Posted By Mark Eastbourne
Morning all

I work in a college. I have just been informed that we have a mature student who attends one day a week.

This student has informed his tutor he has a heart condition. When he has an attack, he has a spray which must administered under the tongue.

I have informed all the first aiders of this student and asked that they get to know what he looks like just in case he has an attack when he is not in his class, eg the refectory and am sending a photo of this student to the first aiders with the information.

However, the reaction I am receiving now is that the first aiders will refuse to administer the spray as it is medication.

I am unsure what to do.

Are they right? Has anyone had a similar experience? Can anyone guide me please!?

Regards

Mark

Posted By MAK
Hi Mark,

Ive just completed my First aid at work training and an additional course to treat older people and kids as I'm now a volunteer for the Red Cross. The course trainer was very clear and emphasised over and over that we are NOT to give potions, pills or lotions during treatment, however we can assist the patient to self-medicate. I.e find the treatment and guide his/her hand (while he/she is conscious) to treat himself.

to assure yourself of the current guidance however I would contact the British Red Cross and other voluntary bodies such as St Andrews or St Johns to ensure you are observing current UK practice guidleines.
However as the person with a heart condition has come forward to advise you of the condition and the necessary treatment, perhaps it may be possible to assign a set person, with the persons written authority to be able to medicate him/her in the event of necessity, this may be sufficient to prevent a lawsuit in the event of the unthinkable, but again I would take counsel on this from relevant organisations.

Myra

Posted By Incolumitas
Mark

The subject title would suggest that you may not fully understand this guy's condition. As Phil has pointed out, from the information you give it is probable that he has something like Angina. This is a distressing condition in which there is restricted blood flow in the coronary arteries, leading to heart attack-like symptoms. These are normally relieved by the tongue spray or a tablet under the tongue. There are other heart conditions, like valve problems, that have a similar efect.

He will almost certainly still be able to self medicate, but, depending upon the severity of the angina attack, may require assistance in retrieving the medication, opening it and getting it into his hand. As other posters correctly state, this is a perfectly ok thing for a first aider to do.

He also will be keen to reassure you and your colleagues that although he may look as if he is having a heart attack, he isn't, and, provided that he can get the medication will be ok in a couple of minutes.

If he does not get the medication, or does not recover after 2 doses of the medication, or if he is unable to self medicate then he may indeed be having a heart attack. In which case, the first aider would treat as for anyone with a heart attack.

Don't be shy to tell him you do not understand his condition. I'm sure he will be more than happy to explain it to you in more detail.

Posted By Chrisopher Gilbert
As a first aider I am supprised by Micheal Haywards comment on giving
asprin. I've revieved 1st aid training from several different reputable
training establishments over the years and all have agreed NO PILLS etc..

Also, there are many persons (myself included) in the UK on Warfarin
medication. This is ablood thinning medication (as is asprin). If the
dose is too high, either accidentaly or deliberately, the person has an
increased likelyhood of heart attack. To then administer asprin could
take a serious situation and make it life threatening.

I have personally been on the wrong end of a dosing error made by my local
hospital, made by highly trained staff aware of the risks. To have a 1st
aider give me a medication with only limited awareness is not to be
contemplated.

Please do not cause confusion 1st Aid is NO PILLS /POTIONSD & LOTIONS
Leave medicine to the professionals.

Posted By Edward Shyer
Hi Mark,

Just a quick question has the student given written consent for their photograph and medical condition to be distributed to your first aiders ?.

Ted

Posted By Ron Hunter
Responses thus far are all very formal and all very correct - and disappointing. Surely those closest to him (tutor and fellow students) would be more than willing to help a fellow /student self-admister his medication? Has fear of litigation really taken such a strong grip on us all?

Posted By Gilles27
Hi Mark and other folks posting on this, I do not wish to seem unhelpful but a competent first aider should know what to do with (what seems to be) angina in this case. With respect to all parties I would get the college FAs to refer back to their training provider to ensure they are clear on current thinking and legal protection in respect of this patient. H&S/Common Sense/First Aid/good samaritan do not always walk hand in hand. If the angina(?) has progressed to the point where self administration is not possible the FAs should have been doing something else by then, but I am not going to say what because each case is dynamic. Hypothetical medical advice is difficult to give out of context so I will refrain. Out of interest though 30:2 is the current EU guidance, but our training provider has stated that if a FAs original training has not been updated they should continue to give ABC 15:2 as trained, Not DRAB 30:2 yet. Cryptic eh?

Hope you can resolve the matter for all parties peace of mind. Best Regards H&S and FA chap.

Posted By Brett Day

As Ex RAF search and rescue I have come across many heart attack casualties who whilst concious are in NO fit state to tell me thier medical history or allergies, I have also had the sad duty of recovering bodies of casualties who had it not been for first aiders trying to be medics and giving medication they would now be alive today.

Under the First Aid at Work Regs you DO NOT administer medication. Simple as that.

As a non 'at work' first aider think very very carefully.

As a civilian first aider I was taught the only medication to be given is that which the casualty carries and is trying to administer, i.e. help a casualty to self medicate.

