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Posted By Martin Thorpe
One of our first aiders recently went on a St John Ambulance course and is keen to have a supply of aspirin in case somebody suffers a suspected heart attack or angina (see advice: http://www.sja.org.uk/sj...-shock/heart-attack.aspx
We've checked HSE advice which states "HSE does have concerns about placing this responsibility onto first-aiders because it implies that they have medical diagnostic skills, which are not normally covered within first aid courses. There is also a potential for litigation against employers/first-aiders if first-aiders are asked to administer medications (even if trained)."
Any advice on this? Many of our offices do have headache tablets that staff can help themselves to, but the issue here is of 'giving treatment'.
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Posted By Ron Hunter
Every HSE Approved First Aid Course I ever attended discussed the use of aspirin in the circumstances you describe Martin.
I haven't checked the latest edition of the First Aid Manual, but it always referenced this treatment by First Aiders too.
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Posted By John Packer
Legal argument aside, If the patient is able to take the aspirin they ought to be well enough to give some indication as to whether or not they have a reaction to it. I think in the heat of the moment it would be a toss up between what's the worse that could happen and what is the best that could happen.
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Posted By Phil Rose
I was intersted in the HSDE advice that you had read as on their FAQs (http://www.hse.gov.uk/firstaid/faqs.htm#tablets) they state "...there is no legal bar to employers making such items available to employees, if the assessment of first aid needs indicates they should be provided. HSE has no objection to paracetamol or aspirin being made available in the workplace. First aiders administering these tablets should have a reasonable understanding of what is involved".
If someone has had a suspected heart attack, crescendo angina etc, then aspirin is the standard treatment given by a GP etc, I can't see that having it available and being administered is likely to be a great problem and hopefully there will never be a need to administer.
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Posted By andy.c.
Martin,
I also attended SJA first at work training, on our course we were advised not to administer aspirin, when questioned on the subject the instructor stated the change in policy was due to aspirin being prescribed and taken daily and further dosage may cause more harm than good.
Reading the above responses though i think I'll get clarification first thing in the morning.
Andy
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Posted By andy.c.
Just lifted this from SJA,
If the casualty is fully conscious:
•Give him or her a 300mg aspirin tablet to chew slowly provided there are no reasons not to give the aspirin.
Time i had a refresher
Andy
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Posted By Dave Wilson
The resons being? What? who makes the diagnostic decision? someone who has done 3 first aid courses who has never had to use this knowledge in anger?
AS an ex para medic and first aid instructor we always advocate that a first aider should never administer ANY drugs of ANY kind and these should not be made available in first aid boxes.
Remember first aid is for 'emergencies' and not a GP surgery. If a person is suffering from a head ache / angina they should have their own prescribed medicine or own pain killers with them, it is not the employers domain to supply / provide.
Paracetamol / Asprin / brufen etc should never be in first aid boxes or in the 'first aiders drawer!!!!
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Posted By leeuk1
Hi all,
I would point out here, that it's always been the case that SJA and FAW don't generally see eye-to-eye on some issues, CPR for example often is different.
I agree with Martin that the risk of litigious accident in work (FAW) is higher than in the community as a citizen, rather than employee - I am aware some people use SJA trainers for FAW, but in general it's not the case (in my experience so far).
What I would add is, that there is a potential of having an allergic reaction to aspiring, potentially one not known or not disclosed by the patient, so giving out ANY medication is never a great idea, because one can argue if Aspirin given, why not x, and why not y, and so it would go on.
I also agree with the point made above that giving any form of medication, in work, starts to give some employees the impression that you are offering a medical treatment service and are fully conversant on different types of medication.
Hope it helps at all!
Lee
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Posted By Coshh Assessor
The point is that the suggested use of aspirin is precisely in an emergency - during a heart attack.
This isn't about headaches. And a GP would not be treating a heart attack as it happened.
