How To… Respond In A Medical Emergency With A Child

child_being_treated_for_a_sports_injurySue Ralston and Louisa Millward have some simple steps for parents and carers to follow in an emergency involving children.

No-one wants to think about what would happen if their child suddenly became sick or injured. But how should you respond?

According to KidSafe, each year about 250 children aged zero to 14 years are killed and 58,000 hospitalised due to accidents, and knowing what to do if your child is injured can make all the difference to the outcome. There are many myths around correct first-aid treatment of common injuries and illnesses, and people need to be sure they are not using outdated techniques.

Here are some 'dos and don'ts' parents and carers should know when it comes to acting quickly in an emergency.

Do…

Know what to do: Learning basic first aid, including cardiopulmonary resuscitation (CPR), takes just a few hours, but gives you the skills, knowledge and confidence to save lives. St John Ambulance Australia recommends all parents, grandparents and carers complete a first-aid course. The organisation's Apply First Aid course covers a range of common childhood illnesses and injuries such as cuts, burns, choking, sprains and strains, CPR and head injuries, and the DRSABCD action plan, which is recommended for use in an emergency:
D – Danger (check for danger)
R – Response (talk to and touch the casualty)
S – Send for help
A – Airway (check mouth and airway)
B – Breathing (look, listen and feel). If breathing is normal, place in recovery position*
C – CPR – apply if breathing isn't normal
D – Defibrillator (apply if necessary)

Have a first-aid kit available: A basic first-aid kit with the essentials will cover the initial treatment for most childhood injuries and illnesses. Keep your kit well stocked and in a cool, dry place to which you can easily direct adults or children in an emergency.

Try to keep calm: Having a sick or injured child can be distressing, however keeping calm will help you think clearly, reassure the child, and give ambulance crew precise information.

Use up-to-date methods in the event of choking: Previous methods for clearing airways include the now-outdated Heimlich manoeuvre, which increases the risk of complications, and shouldn't be used. Instead, encourage the child to cough if they are choking. If that doesn't work, call an ambulance, bend the child forward and give five back blows with the heel of your hand between their shoulder blades (checking after each if the item has been dislodged). Back blows should be firm and relative to the size of the child.

If unsuccessful, give five chest thrusts by placing one hand in the middle of their back for support and the heel of the other hand on their chest.
For babies under 12 months of age, place the infant with their head downwards on your forearm. Support the head and shoulders on your hand and hold the infant's mouth open with your fingers. Apply five back blows using four fingers, with pressure relative to the baby's size, checking after each if the item has been dislodged. For chest thrusts, place the baby on a firm surface and use two fingers to thrust.

Have action plans in place: This is especially important if your child is affected by high-risk illnesses such as asthma or has severe allergies. Make sure medications such as asthma-relief puffers or adrenaline autoinjectors are kept in a safe, cool place.

Recognise and react to a sick child: Signs that your child is not feeling well include changes in their activity levels or an increase in body temperature.

*The recovery position is the position we place an adult or a child in who is unconscious and breathing. This is the best position to keep the airway open, as if they are on their back, chances of suffocation (due to blockage of the airway from the tongue or if vomiting occurs) is possible.
To place a child in the recovery position, we take the arm furthest away from us and place out at a 90 degree angle, palm up. We bring the legs close together, with the leg closest to us crossed over to the outer ankle. We bring the arm closest to us up and tuck the fingers under the neck for support. We then hold those fingers under the neck for support, grab around the waist or belt and roll gently over and away. The elbow and knee will go to the ground for support. Be sure to keep the airway open and monitor the child. Babies need to be held in the arms, lying face down on an adults forearm with the baby's head supported by the hand (between your thumb and middle finger around the jaw).

Don’t…

Panic: When calling for an ambulance, give clear information about what happened, listen to questions you may be asked, and remain on the line with the operator.

Get in the car: Resist the urge to drive a seriously sick or injured child to hospital. Wait for the ambulance so you can give your full attention to the child.

Be afraid to move your child: Children who are unconscious need to be rolled into the recovery position. Infants need to be held on their side. Also, if there is immediate danger to your child, you will need to move them.

Be scared you’ll make things worse: Many parents and carers are concerned chest compressions during CPR may break a baby or child's ribs if they press too hard. While of course you should not use the same pressure on an 80kg adult as you would a 20kg child, any action taken to prolong life through CPR is better than no action. A child or baby can recover from broken ribs.

Use a tourniquet for bleeding: A tourniquet (usually a cord or bandage) is used to stop the flow of blood through an artery. Tourniquet application requires specialist training. St John recommends instead using a constrictive bandage or applying direct pressure to the artery if bleeding is severe.


Sue Ralston is manager of training and education and Louisa Millward communications specialist for St John Ambulance Australia (NSW). For more information about learning first aid with St John, visit www.stjohnfirstaid.com.au and their Facebook page, or call 1300 360 455.

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