First aid: What to do before making that emergency call

First aid is needed in a situation where emergency care is required to save or improve chances of survival at that moment. According to experts, without first aid, a victim’s situation can worsen in a few minutes, or depending on the intervention done within that critical time, the life of the victim can be saved. Principles in case of emergency According to Dr Claude Byiringiro, an orthopedic surgeon at University Teaching Hospital, Kigali (CHUK), there are three major principles that should be taken into consideration by the person who is giving first aid to the victim. Dr Claude Byiringiro explains a point during the interview. / Lydia Atieno One of them, he says, is to call for help on emergency hot lines which operate all day and night. Byiringiro says in Rwanda, the emergency system is efficient and one can get response within few minutes (less than ten minutes) of the call. “Everyone needs to know that there is a public ambulance which can reach out to anyone who needs emergency care. It can be accessed by calling toll free lines 912 or 112,” he says. It also serves areas outside Kigali as it is interconnected to other hospitals from different parts of the country. The second principle, Byiringiro says, is that one should be in a position to check if the victim is able to breathe. This can be done by observing if the mouth and the nose are both open and free. They should observe if there is nothing blocking the nose and mouth. Byiringiro adds that checking if the heart of the victim is beating well is also important. By observing this, he explains that one is in a good position to initiate and prioritise the intervention needed to save the victim. Dr Francis Kazungu, a general practitioner, advises that the person near the victim should first call the emergency line before providing first aid to avoid further complications as they wait for support from the trained crew. He says it is important to evaluate the scene to establish if it’s an accident scene or a person just collapsed. Assessing the safety of the person who intends to provide first aid is also vital. “Before you secure someone else, knowing if you yourself you are safe prevents other accidents that might occur in the line of trying to save another one,” he says. Conditions that require first aid Byiringiro says although it’s hard to educate the whole public about first aid, reaching out to different media is important to raise awareness. “This can help them to know that public medical emergencies exist and they should not shun the service, but rather embrace it,” he says Kazungu adds that this is particularly helpful in cases where someone has been a victim of electrocution, as going to rescue that person can be dangerous because the first aid giver might be putting their life in danger as well. In cases of electrocution, the best thing to do, he says, is to first put off the switch before one attempts to provide any help. The other priorities, Kazungu notes, should be opening the airways and helping the victim to breathe. “Also, one should be in a position to find out if the heart of the victim is beating. If it is not, cardiopulmonary resuscitation (CPR), an emergency procedure that combines chest compressions often with artificial ventilation, should be done, to manually preserve intact brain function until further measures are taken to restore breathing in a person who has a cardiac arrest,” he explains. Kazungu also says moving the victim to a more secure place will help. “Although this is not a priority, it is aimed at ensuring that whatever the recuer is doing to the patient does not bring more complications,” he says. For patients who are not breathing, CPR is recommended. Byiringiro says other than professionals; everyone should be trained to carry out this procedure. “This is because most emergency cases happen in the absence of medical doctors as well as outside the hospital. This is why it becomes important for everyone to be aware of this,” he says. Byiringiro further explains that the victim should be laid on their back, and chest compressions done over the stomach. This should be done very fast, and should be done according to the rhythm of the heart. “The reason why these should be done is to awaken the heart. Most of the time, the heart is in ‘sleeping’ mode and one needs to do something that will help it to start working again,” he says. After compressions, Daniel Gahungu, a general practitioner at Sainte Famille in Kigali, says it’s recommended that one gives the victim oxygen through mouth-to-mouth breathing. “Protecting oneself while doing this is important to avoid contracting diseases as sometimes one might not be aware of the health status of the patient,” he adds. Gahungu notes that this can be done by putting a small piece of cloth on the victim’s mouth. Tilting the chin is also important as it helps in opening the airways. It should be carried on as one waits for help from the emergency crew. “All these apply to anyone who has become unresponsive and their pulse can’t be felt,” he says. In case of bleeding Another common condition that needs emergency care is when someone is bleeding profusely following an accident or a cut. Here, Ivan Ntwari, a doctor at La Medicale in Kicukiro, Kigali, says compressive dressing is needed. “This direct compression is to help stop the bleeding. This can be done with a well-cleaned piece of cloth to apply pressure on the bleeding area,” he says. If the bleeding is uncontrollable, Byiringiro says using a tourniquet is important. This, he says, is a last resort to stop bleeding and is used to save life when direct pressure has failed to work. Shock Shock normally occurs due to low blood pressure. This can be identified when someone faints and pulp veins are very weak. Byiringiro explains that the victim should be laid down, but the legs should be elevated to allow blood to circulate to the vital organs, such as the heart and brain. Another condition that needs quick response is when one gets a heart attack. Kazungu explains that such people tend to feel a very sharp pain in the chest, and risk losing their lives quickly if interventions are not done. “Although there are no standard intervention is to be carried out on such people, calling for help immediately might help the situation. The public should know that when one complains of tight chest pain, it’s urgent to reach out for help from emergency departments to help save the life of such patients,” he says. If they are wearing tight clothes, removing them and laying them down still until help arrives is important, he adds. Choking Another condition where people may need quick help is when something abruptly obstructs the airways such as choking, according to Byiringiro. He says that abdominal thrust is recommended; explaining that standing behind the victim and compressing their abdomen with much pressure can help. Byiringiro also says telling the victim to cough while applying those thrusts can help to push out the stuck substance. Burns According to Ntwari, conditions like burns and eyes getting in contact with other dangerous substances also need quick help. “If something has entered the eyes accidentally, one needs to wash their eyes with clean water as they wait for the help,” he says. For the burns, Ntwari says, people tend to put around the affected area other dangerous things that can actually lead to infections or other complications. He points out that some people put sugar or the rabbit fur; but cautions that this shouldn’t be done in any case. “When one has got a burn, applying cold water is recommended. In case of blisters, water can still work but it is advisable not to interfere with the blister,” says Byiringiro. Epilepsy Ntwari says when one is having epilepsy, removing the patient from hazardous places and putting them in a more secure place is important. Again, he notes that they should be laid on the recovery position (laying them on side) and something put in their mouth to prevent them from biting their tongue. When laying them down, one leg should be in a straight position as the other one should be a bit folded. This helps them to breathe well and protects their tongue as well. ****** EXPERTS SHARE TIPS Boniface Nsekanabo, medic at AVEGA Clinic, Kisementi, KigaliOne needs to have a first aid kit at home to ensure their safety, especially in cases of cuts. It should however be rechecked always to ascertain that everything that is contained inside is still functional. -- Bandora Iraguha, general nurse at Rwanda Military Hospital KanombeFor parents who have small children at home, keeping an eye on them is important. Also keeping harmful substances away from them can help ensure safety at home and prevents emergencies. -- John Muganda, gynecologistThe entire public needs to be educated on how to provide simple first aid to people who accidentally get emergencies. Additionally, taking caution while attending to the victim is important especially in cases of profuse bleeding. -- Aline Gihoza, medical student Being aware of emergency hotlines that are available is important to everyone as it’s the only way one can get the required help in time. People should not fear to help the victims, but provide support where necessary to avoid further complications.

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First aid: What to do before making that emergency call