Forwarded for Omaha: TV Doctors are incompetent when dealing with epileptics

[elfs]

The Epilepsy Foundation of America reviewed scenes from 59 television episodes from "Grey's Anatomy," "House, M.D.," and "Private Practice" and the last five seasons of "ER" in which seizures were portrayed. The conclusion? TV doctors depict first aid practices that are incompetent and dangerous:

The study found that inappropriate practices, including holding the person down, trying to stop involuntary movements or putting something in the person's mouth, occurred in 25 cases, nearly 46 percent of the time. First aid management was shown appropriately in 17 seizures, or about 29 percent of the time. Appropriateness of first aid could not be determined in 15 incidents of seizures, or 25 percent.

I mean, come on, how hard can this be? If the victim is standing up when the seziure happens, guide him to the floor. Put a pillow or folded-up jacket under the head to keep him from hitting it on the ground and injuring his head, neck, or airway during involuntary movements. If you don't know the victim, dial 911 (or the appropriate code for your country) and clear the area around the victim to keep him and bystanders from interacting.

(HT to anonymous.)

Comments

[drewkitty.livejournal.com]

I am a first aid instructor and I train and certify first aid instructors.

>> Why is the whole belt-in-mouth-to-prevent-biting-off-tongue idea a myth?

It is human nature to want a "magic bullet" answer to a question, a simple solution that can be easily remembered.

To some extent, even teaching that a myth is bad can be a problem because people remember the myth while not remembering that it IS a myth. The mind tends to swallow negatives, particularly under stress, and a direction to "NEVER PUT SOMETHING IN THE MOUTH" can so easily become "PUT SOMETHING IN THE MOUTH."

The medical science is impeccable on this point.

A lay rescuer should keep from putting anything in someone's mouth during a seizure.

The tongue can be an airway obstruction, but not during a seizure event. The tongue can relax and block the airway in an unconscious adult. The way to lift the tongue away from the airway once the seizure has stopped is to do a head-tilt chin-lift, which is a basic first aid airway maneuver. Attempting to manipulate the head during a seizure carries all the risks omahas talks about below, to both patient and rescuer.

A BLS rescuer has protocols for airway management, but will only place an oral airway if needed to secure the airway, and when (typically in a conscious patient or an unconscious patient with a gag reflex) it is not tolerated will then use a nasal airway instead. BLS providers also have suction available in case of aspiration of secretions, blood, etc. This is an important point. If they were to stick something in the mouth, they can suction the resulting blood back out.

Under the supervision of a doctor for example, ALS protocols might allow the use of a bite stick by a paramedic. This DOES NOT mean that a layperson should place one. ALS always has suction and is experienced in its use, with a pile of options including advanced airway adjuncts and medications which are not available to BLS or laypersons.

When I see first aid kits with bite sticks intended for use by lay rescuers, I remove and dispose of them.

Let's imagine that someone who means well does put a bite stick in a seizing patient's mouth, and is willing to risk personal injury (from flailing limbs, bites, etc.) to do so.

1) The bite stick can fall back and endanger the airway itself.

2) The bite stick can stimulate the back of the throat and cause vomiting. Vomit can block the airway. Two tablespoons of vomit is enough to cause aspiration pneumonia.

3) Mouth injuries can result from the teeth and gums smashing against the bite stick. The resulting saliva, secretions, blood and possible teeth can block the airway.

The common theme here is BLOCK THE AIRWAY.

No airway, no patient.

Much, much better to put the person on their side once they have stopped seizing, so that any secretions will flow out the side. Medics prefer the left side due to the stomach anatomy, the kind of detail first aiders are not expected to remember.

In the very unlikely event that someone has stopped breathing, the head-tilt chin-lift followed by rescue breaths is appropriate, going to CPR or rescue breathing based on one's training and findings.

In the event of status epilepticus, or a seizure that has continued for several minutes and will not stop (15% fatality rate), BLS rescuers will use a modified jaw thrust with two rescuers and a bag-valve mask (preferably with high flow oxygen). Lay rescuers should immediately call for emergency services. Direct mouth-to-mouth is impractical for a variety of reasons, including risks of personal injury and bloodborne pathogens exposure.

See also this video on the proper first aid for seizures.

[blaisepascal]

In the hopes that I'll never need to use the information, how should a lay rescuer move a victim of a seizure event? In the "I can't move that cast iron radiator away from their head, can I move their head away from the cast iron radiator?" type of situation?

[elfs.livejournal.com]

Maybe it's just been my experience with Omaha, but the average epileptic who's survived a number of seziures has already demonstrated their ability to withstand the throes of epilepsy. Usually, I just grab Omaha by the belt and whatever she's resting her head on to slide her away from whatever might be dangerous.

[drewkitty.livejournal.com]

Generally speaking, patients should not be moved without good cause.

Blanket drag, clothes drag, and foot drag are all accepted techniques for short distance emergency moves. I once tore a student's shirt demonstrating the clothes drag. Both blanket and clothes drag allow some protection for the cervical spine, which is important if a fall is not witnessed or head/neck/back in jury is suspected.

Care must be taken with all to keep from injuring the person, but especially the foot drag as the head tends to drag and wobble up and down. On the other hand, the foot drag is the only technique that works without equipment when the patient weighs >2x what you do.

Short moves can also be accomplished by grasping at the hip and shoulder, this is how you roll a patient on their side.

The most important point (after not injuring yourself, of course) is to protect the head.

Emergency move skills are no fun to teach as they, unlike most other first aid skills, involve some small risk of personal injury if you do it wrong -- just as from picking up or shoving around any other 100 to 300 lb object, but in this case it happens to be a person who could also get hurt.