Developing protocols for managing emergencies

First aid

It is important for all workers to have basic first aid skills. You can ensure you keep up-to- date with information about first aid and related training by going to the St John’s Ambulance website (http://www.stjohn.org.au).

A component of first aid that is particularly relevant to services for homeless people is the St Johns Action plan for resuscitation — Danger, Response, Airways, Breathing, Cardio Pulmonary Resuscitation, Defibrillation (DRABCD) which will be described briefly below*.

Please note this information is not a substitute for first aid training.

Danger

Check for danger, to you, to others, to the casuality. For example, if this is a drug overdose, you must protect yourself from needle stick injury. Do not re-cap the needle, dispose of the needle safely.

Response

Establish if the casualty is conscious or unconscious. This can be done by gently shaking the person’s shoulders and calling his/her name to see if he/she responds. If there is no response, and there is someone else nearby, ask them to call an ambulance. If you are alone with the casualty act quickly to check airways.

Airways

Check airways to remove any foreign matter or obstructions.

Breathing

Check breathing for up to 10 seconds. Is the chest rising and falling? Can you hear the client breathing? Can you feel the breath on your cheek? There should be a minimum of two substantial breaths within 10 seconds.

Cardio pulmonary resuscitation (CPR)

If client is not breathing (i.e. less than 2 substantial breaths within 10 seconds), roll onto back, supporting the head. Make a pistol grip with thumb and index finger, roll remaining fingers into hand. Place thumb and index finger along the jaw line keeping other fingers away from the soft tissue of the neck. Place other hand on the forehead. Gently lift jaw and tilt head back. Seal the nose with thumb and index finger (hand that is on forehead). Open mouth wide enough to make a seal of the casualty’s mouth. Give 2 initial rescue breaths. Check for signs of life (warmth, colour, breath) for up to 10 seconds. If there are no signs of life, commence CPR.

 

  1. Position hands for CPR
    • Locate site for compressions — lower half of breastbone in the centre of the chest;
    • Place heel of one hand on top of compression site and the other hand on top.
  2. Commence chest compressions
    • Position yourself vertically above client’s chest;
    • With your arms straight, press down on breastbone to depress it about on third of the depth of the chest;
    • Release pressure.
  3. Continue CPR (Ratio: 30x2)
    • Complete 30 compressions (at almost 2 compressions a second);
    • Give two effective breaths (watch for chest to rise);
    • Continue 30 compressions and two breaths. Check for signs of circulation about every minute.

Only stop CPR if signs of life return, if there is someone else to take over CPR, medical aid arrives and takes over or if physically exhausted.

If casualty recovers:

  1. Place casualty in recovery position (ensure that tight or restrictive clothing is undone and pockets are emptied);
  2. Reassure casualty;
  3. Cover with blanket if cold;
  4. Check breathing every 2 minutes.

Defibrillation

When ambulance arrives, defibrillation can be done.

*NB: As a result of international research conducted by the International Liaison Committee on Resuscitation (ILCOR), the Australian Resuscitation Council (ARC) guidelines were changed in March 2006. Expired Air Resuscitation (EAR) is no longer recommended, however if you are familiar with EAR and feel comfortable using it, you may do so as it will not place the casualty in danger.

References

St Johns Ambulance. Brochure: Participant Personal Record Form

Australian Resuscitation Council — Guideline Changes 2006. Presentation by Christine Lethlean from the Drug and Alcohol Office, 2006.

Drug and Alcohol Office of WA (in press) Crisis Referral Tool for AOD Services: The Drug and Alcohol Office: Perth, WA