I really want to write about the Ireland-England rugby match of last Saturday, but apart from a few comments on Brian O’Driscoll’s hamstrings there isn’t much of medical interest there. (I could indulge in lots of gloating about the victory, but that wouldn’t be my style.) (Snigger.)
The dreadful head injury that John Terry suffered in Sunday’s Carling Cup final gives more scope for medical musings. For those of you who didn’t see it… Terry was attacking, in a good scoring position and launched himself head first at a cross from the wing…and connected full on with Abou Diaby’s boot. There was no foul play, just one head and one boot going for the same ball.
Terry fell to the ground and lay motionless – truly flaccid, not in that silly way some players do when their hope for a free kick is much stronger than their acting ability. No, Terry was knocked out. What we saw next appeared a model of good practice in dealing with a collapsed patient.
The players called for help; the paramedics saw their patient was unconscious and made sure his air tubes were clear – on TV you could see one of them holding the patient’s jaw forward* – then they checked for breathing and a pulse in the neck. Next they made the sensible assumption that there might be a neck injury too so they didn’t use the ‘recovery position’ but held the jaw forward and fixed their patient’s neck in a splint; and added some oxygen reduce the possibility of brain injury. Finally off to hospital.
Could we do the same?
First-Aiders know that the steps for management of a collapsed patient are now standard throughout Europe. There are two ways – the right one and the others. Whether your patient has tumbled from a horse Rathlin Island or from a bus on the Champs Elysee, the procedure is the same. The Resuscitation Council has a good website - See http://www.resus.org.uk/SiteIndx.htm - and here’s a summary: I remember it as Dr ABC
1. Danger! Is it safe to approach your patient? Traffic? Fire? Bare cables?
2. Response; shake your patient by the shoulders and ask “Missus, are you alright?” (If you ask John Terry this and he doesn’t thump you…he’s not alright!)
If no response – Get Help. Don’t be shy. Raise one hand and shout “I need help here!” Send someone to ring 999. “There’s a collapsed patient at…”
*3. Airway; the air tubes are mouth, nose and throat. Are they clear? Look and see. If there’s food, hoke it out. The famous ‘swallowing his tongue’ really means being so knocked out that the tongue falls backwards and blocks the throat. To avoid this, push the jaw forwards from behind, or just pull the jaw up by the lower teeth.
4. If your patient is Breathing, roll him into the Recovery Position, on his side/tummy. If not, you’re into resuscitation measures – you have learned these, haven’t you? If not – back to the first-aid book or website for you.
Like John Terry, you just can’t tell when these skills might be useful. Learn them today.
And like John Terry, your patient may benefit from proper on-the-scene care, and be up and about in no time. Best Wishes to John for a full recovery. (Even if he’s not an Irish rugby player; did I mention the rugby match?)