Q&A with Joe Mulligan from the British Red Cross
In February 2012 we asked Joe Mulligan, head of first aid at the British Red Cross, to answer your questions about first aid for babies and children.
Joe has spent over 25 years working in emergency care and educating the public on the importance of learning first aid.
He answered Mumsnetters' questions on common occurrences such as fevers and burns, clarified changes in first aid procedures and explained why CPR continues to be vital, even if the real outcomes differ from TV portrayals.
Q. McPhee: Could you tell me what the new CPR procedure means for paediatric resuscitation. Does this mean we no longer do breaths for babies and young children?
A. Joe: First, the procedure is slightly different for babies (under one) and children (aged one to puberty). The research tells us that for babies and children, resuscitation is more effective if rescue breaths are combined with chest compressions. As with an adult, if you are not sure how to do rescue breaths, then compression-only CPR is much better than doing nothing. There's more detailed information on the British Red Cross website.
Q. Elk4baby: I learned parent CPR (child and baby specific) before the guidelines changed. I'd like to know what exactly was the reason for the change? If it was out of concern for the health of those giving the CPR, especially strangers - that's one thing. But if I ever need to do this for my children or my husband, do I still avoid doing breaths?
A. Joe: The main reason for the changes to adult CPR is, as you note, the reluctance on behalf of the public to carry out mouth to mouth (rescue breaths) on a stranger. This directly results in a lack of willingness to get involved. The other reason is clinical: research shows that when adults collapse there is sufficient oxygen in their blood to support life for between five and eight minutes. Therefore. the 'topping up' of oxygen by giving rescue breaths is not as important as we once believed. As I mentioned in my response above, it is important to remember that there are benefits to combining rescue breaths with chest compressions when resuscitating babies and children.
Q. SydneyScarborough: When my daughter was five her life was saved by a teaching assistant performing CPR. It kept her in a shockable rhythm until a paramedic arrived and used a defibrillator. She sustained a very severe brain injury but without a brilliant first aider and a defibrillator she would be dead. Why don't we promote defibrillators in schools? This is standard in many countries.
A. Joe: Thank you for sharing this story. We have supported the public access to defibrillation programme since its inception. We are delighted to see the increase in defibrillators in train stations, workplaces, leisure centres etc. We would welcome the opportunity to work with schools to reinforce the importance of CPR skills and access to defibrillation.
Q. DestinationUnknown: Having had a direct (and very traumatic) experience of performing CPR on an adult to no avail, only to be told later that there was nothing that would have worked and that CPR/resus/shocks don't have the same success rate as you might believe if you watch hospital dramas on telly (when nearly everyone seems to be brought back from the dead). To what extent is CPR performed on children and adults actually successful? Do success rates differ between the two groups?.
A. Joe: Successful outcome of a resuscitation attempt is dependent on many factors other than the age of the person. This is often referred to as the chain of survival. Factors include immediate CPR, access to a defibrillator, arrival of a paramedic ambulance crew and, ultimately, arrival in hospital. However, all the data reinforces our belief that the actions of the first person on the scene are key, dialing 999 for an ambulance and carrying out CPR are the most important links in the chain.
I agree that TV and the movies can present an unrealistic picture of resuscitation success rates; in fact there is published research that looked at this and it also reached this conclusion. It is not possible to give you a definitive statistic on success rates, as all the data is open to interpretation, but we do know that bystander CPR is key.
It is also important to remember that by doing CPR, you may see no change in the victim's condition. In the vast majority of scenarios CPR will not bring the person back to life (as in the movies). What it does do is 'buys the person time' until the ambulance arrives and the crew deliver advanced life support.
Q. Oldenoughtowearpurple: What can we do to prevent febrile convulsions and what should you do if they happen?
A. Joe: Febrile convulsions in young children are usually linked to an increase in body temperature (above 37°C). In order to prevent them, you should get a good thermometer and if you are concerned about his/her temperature, monitor it.
If your child's temperature is raised, your aim should be to cool the child down. Give the recommended dose of paracetamol-based syrup and remove clothing down to nappy or underwear. Switch off the heating in the room and ensure a supply of cool air.
Q. Tee2072: What should we do about fevers? There is so much conflicting advice about Paracetamol and ibuprofen or whether to just let a fever alone.
A. Joe: In addition to my advice above, I agree there are differing views, some of this is evidence based; others have a personal preference. Both are valid and effective, we tend to recommend paracetamol-based syrup.
Q. Kerrymumbles: If someone becomes impaled on something (gate, rod, post, etc) do you leave them or remove it?
A. Joe: If something is embedded in a wound, leave it in place, place something clean, such as a clean tea towel, around where the object enters the body and dial 999 for an ambulance. You should also support the person's body weight until the emergency services arrive. The risk if you attempt to remove it is you will cause further injury and increased blood loss.
Q. bagelmonkey: Do different burns need to be treated differently, or is it all the same no matter how the burn occurs? Do we still just remove the cause, cool with water and dress it with something clean?
A. Joe: You are spot on regarding the treatment. Place under cold running water for at least 10 minutes and wrap with cling film. No potions, lotions, ointment or cream as part of the initial treatment.
Q. Marzipananimal: How should you deal with bumps to the head? How do you recognise and deal with concussion?
A. Joe: Apply something cold (for example a bag of frozen veg wrapped in a tea towel) to the bump. Concussion occurs when the brain has been shaken within the skull, this can result in loss of consciousness.
Other symptoms include dizziness, feeling sick, confusion and a possible headache. This usually only lasts a few minutes. If you suspect a head injury of this type you should seek medical advice.
