FAW Courses - enough useful content for our area?

[paulears]

An accident yesterday left me wondering if the content of the first aid at work course is more suitable for 'not work' type accidents.

 

Huge banner, with conduit cable tied to and bottom to make it fly properly and keep it flat. The accident was caused when removing the ties with a Leatherman, using the blade to cut the tie by sticking the blade under the tie and pushing down. We really should have used short nosed cutters, but none were to hand. I always stick the blade under, and then twist, but a colleague put the blade under and then pushed, so the blade cut as it 'grew' as pushed in. Trouble was, he pushed, the tie cut unexpectedly and the knife went into his leg half way between knee and thigh. He pulled it out and had a half inch wound, a vertical one. FAW says apply pressure, and common sense said the quantity of blood was not like the amount when a vein or artery has been cut. Antiseptic wipe, big plaster and a bit of bandage to make sure the wound didn't gape seemed sensible.

 

Only afterwards did I think about these types of incidents - knife type cuts, glass cuts, burns, foreign bodies as in splingters are our day to day minor accidents, but FAW being generic takes the tack as you do basic first aid but if serious enough your initial first aid is really life preserving, and then you get proper medical treatment. Sitting in A&E for ten hours to discover your treatment was sufficient, or worse, insuffient is not really acceptable.

 

Digging out a splinter with tweezers, getting foreign bodies out of your eye yourself, when you can't actually see, sort of suggests that maybe a FAW-advanced would make sense. The concept that you have to fix yourself is not particularly practical. At my venue, the people who have been on the FAW courses are the permanent staff - so there is a lady in an office who can't do blood, and there used to be someone who just couldn't do any kind of foot injury - and being on a pier made out of wood in the summer means splinters are common, this was tricky. Renewing your FAW really means knowing the new compressions/breaths/no breaths rule - getting a foreign body out of somebodies eye and proper wound cleaning are practical skills that could be taught - because as I said above, sitting all day in casualty waiting for a bit of muck to be removed from your eye is not really acceptable.

 

I looked at the wound in the poor blokes thigh, and realised that I had no knowledge of what having a slice into the muscle actually meant? My training is simply to stop bleeding, clean and cover. Puncture wounds in certain body areas need immediate hospital treatment I've discovered if there are important structures just under the surface, whilst longitudinal wounds in muscles are not considered to need immediate treatment. In the advanced FAW, people would be taught about the differences - so you could identify an ambulance call from a non-emergency. FAW seems aimed at almost no brainwork required. As A&E visits are pretty dreadful for those triaged out, wouldn't adding the kind of triage training to be able to categorise injuries make sense. Maybe in a big firm, 5 people with FAW and 2 with FAW-A?

 

I know people say a little training is dangerous, but waiting hours for a two minute fix that could have been done by somebody competent on site seems poor use of the health service.

 

If a colleague was in pain because he'd got a lump of rust in his eye, would you hand him the squirt bottle and say do it yourself, or actually try to remove it? Me - I'd have a look, and if I thought I could do it safely, I'd do it - exactly what we used to do before self-treatment became the proper way.

 

Any thoughts?

[WiLL]

I do feel that more emphasis should be given on how to treat wounds on your own person. It's all very well knowing how to tie a bandage on a third person, but being able to bandage one of your own hands could be even more important. Since, the logic being, that if you are having to do it yourself, then there is no-one else around to help you after you have collapsed from loss of blood.

[Brian]

I do feel that more emphasis should be given on how to treat wounds on your own person.

Unless I've understood it wrongly the purpose of FAW, and even more so EFAW, is to keep the patient alive long enough to get them seen by a medical professional. Anything else being a bonus.

 

I really think this is an area where 'a little knowledge is a dangerous thing'. People do a FAOY course (First Aid On Yourself) and think that because they've stuck a plaster on it everything will be OK. Three days later they die from toxic shock.

 

If you look at the HSE approved syllabus for either EFAW or FAW it's very clear where the limits on expectation are. EFAW...

