When was the last time you took a first aid class? The '80s? '90s? Like everything in the medical field, first aid is constantly evolving, and what you may have learned to do as a first responder 10 years ago could be completely wrong today. Let's take a look at some of the biggest changes over the last few years. Illustration by Tara Jacoby.
To help sort through all this medical knowledge, we talked with Jordan Ourada, EMS Liaison at HealthONE, who walked us through the most common procedures right now. He was also quick to point out that the research is constantly evolving, so if you're in a position that demands it, keeping up with your first aid training is a must. Oddly, some of these standards have gone in and out of vogue over the years, so depending on when you learned basic first aid, some of your knowledge may still be up to date.
CPR Has Changed Completely
Cardiopulmonary resuscitation (CPR) was first introduced in 1960. Back then, the typical procedure was known as the ABCs: airway, breathing, chest compressions. You started with opening the airway to try and resuscitate the victim by giving them quick breaths through the mouth, then moved onto pumping on the chest to get the heart beating again. Depending on when you learned CPR, you may have also learned to put pressure on the patient's windpipe to decrease the amount of air that entered the stomach. Back in 2010, this procedure completely changed.
Now, the recommended method is CAB: chest compressions, airway, breathing. One cycle of CPR includes 30 compressions, followed by two rescue breaths lasting about one second. The order changed because researchers found that the chest compressions are the most important part, and in a lot cases, the breaths are unnecessary. This type of CPR is best for drowning victims and people who collapse with breathing problems.
In fact, a "hands only CPR" or "compression only CPR" is now recommended for most emergencies we come across as bystanders (unless it's a drowning victim or people who collapse with breathing problems. Regular CPR is still best in those cases). Ourada points out that in some cases, the breathing can actually do more harm than good and compression only CPR is recommended:
The American Heart Association is constantly studying and reviewing the most effective way to save a life in out of hospital cardiac arrest. While in the past it was common practice to do mouth to mouth resuscitation, it has been found that not only does that not help, it can make things worse by filling the belly with air making it more difficult to do effective chest compressions. It also increases the likelihood of the patient vomiting in your face which — let's face it — is gross in addition to being hazardous to the health of rescuers. It is now recommended that the most effective way to resuscitate someone in cardiac arrest is consistent, deep and fast chest compressions without interruption.
Which is all to say, if you cannot give breaths, you should simply continue chest compressions at a rate of around 100 per minute (which is about the same as the song "Staying Alive", as you may have heard) until help arrives or the person shows obvious signs of life-like breathing. It's also worth noting that since CPR research is constantly evolving, it's recommended that you take a CPR course every two to three years to keep up to date.
Applying Tourniquets Is Useful (Again)
Depending on when you took a first aid class, you either learned to apply tourniquets above bleeding wounds or learned expressly not to ever use one. Likewise, if you've ever watched any action movie ever, you just assume a tourniquet is appropriate for just about any kind of injury. However, studies published in the likes of the Journal of Trauma and this one in the Journal of Special Operations Medicine show the rate of complications is pretty low. Ourada explains:
Tourniquets were popular many years ago, then went out of vogue for a long time due to the risk of limb damage and compartment syndrome. In the last few years however, after extensive use and study by the military in the wars in the Middle East, tourniquets are back in a big way and have been found to be the most beneficial way to stop serious arterial (squirting) bleeding in limbs. You do want to be aware of how long it is on the limb as it does cause damage, but that takes a long time and ideally the injured person is on their way to a trauma center in that time.
So, when should you use a tourniquet? They're best used to limit severe external bleeding on limbs. Before you apply a tourniquet, you should attempt to control open bleeding by applying direct pressure to the bleeding site until it stops. If it doesn't slow down within about 15 minutes, then it's time to use a tourniquet (and no, you don't need to elevate the limb, that was also debunked). To properly apply a tourniquet, place it two to four inches away from the wound site, between the wound and the trunk of the body. Then, tighten it in a knot around the limb until the bleeding stops. Many first aid kids have tourniquets you can use that make the process a lot easier.
While tourniquets are back in vogue, it's still only recommended you use them with proper training, so if you missed that in your first aid class, it's worth heading back.
Don't Induce Vomiting Without Calling The Poisons Information Centre
If you took a first aid class prior to 2010, there's a reasonable chance you learned to induce vomiting when someone ingests a foreign, possibly toxic substance. It was so popular that people were told to keep ipecac around in the house just in case. It turns out this is a terrible idea.
The reasoning is pretty simple. In most cases, common treatments for when someone ingests toxic substances, (treatments like milk, activated charcoal, and ipecac), are unhelpful, and in some cases, harmful. Ourada says that depending on what the victim swallowed, inducing vomiting can do more harm coming back up than it did going down, so it's always best to refer to the experts instead of going with some universal treatment plan.
Regardless of whether a first aid teacher may have told you, you should always call Poisons Information Hotline (13 11 26) before doing anything at all.
Don't Store Bare Severed Digits In Ice
When you lose a digit, say a finger or toe, the old advice said your best bet to get it reattached was to put the digit on ice and make your way to the hospital as soon as possible. While that's partially true, and makes for a great scene in a movie, it's not the whole story. Putting it directly on ice is a bad idea.
When you place an amputated digit directly on ice, you risk damaging it. Ourada explains:
Do not throw the digit straight on the rocks because that can freeze and damage the skin and vessels. It's best to wrap the amputated part in cloth or paper towels and then put in a cooler or a cup of ice to keep it cool. Avoid direct ice contact and avoid placing it in liquid and water logging it. Get to a trauma center as soon as possible.
Once you get to a trauma center, they can reattach the digit provided it's still in good shape. If things go well, the victim will regain use of it completely.
Similarly, if someone loses a tooth, the previous recommendation was to simply get to a dentist as soon as possible with the tooth in hand. Now, it's recommended you store the tooth in Hank's Balanced Salt Solution, propolis, egg white, coconut water, Ricetral, or whole milk. If none of these are available, you can also store the tooth in the victim's own saliva until they can get to a dentist.
Never Put Something In a Seizure Victim's Mouth
You may have heard that when you witness someone having a seizure, you should place an object between their teeth for them to bite down on so they don't swallow or bite off their tongue. If your first aid knowledge is really old, you maybe also learned to restrain the victim. Both of these are incredibly wrong. Sticking something in a seizure victim's mouth can cause them to choke, and restraining them can lead to broken bones or other injuries.
Seizures are tough to watch, because you can't really do anything. The best you can do is clear the area and try to make the victim as comfortable as possible. Ourada's suggestions are pretty simple:
Old wisdom says to place something in the victim's mouth, like a wooden spoon, to keep them from biting their tongue. This is not recommended as you can do damage by trying to force something into their mouth, and it also creates a choking hazard. The best thing to do if you see someone seizing is to help lower them to the ground if they are not already there and try to put something soft under their head so they don't strike their head on the ground while seizing.
Beyond that, the CDC adds that while your first reaction might be to offer water to a victim as soon as they stop seizing, you should always wait until they're full alert before doing so.
The American Heart Association and the American Red Cross keep an up-to-date guide for all the changes in first aid procedures here. With each revision, you'll see a note of where it's updated and what it used to be. We didn't cover every change here, so be sure to check that out to brush up on more of the basics.