First aid experience - any first aiders out there?

Pardon the lengthy story, but the details are sort of important here.

We just got back from a holiday in Crete, and passing through Athens we came across a first aid situation. I've been mulling over what happened so I'm posting the story here. Any feedback as to how I could have handled it better is welcome. I know that I can really stress out in a emergency, so for me it's very useful to analyze stuff like this to be better prepared next time.

Don't worry, it wasn't particularly dramatic, and all ends well :) But I keep thinking that it could have been more serious, and I don't know if I would have figured it out in time.

Ahead of us on the street we saw a man supporting a woman, both of them tourists. Her back was dirty so she had obviously been on the ground. She said a few words with her eyes shut and he managed to get her on her feet, but then she fainted clear out. He caught her and we lowered her to the ground. I tried to put something under her head but changed my mind and just put her head flat on the pavement, with her neck straight, thinking of keeping her airways open. She was unconscious, shook a few times, and her skin was very clammy. I don't think I even thought to check if she was breathing. Her mouth was closed, and her face was firm, so she didn't seem completely "slack".

I asked if she was a diabetic or epileptic, which she wasn't. He said he hadn't seen it happen but she'd told him she'd fallen and hit her back, and he kept saying that she needed a doctor. I told him I would try to help in the meantime. Another guy was already phoning an ambulance. I felt around for a pulse, but I kept thinking she might have had a stroke, I don't know why. After a few seconds she opened her eyes but kept her mouth shut and just stared straight ahead. I asked her if she could hear me and asked her to tell me her name. She made a noise but still stared straight ahead. I kept asking her to talk to me, insisting that she open her mouth and tell me her name out loud. Finally she did. Then I asked her her age. She managed to answer that too, but was still staring straight ahead and not at me, and sort of mumbling.

Her husband asked if she could move her hands, and she could. She was behaving sort of like someone seasick behaves, staring straight ahead, stiff lips and mumbling. By then I was pretty sure she hadn't had a stroke, but when she told me that she'd slipped and landed flat on her back hard I was sure she had a concussion. I asked for as many details as she could remember, in case she passed out again. I wanted her husband to be able to tell the ambulance people as much as possible.

After a while she started talking more and behaving more normally, she said she could hear everything but couldn't remember passing out. She kept saying that she was fine, was very embarrassed and didn't need an ambulance, but when her husband convinced her to sit up she looked woozy so I got her to lie back down again. I told her husband that I would recommend she get checked up at a hospital, because a concussion can have pretty bad consequences if not taken seriously. I also insisted that he be the judge of whether she was ok or not, because it's a natural instinct in public to say that you feel fine even if you're not. They were flying out the same evening and I stressed that it was important that she rest until the flight.

Finally she opened her eyes and actually looked at me properly, and started speaking normally. She insisted that they just wanted to take a taxi and finally I had to just let them go. The whole thing took maybe 15 minutes. No ambulance arrived in the meantime, lots of traffic.

So. I'm happy I could take control and stay calm, I think I did and said basically the right things. But I'm not sure I would have picked up on it if she wasn't breathing or was having a heart attack. I feel it would have looked "different", but I honestly don't know.

Well I just had my CPR recertification yesterday, and our training says that after you've secured the scene, checked for responsiveness and opened the airway, the next thing you do is put your face close to the victim's face and check for signs of breathing - look (for chest expansion), listen (for breath sounds) and feel (for exhalation on your cheek).

The American Heart Association no longer trains us to check for a pulse. Supposedly the lips will turn blue quickly when there's no heartbeat. (It was 7 a.m. and not being a makeup wearer myself, I didn't think about how you could tell the lip color of someone wearing lipstick. :rolleyes:)

Sounds like you did what you could. Hope she's okay.

Thanks Oak. Yup, I remember being told that now, but at the time my mind was just a blank and I was on autopilot. I think that if she had seemed "slack" and completely limp I would have thought CPR faster, but I will def. be more quick to check breathing next time. Pulse can be erratic and hard to find, so I remember being told to not waste time looking for one.

One of the things about CPR training is that the protocols for it change every single year.

Wow. I think you did a great job. I recall coming upon someone on the bike trail who had crashed very hard and appeared non responsive. Their was already four or five people at the scene attending to the guy, so I rode on, but still felt a little shocked and concerned-- even as I knew there was nothing I could have added. Got back to the car and heard the siren from the ambulance and mentioned to store keeper who rents bikes about the accident. Didnt feel so bad when I discovered another lady who was a nurse and she rode on as well as she knew they had things under control.

Shannon

Kudos for keeping such a cool head and helping a stranger. The only thing that comes to my mind from my limited first-aid training is that if someone is unconscious but moveable (eg don't suspect spinal injuries, etc), you should try to put them on their side in the "recovery position" rather than flat on the back. Pointing the face slightly towards the ground helps prevent airway obstruction, like from bodily fluids or the tongue falling back into the throat (which probably wasn't a danger for her since you said she wasn't totally limp).

It sounds like you did a great job. You stayed calm and were assessing what it could be, having good instincts about what to do, and what could cause more harm.

