By Steven Shotz
"As to diseases, make a habit of two things - to help, or at least, to do no harm."
When providing first aid care, it is always important to know when NOT to do something. As modern providers of first aid care, we have a responsibility to base our interventions on solid science, and apply good judgment.
I strongly recommend that first responders keep current on first aid techniques by reading reputable journals, such as the Journal of Emergency Medical Services (www.jems.com), and by taking classes and continuing education courses offered either online or in a classroom setting.
Below are some common myths - practices we should not use - and the science-based treatments first aid responders should apply.
Myth 1) Urinate on jellyfish stings to relieve pain and speed recovery.
Science-Based Response: Rinse the area with seawater. Do not use freshwater, do not rub the area and do not apply ice. Apply vinegar or isopropyl alcohol to the nematocysts (stingers). Remove the tentacles with tweezers. If possible, shave the area using a safety razor and shaving cream, mud, or a baking soda paste. Reapply the vinegar or alcohol. If the affected area is an extremity, splint it. Watch for signs of allergic reaction, including anaphylactic shock, and transport to medical care.
Myth 2) A shot of alcohol can warm a hypothermic patient.
Science-Based Response: Alcohol may give you a subjective sense of warmth, but it dilates the blood vessels, which actually causes more heat loss, not less. It can also cause changes in judgment and coordination - two conditions to be avoided.
Prevent heat loss by removing wet clothes, providing insulation, and warming the patient in a dry place. Add layers of clothing and a hat. Warm the core first, if possible, by giving warm, sweet fluids if the patient is conscious and able to swallow. Handle the patient gently to avoid triggering ventricular fibrillation. Don't let severely hypothermic patients sit, stand, or walk until warmed. Rapid or active re-warming techniques require special training.
Note that putting two hypothermic patients together in a sleeping bag is not a good source of warming. One must have normal body temperature. It is better to wrap the hypothermic victim in clothing inside a sleeping bag, and allow him to shiver, which generates heat.
Myth 3) Rub frostbitten body parts vigorously or rub snow on them.
Science-Based Response: Frozen body parts require rapid re-warming techniques in a controlled environment, which require special training beyond the scope of this paper. First aid treatments include removing any objects that will constrict the extremity - like rings, bracelets, etc. (place them in the patient's pockets). Separate fingers and toes with loose, sterile gauze, and loosely wrap the extremity in a sterile roller bandage. Do not pop blisters. Elevate the affected extremity. Insulate the affected area and the person, and transport to medical care.
Myth 4) Apply butter, grease, or oil to treat a burn.
Science-Based Response: Covering a burn with oil or grease causes the skin to retain heat, which is exactly the opposite of what you want to do. Additionally, it is difficult for medical staff to clean. Instead, remove the source of the heat. Cool the area by immersing the burn in cool, sterile water or saline solution. You might also cover with a cool, wet dressing and/or irrigate the area until the burning stops. Do not immerse an area for more than 10 minutes. Make sure to avoid causing the patient to become hypothermic. Cover the burn with clean, sterile dressings. Give oxygen for severe burns and protect from heat loss if the burn covers a large area. Transport to medical care.
Myth 5) Physically restrain a person having a seizure and use a bite block.
Science-Based Response: Keep your fingers out of the patient's mouth, unless the patient does not have an open airway (in which case you would insert an oropharyngeal airway if you are trained to do so). Most authorities recommend against using bite blocks. Protect the patient from injury by clearing a space around him and padding immovable objects he could hit.
Myth 6) Snakebites are treated by cutting between the bite marks, sucking out venom or applying tourniquets or electricity.
Science-Based Response: Read our previous article for a thorough discussion.
Myth 7) Soak sprains in hot water.
Science-Based Response: Most authorities agree that putting a fresh sprain in hot water will increase swelling. Instead, follow RICE: rest, apply ice, apply a compression wrap (elastic bandage), and elevate.
Myth 8) Tilt the head back or place the head between the knees to control a nosebleed.
Science-Based Response: The bleeding you see from a nosebleed may be only part of the total blood loss. The patient may swallow a lot. Most nosebleeds originate in the septum. Have the patient sit with head tilted slightly forward. Pinch the nostrils together for 15 minutes. Do not keep checking to see if the bleeding has stopped before the 15 minutes have elapsed. Releasing the pressure too soon is the most common reason responders fail to stop the bleeding.
Myth 9) Treat hyperventilating patients by having them breathe into a paper bag.
Science-Based Response: A number of things can cause a patient to breathe rapidly to the point carbon dioxide levels drop. We cannot tell in the field whether hyperventilation is the result of a serious illness, e.g. extremely high blood sugar levels, or something relatively innocuous, like a panic attack. Therefore, authorities no longer recommend having the patient breathe into a paper bag in the pre-hospital setting. A patient who is hyperventilating should be given supplemental oxygen, if you are trained to do so, and transported to medical care.
Myth 10) The credit card versus tweezers debate for bee stings.
Science-Based Response: There does not appear to be uniform agreement on whether bee stingers should be removed by scraping across the skin with the edge of a credit card or pulling them out with a tweezers. It is probably more important to just get the stinger out quickly. If you use a tweezers, try to grasp the stinger below the sac and not compress it. Be aware that some people are allergic to bee stings and may have a severe allergic reaction, including anaphylaxis.
Steve Shotz (sjsconsulting [at] comcast [dot] net) is an Emergency Medical Technician and an Outdoor Emergency Care instructor for the National Ski Patrol. He welcomes your questions on first aid practices.