Airway Management for the Victims of Major Trauma Is the First Priority in the Care Of

When it's an emergency

What should you do? Here's what the paramedics wish you knew By Nick Morgan

It was a cold day last April when two-year-old Jade Hoyle and her sister Paige from Dewsbury, West Yorkshire, wandered up to the pond in their neighbour's garden. Fascinated by the goldfish darting about in the three-foot-deep water, Jade leaned forward for a closer look. With a splash she fell in.

Three gas company workers, Bob Page, his father Robert and Terry Boggis, were working in the road when they heard a woman's screams. As Robert and Terry ran to help, Bob dialled 999 on his mobile phone.

The girls' mother was struggling to pull Jade, in a sodden romper suit, from the water. It had been more than a decade since Terry had received first aid training, but it came back to him in a flash. "I checked the girl's breathing, and then felt for a pulse - there was neither," he recalls. "Her skin had turned purple from lack of oxygen."

Terry started chest compressions while Bob relayed advice given over the phone by an ambulance service operator. Every five compressions were followed by one breath of mouth-to-mouth resuscitation.

After five minutes Terry began to think Jade was beyond help, but suddenly the little girl coughed up water, then went blue once more. After another minute of mouth-to-mouth she coughed again and began to breathe. The three gasmen put her in the recovery position until the ambulance arrived.

Jade Hoyle is alive today because bystanders knew what to do. "Unfortunately this is the exception rather than the rule," says West Yorkshire Ambulance Service paramedic Vince Larvin. "Most people dial 999 and feel they've done their bit. As a result there are needless deaths every day."

Here's what paramedics across the country say everyone should know about handling an emergency:

Be prepared for accidents. Keep a record of your family's medical details in your pocket, by the phone and in your medicine cabinet at home.

Adds London Ambulance Service paramedic John Pooley: "Be able to name your road and also the street it runs off. You'd be amazed by the number of people who've lived in the same place for 40 years but can't name the streets around them." All the information about your home's location should be written on a card by the phone - it's easy to forget the most basic things in a panic. Children should also be taught how to call the emergency services.

Know the recovery position. An unconscious patient with poor breathing should be gently moved on to his side to free the airway. This is known as the "recovery position". British Red Cross trainer Alan

Perfect believes thousands of lives would be saved every year if people knew this.

"When someone is unconscious they may vomit," adds John Pooley. "Because the epiglottis is not working properly, this fluid may go down into the lungs and suffocate the victim. In the recovery position the airway will have a greater chance of staying clear."

Take a first aid course. After a person stops breathing and the heart stops beating, permanent brain damage can occur in four to six minutes. Ambulances take up to 14 minutes to arrive. But good cardiopulmonary resuscitation (CPR) carried out immediately can double the patient's chances of recovery.

Richard Webber, a St John Ambulance paramedic, believes basic first aid, which can be taught in three hours, should be part of the National Curriculum. "Learning resuscitation and chest compression is, without doubt, something everybody ought to do," he says.

Dial 999. "Many of us have been brought up not to make a fuss," says London Ambulance Service dispatcher Terry Burge, "but if you need an ambulance, call for it."

John Pooley has seen people die from denial, unable to believe they are having a heart attack. "It's a classic scenario: the patient has crushing chest pain and is sweating. He says, 'It's nothing. It'll be all right tomorrow.' The next day he's dead. The first couple of hours after a heart attack are the most important. Call an ambulance immediately."

Once you have dialled 999 and given all the pertinent information, don't hang up. "Many people believe talking on the phone will delay the ambulance," says Terry Burge. "But the moment we have an address the ambulance is dispatched. Any details we get after that are radioed to the crew so they are better prepared when they arrive."

Make sure you survive. "Don't waste a life trying to save a life," says Alan Perfect. He remembers a recent case when a good Samaritan tried to help an injured motor-cyclist. "The man was so concerned with the accident he ignored the traffic and was knocked down and killed by a car. If you are at a road accident and the patient can't be moved, put a vehicle between you and the oncoming traffic."

Talk to the patient. Someone who has been in an accident will often be in shock. "Reassure them that an ambulance has been called, then find out as much about the event and the person as you can," advises John Pooley

You may find a man collapsed in the street, bleeding from his head, and assume his head injuries are the main problem. But ask him what happened and he might say, "I had sudden chest pains and bumped into a lamp-post". That information will completely change the priorities of the medical team when it arrives - he may well be having a heart attack.

In case the victim loses consciousness before the ambulance arrives, ask about his medical history: is he on any medication or being treated for anything? Is he diabetic? Epileptic?

Pack severed limbs in ice. If a limb has been cut off, pack it in ice or something freezing, such as frozen peas.

"We had a call last year from someone who'd had his arm cut off with a Samurai sword," says Terry Burge. "We advised getting ice from the local pub and packing the arm in it. It was sewn back on and he regained full use of it."

Well-meaning people sometimes do things before emergency help arrives that prove harmful, even fatal. Paramedics warn:

Don't pull an injured person out of a car. It's common for people with neck or spine injuries to suffer terrible damage because they are moved unnecessarily at the scene of an accident.

"Sometimes conscious victims are asked if they are all right and they nod," says John Pooley. "That movement is enough to paralyse them for life." Unless the patient has no pulse or is not breathing and CPR is needed, or the car is about to catch fire (which rarely happens), keep the victim immobile, using your hand to steady the head and neck until help arrives.

Don't remove foreign objects. "If you see someone with a knife or piece of glass in him, the first instinct for many people is to remove it," says Alan Perfect. "But when something cuts through a body there is a danger it might pierce an artery. While the foreign object is in place it acts as a plug and is possibly the only thing stopping that person bleeding to death."

Don't put on a tourniquet. "If you put a tourniquet on a limb, you run the risk of cutting off circulation," says John Pooley. "I've seen cases where a shirt sleeve has dropped over the tourniquet and nobody realizes it's there until permanent damage has been done. Those patients have sometimes ended up losing an arm." Control bleeding by applying direct pressure to the wound, "A tea towel is ideal but any cloth will do," says Terry Burge. "Place it over the wound and apply pressure. If blood comes through the fabric, apply another layer and press harder until the bleeding stops. If an artery has been severed, you might have to put your finger or even your heel into a wound to stop the bleeding."

Don't give anyone in shock a cup of hot, sweet tea. "If someone has been in a life-threatening incident the rule is nil by mouth," says Vince Larvin. "Hot, sweet tea can cause vomiting which might take the victim deeper into shock." If the patient is desperate for water, wet cotton wool and put it against his lips.

Don't put butter on a burn. "In the simplest sense the body is a piece of meat," says John Pooley. "When it gets burned, it is effectively being cooked. Apply butter or ointment and you will seal the heat inside and the meat will carry on cooking. The burnt area should be put under cold water for at least ten minutes to reduce tissue damage.

Don't try to restrain someone having a fit. "There is a belief that you should put a spoon into the mouth of somebody having a fit to stop him swallowing his tongue," says John Pooley. "This is rubbish. Teeth could break against the spoon and the broken tooth might block the airway."

You should never put anything inside the mouth of somebody having a seizure, especially not your fingers as they can be bitten off. You should simply let the fit run its course, moving sharp objects out of the way.

Don't perform CPR unnecessarily. Any first aid is better than no first aid, but only give it if it's needed. "I've been called to accidents were someone is performing chest compression and the victim is screaming, 'Get off!'" says John Pooley. Even properly performed chest compression can break ribs, lacerate internal organs and cause vomiting. Before giving mouth-to-mouth make sure the person is not breathing and before performing chest compressions make sure there is no pulse.