How to deal with some of the most common accidents and emergencies.

Choking

Adults and children

If the obstruction is mild, encourage the person to continue coughing, and try to remove the obstruction from the mouth.

If the obstruction is severe, give up to five back blows (between the shoulder blades), using the heel of your hand, and then check the mouth and remove any obstruction.

If the obstruction is still there, give up to five abdominal thrusts. Stand behind the person and put your arms around them, with one fist below the rib cage. Link your hands and pull sharply inwards and upwards. Check the mouth and remove any obvious obstruction. This procedure can also be used for children.

If the obstruction does not clear after three cycles of back blows and abdominal thrusts, dial 999 or 112 for an ambulance and continue the procedure until help arrives.

Burns and scalds

Burns and scalds are some of the most common injuries needing emergency treatment in Ireland.

remove any clothing or jewellery unless it is attached to the skin
as quickly as possible cool the burn with cold (but not ice cold) running water for a minimum 10 of minutes
cover the burn with a sterile dressing of non-fluffy material, such as cling film, or a plastic bag, do not put creams on the burn
if appropriate raise the limb to reduce the swelling and offer pain relief
call 999 or seek medical help unless the burn is very minor

For chemical burns, determine what has caused the injury, remove any clothing affected, brush the chemical off the skin if it is in powder form and rinse the burn with cold running water for a minimum of 20 minutes.

Be careful to not injure yourself, wear protective clothing if necessary. Call 999 or 112 and arrange immediate medical attention.

Babies

Babies can easily choke on food and small objects. For children with a severe obstruction who are distressed, and unable to cry, cough, or breathe, lay them face down along your forearm, with their head low. Give up to five back blows, with the heel of your hand. Check the child's mouth, using one finger to remove any obvious obstructions.

If the airway is still blocked, turn the child onto their back and give up to five chest thrusts. Use two fingertips to push inwards and upwards (towards the head) against the breastbone, one finger's breadth below the nipple line. The aim is to get the obstruction out with each chest thrust rather than necessarily doing all five.

If the obstruction does not clear after three cycles of back blows and chest thrusts, dial 999 or 112 for an ambulance and continue until help arrives.

Any person that has abdominal thrusts performed on them must be seen by a doctor afterwards.

Poisoning

Poisons can be swallowed, absorbed through the skin, inhaled, splashed into the eyes or injected. They can include common household substances such as bleach, prescription drugs or even wild plants and funghi. Once in the body they can enter the bloodstream and be carried to organs and tissues.

Being poisoned is potentially life-threatening. Most cases of poisoning occur when a person has ingested a toxic substance.

If you think someone has swallowed a poisonous substance, call 999 or 112 to get immediate medical help.

The effects of poisoning depend on the substance swallowed but can include vomiting, loss of conciousness, pain or a burning sensation.

If the person is unconscious, try to rouse them and encourage them to spit out any pills but do not put your fingers in their mouth.

While waiting for help make sure the persons airway is open and they are breathing. If they are breathing put them in therecovery position, preferably with their head down so any vomit can escape without being swallowed or inhaled. If they are unconscious, perform mouth-to-mouth resuscitation until they start breathing or medical help arrives. Take care not to contaminate yourself if there is poison around the patient's airway.

Find out what has been swallowed so you can tell the paramedic or doctor. Do not give the person anything to eat or drink unless a health professional advises you to.

If there are no symptoms after a substance is swallowed, consult your GP or your local Emergency Department.

Electricity

If someone has been electrocuted, dial 999 or 112 for an ambulance.

Switch off the electrical current at the mains to break the contact between the person and the electrical supply.

If you cannot reach the mains supply, protect yourself by standing on some insulation material (such as a phone book) and then using something non-conductive, such as a wooden broom handle, push the person away from the electrical source (or the source away from the person if this is easier).

Do not go near or touch the person until you are sure any electrical supply is cut off and it is safe.

If the person is not breathing, commence CPR and call an ambulance. Always seek medical help unless the shock is very minor.

Drowning

Once the person is on land, if they are not breathing then commence CPR. If unconscious but still breathing, put the person in the recovery position, and call an ambulance immediately.

Bleeding

If someone has severe bleeding, the main aim is to prevent further loss of blood and minimise the effects of shock (see box, above left).

First, dial 999 and ask for an ambulance as soon as possible.

If you have disposable gloves, then use them to reduce the risk of any infection being passed on.

Check that there is nothing embedded in the wound. If there is, take care not to press down on the object. Instead press firmly on either side of the object and build up padding around it before bandaging to avoid putting pressure on the object itself.

If there is nothing embedded, apply and maintain pressure to the wound with your hand, using a clean pad if possible. Use a clean dressing to bandage the wound firmly.

If it is a wound on a limb and there are no fractures, raise the limb to decrease the flow of blood. Always seek medical help for the bleeding unless it is minor.

If there is a severed body part (such as a finger) wrap it in a plastic bag, cling film or soft material and keep it cool. If possible, place the severed body part in ice, but do not put it in direct contact with the ice.

Nosebleeds

Get the person to sit down and ask them to tilt their head forward to allow the blood to drain from their nostrils. It may help to place a bowl on their lap or on the floor in front of them to catch the blood.

