American Red Cross Month

WWII Poster

Caesar:
Who is it in the press that calls on me?
I hear a tongue shriller than all the music
Cry "Caesar!" Speak, Caesar is turn'd to hear.

Soothsayer:
Beware the ides of March.

- Shakespeare's Julius Caesar Act 1, scene 2.
Caesar is killed on March 15

The month of March may be halfway over at the Ides but it's not too late to mention that March is Red Cross Month. The American Red Cross (ARC) responds to disasters, helps members of the military, provides blood for those in need and teaches lifesaving skills.

• Every year the Red Cross responds to more than 70,000 disasters—including approximately 150 home fires every day.
• About 11 million Americans turn to the ARC to learn first aid, CPR, swimming, and other health and safety skills. Last year, more than 158,000 people volunteered to teach those courses.
• Half the nation's blood supply— six million pints annually—is collected by more than 155,000 Red Cross volunteers .
• Among the emergency services for the men and women of the armed forces is the delivery of urgent family messages—around the clock and around the globe.

Here's how you can help...

The Red Cross Depends on Volunteers
Volunteers constitute 96 percent of the total work force to carry on ARC's humanitarian work. You can search for volunteer opportunities at http://www.redcross.org/en/volunteertime
More than 30,900 volunteers serve as chairs, members of boards of directors, or on advisory boards for local Red Cross units - chapters, Blood Services regions, and military stations.

Donate to the Red Cross
A hot meal delivered to victims after a disaster, blood when it is needed most, shelter when there is nowhere else to turn, an emergency message delivered to a member of the Armed Forces from their family -- these are just some of the ways that gifts are put to work through the American Red Cross. Thanks to the generosity of donors, the American Red Cross is empowering people to perform extraordinary acts in the face of emergencies.
Find out how to donate online or by mail.

Give Blood
See http://www.redcrossblood.org/make-donation to find a blood drive near you.
See http://www.redcrossblood.org/donating-blood/eligibility-requirements to see if your are eligible to donate blood.

Bottom Line

During Red Cross Month, the ARC asks that you support your community by making a donation, volunteering, taking a class, or giving blood.

Drowning

“We are drowning in information and starved for knowledge.” - unknown

Each year, almost 8,000 Americans die from drowning. Of those nearly drowned, 70% recover, 25% die, and 5% have permanent brain damage. Drowning is the leading cause of injury-related death among children ages 1 to 4 and the second-leading cause of death in children 14 and under. The sooner the rescue and first aid begins, the greater the victim's chance of survival. However do not endanger yourself in rescuing the victim during this process.

A person in the water may be drowning if they show signs of distress, can't stay above water, swims unevenly, signals for help, etc.

How to respond to a Near Drowning

• Notify a lifeguard. If the swimming area is unsupervised and you’re alone, then call 9-1-1 BEFORE jumping in to rescue. Otherwise you might become the second drowning victim with no one to rescue you.
  
• A drowning person is desperate. If you toss a rope or use a stick you might get pulled in the water. If you swim out (a last resort) a panicked victim may grab hold and pull you down. Swim out with a flotation device and approach the person from behind. Grab a piece of the person's clothing. Don’t let them grab you.
  
• When getting the person out of the water, support the head and neck. Suspect a neck injury around rocks, water sports, and swimming pool diving areas.

The primary focus of first aid for a near-drowning victim is to get oxygen into the lungs without aggravating any suspected neck or spine injury.

• Check for a response. (Ask, “Are you OK? May I assist you with first aid?”)
  
• No response gives implicit permission to begin first aid. Call 9-1-1 if you haven’t yet. Give Rescue Breaths and CPR, as needed. Strong swimmers with lifeguard training may begin the rescue breaths while still in the water.
  
• If the airway is obstructed and rescue breaths are not working, ONLY then perform the Heimlich maneuver. DO NOT perform the Heimlich maneuver just to force “bad” water out. An unneccessary Heimlich maneuver can cause an unconscious person to vomit and choke on the vomit.

