For people who have never performed CPR or even been at the scene of an incident while it is being done there is a range of different images of exactly what the scene may be like. For some it is the image of the person who has been pulled from the water by a bronzed Lifeguard from Bondi Rescue. The causality receives 2 quick breaths, coughs, splattering up water and maybe some lunch. They thank the Lifeguard for saving their life and go off to the hospital to be checked over. Or maybe it is a little more dramatic; it is an elderly stranger in a shopping centre, he collapse just meters from you, and his partner is screaming for help. You are the only one who comes forward to help, your mind races back to that First Aid Training Course you HAD to take; it all comes back in a flood of images. Breaths, Compressions, don’t stop, must move the blood around his body, before you know it, the Ambulance has arrived and take over. That 1 day you spent doing a First Aid course because you HAD to have saved this man’s life, it could have been your dad, your partner or your child, could you have done it?

But what are we doing when we perform CPR?
The air around has contains approximately 21% of oxygen, when we breath that air in our body uses only 5% and we exhale 16%, it is that 16% of oxygen that we exhale that helps to replace the oxygen that is no longer getting in to circuitry system of a person who has no movement of their heart (it has arrested).

We know that between 3-5 minutes without oxygen to our cells the cells will start to die, particularly our brain cells, our brain needs about 20% of the oxygen that we have in our system and is very sensitive to a lack of oxygen.

So we now have oxygen in the blood but how does it move to the cells?

A normal healthy adult hearts beats between 60 – 100 times a minute when resting, this ensures that the oxygen rich blood can reach all of the millions of cells in our body. When we perform CPR you must deliver your compressions at a rate of 100 per minute so as to replicate the action of a beating heat.

The skills that are taught in a First Aid Course are ones that could save a life, it is always hoped that you may never have to be in the position to have to perform CPR. But if you do the skills will be with you and you may be able to assist.
Remember, any attempt at CPR is better than no attempt at all.

When you mention heart attack to most people, their first thoughts are that it is fatal.
Often they are right, but what is heart attack and heart disease? Can you avoid it? What do you do if you see a person suffering from pain on the chest?

How do heart attacks occur?
Over time, plaque can build up along the course of an artery and narrow the channel through which blood flows.
Plaque is made up of cholesterol build-up and eventually may calcify or harden, with calcium deposits. If the artery becomes too narrow, it cannot supply enough blood to the heart muscle when it becomes stressed.

Just like arm muscles that begin to ache or hurt when heavy things are lifted, or legs that ache when you run too fast; the heart muscle will ache if it doesn’t get adequate blood supply.

This ache or pain is called angina. It is important to know that angina can manifest in many different ways and does not always need to be experienced as chest pain.

If the plaque ruptures, a small blood clot can form within the blood vessel, acting like a dam and acutely blocking the blood flow beyond the clot. When that part of the heart loses its blood supply completely, the muscle dies. This is called a heart attack, or an MI – a myocardial infarction (myo=muscle +cardial=heart; infarction=death due to lack of oxygen).

Signs and Symptoms of a heart attack
Any chest pain should be considered a medical emergency. A call to the emergency services should be your first action.

Warning signs include:

• Pain or pressure in the chest
• Discomfort spreading back, jaw, throat, or arms
• Nausea, intergestion or heartburn
• Weakness, anxiety, or shortness of breath
• Rapid wreak or irregular pulse
• Clammy skin

Heart attack Signs and Symptoms in women

Women do not always have the pain or heavy weight feeling in the chest.

Women are more likely than men to have:

• heartburn
• tiredness
• loss of appetite
• weakness
• Heart flutters.

None of these symptoms should be ignored the longer you leave treatment the greater the risk of damage to the heart and to the risk of death.

How do I help if they are having a heart attack??
If there is any pain on the chest, call 000 immediately, they will guide you through with instructions on how to manage this causality or if you are a first aider or did any of CPR courses or training you can help the casualty. Such type first aid courses help you very much in such crucial time as well as in your day to day life.

If they are conscious:
o Ask if they have any medical history/medications
o Keep them in a sitting position
o Loosen any tight clothing
o Try to reassure them
o Try to monitor their breathing and their pulse

If they are unconscious:
o Follow the Basic Life Support Flow Chart
o If there are bystanders have them assist by calling for help
o Begin CPR as soon as possible

Any attempt at CPR is better than no attempt at all.

