Part 9: First aid

Zideman, David; Singletary, Eunice M.; Buck, Emmy De; Chang, Wei‐Tien; Jensen, Jan; Swain, Janel; Woodin, Jeff A.; Blanchard, Ian E.; Herrington, Rita Ann; Pellegrino, Jeffrey L.; Hood, Natalie; Lojero-Wheatley, Luis F.; Markenson, David; Yang, Hyuk Jun; Arnold, L. Kristian; Bradley, Richard N; Caracci, Barbara C.; Carlson, Jestin N.; Cassan, Pascal; Chalkias, Athanasios; Charlton, Nathan P.; DeVoge, Justin M.; Dieltjens, Tessa; Evans, T.R. Jeffry; Ferguson, Jeffrey D.; Fringer, Ryan; Hafner, Christina; Han, Kyee; Handley, Anthony J.; Kitch, Bryan B.; Koehler, Danita N.; Kule, Amy; MacPherson, Andrew; Meyrán, Daniel; Nemeth, Michael; Patocka, Catherine; Pauwels, N.; Reilly, Michael J.; Rusk, Richard C.; Schunder-Tatzber, Susanne; Seitz, S. Robert; Shenefelt, Ralph M.; Wang, Chih‐Hung; Woo, Jae-Hyug

doi:10.1016/j.resuscitation.2015.07.047

Cited by 47 publications

(48 citation statements)

References 159 publications

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“…A policy of last resort often meant that the intervention was done too late to be lifesaving, and bleeding control with tourniquet use eventually became first aid, as recommended by international authorities. 8,9 However, either the treatment effect size of tourniquets, such as the percent survival with or without tourniquet use, appears to be small or a survival bias exists in the way we gather data. 38,39 Altogether, such findings indicate that tourniquet science needs more research to clarify risks and benefits.…”

Section: Safety Of Tourniquet Usementioning

confidence: 99%

“…7 Although international authorities consider recent developments within the science of bleeding control with tourniquet use to be weak evidence, such authorities state that tourniquet use is a recommended first aid intervention. 8,9 Furthermore, such authorities state that they believe education in first aid should be universal. Everyone, including the lay public and nonmedical military personnel, can and should learn first aid, which can include tourniquet use.…”

Section: Introductionmentioning

confidence: 99%

“…Everyone, including the lay public and nonmedical military personnel, can and should learn first aid, which can include tourniquet use. 8,9 A scientific review of tourniquet use to control life-threatening bleeding is now timely to aid in potential application to specific aspects of civilian care. The purpose of the present review is to summarize tourniquet science for possible translation to wilderness settings.…”

Section: Introductionmentioning

confidence: 99%

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Bleeding Control With Limb Tourniquet Use in the Wilderness Setting: Review of Science

Kragh

Dubick

2017

Wilderness & Environmental Medicine

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The purpose of this review is to summarize tourniquet science for possible translation to wilderness settings. Much combat casualty data has been studied since 2005, and use of tourniquets in the military has changed from a last resort to first aid. The US Government has made use of tourniquets a health policy aimed to improve public access to bleeding control items. International authorities believe that education in first aid should be universal, as all can and should learn first aid. The safety record of tourniquet use is mixed, but users are reliably safe if trained well. Well-designed tourniquets can reliably attain bleeding control, may mitigate risk of shock progression, and may improve survival rates, but conclusive proof of a survival benefit remains unclear in civilian settings. Even a war setting has a bias toward survivorship by sampling mostly survivors in hospitals. Improvised tourniquets are less reliable than well-designed tourniquets but may be better than none. The tourniquet model used most often in 2016 by the US military is the Combat Application Tourniquet (C-A-T), and civilians use an array of various models, including C-A-T. Evidence on tourniquet use to date indicates that most uses are safe and effective in civilian settings. Future directions for study relevant to the wilderness setting include consideration of research priorities, study of the burdens of injury or capability gaps in caregiving for various wilderness settings, determination of the skill needs of outdoor enthusiasts and wilderness caregivers, and survey of wilderness medicine stewards regarding bleeding control.

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Section: Safety Of Tourniquet Usementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bleeding Control With Limb Tourniquet Use in the Wilderness Setting: Review of Science

Kragh

Dubick

2017

Wilderness & Environmental Medicine

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“…Six of the 10 international agencies provided guidelines on the emergency treatment of hypoglycaemia in adults: the USES [29], ADA [30,31], CDA [32], JBDS [33], ADS [34] and ILCOR [35] (Appendix S1a). Appraisal carried out using the AGREE II instrument showed moderate to high scores across the domains of the tool for the majority of guidelines (Appendix S1b).…”

Section: Guidelinesmentioning

confidence: 99%

Emergency treatment of hypoglycaemia: a guideline and evidence review

2017

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“…However, since first aid providers would have to administer aspirin based on symptoms, it is important to elucidate the benefits and risks from the early or pre-hospital administration of aspirin prior to a confirmed diagnosis of an MI. In 2015, the International Liaison Committee on Resuscitation (ILCOR) published a Consensus on Science and Treatment Recommendation (CoSTR), establishing the role of oral aspirin compared with placebo [5][6]. However, the optimal timing for aspirin administration is currently unknown.…”

Section: Introductionmentioning

confidence: 99%

Early or First Aid Administration Versus Late or In-hospital Administration of Aspirin for Non-traumatic Adult Chest Pain: A Systematic Review

Djärv¹,

Swain²,

Chang³

et al. 2020

Cureus

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Chest pain is a common symptom of acute coronary syndrome, including myocardial infarction (MI). Treatment with antiplatelet agents, such as aspirin, improves survival, although the ideal dose is uncertain. It is unknown if outcomes can be improved by giving aspirin early in the course of MI as part of the first-aid management as opposed to late or in-hospital administration. We searched the Medline, Embase, and Cochrane databases and used Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for determining the certainty of evidence. We included studies in adults with non-traumatic chest pain, where aspirin was administered early (within two hours) following the onset of chest pain as part of first-aid management as compared with late or in-hospital administration (The International Prospective Register of Systematic Reviews (PROSPERO) registration number: CDR153316). From 1470 references, we included three studies (one randomized controlled trial (RCT) and two non-RCTs). Early administration (median 1.6 hours or pre-hospital) was associated with increased survival as compared with late administration (median 3.5 hours or in-hospital) at seven days; risk ratio (RR) 1.04 (95% CI 1.03-1.06), 30 days RR 1.05 (95% 1.02-1.07), and one-year RR 1.06 (95% CI1.03-1.10). The evidence is of very low certainty due to limitations in study design and the imprecision of the evidence. This systematic review would suggest that the early or first-aid administration of aspirin to adults with non-traumatic chest pain improves survival as compared with late or in-hospital administration.

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Part 9: First aid

Cited by 47 publications

References 159 publications

Bleeding Control With Limb Tourniquet Use in the Wilderness Setting: Review of Science

Bleeding Control With Limb Tourniquet Use in the Wilderness Setting: Review of Science

Emergency treatment of hypoglycaemia: a guideline and evidence review

Early or First Aid Administration Versus Late or In-hospital Administration of Aspirin for Non-traumatic Adult Chest Pain: A Systematic Review

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