First aiders are still told that aspirin should be taken for heart attacks - although sometimes in mealy-mouthed terms such as "let the casualty slowly chew one of his own aspirin tablets".
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Posted By Adam Worth
"CPR for example often is different" Really???
I would say what we've all been waiting to hear :) that this is a risk assessment based decision.
Where I work we would have an ambulance within a few minutes and the local hospital is next door - on previous plants the wait was somewhat longer, use of asprin may well save a life?
This in area where there has always been a big debate (much like admistering epipens or using a defib 'untrained' would you give it a go???)
I too would be cautious to stock first aid kits with aspirin as it's just going to get used for headaches, but if I was treating and a casualty was displaying heart attack symptoms then I would offer aspirin if I had some to hand. (However this is unlikely unless I am working with St John and have a full kit to hand)
IMHO the probability of aspirin causing detrimental effects at 300mg is less than the effects of heart attack but this as pointed out above is guess work on my part I am not trained to make this decision.
maybe clearer guidance is need from the HSE to trainers so training organisations can filter this through.
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Posted By martinw
I have had this argument a number of times in different work settings, and it comes down IMHO to what is 'giving treatment'. I think that if you are administering CPR or administering an injection, that you are giving treatment. If you offer someone an aspirin tablet in circumstances when you have previously received first aid instruction to say that the person may need it, you are not 'giving treatment', you are offering first aid which is just that, and not emergency aid. The person unless unconscious is self-medicating, and makes the choice to take the aspirin.
It is not a dangerous drug to most people in small doses, and I also recieved instruction to offer aspirin to someone if they or I thought that their symptoms were in line with suspected heart attack. I fully understand the posts above to say that it should not be in first aid kits in case of misuse, but that is not what is being discussed here.
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Posted By Coshh Assessor
CPR being different at SJA - perhaps this misconception has come about because of the frequent recent changes to CPR. The changes of course affect everyone, but people will catch up with them at different times as they get their refreshers.
Unconscious casualties - it's worth saying that no one is going to be given aspirin by a first aider if they are unconscious!
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Posted By Seamus O Sullivan
My understanding is this raises a number of issues.
All types of medication should be stored in a locked location , yet a first aid box must not be locked. I have heard that one asprin is the max that should be in the first aid box.
Tablets for headaches etc should not be given or stored in a first aid box.
A suspected heart attack is of course different, assuming the person is conscious etc, the idea behind taking the asprin is that it tends to thin the blood, the patient will still need urgent medical care. The idea of thinning the blood is why people sometimes take an asprin before going on a long haul flight, it may reduce the chances of clots, and some people are on warfen to thin their blood on a regular basis..
The problem arises where a person may have ulcers or intestinal problems , the asprin could cause problems.
There is other medication which could be used but it is unlikely to be allowed in the hands of a first aider.
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Posted By Ron Hunter
Hmmm. At this link http://www.hse.gov.uk/fi...d/review/firstaidl74.pdf
you'll see a proposed redraft of the L74 First Aid ACoP with this statement:
"First aid at work does not include giving tablets or medicines to treat illness. The only exception to this is where aspirin is used when giving first aid to a casualty with a suspected heart attack in accordance with currently accepted first-aid practice. It is recommended that tablets and medicines should not be kept in the first-aid container."
I wonder why this statement never made it to publication. Are the HSE (despite their sensible risk stance) also running scared of the litigation mob?
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Posted By Eddie
"The problem arises where a person may have ulcers or intestinal problems , the aspirin could cause problems"
I feel sure that the immediate and potentially lifesaving benefits of giving an aspirin to someone having a heart attack will greatly outweigh any potential risk of exacerbating an existing ulcer or intestinal problem.
Isn't it the emergency element of given a soluble aspirin that would make it an appropriate course of action for a heart attack victim. Even if it wasn't a heart attack just how much "damage" could one small aspirin cause to the average person.
I know if I was having a heart attack, the niceties of whether it is "medical treatment" or not would be small potatoes.
