Practical Management of Emergencies

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Cutting the rope vs untying

It is difficult to cover in writing which situations are best to cut the rope and which to untie. Both approaches can be the right thing to do. Cutting through ropes that are helping to hold a person’s weight can cause injury during a fall, but equally not cutting the rope may be causing a potentially life threatening situation. Untying the lines may be more appropriate, especially if the person has not yet come to any harm and a more controlled approach will be safer.

 

If in doubt, support the person’s weight and cut the ropes.

 

Rope is replaceable. People are not.

Safe removal of tight bindings

 

A ligature cutter is most effective when used to cut softer and thinner materials but will also cut tougher materials, but more effort may be required and the cutting process may take longer. Avoid cutting through any knots, as it makes a removal attempt more difficult owing to multiple layers at the point of the knot.

When cutting a line that is under load, such as suspension lines, you should be prepared to take the weight off the load immediately. Don’t let a bound person fall to the floor as they are unable to protect themselves from injury.

To optimise the use of the ligature cutter, the rounded and blunt end should be initially placed flat against the person’s body so that it can slide under the ligature. Once the ligature cutter has been located between the person’s body and the ligature, the ligature cutter should be turned so that the sharp edge of blade faces the ligature i.e. with the opening away from the person. Pull away from the person’s body, using a rocking or sawing motion, so that the ligature cutter cuts through the ligature material.

In situations where the person resists actions to remove the ligature, it may be appropriate to restrict the person’s ability to struggle, especially where the struggling behaviour increases the risk(s) presented by the ligature, or by the use of the ligature cutter.

Once a ligature cutter has been used it should be cleaned and re-sharpened by either replacing the blade or by following the manufacturer’s instructions. Some manufacturers offer a sharpening service. If there has been accidental contamination with blood this should be cleaned off with isopropyl alcohol (available at chemists either as liquid or wipes). If you have come into contact with someone else’s blood you should seek medical advice regarding testing for blood borne viruses.

Practical management of panic

A panic attack occurs when the body experiences a rush of intense psychological (mental) and physical symptoms.

 

  • A feeling of intense anxiety/fear/”impending doom”
  • nausea
  • sweating
  • trembling
  • a sensation that your heart is beating irregularly (palpitations)

 

Panic attacks can be very frightening and intense, but they are not dangerous. A panic attack will not cause you any physical harm and it is unlikely that you will be admitted to hospital if you have had a panic attack.

 

In the main the self -management of panic is down to the person, but knowing a bit about what helps will let you give helpful advice. “Just calm down” is not good advice!

Focus

During a panic attack, remind the person that the frightening thoughts and sensations are a sign of panic and will eventually pass. During a panic attack it is important to focus on something that is non-threatening and visible, such as the time passing on your watch, or count the tiles on the ceiling.

Slow deep breathing

While you are having a panic attack, try to focus on your breathing. Your feelings of panic and anxiety can get worse if you breathe too quickly. Try to focus on slow deep breathing while counting slowly to three on each breath in and out.

 

Creative visualisation

During a panic attack, lots of things can go through your mind. Some people think about disaster, or even death. Instead of letting your imagination focus on these negative thoughts, try to concentrate on positive images. Think of a place or a situation that makes you feel peaceful, relaxed or at ease. Once you know have this image in your mind, try to focus your attention on it. It should help to distract you from the situation, and it may also help ease your symptoms.

Do not fight an attack

Fighting a panic attack can often make the experience worse. Trying to resist the attack and finding that you are unable to can increase your sense of anxiety and panic. Instead, during a panic attack, reassure yourself by accepting that although it may seem embarrassing, and your symptoms may be difficult to deal with, your attack is not life-threatening. Focus on the fact that your attack will have an end and try your best to let it pass.

 

For excellent (and free) education about Panic Attacks and Panic Disorder by Dr Chris Williams follow this link.

 

Heat injury & Heatstroke

 

What is a heat injury?

A loss of water and salt through sweating that causes dehydration to the body. This is particularly troublesome in hot buildings with poor ventilation. It is also applicable to people who do their rope wearing restrictive clothing or who engage in long sessions (>1hr duration)

Heatstroke is caused by prolonged exposure to high temperatures or by doing physical activity in hot weather. You are considered to have heatstroke when your body temperature reaches 40oC or higher. High humidity, certain health problems and some medications increase your risk of heatstroke. Heatstroke is the progression of two worsening heat-related conditions. When your body overheats, you first may develop heat cramps. If you don’t cool down, you may progress to symptoms of heat exhaustion, such as heavy sweating, nausea, lightheadedness and feeling faint.