What is sudden cardiac arrest?
A medical emergency with absent or inadequate contraction of the left ventricle of the heart that immediately causes body wide circulatory failure.

The signs and symptoms include:
o Loss of consciousness
o Rapid shallow breathing progressing to apnea (absence of breathing)
o Profoundly low blood pressure (hypotension) with no pulses that can be felt over major arteries
o And no heart sounds.

Cardiac arrest is one of the greatest of all medical emergencies. Within several minutes, there is lack of oxygen (tissue hypoxia), leading to multiple organ injury. Unless cardiac arrest is quickly corrected, it is fatal.

The most common causes of cardiac arrest are electrical problems in the heart with ventricular fibrillation representing the major type. In ventricular fibrillation, there is loss of coordinated ventricular contractions leading to immediate loss of effective output of blood by the heart, resulting in circulatory arrest.

How do I manage Sudden Cardiac arrest?
The Chain of Survival
The Chain of Survival is the term applied to a sequence of actions that, when put into motion, reduce the mortality associated with cardiac arrest.
While each action in the chain is unlikely on its own to revive a casualty, when all actions are effectively used together they can improve the outcome for the casualty.

Sudden cardiac arrest is the unexpected collapse of a casualty whose heart has stopped. Cardiac arrest occurs suddenly due to a disturbance in the electrical signals of the heart and is closely linked with sudden chest pain.

It is estimated that more than 95% of sudden cardiac arrest casualties die before reaching hospital as the casualty has only minutes from the time of collapse until death. If all four links in the Chain of Survival are strong the chance of survival for a sudden cardiac arrest casualty can rise from 5% to as high 49%.

How important are First aid courses?
First Aid courses and CPR courses give instructions on how to react to emergencies brought on by natural calamities, keeping your household safe in case there is such occurrence.

There are many programs to learn basic first aid course taught by schools, Fire Departments, hospitals, and community organizations that are a great tool for everyone. First Aid is usually administered under the premise of immediate care for an illness or injury. Members of the general public are taught to administer this care until the arrival of qualified medical personnel at the scene of a medical emergency.

What is the difference of being a first-aider or not?
It resumes being the same difference between saving a life and losing someone, especially if it is a loved one.

“So Do not hesitate to start CPR“

An infection is the entry and multiplication of an infectious agent in the tissues of the body. An infection may be due to bacteria, viruses, parasites or fungi and may be spread through cross-infection between a casualty and a first aider. To limit exposure to infectious agents first aiders must take precautions to avoid body fluids and other contaminants and he should follow the procedures of First Aid Training.

To minimize the risk of infection:

• Wash your hands with soap and water before and after assisting a casualty.
• Use protective barriers including disposable gloves, masks, CPR face shields and goggles.
• Change gloves before assisting another casualty.
• Ensure assistance is given in a clean and hygienic environment.
• Cover any open wounds you may have with a clean, waterproof, lint free dressing.
• Clean re-usable equipment hygienically after any use.
• Dispose of used gloves and other contaminated waste correctly. Place in a plastic bag, which is then placed inside another plastic bag and securely closed. Do not dispose of in a normal rubbish bin. Seek advice from your local Health Department on disposal options.
• Wash off any body fluids immediately with warm soapy water.
• Avoid coughing, breathing or speaking over wounds.

Signs of Infection

If a wound shows signs of an infection seek medical assistance.

• Skin is red and swollen around wound.
• Painful to touch.
• Skin surrounding the wound is hot to touch.
• Fluid discharge.

Avoid touching the infected area, ensure gloves are used and all equipment is cleaned after care is given.

Needle Stick Injuries

Some people, such as health care workers are at increased risk of needle stick injury, which occurs when the skin is accidentally punctured or scratched by a used needle or sharp object. Although the risk of transmission is low, blood-borne diseases that may be transmitted by such an injury include human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV).

Reducing the risk of needle stick injuries:

• It is generally recommended that workers who may come in contact with blood or body fluids should receive hepatitis B vaccinations.
• Follow all safety procedures in the workplace.
• Latex or nitrile gloves will not protect you against needle stick injuries.
• Never bend or snap used needles.
• Never re-cap a needle.
• Always place used needles into a clearly labelled and puncture-proof sharps approved container.