Don't assume it's too late to save a life -- even if the person is unresponsive. Continue performing CPR and do not stop until medical professionals take over.

• If the person is conscious but weak, confused or lethargic, then put them in the Recovery Position. A bloated, water-filled abdomen may lead to vomiting and choking. Clear his or her mouth if necessary. Make sure 9-1-1 is on the way.
  
• Another danger sign is blue lips and ears and the skin is cold and pale.
  
• If possible remove cold, wet clothes and cover the person with a blanket to prevent hypothermia. This applies to everyone.
  
• Stay with the person until medical personnel have arrived or they are taken to a doctor.

Even someone with no symptoms after a near drowning should be observed in the emergency department for 6-12 hours and should follow up with a doctor in 1-3 days. Secondary drowning can occur when a victim appears fine but in reality has a small amount of fluid in their lungs. The person may “drown” several hours later as the fluid damages the interior lung lining. A ten-year-old can die with just four ounces of water in the lungs.

• After the incident, if the recovered victim develops a fever, cough or muscle pains, take them to an emergency room.

Bottom Line

Did you know a small child can drown in just 2 inches of water? This makes bathtubs, sinks, buckets, toilets and pools unsafe for unsupervised toddlers.

Resources

http://www.healthy.net/scr/article.asp?ID=1468

http://firstaid.webmd.com/drowning-treatment

http://www.parents.com/baby/health/first-aid-emergencies/first-aid-for-drowning/;jsessionid=0HWLDKMD0NF5SCQCEAQB42Q?page=2

http://www.firstaidtopics.com/secondary-drowning/

http://www.indianchild.com/first_aid_for_drowning.htm

http://www.nlm.nih.gov/medlineplus/ency/article/000046.htm

Triage

“Getting out of the hospital is a lot like resigning from a book club. You're not out of it until the computer says you're out of it.”
- Erma Bombeck

Since hospitals are private companies in the business of making money, it makes little sense for them to have empty beds or unused capacity. That’s just wasteful and unprofitable as a business. And yet that “efficiency” means hospitals can quickly become overwhelmed with the smallest of disasters.

Normally, one should not consider a rock concert a “disaster scene”. (Unless you really, really hate rock music :-) But last year, in Kansas City, Rockfest2008, exceeded the capacity of St. Luke’s Hospital, a major institution and winner of frequent quality awards. A concert of 50,000 fans created 22 ambulance calls over a couple of hours with cases ranging from heat exhaustion to a broken spine. This is an incident rate of just 0.044% but “The surge was so great the hospital had to place some patients on mattresses on the floor and tell ambulances that it had reached its limit for all but trauma patients.” Just imagine what would happen if the incident rate were higher like a biological agent or dirty bomb exploded in a sport stadium or other crowded event.

With mass care events, triage is activated (with a twist). Normally, with hospital emergency room triage, the most serious cases go first. Mr. Gunshot wound goes to the head of the line; Little Runny Nose Kid gets to wait (and wait). But with mass care, with overwhelming number of patients, the most serious patients are allowed to die. The goal is to save the highest total number of lives. A first responder or medical practitioner could spend 30 minutes trying to revive one person with CPR or save 6 seriously wounded from bleeding to death in the same time period. When forced to choose, would you save the one or the six?

When I was a “victim” in a Sarin gas attack drill, it took hours for medical rescuers to arrive. The fireman who arrived first became victims. Then guys in “space suits” showed up to take air samples. Then a bio-unit set up decontamination tents and finally bio-suited teams brought in stretchers or escorted the wounded to the tents for processing. All “victims” had a card stating the severity of our “wounds”. We noticed the rescuers were NOT saving those with “black” tags, the most seriously wounded. When we asked, they explained, these people were already dead after so long a wait or soon would be. They had to remain focused on the lives that could still be saved.