E
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Posted By Seamus O Sullivan
I agree with Eddie,
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Posted By Coshh Assessor
Yes, if I have a heart attack, please give me an aspirin.
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Posted By Clive James
The use of Aspirin is included in the treatment of heart attacks for conscious casualty's in the current edition of the First Aid Manual (9th edition).
Our trainers would advise that this should be given 'if available', if not then treat in a sitting position with knees supported until the ambulance arrives and give plenty of reassurance!
It is important that the first aider includes the administration of Aspirin (or not as the case may be), in the handover to the ambulance crew.
Clive James
Training Development Manager
St John Ambulance
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Posted By Clive James
Lee
Interested in your comment 'that it's always been the case that SJA and FAW don't generally see eye-to-eye on some issues, CPR for example often is different'.
All of our trainers and the training they deliver is based around the current edition of the First Aid Manual, the protocols are based on the UK Resuscitation Council guidelines, which the HSE accept as best practice.
Clive
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Posted By Raymond Rapp
Imagine a scenario where a person had a suspected heart attack...do I or don't I. Reading this thread would not provide me with much confidence either way. A sad indictment of where we are today me thinks.
Ray
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Posted By Jinxy
The moral of the story:
Have a heart attack well away from any H&S advisors/consultants/etc by the time they have deliberated over it....
Give the asprin.....
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Posted By GT
WOW!
Is there a Doctor in the house?
Regards
GT
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Posted By Swis
Quite interesting debate…
As Eddie mentioned earlier, Asprin along with other salicylates and non-steroidal anti inflammatory drugs can have severe adverse effect to those suffering from stomach ulcer/gastric problems. In severe cases person even struggle to even breath due to intense pain in the stomach lining. A lot of the symptoms equate to those of myocardial infarction (heart attack). First aider (even the sufferer) would not be competent enough to diagnose, whether it’s a gastric or heart attack. In this case, aspirin could have some very serious consequences.
Please bear in mind that heart attack is a very serious condition and should be left to the professionals to deal with….Priority should be to call for professional help (calling for ambulance etc) and to provide assurance to the causality etc..
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Posted By martinw
However, there are other life-threatening situations that first aiders are trained to take short term control of, such as whether to carry out CPR. Aspirin may assist a person having a heart attack long enough for the ambulance to arrive and allow removal/defib/whatever is necessary.
My opinion - give the aspirin. In doing so you are not diagnosing someone with acute gastric problems when you are probably unqualified to do so, but you are acting positively and with first aid trainer advice(in my case)to assist until the medics arrive and take over.
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Posted By Jinxy
While over a long period asprin may not be advised for people with gastric or duodenal ulcers, the symptoms of a perforated ulcer which would cause hematemesis(vomiting of blood) in copius amounts are different from the symptoms of a myocardial episode.
The term "infarction" means death of tissue and can be used to describe other dieases i.e Pulmonary or Cerebral.
If an acute myocardial episode is occuring then asprin would undoubtly (IMHO) be useful.
Lets save the person long enough to sort out their ulcer!!
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Posted By Coshh Assessor
Swis, are you advocating that first aiders should go against their training?
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Posted By martinw
Cossh, bit harsh, but are you saying that they never should?
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Posted By Coshh Assessor
Am I saying that first aiders should never go against their training? Er, yes!
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Posted By martinw
I have had to at times. Not recommending it, but couldn't watch someone expire because I didn't have a face mask when they needed CPR.
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Posted By Coshh Assessor
"Never do mouth-to-mouth without a barrier" hasn't been part of the training I've received on any first aid course, only a recommendation to use one when possible.
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Posted By Phil Rose
Yes an interesting debate with a number of views. As someone who has been there myself, my doctor 'prescribed' two soluble aspirin immediately, these were given to me in the reception by the receptionist, I don't think that they had time to consider whether I had an ulcer or not. I accept that the symptoms of 'heartburn' and similar gastric complaints and angina or MI can be very similar. In my experience positive diagnosis of an MI is normally done with blood tests. Me, I personally wouldn't have any great concerns about giving aspirin, and on balance I think that this would be entirely appropriate and consistent with the training I have been given.