 

Heatstroke occurs if your body temperature continues to rise. At this point, emergency treatment is needed. In a period of hours, untreated heatstroke can cause damage to your brain, heart, kidneys and muscles. These injuries get worse the longer treatment is delayed, increasing your risk of serious complications or death.

 

Mostly this can be avoided through ensuring that everyone has had enough to drink and adding ventilation where applicable. If it is a particularly hot or humid day consider whether or not it is sensible to continue with your plan to tie.

What are the signs and symptoms of heat exhaustion?

  1. Excessive sweating with pale, moist, cool skin
  2. Headache
  3. Weakness
  4. Dizziness
  5. Loss of appetite
  6. Stomach cramps
  7. Nausea (with or without vomiting)
  8. Urge to defecate
  9. Chills (Gooseflesh)
  10. Rapid Breathing
  11. Tingling of Hands/Feet
  12. Confusion

 

What would the treatment be for heat exhaustion?

  1. Reduce the temperature: open a window, move to another room
  2. Loosen clothing
  3. Apply a wet cold towel or ice pack to the forehead, neck, armpits and groin
  4. Drink small amounts of cold water to rehydrate: don’t drink large volumes quickly
  5. Elevate the legs above the level of the heart
  6. If symptoms do not resolve with basic measures seek medical help
  7. Even if symptoms resolve do not do further physical activity in the same day

 

What are the signs and symptoms of heat stroke?

  1. Skin is red, hot and dry
  2. Weakness
  3. Dizziness
  4. Confusion
  5. Headaches
  6. Seizures
  7. Nausea
  8. Stomach pains or cramps
  9. Respiration and pulse may be rapid and weak.
  10. Unconsciousness and collapse may occur suddenly.

What would the treatment be for heat stroke?

As for heat exhaustion except in this instance you MUST seek medical attention. This is a medical emergency.

Loss of consciousness

If your partner loses consciousness for more than a few seconds for any reason you must seek medical help. Being unconscious means that the person is not moving and not responding to you speaking to them or to shaking them.

 

If the person is unconscious but breathing normally you will need to put them in the recovery position. Kneel next to them and bend the furthest away knee and furthest away arm as in the diagram opposite. By pulling gently towards you the person will move into the recovery position.

 

Stay with the casualty until help arrives, but you may have to leave to phone for an ambulance. Make sure that the casualty is still breathing and watch for any vomitting.

Seizures

You may find yourself working with someone with epilepsy or non-epileptic seizures. If a seizure occurs the important thing is to remain calm. Remove anything that may cause injury (this includes ropes!). Do NOT put anything in the casualty’s mouth. You are more likely to cause a blockage of the airways than you are to prevent them biting their tongue.

 

After a seizure most people are tired, confused or may act a bit strangely. Try to keep them in a quiet environment and relaxed. People with seizures can lose control of their bladder or bowel during the event and may be incredibly embarrassed about this. It is ok to ask if this has happened before and what you can do to help.

 

Ideally you should already know where any rescue medications etc are because you will have covered the fact that the person has a seizure disorder in your negotiations. Some people with seizures don’t need to go to hospital every time they have one. If however the person normally has well controlled seizures or this is a new symptom then medical help is needed.

 

The non-breathing collapsed partner

IF YOUR PARTNER IS NOT RESPONDING AND IS NOT BREATHING PHONE 999 IMMEDIATELY!!

 

Around 60 thousand cardiopulmonary arrests (the heart stops beating and the person stops breathing) occur outside of hospital every year in the UK. Only 30 thousand of these are treated by the emergency services. By far and away the most common causes of cardiorespiratory arrest in adults are fatal arrhythmias (abnormal heart beat) and this will only be “fixed” by a defibrillator or drugs. The likelihood of survival of the victim drops 10% with each passing minute until a fully trained resuscitation crew arrives. CPR, or CardioPulmonary Resuscitation to give it the proper name, given by bystanders will help improve the chances of survival. Survival until discharge from hospital varies between 2-12% of cases which is only 1 in 10 people. It is highly unlikely that you will revive an arrest victim, but you might buy them enough time to get the treatment that will save them. There are however occasionally success stories from CPR only.

 

Now, we have to be very clear for this next section that this is general, lay person advice and in no way constitutes formal training in resuscitation, first aid or any form of life support. We recommend that all adults should consider getting themselves into a First Aid or Heartstart course for not just rope, but for the sake of their family and friends. Anyone who has attended a formal course will have been taught a different algorithm for life support and they should follow that instead. This advice does not supercede formal training in any way.