 

Content of an EFAW course

 

On completion of training, successful candidates should be able to:

• understand the role of the first-aider including reference to:

-the importance of preventing cross infection;

-the need for recording incidents and actions;

-use of available equipment;

• assess the situation and circumstances in order to act safely, promptly and

effectively in an emergency;

• administer first-aid to a casualty who is unconscious (including seizure);

• administer cardiopulmonary resuscitation;

• administer first-aid to a casualty who is choking;

• administer first-aid to a casualty who is wounded and bleeding;

• administer first-aid to a casualty who is suffering from shock;

• provide appropriate first-aid for minor injuries (including small cuts, grazes

and bruises, minor burns and scalds, small splinters).

 

 

The important thing to remember that this is all about 'First Aid' ie, the initial response.

[brainwave-generator]

For future reference Paul, if forced to remove cable ties by use of Leatherman, use the pliers bit, grab the cable tie and twist. They snap straight off with no need for a blade.

[Andrew Edwards]

The thing that would concern me most about anything more than a slight nick or slice would be infection.

 

I recently saw the result of an accident which occurred off premises and out of work to a colleague. It was a small 10mm leg wound caused by being kicked by a horse. Amazingly, their clothing had not in any way been ripped or torn but underneath the skin had split. A week later and they were being treated for gangrene...

 

I'm not sure I would have initially sent them off to minors had it happened at work. However, it transpired that it had been several days since the injury when I saw them redressing it themselves. Had I know this at the time I would have advised to get it looked at as it clearly wasn't healing.

 

Cue 3 weeks off...

[WiLL]

I am in no way talking about ignoring a hospital case on your own leg, but if you are working alone and cut yourself badly you could be minutes away from being a coroner's case unless you can apply a tourniquet or suitable dressing on yourself, at speed. It's no good sitting alone in a room saying 'I wish there were a first aider here' and then fainting through blood loss. I just think FAOY should be included in FAW courses. Especially for those who work alone at work.

[westdev]

I have never known a case where a first aider has been sued for causing more damage while trying to help. However, as said previously, first aid is exactly what is said on the tin first aid - meaning that you should consult an authority on the injury after a first aider has treated it. It is exactly the same for a paramedic, their job is to keep you alive until they get you to hospital, once at hospital it is a doctor's job to treat you. Notice the difference between treatment and keeping you alive..exactly the same as first aid, as a first aider you are trained to keep someone alive long enough to get professional help, under no circumstances should you move into treatment unless it is a minor injury.

 

This has got on my wick a few times, I suffer from my lungs being inflamed by pollen and use exactly the same inhaler medication as an asthmatic. I once had a case where an asthmatic was having an asthma attack and was unable to use their inhaler themselves. They had it in their pocket and all they needed was someone to hold to their mouth for them - I was told I could not help them and to phone an ambulance because I was not trained to administer medication. That is completely true and I see the point - you can't just start giving anybody anything, however, it meant I left someone very distressed waiting for an ambulance. A complete waste of time and money in my eyes....but hey I don't write the law.

[Jivemaster]

In this country the issue is actually medical liability and it's insurance. IF you do something as treatment outside the remit of your training then people could sue, strangely if you have had NO training it's considered that any action may be good!

 

I occasionally administer oxygen, but cannot administer entonox even though it's simply a reg on a cylinder just like the oxygen -all to do with training and insurances.

[cedd]

We're very fortunate that the local community hospital has a minor injuries unit (no A&E though - it's Leeds or Bradford City Centres for that). I've been down there a few times, mainly accompanying somebody else thankfully. They're able to do stitching, pots, simple eye debris removal, that kind of thing. We've never waited longer than 1/2 an hour to be seen and it's a far more sedate atmosphere than A&E.

 

It might be worth doing some research and working out if there's one nearby. If I'd got a small cut (but too big for a plaster to suffice) I'd probably sooner drive past an A&E unit to this place because the chances are you'll be seen quicker and leave far less stressed.

 

I agree with Paul on this one. My first aid background has always very much focussed on preservation of life. Dad taught me some basics when I was much younger (early teenage father and son bonding if you like). His background was as a police officer who sadly over the years dealt with more than his fair share of serious and fatal road accidents. The training was very no-nonsense - "if there's blood coming out, stick your finger in it" - that sort of thing!

Then I trained as a pool lifeguard. That was very different. There was still that emergency response element, but pretty much any other injury involving more than a plaster usually resulted in the attendance of an ambulance.

Since then I've done the usual first aid at work courses.

In none of those cases have I really been taught much about the other two "P's" of first aid (Prevent from worsening, Promote recovery). Preservation of life was always key.