Staying safe in Summer

Heat and water make summer a fun - but potentially dangerous - time. Here's some first aid advice to help you handle a summer health emergency.

Cuts and burns

Responding to a bleeding cut or wound.

First aid steps:

Apply firm direct pressure to the wound
Seek emergency medical assistance

The first aid for any bleeding wound is to apply direct pressure using whatever pad material is available. Avoid direct contact with blood where possible.

A wound that is spurting blood indicates that an artery of significant size has been cut. That means the blood is flowing out under the pressure of the heart's contractions and needs firm pressure applied.

In a child, shock may occur with the loss of only a relatively small amount of arterial blood and you must stop that blood loss as soon as possible, meaning early intervention is absolutely essential.

A clean handkerchief folded into a pad placed over the wound and then bandaged firmly in place with a 75-100mm wide compression bandage is a good option. Elevating the wound can help reduce the blood flow, but will be nowhere near as effective as if the wound had only involved a low pressure vessel, such as a vein, carrying blood back to the heart.

Get the child to the nearest accident and emergency department as quickly and safely as possible. This may mean ambulance, or it may be using a private vehicle.

If the trip is longer than 15 minutes, watch the colour and temperature of the fingers. If these begin to feel cold, ease the tension in the compression bandage, but do not remove it.

If blood flows through the pad, place another compression bandage over the top of the first, applying the same firm gentle pressure over the whole dressing.

If you get blood on you, wash it off with plenty of running water and soap as soon as possible.

Responding to a child with blistering sunburn.

First aid steps:

Cool affected area
Provide pain relief
Drink plenty of fluids

There is no active treatment that will hasten the healing of sunburn – only time.

Cooling any burn gives some fast pain relief. However, following this up with oral pain relief like paracetamol in the appropriate dose will keep the child more comfortable.

Covering the burn with wet dressings will provide pain relief when the bath or shower is no longer practical.

Encourage the child to drink plenty of cool drinks.

Do not intentionally puncture any blisters as they protect the burn from getting infected.

If the sunburn includes the face, cover the eyes with cool moist dressings and seek medical advice, especially if there is any swelling or blistering.

Speak to your pharmacist about a suitable topical pain relieving spray, ointment, cream or gel. Sprays might be preferable to avoid the pain of applying a cream or gel. Follow the product instructions closely.

Use a moisturiser on the skin, such as sorbolene, when the pain has settled and especially if the skin begins to itch.

Remind children about the importance of the slip, slop, slap slogan.

Gastro

Responding to a child who has vomiting and diarrhoea.

First aid steps:

Give the child small amounts of a commercial rehydration fluid (see below) at frequent intervals – maybe 15 mls every 15 minutes initially increasing this as soon as you can, depending on the child's tolerance, to where you are giving the child at least 5ml/kg of body weight each hour. Do not let them gulp down the fluids as this will make vomiting worse.
Monitor their urine output, for example, by the number of wet nappies
If the child is improving, reintroduce solids as soon as the vomiting ceases or within 24 hours.
Seek medical advice if the child seems to be getting worse or the condition lasts longer than 24 hours. The smaller/younger the child, the earlier you should seek medical attention. If, at any stage, you notice your child to be listless, disinterested in the world around them and passing reduced amounts of urine, you MUST seek URGENT medical assistance.

Summer is especially tough on little kids who get gastroenteritis with both vomiting and diarrhoea. Extra fluid is lost through perspiration in addition to that lost from the gut. The loss of as little as 10 per cent of a child's body weight by fluid loss can be fatal. In a child weighing only 10 kilograms that is only one litre of fluid!

Replacing fluids

Plain water does not replace lost electrolytes and dilutes those remaining in the child's body.

Full strength cordial and adult sports drinks in particular contain too much glucose/sugar, which will promote fluid loss into the bowel and so worsen diarrhoea. Some also may contain caffeine, which should not be consumed by children.

The advantage of commercial rehydration products such as Gastrolyte and Hydralyte is that they have the correct amounts of electrolytes (most importantly sodium and potassium) as well as glucose, therefore they replace the lost electrolyte and provide a source of energy for the sick child.

If you have young children, there is good sense in having these products available in your home all the time. However, in the absence of these off-the-shelf items, there are other suitable home-made options.

Fruit cordial concentrate (not sugar free or low calorie/joule products) diluted one part to twenty of water (1:20)
soft drinks (as in the 'old favourite' flat lemonade) or fruit juice (again not low-cal or sugar free) diluted one part in five (1:5)

Note that dilution of homemade rehydration fluids is very important. At full strength these drinks are quite high in sugars which, similarly to sports drinks, promote fluid loss into the bowel and worsen the dehydration. Dilution at the strengths recommended will bring the sugar concentrations close to those of the body and minimise this risk, while still providing a needed source of energy for the sick child.

