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[Philippe-Nicolas Pia (1721-1799), creator of the first-aid service to rescue drowned people].

Ph.-N. Pia is known as a philanathropist. In 1770, this apothecary is elected at the board of the city of Paris. Then, he wishes to create a first-aid service to rescue drowned people. In wooden boxes, he gathers together the drugs and devices used at that time, as a fumigating machine to inject tobacco smoke into the intestine, bottles of spirit of camphor, ammonia, a long shirt of wool, wood canulas and flexible pipes made of thin sheep leather. In each of the fiveteen guard houses standing along the river, are deposited a box and a stretcher. As far as Pia is at the head of the military police, he is especially innovating when he decids to train the guards to apply the drugs and the resuscitation processes. With such a regulated way of functioning associated to medical education and granting of awards, within fiveteen years hundreds of people are rescued and resuscitated. Yearly, he publishes the results obtained in Paris and in several places in France, with comments on the situation in the Netherlands, Germany and Britain. In 1780, the king nominates him in the royal order of Saint-Michel. The Révolution supresses the Etablissement en faveur des noyés, and Pia died in 1799 as completely forgotten. In Paris, the first-aid services come back to their former efficiency around 1835, when Marc proposes a special medical training to the fire-men and the military police to form first-aid groups. In this field, the pionneering work of Pia is still of great value and can abe kept in mind as a worldwide reference.

Drowning↗

Impact of a child first aid wall calendar on lay people's skills and knowledge of infant CPR.

The aim of the study was to evaluate whether mass-mailing of a 12-month wall calendar which focused on child and infant safety and first aid treatment had any educational effect on lay people. The calendar included algorithms for removal of a foreign body from the airways and infant and child CPR. The knowledge and skills in these procedures were tested in two groups using a previously validated check-list before and after the introduction of the calendar. One group received the calendar by mass mailing, free-of-charge. Six months after calendar distribution the mean result for 52 persons tested was 18% correct, not different from the 19% correct for 65 persons tested before calendar distribution. The other group received the calendar as part of an internal company campaign focusing on infant and child safety with a possibility for borrowing a baby manikin, but with no instruction involved. In this group the mean result improved significantly from 27% precalendar (n = 57) to 47% (n = 125) (P < 0.001) 1 week after calendar distribution with a significant reduction to 38% (n = 52) (P = 0.004) 6 months later, still significantly better than precalendar (P = 0.004). Test persons younger than 50 years old scored better than those older than 50 years (39 vs. 22%, P < 0.001), and the test persons scored better if they had been tested previously (44 vs. 35%, P = 0.04) or had practised with a baby manikin (45 vs. 35%, P = 0.02). Whether the test persons had children 0-8 years old or not, did not affect the results. In conclusion the calendar had no educational effect when distributed by mail, but a safety campaign which included distribution of the calendar and a possibility to borrow a manikin had a positive influence on the first aid skills and knowledge of lay people. Mass mailing of CPR or other first aid material free-of-charge does not seem to further the goal of increasing the rate and proficiency of bystander interventions to save lives.

Adult↗

The efficacy of Polysporin First Aid Antibiotic Spray (polymyxin B sulfate and bacitracin zinc) against clinical burn wound isolates.

Polysporin First Aid Antibiotic Spray (Burroughs Wellcome Co., Research Triangle Park, N.C.) is a dry spray containing 200,000 units Aerosporin (polymyxin B sulfate) and 10,000 units bacitracin zinc, along with a propellant. Each 1-second spray delivers approximately 2300 units of polymyxin B sulfate and 115 units of bacitracin zinc. This study was designed to evaluate the efficacy of Polysporin Spray against various clinical isolates. Blood agar plates were inoculated with a pure culture of each isolate. Polysporin was then sprayed in an area approximately 30 mm in diameter. The area of inhibition was measured and recorded after 18 to 24 hours of incubation. A clear zone at least 20 mm in diameter with surrounding edges of growth indicated sensitivity. A zone less than 20 mm in diameter or growth over the whole plate indicated resistance. Three hundred fifty-three clinical isolates (202 gram positive and 151 gram negative) were tested. The results show that Polysporin inhibits the growth of all the gram-positive organisms, including methicillin-resistant strains of Staphylococcus. The gram-negative organisms were also sensitive to Polysporin Spray, with the exception of Serratia marcescens, Morganella morganii, and Proteus mirabilis. This study suggests that Polysporin First Aid Antibiotic Spray may be effective for wounds contaminated with gram-positive and some gram-negative organisms.