Q. PrettyCandles: There is an obsession about babies choking on lumps and on objects in general. I would like to see a bit more education and a bit less hysteria about this. People need to know the difference between choking and gagging. And not to panic.
If babies are allowed the opportunity to mouth small objects, they learn to manipulate them safely and are less likely to choke. I'm not advocating giving babies beads and such like to play with, and obviously they should not be left alone with small objects, nor allowed to mouth them when lying on their backs, but there is no need to panic when a baby puts something in her mouth.
A. Joe: Yes, choking in babies and young children usually comes top of the list of things parents and carers are concerned about. The data also confirms that most choking incidents occur at feeding time. To learn the most effective way to treat choking in babies and children follow this link.
Q. Countessbabycharm: How long do you leave a gusher of a nosebleed in a small child before seeking help? Should you call an ambulance at any point?
A. Joe: If it lasts longer than 30 minutes the child will probably need hospital treatment due to the amount of blood they have lost. You may need to call an ambulance. Remember, the most effective way to treat a nose bleed is to pinch the soft part of the nose and tip the child's head forward.
Q. Heliumballoon: Can you recommend a baby and child first aid/healthcare bible? Preferably a big one with loads of photos.
A. Joe: No bias from the author intended, but I recommend the British Red Cross First aid fast for babies and children manual. It shows you how to deal quickly and confidently with a wide range of emergency situations involving children. This can be purchased from the Red Cross website: redcross.org.uk/shop.
Alternatively, you may consider attending the First Aid for Baby and Child course. You'll learn everything you need to know to deal with an emergency, including what to do if your child is choking, unconscious (breathing and not breathing), how to deal with bleeding, burns and scalds, sprains and strains. You'll also be taught how to recognise the signs and symptoms of meningitis and how to handle head injuries, severe allergic reaction and swallowing of harmful substances.
For more information, go to redcrossfirstaidtraining.co.uk or speak to one of our advisers on 0844 412 2808
Q. Marzipananimal: What should I have in my first aid kit?
A. Joe: Ideally, all homes should have a first aid kit. It doesn't need to be an off-the-shelf expensive version, you can make up your own, just remember where you put it. The most used items are plasters. Remember that there are a number of household items that can be used in an emergency - follow this link.
Q. outofbodyexperience: Why isn't basic first aid taught in schools. It's covered by lots of uniformed youth organisations, (cubs, guides, whatever) and if you start teaching children basic first aid early you remove the fear factor. It also stays with them. Is it already part of the PSHE curriculum? And, if not, do you agree it should be?
A. Joe: Absolutely. We have campaigned for a number of years to try to make first aid a mandatory part of the primary and secondary curriculum. Let's develop a generation of life savers. Please let your MP know your thoughts - for more information please follow this link.
Q. Nevergarglebrandybutter: I was wondering what support is available for people who have been a first aider in a traumatic situation. Having performed CPR twice in my life, it would be nice to know that you can have a debrief with someone or even just to offload about what has happened.
A. Joe: I agree. We include an element of psychosocial first aid in most of our education programmes. As you have correctly acknowledged, it can be a traumatic experience. I advise in the first instance you seek the advice of your GP, he will advise on the best route for debriefing.
Q. PrettyCandles: What happens if you try to help a casualty but cause harm to them? Can they sue you? Could your actions be classified as an assault? Does it make any difference whether you have any formal first aid training, or whether that training is current?
A. Joe: Where someone is acting in good faith to help to save someone's life or prevent further injury, there is very little risk of them being successfully sued for doing that.
Q. Latrucha: My husband's uncle was an A&E doctor and told my mother-in-law never to give first aid to her children as he'd seen many children brought to the hospital who had had first aid wrongly done, which had made things worse. He said she should just get to a doctor ASAP. What do you think of this?
The British Red Cross offers first aid advice and a range of courses including a first aid for baby and child course.
The course includes what to do if your child is unconscious (breathing and not breathing), choking, drowning, how to deal with bleeding, burns and scalds, sprains and strains.
You will also be taught the signs and symptoms of meningitis and how to handle head injuries, severe allergic reaction and swallowing of harmful substance. It takes just five-hours to complete.
To book a first aid training course visit: redcrossfirstaidtraining.co.uk or call:
0844 412 2808 (quote: mumsnet)
A. Joe: While I would not wish to decry the clinical insights of your uncle, I do not agree. I believe it is widely accepted that first aid saves thousands of lives every year, reduces the burden on the health service and is the ultimate humanitarian act.
It was/is never intended as a substitute for professional advice, rather a life skill all of us should have in the event of being the first person on scene.
Q. Vonnegut: My friend did the Red Cross baby first aid course but she said it was quite intimidating and a bit of a lecture. I think it would be much better if the Red Cross did training during home visits, then maybe they could give specific advice about baby safety issues in your home.
A. Joe: I'm sorry to hear about your friend's experience, coming into a strange building with new people can be off-putting. Customer feedback is very important to us and the vast majority consider the training experience as interactive, engaging and easy to learn. Often trainers take extra time to cover areas that members of the group are particularly worried about. First aid education does not have to be classroom based and we would like to think our programmes are learner centred, not lecture based. Yes, we routinely do group first aid sessions at mums and toddlers meetings. If you have a group of 10 or more, one of our expert trainers can deliver a first aid for baby and child course at a location you have arranged. Next time you are having your friends round to discuss first aid, send me an invite.
This Q&A has been sponsored by the British Red Cross