Bottom Line

Most of the time the American health system is a marvel with speedy service. But come flu season, a rock concert or a real disaster, there will be too few doctors and too few beds. This is one of the real fears behind a viral pandemic – hospitals will not be able to cope with the patient load. For this reason it is vital to know First Aid and be able to care for the health of yourself and your family as much as you can.

P.S. New Scientist magazine notes that Health workers may flee in pandemic panic. A survey in the UK revealed that only 15% of hospital workers would go to work during a pandemic. Even the Nurses and Doctors would stay home.

When to see a Doctor?

"An apple a day keeps the doctor away” – proverb

The media has had a field day with Swine Flu and the number of health related stories is up - way up! Swedish researcher, Hans Rosling (of Gapminder.org), published a video last month comparing Google news of Swine Flu versus Tuberculosis. For each Swine Flu death there were 8176 stories published between April 24 and May 6. For each Tuberculosis death there was one tenth (0.1) of a story. So while the flu is being overhyped there is a silver lining – this is a great time to find articles on health care.

When fighting a pandemic, the best weapon is quarantine; i.e. keep away from sick people. And where are you most likely to find sick people? The Hospital! You might visit the hospital for an injury and pick up the flu in the waiting room or emergency room. I read a story today by an EMT worker who was told if they carried a person with signs of the flu, the vehicle had to be completely scrubbed and disinfected and allowed to air dry for three hours before they could pick up another patient. During a pandemic the EMS fleet would be largely grounded (at most 8 passengers a day per vehicle) if this disinfection rule were maintained. In cases of large-scale emergencies like an earthquake or hurricane, 50% of the regional hospitals may be knocked out of service when needed most.

So what happens if you need medical care during a pandemic or disaster? Many sites promote being your own doctor and stocking up now for a first rate medical supply. But do not carry this to extremes. Certainly you can do more first aid and even advanced first aid at home. Many emergency rooms visits are for minor injuries or illnesses that don’t require a doctor or for which a doctor can do nothing (You paid good money to hear, “take two aspirin and get some rest”?).

My newest commuting CD is about the history of Medicine and disc one is about Hippocrates who started modern western medicine. The instructor points out that it was not easy convincing people that natural causes, not the gods, were responsible for illness. “Faith healers”, priests of Apollo, sacrifices, etc had an excellent reputation because 90% of the time a patient will recover regardless of what is done. The human body is very resilient.

Sadly our schools don’t teach the public how to distinguish the 9 times you’ll recover on your own from the 1 time profession help is required. “Doctors cannot give set guidelines for when to see a doctor and when it is unnecessary because symptoms with the same cause vary too much and symptoms with different causes overlap too much.” [Merck] Many people play it safe and see the doctor every time or for every sniffle. When SARs hit the world in 2002-2003, there were just 208 officially reported cases in the US but the number of calls to 911 and the number of EMS runs increased by 10%. In Maryland this meant an additional 60,000 EMS calls by those who thought they might have SARS. [Based on 2002 call volume of 600,000]

Here are some sites about when to see a doctor:

About.com: Cold & Flu
Merck.com
WebMD
MyDr.com.au

Bottom Line

We can all do more to be our own doctor at home. Yet don’t over do it. Don’t bleed to death from a serious injury or attempt surgery at home because you might catch the flu in an ambulance or at the hospital. During a pandemic or disaster you will most likely need to drive yourself the hospital (ambulances and EMS being overwhelmed). And once there, the hospital staff will be overwhelmed so bring your own facemasks, water, food, and be prepared for a long wait.