Administration, Topical↗

[Emergency medicine--first-aid outside of the clinic. Development and status determination].

A survey of actual problems in first-aid-treatment of life threatened patients is given. The life-threatened patient who needs immediate and sufficient treatment on the place of the accident is described and all the necessary steps to accomplish efficiency are listed as well as the necessary training of doctors who will be emergency-doctors in the future. Statistical data on the positive results of a sufficient first aid treatment with special ambulances are shown.

Emergency Medical Service Communication Systems↗

First aid, transport, and triage.

A favorable outcome for a patient suffering acute trauma or disease is more likely if prehospital first aid can be administered. Veterinary facilities should teach their clients about first aid and transport and be able to give instructions over the telephone. Once a patient arrives at a veterinary facility, the entire staff should be prepared so that triage, the primary survey, resuscitation and stabilization, and the secondary survey may be performed efficiently and effectively.

Animals↗

Mental first aid.

This paper reports a survey of staff of Oslo Sporveier who had been involved in serious incidents such as accidents resulting in severe personal injuries and death, suicide, robbery and assault. The survey was carried out to evaluate the efficacy of Mental First Aid in a retrospective study. The introduction of Mental First Aid was based on the beneficial effects from early intervention reported from follow-up studies after previous disasters, so for ethical reasons there was no control group. When help was given within the first few days without the use of any external specialists, and with strong support from colleagues during the first days back at work, there was little absenteeism. The beneficial effects of early intervention are stressed as is the use of non-professionals in forming a social network around employees who have been involved in traumatic incidents. Safety ombudsmen who have been given brief instruction are brought to the site of the incident to apply the principles of Mental First Aid. These secondary preventive measures are very effective and could be implemented by other medium-sized transport companies whose staff are exposed to the risk of suicide attempts.

Absenteeism↗

First aid for jellyfish envenomation.

To determine a reliable first aid topical remedy for jellyfish stings, we investigated several commonly available preparations to determine their ability to prevent nematocyst rupture from sea nettle (Chrysaora quinquecirrha) and Portuguese man-of-war (Physalia physalis) tentacles. The application of a baking soda slurry was a good inhibitor of nematocyst discharge for the nettle and vinegar was a good inhibitor for the man-of-war.

Acetates↗

First-aid treatment of poisonous snakebite: are currently recommended procedures justified?

A survey of the literature on first-aid treatments for poisonous snakebite reveals conflicting recommendations. A subsequent review of experiments and case surveys investigating such treatments indicates that the most commonly recommended procedures (incision and suction, ligation, and ice-packing of the bite) are not well supported by experimental evidence, and may possibly be harmful. We suggest that further clinical research and case studies are necessary in order to determine safe and effective first-aid procedures for the bites of American poisonous snakes.

Cryosurgery↗

[Evaluation and first aid of burned patients].

First cares of burned patients depend of an accurate evaluation of the injury severity. Total body surface area burned can be estimated taking into account the fact that the area of one hand face is equivalent to 1% of the total body surface (TBS) of the individual. Second-degree burns are characterized by the occurrence of phlyctena, third-degree burns appear like adhering necrosis without any sensibility. Smoke inhalation injuries are frequent and can be recognized on the presence of tare deposits inside the mouse and on the respiratory conducts. Taking care of the patient begins with making the victim safe from the thermal aggression. Then, cooling the burn is to be performed. The emergency medical care consists in securing respiratory function, and, as early as possible, in beginning perfusions of Ringer Lactate Lavoisier exceeding 20 mL/kg during the first post-burn hours for patient suffering of burns exceeding 10% of the total body area. Pain must be controlled using preferentially morphine or related products. Transport to the specialized unit, in case of severe injury, will be performed assuring thermal comfort, wound protection and vital function monitoring.

