Real aid

THE thought that there are people out there who think they can perform a tracheotomy because they saw it done once on Casualty is scary. Yet that's exactly what one London ambulanceman claimed in a worrying report from the Broadcasting Standards Commission last week looking at the way TV influences our behaviour.

A tracheotomy is a surgical operation in which a hole is made into the windpipe through the neck to relieve an obstruction that is stopping someone breathing. It is not something you even think of doing unless you are medically qualified.

The un-named ambulanceman, however, told how a member of the public at an accident scene tried to advise him how to perform the operation.

"He was like, 'No, you put it in the neck, then you make the incision, turn it 90 degrees. Get out a Biro, I saw it on Casualty'," the paramedic said.

It is not the only case of interference from people who think they know how to deal with medical emergencies after watching TV medical dramas such as Casualty or Holby City.

The Broadcasting Standards Commission report entitled Dramatic Licence: Fact Or Fiction? lists many other examples, and describes it as a "worrying trend".

One ambulanceman described being called out to see a victim who had suffered a fit. "This guy had obviously seen something on TV or film, that you put something in their mouth to stop them biting their tongue, so he pulled out a 50p piece. Not only am I dealing with this guy fitting, he's now semi-choking on a 50p piece. It was just chaos," he said.

Others reported patients demanding that the ambulance's blue lights be switched on for the journey to hospital because they had seen the same happen on TV.

One paramedic even claimed medical dramas were "totally undermining" the ambulance service - while another admitted it made their jobs harder.

John Pawelec, head of education and development at the Tees, East and North Yorkshire Ambulance Service's training centre just outside York, says talk of popular TV shows undermining the work of paramedics is probably an overstatement.

But he does agree that there are plenty of misconceptions around about First Aid and emergency medicine, whether they come from the TV or are just old wives' tales.

"There have always been misconceptions about First Aid. It is certainly true that a little knowledge can be dangerous," he agrees. "So don't just copy what you have seen on TV. It doesn't make you an expert!"

Some of the most common misconceptions he has come across include how to deal with a nosebleed. One old wives' tale suggests putting a key down somebody's back beneath their shirt - quite useless, says John. More dangerously, there is the advice to get somebody who has a nosebleed to tip their head back. That is absolutely the wrong thing to do, says John says. "If someone has a nosebleed, what you should do is pinch their nose and lean the patient forward. Don't tip their head back. All that happens then is that blood drains down the throat into the stomach. The next thing is you will have the patient vomiting because of the irritation caused by the blood in their stomach!"

Another common misconception is that if someone is having a fit or is in convulsions, you should put something in their mouth to stop them biting their tongue. Again, not true, John says. "The danger is that the person is going to choke on whatever it is they have in their mouth."

What you should do is put them in a position in which they are not going to be able to injure themselves by thrashing about.

"There is really nothing else you can do," he says. "The convulsion is going to progress. So just put them in the recovery position (see diagram above) on a soft surface." Don't be tempted to try to hold them and stop them from jerking, he says - that way they could easily injure themselves or dislocate a limb. The best advice for anyone who is interested in first aid is to sign up for a First Aid course. St John Ambulance and the Red Cross provide excellent courses locally.

If you're not trained and you encounter somebody who is injured or unconscious, call 999 immediately, says John. Ambulance staff will then advise you of simple measures to take while the ambulance is on its way.

There really is a basic ABC of First Aid, John says - and it can help save lives. A stands for airway, B for breathing, C for circulation. "It really is the simple things that can save lives," John says. "You don't need to try to perform thoracic surgery."

Here, with thanks to John, are a few simple ABC do's and don'ts.

AIRWAY

John has known people who have died because they were left lying on their back and could not breathe properly. If you encounter someone who is unconscious, the first thing to do is check their airway is clear.

To make sure their tongue is not blocking the airway, hold the jaw and pull it gently forward. Do not put your fingers in the mouth unless you can see there is something in there the patient is choking on. You could think about tilting the head back gently, advises John - but don't do that if there is any chance that the patient may have injured their neck, for example if they have fallen or have been assaulted.

If satisfied that there are no injuries to the patient's back or neck, you can try putting them into the recovery position (see diagram), in which they lie on their side with one hand supporting the head, the other arm stretched out, and one leg bent. This makes it easier for them to breathe and also means that if they have been sick, for example, the vomit can drain from the nose and throat.

BREATHING

Check the patient's breathing by listening for breathing sounds at the mouth or nose. If they are not breathing, after clearing the airway, gently pinch the nose then breathe lightly into their mouth, just enough to get the chest to rise (called an inflation). If you have one, use some kind of protective barrier between your mouth and the patient's.

CIRCULATION

If the patient is still not breathing after two inflations, you may have to perform cardiac compressions because the patient's heart may have stopped beating.

Make sure the patient is lying on a firm surface, then with the heel of the hand, press down lightly on the breastbone - not the chest itself - depressing it by 4-5 centimetres. Make 15 controlled compressions at a rate of about 100 a minute (more than once a second), then follow up with two mouth-to-mouth inflations. Check the patient's response and, if necessary, repeat as long as necessary, 15 compressions followed by two inflations each time. A First Aid course will teach you how to carry out resuscitation properly.

If a patient is bleeding from a wound it is important to stop this. First, check that there are no sharp objects still in the wound. Then seal the wound by using a sterile bandage - or a clean piece of cloth if you don't have one - to apply gentle pressure. .

If there is an object sticking out of the wound - a knife, or a shard of broken glass, for example - do not remove it. Pack a clean cloth or bandage around the object.

To find out about First Aid courses in your area, call the Red Cross on 020 7201 5027 (website www.redcross.org.uk) or St John Ambulance on 01757 708781 (website www.sja.org.uk).

Updated: 09:39 Monday, August 04, 2003