Last week a friend rang me as she felt like having a chat about a bad experience. Earlier that same day, she had conducted First Aid on an infant, only 2 years old that fell from a split level veranda onto her (the infants) forehead. Immediately the child was unconscious, barely breathing and with a clear liquid coming from both ears, and blood from both nostrils. The child had also landed on concrete which was not shaded and this was one of those typical Australian summer 38 degree Celsius days (100 degrees Fahrenheit). The child’s mother who was present at the time of the fall quickly became hysterical.
My friend quickly decided that the child had to be removed from the hot concrete and giving consideration to the appropriate way to move the injured child, managed to lift her whilst supporting head, neck and body to ensure they remained static into a shady area, where she continued to treat the child after ringing paramedics. Afterwards, my friend was quite upset for the following reasons:
I explained to my friend that at the end of the day, a little perspective needs to be had because she was the only person that actually took action. She had the fortitude to act and handle the mother to the side when it was clear that the mother was only making things worse. She made the correct decision to move the child and manage the associated risk from the concrete which 12 minutes of exposure could have turned fatal to a child this young. She also had to do all this and stabilise the infant whilst making the phone call to paramedics, since the mother was so hysterical that she wasn’t able to respond well enough to commands to make the call.
I also explained to her that rendering First Aid assistance is not about being perfect. It’s about doing what you can with what you’ve got, and continuing to do this for as long as it takes for help to arrive. The ability to keep fluids inside, treat shock, prevent further injury or harm and perform CPR if required and call for assistance is about as perfect as any First Aid situation can get. In my friends situation, she kept the infant alive, made sure she didn’t die from the heat of the concrete, made sure she didn’t die from choking on her own blood or vomit whilst being stabilised, ensured that no spinal damage occurred during the moving process and managed this until Paramedics arrived to take over the situation. So whilst she felt bad that she didn’t do more, what she did do was enough, and in quite realistic terms was enough to save the child’s life, prevent further harm - and that is all that matters.
I reflected on an incident I came across about ten years ago in which two motorbikes had collided with a vehicle and I was the first on the scene. Despite other problems one rider was bleeding profusely from an arterial wound in his leg whilst another was bleeding heavily from a compound foot fracture (he had been wearing thongs on the bike). With very little at hand to work with and no first aid supplies I made an emergency tourniquet of the arterial wound, writing a capital T and the time on the patients forehead, whilst I treated the bleeding from the foot fracture using my T-shirt, a sock and the leg off a pair of jeans.
Several ambulances turned up to the incident. After I quickly briefed the paramedics and handed over control of the situation to them two interesting things happened:
As above, it is the goal of any First Aid to keep the patient going by doing the best that you can until further help arrives. In this situation, the bleeding from the arterial wound was so intense that without taking some immediate action to slow the bleeding the patient would most likely be dead. Using the mantra of doing the best you can with what you’ve got, and not having the luxury of a single First Aid kit or First Responder kit at hand and the knowing that only minutes remained between the life and death of this patient, I used my belt as a tourniquet. Now, you may be thinking why didn’t I use the pants, T-shirt or sock that I used on the subsequent patient, and my answer would be Time. Within 1 minute of being on scene I had implemented a control measure to slow the arterial bleeding enabling me to focus on the next patient for a short but long enough time to address his issues. Even if I had a full pressure bandage or First Aid kit on standby, the time it would have taken to begin to ebb this flow of bleeding would have resulted in such blood loss that the patient may have died.
Once the tourniquet was attended to, a quick check of other patients followed by the marking of the T and time onto the tourniquet patients forehead and continue to comfort the patients until paramedics arrived approximately 10 minutes later. By this time my arterial patient was very pale and cold despite the heat of the day. By this time I had other assistants that were working to keep the arterial patient warm and slow the onset of shock and further to keep the patient conscious.
As I have on many occasions since I ask myself if I could have done anything better on that day. Occasionally something I might have improved pops into my head but everything in context, after the incident I stood there on the side of the road missing my T-shirt, 1 sock and my belt (the jeans leg came from the patient). Essentially I had almost exhausted all of the resources available to me at the time and both patients survived. First Aid is not clean. It is not perfect and it is often messy. People vomit, bleed, shit themselves and do all sorts of wonderful things when they are injured but as long as you keep them going to the best of your ability until help arrives, you have done your bit.
Several years later in a First Aid refresher I asked the instructor about tourniquets. He told me that they should never be used. After I repeated to him the above story, he then relaxed his attitude and told me that a tourniquet is still a perfectly viable First Aid treatment if all other options and resources had been exhausted. He also told me that due to the liabilities associated with complications if tourniquets are not applied and released correctly, that he can not advise his class in general to use them. Whilst I understand the liabilities issue, I do not think it is responsible, ethically or principally correct to not use a life saving device or technique because of a liability issue.
So my real learning from this experience and the different reactions of the paramedics was that different people have different perspectives. Whether or not you do well or not in a situation like this depends on your perspective. So to my friend, well done. Before you feel too bad about your action, invite yourself to the child’s third birthday party and see how bad you don’t feel then.