Burn Units↗

Experiences in applying skills learned in a Mental Health First Aid training course: a qualitative study of participants' stories.

BACKGROUND: Given the high prevalence of mental disorders and the comparatively low rate of professional help-seeking, it is useful for members of the public to have some skills in how to assist people developing mental disorders. A Mental Health First Aid course has been developed to provide these skills. Two randomized controlled trials of this course have shown positive effects on participants' knowledge, attitudes and behavior. However, these trials have provided limited data on participants' subsequent experiences in providing first aid. To remedy this, a study was carried out gathering stories from participants in one of the trials, 19-21 months post-training. METHODS: Former course participants were contacted and sent a questionnaire either by post or via the internet. Responses were received from 94 out of the 131 trainees who were contacted. The questionnaire asked about whether the participant had experienced a post-training situation where someone appeared to have a mental health problem and, if so, asked questions about that experience. RESULTS: Post-training experiences were reported by 78% of respondents. Five key points emerged from the qualitative data: (1) the majority of respondents had had some direct experience of a situation where mental health issues were salient and the course enabled them to take steps that led to better effects than otherwise might have been the case; (2) positive effects were experienced in terms of increased empathy and confidence, as well as being better able to handle crises; (3) the positive effects were experienced by a wide range of people with varied expectations and needs; (4) there was no evidence of people over-reaching themselves because of over-confidence and (5) those who attended were able to identify quite specific benefits and many thought the course not only very useful, but were keen to see it repeated and extended. CONCLUSION: The qualitative data confirm that most members of the public who receive Mental Health First Aid training subsequently provide support to people with mental health problems and that this support generally has positive effects.

Adult↗

[First aid for multiple trauma patients: investigative survey in the Firenze-Bologna area].

Overall mortality ascribable to multiple traumas, that in Italy is responsible for about 8,000 death/year, is strictly dependent on the function of the so called Trauma Care System. This study reports on an epidemiological survey conducted in the urban area of Florence along a 23-month period (from Jan 97 to Nov 99), with the aim to identify the typology of traumas and the first aid care delivered to the person until hospital admission. These data were compared to those collected in the urban area of Bologna because the composition of the first-aid team is different, being nurses, in Bologna, an integral component of the first aid system. On a total of 118 multiple traumas, 17% was represented by isolated head trauma, while in 72% involvement of other organs was present in addition to the head; 11% of cases were abdominal or thoracic traumas, 1% of lower extremities. In 46% the cause of trauma was a car accident. The complexity of care delivered to the person with trauma was less in the Florence survey, as indicated by the immobilization of patients, performed in only 11% of cases as compared to 47% in Bologna, by the application of the cervical collar, applied in 12% versus 62% of traumas. Although the two samples are not strictly comparable, these data suggest that the presence of nurses in the Trauma Care System can be one of the elements of improvement of the quality of delivered care.

Adolescent↗

Snake bite in Australia: first aid and envenomation management.

Australia is inhabited by a large variety of snakes, including some of the most poisonous in the world. Sightings are regular, and the incidence of snake bite is estimated to be several thousand a year. A bite does not necessarily result in envenomation occurring, however there are at least 300 snakebites a year requiring treatment of envenomation, with between 1 and 4 fatalities every year. The incidence of fatalities from snake bite has increased over recent years. The explanation for this is unclear, but possible reasons include the urban sprawl, and a delay in application of appropriate first aid and definitive treatment for envenomation. Emergency nurses in particular should be aware of the first aid techniques appropriate for Australian snake bite, as well as the recognition and management of envenomation. This article will outline the steps required and rationale for applying first aid techniques considered to be effective in retarding spread and circulation of snake venom. It will also discuss the manifestations that indicate systemic envenomation, and management considered to be responsible for reducing the incidence of death from snake envenomation in Australia.