Michael, with all due respect whilst the current protocols may say aspirin is ok, given the state of some first aiders in an emergency two years down the line from their training I would not want to be on the recieving end of medication. IMO a very bad protocol.

Posted By Michael Hayward
ref the use of aspirin, I can only refer you to the relevent section of the First aid manual 8th edition endorsed by the 3 major first aid organisations

Posted By Phil
Giles,

The new resus council guidelines are also sanctioned by the UK Resuscitation Council. The reason most of the agencies arent teaching the new protocol of 30 compressions to 2 ventilations is due to the cost involved in changing the manuals!

Other subtle differences are the initial rescue breaths are now not used,(except in drowning and children).
the hand placement instructions are "place one hand on top of the other in the centre of the chest", rather than training lay first aiders to locate the xiphisternum landmarks exactly. The ventilations are now also given over a shorter time.

Most of the changes are to facilitate telephone CPR to a person who is untrained. 30:2 came about through research and is too broad a subject to go into detail here.

We have been training Firefighters, Paramedics and Doctors using the new protocol since April. The protocol for defibrillation has changed too. Below is an extract from the UK Resus Councils guidlines.

Resuscitation Council (UK)
9
RESUSCITATION GUIDELINES 2005
Adult Basic Life Support
Introduction
This section contains the guidelines for out-of-hospital, single rescuer, adult basic
life support (BLS). Like the other guidelines in this publication, it is based on the
document 2005 International Consensus on Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care Science with Treatment Recommendations
(CoSTR), which was published in November 2005. Basic life support implies that
no equipment is employed other than a protective device.
Guideline changes
There are two main underlying themes in the BLS section of CoSTR: the need to
increase the number of chest compressions given to a victim of cardiac arrest,
and the importance of simplifying guidelines to aid acquisition and retention of
BLS skills, particularly for laypersons.
It is well documented that interruptions in chest compression are common1 and
are associated with a reduced chance of survival for the victim.2 The ‘perfect’
solution is to deliver continuous compressions whilst giving ventilations
independently. This is possible when the victim has an advanced airway in
place, and is discussed in the adult advanced life support (ALS) section. Chestcompression-
only CPR is another way to increase the number of compressions
given and will, by definition, eliminate pauses. It is effective for a limited period
only (about 5 min) 3 and is not recommended as standard management of out-ofhospital
cardiac arrest.
The following changes in the BLS guidelines have been made to reflect the
greater importance placed on chest compression, and to attempt to reduce the
number and duration of pauses:
1) Make a diagnosis of cardiac arrest if a victim is unresponsive and not
breathing normally.
2) Teach rescuers to place their hands in the centre of the chest, rather than to
spend more time using the ‘rib margin’ method.
3) Give each rescue breath over 1 sec rather than 2 sec.
4) Use a ratio of compressions to ventilations of 30:2 for all adult victims of
sudden cardiac arrest. Use this same ratio for children when attended by a
lay rescuer.
5) For an adult victim, omit the initial 2 rescue breaths and give 30
compressions immediately after cardiac arrest is established.

Posted By Tabs
Oh my goodness.

Mark, sit down and discuss this with the person involved, and discover how likely it is that he would need help beyond putting the spray in his hand. If it has never happened and is unlikely to happen, end of story, don't go further.

If it is likely, let's not condemn a man to death to comply with people's opinion.

The Regulations do allow for first aiders to provide further assistance - so long as they are qualified to do so. In this case it would mean teaching people when and how to administer this drug (examples of precidents already exist: hydroflouric acid cream; oxygen; anti-venom; etc). Speak with your HSE/LA contact and get a Doctor or other to provide a brief training session to your first aiders.

Also discover what the consequences are of wrongly administrating the drug - if there is a life risk, I can understand a hesitancy to administer (I am not a pharmacist, you need to check).

Asside: Michael you write "On the rare occasions where I have known first aiders being brought before the courts" ... I have only heard of one case, have I missed others? - I would like to read up on them, thanks.

Posted By Gilles27
Hey Mark,
It is a jungle out there. The amount of knowledge we have between us is phenominal. Important thing is to check your potential patient and the aiders are clear on what needs to be done when. If the patient ever is in need and people are competent to help then that will surely be a good outcome. J

Posted By Ken Taylor
This all sounds like the arguments regarding the use of epipens in schools, etc. It doesn't seem particularly relevant as to whether a person is a first-aider or not but rather that they know what they are doing when they save the life of someone who has previously asked to be helped in this way and who may well die without that help. We simply provide the training and notify those that need to know who might need this assistance - including photographs in staff areas and to catering personnel. I don't remember the use of defibrillators being part of the basic first-aid at work training either - but, with a little extra training on today's modern and easy-to-use equipment, first-aiders are ideal people to save those who may soon die before medical assistance arrives.

Posted By Bob Henson
I work as a freelance mountaineering instructor and am currently writing some guidelines regarding the administering of first aid for our association. I am particularly interested in cases where first-aiders have been sued. If anyone can give me some leads as to where to search, I would be most grateful.