1. How to call an ambulance
There are two ways to make a mistake when calling an ambulance: If you call them without good reason, or if you do not notify them in time in case of life-threatening or alarming symptoms, Barbara Ozsvárt pointed out. You can call the ambulance on 112, but some apps make it possible to call for help at the touch of a button even if you can’t speak due to an allergic reaction or choking.
When calling the ambulance, introduce yourself, tell your phone number, where exactly the incident happened, how many people were injured, what condition they are in, and what problems or alarming symptoms you notice. Keep it brief, concise, and to the point. There’s no reason to worry about missing anything because there are trained rescue managers on the other end who will ask targeted questions based on a structured protocol. If the person in need shows alarming symptoms, such as unconsciousness, severe pain, heavy bleeding, or unresponsiveness, the rescue call and the care of the injured person should be performed simultaneously. If possible, ask for assistance in making the call by assigning a specific person nearby. If you are alone, put the phone on speaker and at the same time, start caring for the person in distress. It is also worth informing the ambulance on the specifics of how to enter the apartment. Call an ambulance if there is an acute threat to life or if you observe alarming symptoms, such as severe pain, heavy bleeding, unconsciousness, shortness of breath, choking, or labor. In other cases, contact the GP or a doctor on call outside office hours.
2. How to perform resuscitation
In Hungary, the current number of out-of-hospital circulatory arrests is extremely high by European standards, with around 24,000 such cases occurring every year. However, bystanders perform cardiopulmonary resuscitation (CPR) in only 40 percent of cases, even though the importance of CPR cannot be overstated, as it could increase the current survival rate of 5-12 percent. Sudden cardiac death can happen to anyone, anywhere, be they young or old, healthy or ill, on the street, at work, or at home. Good quality chest compressions are crucial, but it is even more important to be early enough to notice if there is a problem, dare to approach and examine the person, and call an ambulance. CPR can start right away.
Start first aid only in safe circumstances. Shake the person by the shoulders and address them. Should there be no response, tilt their head back by holding the forehead with one hand and the chin with the other, and then examine the breathing for 10 seconds using three senses. Check whether the chest is rising and falling, listen and feel if there is an outflow of air. If you have not counted at least two satisfactory breaths in 10 seconds, start chest compressions without delay. Ask those around you, pointing specifically to individuals, to call an ambulance and bring a semi-automatic defibrillator (AED) if accessible nearby. Starting CPR helps survival even if it is not performed perfectly.
To do chest compressions, free the chest, place the back of your hand on the middle of the breastbone (sternum), place your other hand on top, clasp them together, then with your arms extended and your back straight, perform 5 to 6 cm-deep chest compressions uninterrupted, at a rhythmic rate of 100-120 compressions a minute. Only trained persons should administer CPR with rescue breaths: in this case, after 30 chest compressions, give two rescue breaths. However, if you are not familiar with the technique, you should rather aim for continuous quality chest compressions. If possible, rotate the rescuers every two minutes.
In the case of children, however, rescue breathing cannot be omitted: after blowing five times in the child’s mouth, if there are still no signs of life, give 15 chest compressions.
3. How to treat airway obstruction
Choking is one of the most common life-threatening situations that can occur anywhere and at any time. In everyday activities such as eating; during a child’s play; or in the elderly after a stroke, due to dentures or chewing and swallowing difficulties. In the majority of cases, the body tries to clear the foreign object from the trachea by coughing. The most common misconception is that you need to pat the person on the back; however, this is not necessary if the cough is good. On the contrary, if you intervene and start patting the person on the back, you may be hindering them. If the person is presumed to have a blocked airway but is coughing well, there is nothing else to do but to encourage them to cough, call an ambulance, and monitor any changes in their condition. A good cough means that they can breathe deeply enough.
You need to intervene, though, if coughing becomes weak or even stops, or if there is no cough whatsoever after choking, but the person is wheezing, has a bluish color to their skin, and cannot speak. In this case, stand next to them, support their chest with one hand, and strike five times firmly between the two shoulder blades with the palm of your other hand, checking after each pat whether the airway has cleared (by looking at them or checking whether they are relieved or talking, or whether they can cough well again). If so, do not proceed with the intervention.