Antivenins↗

Training of 'first-aid' trainers: a medical school example in Turkey.

OBJECTIVE: A student-oriented basic life support and first-aid training is practical to enlarge the number of qualified people in the field. In this study, we aimed to describe and discuss the training process of a group of medical students at Hacettepe University, School of Medicine and their assessment as basic life support and first-aid trainers. METHODS: A '6-hour' 'Training the Trainers' course was conducted and participants' demonstration and coaching skills were evaluated by using a 3-point scale (1 - needs improvement; 2 - competently performed; 3 - proficiently performed). In total, 31 students out of 45 volunteers were certified as trainers. RESULTS: All of the students proficiently performed 'explain the aim of the demonstration', 'motivate participants to use checklists', and 'motivate the participants to ask questions' for demonstraton skills. Similarly, they all got the maximum grade for 'answer the questions of the participant', 'discuss the coach role of the participant', 'apply the skills', and 'follow up with the participant by using the checklist' as steps of coaching skills. None of the skills within the checklists needed improvement for any of the candidates. CONCLUSION: Although there are limitations, we hope that our experience of the Training the Trainers course will be useful for readers to highlight the importance of skill-based peer education on a very important public health concern, especially for the developing countries.

Curriculum↗

Establishing evidence-informed core intervention competencies in psychological first aid for public health personnel.

A full-scale public health response to disasters must attend to both the physical and mental health needs of affected communities. Public health preparedness efforts can be greatly expanded to address the latter set of needs, particularly in light of the high ratio of psychological to physical casualties that often rapidly overwhelms existing mental health response resources in a large-scale emergency. Psychological first aid--the provision of basic psychological care in the short term aftermath of a traumatic event--is a mental health response skill set that public health personnel can readily acquire with proper training. The application of psychological first aid by public health workers can significantly augment front-line community-based mental health responses during the crisis phase of an event. To help achieve this augmented response, we have developed a set of psychological first aid intervention competencies for public health personnel. These competencies, empirically grounded and based on best practice models and consensus statements from leading mental health organizations, represent a necessary step for developing a public health workforce that can better respond to the psychological needs of impacted populations in disasters.

Clinical Competence↗

Mental health first aid training of the public in a rural area: a cluster randomized trial [ISRCTN53887541].

BACKGROUND: A Mental Health First Aid course has been developed which trains members of the public in how to give initial help in mental health crisis situations and to support people developing mental health problems. This course has previously been evaluated in a randomized controlled trial in a workplace setting and found to produce a number of positive effects. However, this was an efficacy trial under relatively ideal conditions. Here we report the results of an effectiveness trial in which the course is given under more typical conditions. METHODS: The course was taught to members of the public in a large rural area in Australia by staff of an area health service. The 16 Local Government Areas that made up the area were grouped into pairs matched for size, geography and socio-economic level. One of each Local Government Area pair was randomised to receive immediate training while one served as a wait-list control. There were 753 participants in the trial: 416 in the 8 trained areas and 337 in the 8 control areas. Outcomes measured before the course started and 4 months after it ended were knowledge of mental disorders, confidence in providing help, actual help provided, and social distance towards people with mental disorders. The data were analysed taking account of the clustered design and using an intention-to-treat approach. RESULTS: Training was found to produce significantly greater recognition of the disorders, increased agreement with health professionals about which interventions are likely to be helpful, decreased social distance, increased confidence in providing help to others, and an increase in help actually provided. There was no change in the number of people with mental health problems that trainees had contact with nor in the percentage advising someone to seek professional help. CONCLUSIONS: Mental Health First Aid training produces positive changes in knowledge, attitudes and behaviour when the course is given to members of the public by instructors from the local health service.

Adolescent↗