I've had 2 recent crossings with injuries in the last month, so I'm also wishing I knew more. Both were bike crashes. One at a race, and I drove the guy to our lbs where he ended up getting a ride to the hospital from the team manager; then a couple of weeks ago, a little girl fell in front of my house. Her screaming made me run out to help her, and I grabbed my cell phone, which was all I could think to bring. Her mother was to her before I was, and started trying to get her to stand (which seemed wrong to me). Her screaming got worse, and she couldn't stand. Her father came and carried her home, but by this time I was pretty sure her leg was broken, and asked if they wanted me to call an ambulance because I thought she shouldn't be moved. Well, they carried her home, telling her "it's just a scratch". Turns out her leg is broken. Poor thing.

I ended up looking up info on what to do for a broken leg, and now know (I know this is the bare minimum, but it's still more than her parents knew) to splint (use a wooden spoon if that's all that's available) before moving. So many other things can come up that I'll be of no help with, I really should take a first aide class.

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Originally Posted by Irulan

One of the things about CPR training is that the protocols for it change every single year.

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I have heard of this.

I got a CPR certification in July -- what you did sounds correct. According to what I was taught, there would be no need to move the person. However, it was rather foolish of them to take off in a cab. I hope she got checked out before traveling: why did she fall in the first place and then faint?

In order to prevent shock you are to raise the feet above the heart, to encourage blood to the organs. You did right by keeping her neck still. Good job for acting intelligently and quickly. I'm sure they appreciated you.

She fell because she was hurrying along trying to keep up, pulling heavy luggage, and slipped on a metal ramp. She said her feet just flew out from under her and she landed hard flat on her back. I don't think she even knew she had hit her head, she just heard a loud bang. She also thought she had remained conscious and aware the whole time, when she had actually lost consciousness for at least a minute.

I wish she had gone to get checked up too, but this was in a busy street with heavy traffic, a metro and bus strike, no ambulance after 15 minutes in a foreign town (she was American), and taxis waiting just a few yards away. So I guess I understand how she just wanted to get into the calm of a hotel to rest once she actually did feel ok.

Red, must have been upsetting to handle a child screaming. That would have freaked me out a bit, it's hard to remember that "the ones that scream aren't the ones in danger", as I was once taught. You're right that she have stayed still, but I think it's natural for family to want the person to stand up and "be normal". I should have been stricter about that myself.

I took a CPR class this year and highly recommend it for all. If there isn't a class nearby Red Cross has online versions of the class. Check their site. More people trained is more better :D

I think you did a great job! The most important thing is staying calm. This allowed you to think through stuff like not moving her head in case there was spinal damage.

Falls are so tough, you never know what causes them. Hip fractures (which this wasn't) come to mind. Lots of folks think they fall and break their hip where often, especially for elderly or those with low bone density the hip breaks and then you fall.

So did she faint or have a mini stroke or heart event or ... and then fall? That will be up to her doctor. But you stayed calm, made a note of her reactions which would have been important when EMT's arrive.

You done good! :)

Thanks Trek :) No, the guy who called the ambulance actually did see her slip on the ramp and fall.

Ok, so I learned the following from this:
1. as long as no-one is screaming I can keep my cool ;)
2. remember to check breathing immediately
3. people behave strangely after fainting, with some senses returning before others. This is ironic, actually, because I almost-faint all the time due to low blood pressure, so I know exactly how it feels to get tunnel vision, weak knees, stop speaking but still hear everything - I just didn't know it could be like that when coming to as well.
4. don't let the patient decide what to do, or their helpful family, unless you agree. The husband got her on her feet once and sitting once before she was ready, and both times she could easily have hit herself harder blacking out again. And she was talking about being fine and I could go, when she was very obviously not ok (eyes closed, mumbling).

Ok, I'll stop re-hashing this now :) Thanks for your input folks!

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Originally Posted by lph

4. don't let the patient decide what to do, or their helpful family, unless you agree.

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Actually you kind of have to. :o this is the thing I found out in class. When an emergency occurs, you arrive on the scene or are there you are supposed to identify yourself; "Hi, I'm Trek, I know 1st aid sort off, I took one class Can I help you?"'

If they say no there's nothing you can do about it (unless their unresponsive then you can go to town). So if they refuse and you want to help you have to knock them out first. :) :p ;)

But if they agree you need to stay till help arrives.

Yep, sounds like she was concussed which by definition is a loss of consciousness for even a brief time after trauma to the head. Good on you for not moving her although the likelihood of spinal injury is pretty low in these situations. The immediate post-concussive period can present itself in many ways but hers was classic. Did you stick around for the ambulance service?

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Originally Posted by Trek420

If they say no there's nothing you can do about it (unless their unresponsive then you can go to town). But if they agree you need to stay till help arrives.

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This sounds... like a US thing :D

But no, what I meant was more that, as a good polite standoffish Norwegian ;), I would normally never insist that a stranger do this or that and just stay out of their business. But leaving her while she was half conscious, just because she was mumbling "no, I'm fine, we can go now" would not have been right to do. I just gently ignored her, and talked to her husband instead. What I meant is that I had to be a bit more assertive than I would otherwise be, until she was conscious enough to know what she was saying.