Immediately after the Injury

• Wash the wound with soap and water.
• If the eyes are contaminated, rinse eyes while open with water or saline.
• If blood gets into the mouth, spit it out and then repeatedly rinse with water.
• If soap and water are not available, use alcohol-based hand rubs or solutions.
• Ensure the safe disposal of the sharp.
• If you are at work, notify your supervisor or Occupational Health and Safety Officer – you will need to fill out an Accident Report Form.
• Go straight to your doctor, or to the nearest hospital emergency department.

At the Doctor’s Surgery or Emergency Department
Your general practitioner or emergency department doctor should:

• Take detailed information about the injury, including how long ago it happened, how deeply the skin was penetrated, whether or not the needle was visibly contaminated with blood, and any first aid measures used.
• Explain the transmission risks, which are small.
• Offer blood tests to check for pre-existing HIV, HBV and HCV. You should be offered counseling about these tests before the blood specimens are taken.
• Inform the original user of the needle about the needle stick injury – if they are known. They will be asked to consent to blood tests to check their HIV, HBV and HCV status. They should be provided with counseling before the tests are done.
• Advise you about reducing the risk of transmission until the test results are received. You should practice safe sex and avoid donating blood.
• Ask your doctor about additional counseling if you think that you will require it.

Always dispose of sharps in approved sharps disposal containers and in accordance with relevant workplace and local, state, territory and commonwealth legislation.

There is no legal obligation to assist an ill or injured person in the case of an emergency unless a “Duty of Care” has already been established. Duty of Care is the legal relationship owed by one individual or organisation to another. If you are the first aider in your work place then you owe a Duty of Care to your co-workers, if you are the career of minors then you owe a Duty of Care to those minors. The first aider should have knowledge acquired in formal first aid training.

If there is no Duty of Care owed and you provide first aid assistance you are considered to be a “Good Samaritan”. First aiders should not be concerned or delay giving assistance for fear of litigation. No Good Samaritan has been successfully sued for acting in a reasonable and responsible manner when rendering first aid.

A person that does have a Duty of Care to others when providing emergency first aid assistance must provide care that is:

• Prudent and reasonable in the circumstances.
• In the best interests of the casualty.
• Based on skills and knowledge acquired in formal first aid training.
• Unlikely to make the casualty’s condition worse.

Once you commence first aid treatment you have taken on a Duty of Care and you should continue to provide first aid until:

• Someone with more qualifications arrives to help e.g. ambulance personnel, medical professional.
• The casualty no longer requires treatment.
• You are no longer physically capable of providing first aid.
• The scene becomes unsafe.

Consent

Before providing first aid to a casualty you must obtain their consent. If the casualty is unconscious, or is unable to give consent due to their injuries then consent is assumed and you should commence first aid treatment. If the casualty is conscious and appears to be in sound mind then they have the right to refuse your offer of assistance and any first aid treatment.

If the casualty is less than 18 years of age consent should be obtained from a parent or guardian. However, if no parent or guardian is present then consent is assumed and you can commence emergency first aid treatment.

Always remember that a casualty’s consent only extends to their immediate illness or injury and you should not attempt to treat any condition beyond your knowledge of first aid. All rules and regulation regarding first aid are covered in  first aid training.

Negligence

For negligence of a first aider to be established a court must find:

• A Duty of Care existed between the first aider and the casualty.
• The first aider failed to exercise reasonable care and attention in applying emergency first aid.
• The casualty suffered additional damage.
• The additional damage resulted from the actions of the first aider’s standard of care.

Recording

A first aider should always make notes or fill out a first aid report on all events of an incident no matter how minor the incident or emergency first aid provided. This will help them to remember the incident at a future time if required. If you are a first aider in a workplace your reporting obligations are greater under your State or Territories Occupational Health and Safety legislation. Any notes or reports can be used in a court of law. Ensure all documentation is accurate and factual, based on observations and not opinion.

General guidelines for first aiders completing a report for a first aid incident include:

• Use ink and not pencil.
• Amend any errors by drawing a single line through the error and initialing.
• Never use correction fluid/tape to correct mistakes.
• Include date and time of incident.
• Brief personal details – name, address, date of birth.
• History of illness or injury.
• Observations – signs, symptoms, vital signs.
• All notes should be legible.

Privacy and Confidentiality

All personal information regarding a casualty is considered to be confidential, including details of the illness or injury, treatment and medical history. In a workplace environment disclosure of personal information without the individual’s prior consent is unethical and in many cases illegal.