Could you lovely people check the answer to this first aid question I will be asking a nanny at interview please?

[fridayschild]

The post is sole charge full time live out for boys aged 3 and 5. I need to check the first aid certificate is more than just a piece of paper so I was going to say

"If you were in the kitchen, boys in the garden, and you looked up to see a boy lying on the grass by the climbing frame, howling but not moving, what would you do?"

Now I think the answer is

• rush out there
• if you think it is broken (and she should be able to tell me what would lead her to think this) dial 999 or get in the car to go to A&E
• if it is probably a sprain, go to A&E or the GP
• if he has mainly hurt his pride, administer love and cuddles, keep an eye on him for the rest of the day in case things don't improve or get worse and tell me/ write in the diary

But obviously mummies do not heed to have first aid certificates. Is my answer correct?

I think you're spot on apart from "or get in the car to go to A&E" - if it's (whatever "it" is) should she really be moving him?

(Not medically qualified in any way shape or form - dredging distant memories here)

aaargh!

if it's broken

Very important to see if she knows how to ascertain those conditions because such a child should NOT be moved unless he can do so on his own steam. A child who is howling but not moving is quite likely badly injured... (This from my sports first aid course).

agree

it is if they are injured and quiet then you need to worry

I would diagnose as follows:

First go quickly to the scene.
howling = concious, therefore look for any other casualties. Lets assume that 3 year old fell, 5 year old is fine.

Talk to casualty in calming way, while feeling over the body for obvious signs of breaks (bones sticking out for example) and blood/fluid loss - trying not to overly react such as "OMG there's loads of blood", as you don't want the casualty or any bystanders going into shock.

If blood loss, bones sticking out etc... then call am ambulance. Far better to have medical help on site as fast as possible, especially if there is any possibility that there could be a back injury, and/or extensive blood loss (children don't have a lot of blood)- then the paramedics can access the situation and decide if hospital treatment is required. Paramedics do not mind attending to an injured child. If child needs hospital admission, better than the child gets taken by ambulance, as nanny will need to care and support the other child involved, notify parents, drive to hospital etc.

Ask other child what happened. If casualty is calmer, casualty may also be able to confirm the series of events - such as climbing, fell, landed on back, didn't roll - or whatever. This should be recorded at the earliest opportunity (insurance requirement, plus helpful for medical staff to know series of events, timings etc).

If non-serious, then lots of TLC, rest for the casualty, frequent monitoring (casualty could still go into shock). If casualty develops any further symptoms, check those and visit A&E if required.

agree child should never be moved if they cant move theirselves, ring 999 and wait for medical back up

If they can move and try to get up but foot/ankle hurts then access the situation to whether hopefully just a sprain rather than broken ankle, though this is hard to be sure, 2 weeks ago friends own child fell over playing football and hurt ankle, but got up and carried on playing, limping a bit but was fine, so mum didnt take him to be checked, still hurt a few days later so took to hospital and he had broken ankle but could still walk on it!! He is now in plaster for 6 weeks.

I would prob take to our local minor injuries (10mins drive) to be sure if child complained of sore ankle/foot and was limping, better safe then sorry.

Hopefully child can get up, and be able to walk,then lots of tlc.

As a nanny I have a note from the parents which allows me to give permission for surgery/give medication/ act as parental locu, incase parents cant be contacted - ,those of you who are MB's - might be worth doing a note for your nanny to have just in case - luckily never needed it, but its good to have imo

i can always contact my present mb and db, both their mobiles are always on, and both secretary's know if I call work no, it would be serious and would be put through asap - though its amazing how many of my friends employers and some of my ex employers seem to be uncontacable during the day

Thank you very much to you all, I feel much more confident to interview (and indeed care for my little darlings!)

I would say that as he/she will be looking after TWO childen then the car option MIGHT not be such a good idea if the injured child is hysterical and needs comforting - how on earth will she be able to drive safely at the same time. In such a circumstance, 999 is the best option.

Hi Fridayschild,

I used to run a first aid training co so hopefully I can help.

I haven't read other posts. But first aid is broken down into many acronyms. The first and most important being

D anger
R esponse
(shout for help)
A irway
B reathing
C irculation

In this situation, it seems fairly safe that you are not in danger, but always check as you approach.

The child is crying out in pain, so you have your Response, to cry you need an Airway and Breathing, so that's all 'ok', next comes circulation.

Kneel down as close to the child's level and quickly look for any obvious injuries, like bones sticking out, 'extra' bends where there shouldn't be, or bleeds. If the child is old enough, ask them where it hurts. (Be careful not to 'suggest' that the child may have a sore leg or arm, they may say yes and this can confuse.). Get the child to tell you or point to the pain. See if anyone saw it happen, therefore you can ascertain the height of fall.

Put on gloves, feel over the child (top - to - toe), looking at hands every now and again (for blood), monitor pulse.

Look for signs of shock

PALE COLD CLAMMY SKIN
RAPID SHALLOW BREATHING
RAPID WEAK PULSE
NAUSEA

In this situation, if you are unsure as to how the child has landed or how far they have fallen, I would treat as a potential fracture, I would call 999. I wouldn't advise moving the child UNLESS they become unconscious.

Under 'first aid at work' you aren't allowed to take a child to hospital yourself, you must call an ambulance.

VERY IMPORTANT, REASSURE REASSURE REASSURE the child, get a favourite teddy or toy, distract and STAY CALM or at least try and pretend!!!!

Disclaimer, since I last delivered a first aid course there have been a few protocol changes but I'm fairly sure they are just to do with CPR>

I would watch for a few seconds and see what happens next. Sometimes children can perform very realistic role play, or can be howling one minute and then get up laughing the next.
I wouldn't rush but I would go out quickly and then talk to the child(ren) calmly to see if they could tell me what happened (mechanics of injury). This would give an idea as to the potential severity of any injuries i.e. the child may have tripped over next to the frame or may have fallen off from the top, or may have been walloped by the other child.
I would check the child thoroughly and note any pain or deformity.
Call 999 if any suggestion of a fall from height, head injury with reduction in conscious level, or fracture. Then keep child warm and reassured. No food or drink.
Minor injuries would be treated with a kiss better, a soapy wash, a plaster, and a no nonsense "You'll live". An accident book entry would be made for any incident.