Ask the person to pinch the soft part of their nose and continue to breath through their mouth. After 10 minutes, release the pressure on the nose. If the bleeding has not stopped reapply the pressure for another two periods of 10 minutes.

If the bleeding is severe or still has not stopped after 30 minutes call for medical help.

Heart attack

Symptoms of a heart attack include:

persistant central chest pain, often described as crushing or vice-like
this pain can often spread up the neck and down one or both arms
profuse sweating, skin cold to the touch
ashen face and a blue tinge to the lips
breathlessness and extreme gasping for air
sudden fainting or dizziness
rapid or weak pulse that may be irregular
nausea and/or vomiting

If you think a person is having or has had a heart attack make them as comfortable as possible and call 999 or 112 for an ambulance.

Sit the person down, sitting up with their knees bent.

If they are conscious, reassure them and give them a 300mg aspirin tablet to chew slowly (unless there is any reason not to give them aspirin, such as they are under 16 or have an allergy to aspirin). If the person has any medication for angina, such as a spray or tablets, help them to take it. Monitor their vital signs until help arrives.

If the person becomes unconscious, open their airway, check their breathing and, if it has stopped, start CPR.

Stroke

FAST is the most important thing to remember when dealing with people who have had a stroke, the earlier they receive treatment the better. Call for emergency medical help straight away.

If you suspect a person has had a stroke use the FAST guide:

Facial weakness: is the person unable to smile, are their eyes and/or mouth droopy?
Arm weakness: is the person only able to raise one arm?
Speech problems: is the person unable to speak clearly or understand you?
Test all these signs and then call 999 or 112 for emergency help if you think a person has had a stroke.

Fractures

It can be difficult to tell if a person has a broken bone, or a joint or muscle injury. If in any doubt treat it as a broken bone.

If the person is unconscious, has difficulty breathing, or is bleeding severely, these should be dealt with first.

If the person is conscious, prevent any further injury by keeping them still until you get them safely to hospital. Assess the injury and decide the best way to get them to hospital. If it is a broken finger or arm you may be able to drive them yourself without causing more harm. If a broken spine or leg is suspected, call an ambulance and do not move the casualty.

Patients with a possible spinal injury (e.g. having fallen from a height or having been involved in a road traffic collision) should be left as they are until the ambulance service arrives.

Support the limb: keep them in the position they were found (unless it is an apparently simple limb injury, with no risk of spinal injury and the patient can move themselves). Support the injured part with anything you have handy, for example rolled up blankets or clothes.
Get them to hospital: either by driving them yourself (if it is a minor injury) or call for an ambulance.
Look out for signs of shock: if the person is pale, cold and clammy, has a weak pulse and rapid shallow breathing, they are probably in shock.

If you suspect shock, and it is not a severe fracture that means you cannot move the person, lie the casualty down. Loosen any tight clothing and raise their legs above the level of their heart, if their injuries allow, by placing something suitable under their feet such as blankets or cushions.

Do not give them anything to eat or drink as they may need a general anaesthetic when they reach hospital.

Anaphylactic shock

Anaphylactic shock is a severe allergic reaction that can occur after an insect sting or after eating certain foods, such as peanuts and shellfish. The reaction can be very fast, within seconds or minutes of contact with the allergen (the thing a person is allergic to). During a reaction chemicals are released into the blood to widen the blood vessels causing blood pressure to fall. Air passages then narrow making it difficult for the person to breath. Their tongue and throat may also swell obstructing their airway.

Patients with anaphylactic reaction may have any of the following symptoms:

Rash
Difficulty breathing
Mouth or facial swelling
Collapse or fainting

If you suspect a person is having an anaphylactic reaction call 999 (or 112) straight away.

Then check if the person is carrying any medication. Some people who know that they suffer from severe allergies may carry epinephrine on them. This is a kind of adrenaline and usually comes in the form of a pre-loaded syringe. You can either help the person administer their medication, or if trained, give it to them yourself.

Make sure they are comfortable and able to breath as best they can while waiting for medical help to arrive. If they are conscious, sitting upright is normally the best position for them.

Treating shock

In the case of a serious accident, it is important to watch for signs of shock.

Shock is a life-threatening condition that occurs when the circulatory system fails and, as a result, deprives the vital organs of oxygen. This is usually due to severe blood loss, but it can also happen following severe burns, severe vomiting, a heart attack, bacterial infection or severe allergic reaction (anaphylactic shock).

The type of shock described here is not the same thing as the emotional response of feeling shocked, which can also occur after an accident.

Signs of shock include:

pale, cold, clammy skin
sweating
rapid, shallow breathing
weakness and dizziness
feeling sick and possibly vomiting
thirst
yawning
sighing

If you notice any signs of shock in a casualty, seek medical help immediately.

Dial 999 and ask for an ambulance as soon as possible.
Treat any obvious injuries.
Lay the person down if their injuries allow it, and raise and support their legs.
Use a coat or blanket to keep them warm, but not smothered.
Do not give them anything to eat or drink.
Give lots of comfort and reassurance.
Monitor the casualty. If they stop breathing, start CPR (cardiopulmonary resuscitation).

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