hurt themselves and end up having to go to hospital,” Tracey explained.

“There are different things that can be caused by falls, depending on how they have fallen.

“If we are talking about a broken bone, the key thing to look out for is pain in the limb, the limb might be a different shape or they can’t move or bend it, and also swelling and bruising.

“Broken bones are difficult to diagnose without an x-ray, so if you are unsure treat it like a broken bone until you can get to hospital.”

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7. Burns

Cool the burn under cold running water for at least ten minutes.

If you’re out and don’t have water on hand, you can use any cold liquid, think milk, orange juice, even a fizzy drink.

Then loosely wrap the burn in some cling film, or a clean plastic bag.

This will reduce the pain and help prevent infection.

If your baby or child has been burned, seek medical attention straight away.

“It is important to act as quickly as possible with burns – the quicker you can cool the burn you are lessening the impact of the injury,” Tracey said.

“The best thing to use to cool a burn is cold running water, so put the cold tap on and put the burn underneath the water for at least 10 minutes.

“Once you have cooled it the best thing to use to cover the burn is clingfilm to protect it from the air and the risk of infection.”

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Increasing preventer medication at the time of an asthma flare-up should not be recommended for children, a study suggests.

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By Carolyn Crist

(Reuters Health) – Parents and caregivers should know what to do when an extreme allergic reaction known as anaphylaxis occurs, according to a new resource published in the medical journal JAMA.
Adults should be aware of the signs and symptoms of this kind of reaction and be prepared to respond with an emergency plan and epinephrine injections, if needed.
“Pediatric allergy reports are increasing in incidence – it is unclear whether this is increased recognition or a true increase in incidence – regardless, it is a public health issue as food allergies are common and have various degrees of presentation,” said Dr. Elliott Melendez of Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, who co-wrote the one-page primer intended for patients and caregivers.
The content of the page, accessible for free (http://bit.ly/2oTXzlM), is based on recommendations given by the Centers for Disease Control and Prevention. The resource emphasizes the symptoms and treatment of anaphylaxis caused by foods, medications or insect bites.
The primer was published alongside a summary of guidelines for physicians for preventing and treating peanut allergy, which afflicts 2 percent of children and 1 percent of adults in the U.S., and is the number one cause of death due to food-related reactions.
Anaphylaxis symptoms can include vomiting, throat swelling, face or lip swelling, rash or feeling faint. The only treatment, according to the primer, is subcutaneous epinephrine from an injector such as the EpiPen.
“Parents and patients most commonly see mild symptoms and delay treatment first by administering diphenhydramine (Benadryl) when epinephrine should have been administered,” Melendez told Reuters Health by email.
Anaphylaxis is a serious and potentially life-threatening condition that typically occurs within seconds to minutes of an allergic exposure, the resource says, but some reactions can be delayed for several hours. Symptoms typically involve more than one organ system, so one symptom alone, such as hives, doesn’t mean anaphylaxis. Multiple symptoms, such as hives and difficulty breathing at the same time, are more of a concern.
Typical symptoms for the skin include itching, flushing, hives, swollen lips or tongue. Breathing-related symptoms include fast and noisy breathing, gasping for air, drooling and turning blue. Stomach symptoms include vomiting, abdominal pain and diarrhea. Heart symptoms include fainting, weakness and low blood pressure.
“Parents should understand what’s happening when multiple parts of the body are involved. What does belly pain have in common with itchy eyes for their children?” said Dr. Stephen Tilles of Northwest Asthma and Allergy Center in Redmond, Washington, who wasn’t involved in the guide.
“As horrible as anaphylaxis can be, it’s one of the easiest conditions to resolve,” he told Reuters Health by phone. “Having an action plan, as well as an epinephrine injector, are the keys to responsive treatment.”
The resource advises avoiding exposure to foods, medications and insects that spark allergic reactions, as well as teaching children how to protect themselves. It also suggests having two epinephrine injections available and encouraging your child to wear a medical alert bracelet.
The authors also note that a second anaphylactic reaction can occur within 24 hours without a second exposure to the allergenic substance. One in five children have a second reaction, and the only way to decrease the likelihood of this happening is to make sure epinephrine is given as soon as possible after the onset of symptoms, according to the resource.
“Anaphylaxis is increasingly preventable and treatable, which is wonderful news,” said Dr. Chitra Dinakar, the clinical chief of allergy and asthma at Stanford Health Care in California, who wasn’t involved in drafting the resource.
“It is possible to identify the triggers, create strategies to minimize exposure to the known triggers, and devise plans of action to detect and treat anaphylaxis early to prevent harmful consequences,” Dinakar said by email. “There are also emerging treatment options to desensitize oneself to some of the triggers.”

SOURCE: http://bit.ly/2oTXzlM JAMA, online March 6, 2018.

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