Here are some sites for stocking your medicine cabinet and learning advanced first aid:

How to Maintain a Good First Aid Kit
Stocking Up on Prescription Medicines (amazing details of what to buy)
Advanced Trauma Care First Aid Kit

Wilderness First Responder
Wilderness Medicine-Beyond First Aid
Where There Is No Doctor - (html)

Approaching Danger

Curiosity killed the cat - proverb

As described in the story Citizen journalism: 1, evolutionary instincts for survival: 0,

There was a massive gas explosion in Moscow that led to an inferno that injured
five people, raising questions about Russia’s ageing energy infrastructure and
the sanity of Russian civilians. … [In the embedded YouTube] notice how people
are not all running from the explosion; many are walking towards it, recording
the scene on their mobile phones

Humans are funny animals. They will panic over a disease that killed people in another country yet walk straight towards a local disaster. And I’m no different. I’ve always wanted to see a tornado so my inclination in college during a tornado alert was to go outside and look instead of sheltering instead and missing it. I still have not seen one.

When my wife and I visited Yellowstone National Park and the Canadian Rockies, we were warned about wildlife and “Bear Jams”. A bear jam occurs when someone sites a bear and everyone parks their car on the road shoulder and gets out to look. Now-a-days the bear is typically far away so in one case we watched as some foolhardy young visitors decided to hike closer to the bears. When a Park Ranger arrived, she was furious. She yelled at the hikers, chased after them and we could see her asking for their driver licenses (giving them a park ticket I suppose).

People appear to think of Yellowstone as a giant petting zoo. We watched photographers approach a mother moose and her child. Other tourists must have thought that the boarded walkways were a safe zone and would walk within feet of a wild bison while staying on the path.
Most animals in real zoos are not tame either. One extreme danger program on TV showed video of a woman who climbed two walls to get a better picture of a polar bear. The bear grabbed her leg through the cage bars with his teeth and wouldn’t let go. The zookeepers were pulling on the woman and trying to distract the bear. Fortunately her shoe came off and the bear let go to check it out. She was lucky to keep her leg.

Bottom Line

An important survival skill is to show proper respect for danger. We forget about risk when trying to get a better photograph or when rushing in to save a person. In a Red Cross First Aid/CPR class I just attended, the first step was always to evaluate the scene to determine if it was safe for you to approach an injured person. No point in you also being electrified, bitten by a rattlesnake, poisoned by gas or burned by a chemical and becoming another victim. The second step was to put on rubber gloves (to protect yourself) before touching the victim. You may save life but acquire HIV or Hepatitis.

Think before you leap towards danger.

Emotional Stress for First Responders

“If you had to define stress, it would not be far off if you said it was the process of living. The process of living is the process of having stress imposed on you and reacting to it.” - Stanley J. Sarnoff

In yesterday's blog I discussed the emotional issues that disaster survivors may face during recovery. In addition, people who serve in the various emergency services, such as police, fire, EMS and other rescue personnel are at a heightened risk for traumatic stress and other powerful emotional reactions in the wake of a major disaster. During an emergency responders try to suppress their fears and emotions and deal with calmly with a not so calm public. After hours or days of control, these bottled-up emotions need to be released and dealt with.

The CDC (Center for Disease Control) has a series of slides and a pdf on surviving field stress for first responders, http://www2.cdc.gov/phtn/webcast/stress-05/. Field stress impacts one's ability to think clearly, to concentrate, and to think quickly. There is an increased risk of making a dangerously wrong decision.

A recent TV show on PBS described the efforts of firemen to rescue pets from a burning animal shelter. The firemen did not want to leave the burning building and abandon the pets to certain death. The fire chief had to order them out for their own safety. The sorrow and grief and guilt over death can be overwhelming.

Ways to Manage Field Stress

1. Have experienced officers supervising
2. Provide on scene briefings for new personnel
3. Limit caffeine and sugar
4. Ensure adequate rest and rotation of personnel
5. Provide mental health counselors for debriefing

Common Aftereffects of a Response

1. Anger or Sorrow
2. Dreams and nightmares
3. Distracted by frequent thoughts about what happened
4. Strains in family and work relationships
5. Difficulty sleeping

Severe effects can include depression, anxiety disorders, and post-traumatic stress disorder.

BOTTOM LINE
Disaster field stress and aftereffects are normal and nothing to be ashamed of. It helps to talk about what happened. Check the Internet for first responder support groups in your area where you can share stories and grief together.