Reintroduction of solids

Not too long ago the advice was to keep children off solid foods for some time after gastroenteritis, but this is no longer the case. Now it is suggested that easily digested food be introduced more or less as soon as the vomiting stops, but certainly not later than 24 hours after that time.

Even if your child continues to have soft runny stools, you should offer them age-appropriate solids.

An uncommon consequence of a nasty bout of gastroenteritis in children can be temporary lactose intolerance. This is caused by damage to the lining of the gut with the consequent loss of the ability to break down this particular sugar. If your child develops a lactose intolerance, they may have to go on lactose-free formulae for a month or so while the gut recovers.

Smaller children

Babies still breast feeding:

If your child is still being breast fed, this should be continued on demand or offered at least every two hours. Oral rehydration fluids can be offered in between times.

Bottle-fed children and infants:

Replace the formula with the rehydration fluids as above. If the child is not able to be placed back on the usual formula within 24 hours, seek medical advice.

Heat and water

Responding to a person who is pulled from a swimming pool, unconscious, blue and with no signs of life.

First aid steps:

Check for a response by gently shaking the person and calling their name.
Check and clear airway
Check breathing. If absent then:
Begin cardio-pulmonary resuscitation – 30 compressions followed by two breaths until emergency medical assistance arrives.
If you are unable to give rescue breaths just keep performing chest compressions - aiming for 100 a minute.

Once you are sure the person is not responding to gentle shaking or calling their name, check the airway first.

Delegate someone to call 000.

With the person lying on their back, place one hand on the forehead to pull the head gently backwards, the other hand should now elevate the jaw to help clear the airway.

Check for breathing. If they are not breathing, or are breathing abnormally, begin cardio-pulmonary resuscitation with chest compressions. (Note: it's important to start resuscitation with compressions, not mouth-to-mouth 'rescue' breathing.)

Do 30 compressions over the lower half of the breast bone before giving two breaths of expired air - you should be aiming for two compressions a second. The 30:2 ratio with five sets completed in two minutes is currently recommended, with each compression depressing the breastbone down about 1/3 of the chests front-to-back dimension.

Ideally more than one person will be involved in this resuscitation. One person attends to the breathing and the other the chest compressions.

Swap jobs every 3-5 minutes or as necessary, maintaining the rhythm as best as possible as this is quite a physical exercise beyond five minutes.

Continue this process until more qualified help arrives. If you are unable to give rescue breaths, just keep performing compressions aiming for 100 a minute.

Do not stop unless directed to do so by an ambulance paramedic or a doctor, or the victim responds.

If you are on your own and trying to resuscitate a child, it may be practical to pick them up and move the resuscitation to the nearest phone.

Using one hand to dial 000 while continuing to compress the chest is no easy task and even with a child, you will quickly tire.

Screaming for help from the neighbours may or may not be practical, depending on the situation. Getting to the nearest road to attract a passing motorist may be a last resort.

With an adult, your options of moving the victim will be more limited and you may need to cease resuscitation for a time to call 000 or summon nearby help.

Obviously time is at a premium, but you will not be able to continue indefinitely by yourself and you will need help if this person is to survive.

Responding to someone who has collapsed with heat stroke.

First aid steps:

Remove person from the sun to a shady cool place
Call 000
Remove clothing and sponge down with cool water
Place ice packs over large blood vessels
Only give fluids to drink if the person is fully conscious

Heat stroke is caused by your body's overheating from excessive exposure to heat +/- strenuous activity. This results in the loss of too much water and essential body salts. When you are severely dehydrated, you stop sweating and so your cooling mechanism fails. This contributes further to a rise in body temperature and severe rapid overheating of the body, which can cause brain injury and death.

Symptoms of heat stroke include thirst, infrequent urination, dizziness, dry mouth, confusion and increased heart rate and breathing. Children may be listless, irritable and display signs such as a dry mouth and tongue, no tears when crying and dry nappies for more than three hours.

It is important you move them to a cool, shady spot.

Call 000 for an ambulance.

You should not force them to drink if their level of consciousness is impaired.

Remove as much clothing as possible, and sponge with cool water.

Place ice packs (ice wrapped in a wet towel) over areas where large blood vessels bring the heated blood closes to the surface, such as the neck, groins and armpits.

If you can, cover the person with a wet sheet with a fan blowing over it.

If they regain consciousness, give small amounts of cool water at short intervals.

An extreme level of heat stress requires medical review so make sure the person goes to the local accident and emergency department at the nearest hospital.

Adapted from information at ABC Health & Wellbeing