Is it safe to approach?

Chances are you will have been present at the moment the person lost consciousness and will have a good idea of what has happened. You should always consider your own safety first however. To give examples (all hopefully never to happen!) could the person have been electrocuted and still in contact with the electrical source? Was there a structural collapse that remains unstable? An injured rescuer only makes the victim’s situation worse.

 

There is no question about it at all if the person is still bound they should be cut free immediately. You will want the person to be on their back on the ground ideally.

 

If it is safe to do so, continue.

Is the person responding?

Give them a good shake and in a raised voice ask if they are ok. If yes, simply ask what was wrong and use common sense as to whether further assessment is needed. See above section on faints and fits.

 

If there is no response, continue……

 

Shout loudly for help and call 999

You need help and you need it fast. Let others around know you need help and either call 999 yourself or get someone else to do it for you. Ask for the Ambulance service when asked which service you require. An operator will ask you some questions. Answer them as calmly as you can.

 

You need to be able to tell the call handler exactly where you are, who you are & who the patient is. You need to give the person’s condition first before any explanation of how it happened as this will decide how urgently the call is handled. In this instance use the phrase “collapsed and unresponsive” when describing what has happened to the victim to quickly communicate the level of urgency. Recruit others around you (if applicable) to take responsibility for going to meet the ambulance crew and guide them to you when they arrive.

An example would be:

“My name is Jane Smith and I am at 42 West Street, Glasgow. I am with a man in his 30s who has collapsed and is not responding. He collapsed a few minutes ago and doesn’t appear to be breathing.”

That small amount of information is enough for the dispatcher to know you have a life threatening emergency that needs immediate response.

 

If you are on your own you might want to stick the phone on speakerphone so you can continue to talk to the operator. In the UK the operator stays on the line until the paramedics arrive and chances are they will talk you through the next stages.

 

If someone else has called for help, don’t hang around listening in on the call and continue….

Do your ABCs

Airway

ImageIf someone’s airway is blocked, it won’t matter if their heart is still beating. They’ll asphyxiate shortly. Clearing the airway is the first priority. Place your hand on their forehead and gently tilt the head back. With your fingertips under the point of the victim’s chin, lift the chin to open the airway. See the section on managing choking also for more advice.

 

If the airway is clear, continue…

 

BreathingImage

If someone is not breathing it doesn’t matter if they have a pulse or not. They’ll start running out of oxygen pretty quickly. Look, Listen and Feel for breathing. Look at the chest for movement, Listen at the mouth for breath sounds, Feel with your cheek for air movement. Do this no more than 10 secs. Gasping or sighing noises do not count as normal breathing.

 

If breathing is not present or not normal, continue….

 

Circulation

If you’ve got this far then you are dealing with a cardiorespiratory arrest. Checking for a pulse wastes valuable time, and as above if the person isn’t breathing then they won’t have a pulse for very long. You need to commence CPR. It has been proven that lay people are notoriously bad at finding a pulse even on a live person.

 

At this point we will describe Hands Only CPR. If you are trained in any other variant of CPR please ignore this section. Use the algorithm for those with a duty of care or whichever is appropriate to your level of training.

Hands only CPR: Hard & Fast

Image

Hands Only CPR is a new approach developed by the British Heart Foundation for use by lay persons without formal training. The emphasis is on keeping compressions going without interruption. There are no rescue breaths given in this style.

 

The correct place to put your hands is in the centre of the breast bone. It doesn’t have to be exact. Interlock your hands one on top of the other, palms down and press with the heel of the bottom hand.

 

When giving compressions ignore what you have seen in just about every movie and TV resus scene. Keep your arms straight and do not bend the elbows. The thrust comes from the shoulders and hips and should compress the chest at least 6 cm (2 inches). Don’t worry about breaking ribs. Better having a broken rib than being dead.

 

Push hard and fast at a rate of 100 compressions a minute. This is very tiring. If other people are present take turns to do the compressions. 100 beats per minute is the same as the beat of the Bee Gees’ Stayin’ Alive.

 

Do not stop unless the person wakes up or you are asked to by a paramedic.

 

Need a simpler way to remember all of that?

Dial 999, push hard and fast in the centre of the chest to the beat of Stayin’ Alive

 

Or  watch the British Heart Foundation’s video featuring Vinnie Jones

 

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