If there is no improvement, perform the Heimlich maneuver. Stand behind the person and wrap your arms under the person’s armpits, make a fist with one hand, place it just below their ribcage, clasp your other hand tightly around the fist, and thrust your hands inward and upward five times. After each intervention, check whether the airway has cleared! If not, continue with the intervention: five back blows followed by five Heimlich maneuvers. Keep going until the foreign object has been dislodged from the airway or the victim has lost consciousness. The latter is a sign of respiratory arrest: In this case, lay the person on their back on a hard surface on the ground and immediately start chest compressions as described in point two, skipping the primary survey part.
In the case of children over the age of one, follow the same procedure, but instead of standing, kneel or squat behind the child during the Heimlich maneuver. However, do not use the Heimlich maneuver under the age of one! Instead, after five back blows, do five chest thrusts. Get into a seated position with your feet firmly resting on the ground, and lay the infant face-down on your forearms, using your thigh for support. Hold the infant’s chin and face with your hands, then apply 5 back blows between the infant’s shoulder blades. If the intervention has failed, turn the infant face-up on your forearm, using your thigh for support, supporting the infant’s head in the palm of your hand. Keep giving chest thrusts by pulling straight back. If the infant loses consciousness, start CPR without a primary survey.
4. How to put someone in a recovery position
The muscles of an unconscious person are toneless, leaving their airway potentially compromised. The recovery position, also known as semi-prone, allows the airway to remain clear until the ambulance arrives. It is recommended for any casualty who is breathing satisfactorily and is not suspected of having suffered a serious traumatic injury, i.e. has not fallen from a height, has not been hit by a vehicle, or is not suspected of having a spinal injury.
Primary survey is performed the same way as for resuscitation (see point 2): If the patient is still unconscious, there is a possibility of airway obstruction due to a relaxed tongue or residue vomit, therefore it is important to place the patient in a stable lateral position to ensure an open airway.
Position the arm that is nearest to you perpendicular to their body, with the elbow straight and their palm facing upwards. Place the back of their other hand against the cheek. Pull their far knee up so that their foot is flat on the floor, and pull on the far leg to roll the casualty towards you on to their side, while still holding their palm in your palm. After rolling over, tilt the casualty’s head back, and bend their upper leg at hips and knees to a right angle. Finally, check their stability and breathing and protect them from cooling down by covering them. Stay with the patient and call an ambulance.
5. How to treat severe bleeding
While an unconscious patient can look scary, a heavy bleed can be even more frightening for the first aider and the patient alike; however, effective bleeding control can save lives. Therefore, it is essential to keep calm and soothe the injured person throughout – because if they are nervous, both their pulse and their bleeding will increase. This reassurance and assertive communication should go hand in hand with patient survey and intervention.
Depending on the type of injury, blood may pulse or even spurt from the wound. Sit or lay down the injured person, locate the source of the bleeding, and apply direct pressure to the wound as quickly as possible with a clean cloth. Raise the limb above the level of their heart and call or get an ambulance. Do not leave the casualty alone and do not encourage them to apply direct pressure to the wound themselves. As soon as a bandage is available, make a pressure dressing. It is only used for controllable bleeding, e.g. in limbs, but not for neck cuts. For neck, abdominal, or chest injuries, direct pressure is required. If the patient’s skin is pale, sweaty, or if they complain of dizziness or fainting, always lay them down and elevate their lower limbs. Do not remove the pointed object (e.g. knife or stick) from the puncture wound but use a clean cloth to secure the object in place. The injured person should remain still, this will also prevent the foreign object from moving out of the puncture channel. If there is no object in the channel, apply direct pressure with two hands and a clean cloth.
+1 How to administer an EpiPen
It is essential for the first aider to recognize whether the person is having an allergic reaction or a severe anaphylactic shock: This can include rapid deterioration, choking, wheezing, body-wide nettle rash, or edema. In this state, the body is undergoing changes that might hinder the patient from administering the EpiPen to themselves, so don’t be afraid to use it! These medical devices are becoming increasingly available in schools and public institutions. The device clearly indicates whether it is intended for adults or children. Its use is simple: remove the cap, insert the tip of the device at 90 degrees into the outside of the patient’s thigh, holding it firmly for 10 seconds. This gives enough time for the ampule to release the active ingredient, after which the EpiPen can be safely removed from the patient.
Ádám Szabó
Translation: Judit Szabados-Dőtsch
Photo by Boglárka Zellei – Semmelweis University
Video credit: Mayo Clinic, Cincinnati Children’s, St John Ambulance, Action & Emergency