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Posted By martinw
Mm. Just think how happy I was when the person to whom I was giving mouth to mouth woke up and vomited while I was lip to lip. Lovely. Must have been my mouthwash.....
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Posted By leeuk1
I agree totally with Adam Worth; I guess we don't consider medication partly because we too have a hospital very close, and para/ambulance service literally 5 minutes away.
Also, having looked into it further I can certainly see that EU requirements of things like CPR (and others) do indeed filter down to SJA as well as everyone else.
Wonders of Chinese whispers eh!
(A colleague of mine even told a story of how he visited a GP with heart-issue type symptoms, and his GP even advised he take one "weak" aspirin a day as a type of prevention - Chinese herbs anyone? ;)
Lee
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Posted By Phil
Aspirin
The use of aspirin has been shown to reduce mortality from MI. Aspirin in a dose of at least 160 mg and up to 325 mg should be administered immediately on recognition of MI signs and symptoms and continued daily indefinitely. 1 The nidus of an occlusive coronary thrombus is the adhesion of a small collection of activated platelets at the site of intimal disruption in an unstable atherosclerotic plaque. Aspirin interferes with function of the enzyme cyclooxygenase and inhibits the formation of thromboxane A2. Within minutes, aspirin prevents additional platelet activation and interferes with platelet adhesion and cohesion. This effect benefits all patients with acute coronary syndromes, including those with an MI. Aspirin alone has one of the greatest impacts on the reduction of MI mortality. Its beneficial effect is observed early in therapy and persists for years with continued use. The long-term benefit is sustained, even at doses as low as 75 mg/day. 1
In other words GIVE THE ASPIRIN. We cant promise to be there in 8 minutes, so lets get the theraputic effects underway asap.
None of the other cardiac drugs that we carry on the road (apart from O2) have anywere near as good an evidence base. As an ambulance service, immediate administration of a 300mg asprin is one of our key performance indicators.
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Posted By Adam Worth
I also wanted to point out in answer to the Ulcer comments - Aspirin should be administered from under the tongue, NOT swallowed as this is one of the thinnest membranes and quickest route into the blood stream.
For this reason an ulcer won't be affected in the same way as swallowing the drug...
Girl Friend who is nurse also stated she would give aspirin on the same basis of all the above arguments.
The patient is conscious and should know if allergic, probability is on our side!
My only concern from this thread is an ex paramedic disagrees.
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Posted By IanS
leeuk1, as a heart disease sufferer I would say that the doctor's advise was quite correct and not herbal medicine of any origin. 75mg per day of aspirin is prescribed, as far as I am aware, to all CHD patients.
Adam, as regards aspirin under the tongue, are you getting confused with the GTN spray or tablet which must be taken under the tongue?
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Posted By Phil
Sorry about the copyright issue, it was basically saying that there is good evidence in reducing mortality by using aspirin in MI.
By way of its anti-platelet action.
We as an ambulance service cant guarantee to get there in the 8 minutes, so better to start the therapeutic effects of the aspirin early.
None of the other cardiac drugs that we carry have any where near as good an evidence base as aspirin.
Anyone having an MI is going to a place of definitive care anyway. Ask the questions for the contra-indications, and if there are none,
give the aspirin!
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Posted By Tabs
IanS - under the tongue for the reason stated - which happens to be the same reason for the GTN I would imagine.
Sad to see some opposing posts here, but this is all down to the guidance coming from real life rather than experiment. As more data comes in, with more ifs n buts, more confusion.
CPR, circulation checks, immobilization techniques, bandage over bandage ... all seem to be in a state of flux when examined over a long enough time period (my first CPR for drowning person was sit astride and pump arms (1972?))
On balance I would provide (not administer) aspirin if available. For the moment.
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