The horror lived in Barcelona last Thursday after the terrorist attack has left us with terrible images of dozens of people lying on La Rambla, some of them were seriously injured children. I hope we never see each other in a similar situation, but would you know how to act in that case, how could you help?
Our way of acting can help save the life of our son or that of any other child who has suffered an attack, catastrophe or accident. José Ramón Fernández, pediatrician of the General University Hospital of Santa Lucia de Cartagena, Murcia, explains how we should proceed step by step if, unfortunately, we have to witness a similar situation.
Instinct pushes us to help
There is a viral image of the horror that has circulated through the networks taken minutes after the terrorist attack in Barcelona left more than a hundred dead and wounded on La Rambla. In it you can see the seven-year-old Australian boy, Julian Cadman who lies unconscious on the floor while the British Harry Athwal strokes his hair, ignoring the instructions of the police to leave the place.
Very proud of you sir #harryathwal #Barcelona #spain pic.twitter.com/aAEBsxWFTn
- Dawnraider (@Dawnraider) August 19, 2017
Instinct pushes us to help, to help as you can (except for unfortunate exceptions). If the child has a thread of life left, we would do anything to save him. But you have to be careful because we can hurt you even more if we don't know how to do it.
José Ramón Fernández (@jramonfernandez), a pediatrician at the General University Hospital of Santa Lucia de Cartagena, Murica, has published a thread on his Twitter account about how to act with an injured child in case of an attack such as Barcelona or any other catastrophe.
We have found it so useful that we have asked you for permission to reproduce it. Hopefully we never have to put it into practice, but Knowing what to do at that time can help save your child's life or that of any other child.
How to treat an injured child in the event of an attack, catastrophe or serious accident
Do not move it!
When an attack like the one in Barcelona or another catastrophe happens, it is not uncommon to see images of injured children carried on wings by adults.
Injured children, transferred in the arms of people who with all their good intentions intend to help. Be careful because we can do more damage.
The first instinctive reaction we have when we see an injured child lying on the floor is to take him in his arms. Normal.
That hit child is a polytrauma patient with possible spinal injury. It should NEVER be moved except exceptions.
Exceptions such that there is a danger of imminent death from a new attack, fire, etc ... that forces you to evacuate immediately.
Children are easy to transport in arms because of their low weight, facilitating worsen existing injuries or causing others.
How can we help then?
Well, what I am going to explain can be done by anyone, whether sanitary or not. It will be easier as a team with 2 or 3 people.
If we have the misfortune of witnessing an attack like this, the first thing is Protect yourself, Warn emergencies and then Help (PAS).
Always, the first thing is not to do more damage. Do not mobilize the child except for exceptions explained before.
Three key steps:
Cervical control: We will immobilize the cervical spine by firmly but gently holding the head between the hands.
We will check the child's response to stimuli, speaking aloud or giving small pinches. This way we will know if it is conscious or not.
Airway: if the child speaks, cries, screams ... the airway is permeable (lets in the air). Otherwise, we must make it permeable.
To achieve this, we must slightly raise the jaw, while keeping the neck immobilized at all times.
Once we have checked the consciousness, we have the neck immobilized and the airway permeable, we move on to the next step. See if he breathes.
If he cries, talks or shouts, he is obviously breathing. Otherwise, we must check if you breathe as follows.
To check if he breathes we must bring our face to that of the victim. We must see, hear and feel the air.
If you breathe, perfect. If you do not breathe, we should start mouth-to-mouth ventilation (covering the nose) or covering the mouth and nose if you are a small infant.
We will give an insufflation every 2-3 seconds approximately, checking that the chest rises when we put air. In total 5 insufflations.
Then we can try to check whether or not there is a pulse, although this can be complicated and delay resuscitation measures.
So now it is recommended that if there are no signs of life (movements, normal breathing, cough ...) we begin chest compressions.
Chest compressions should occur in the center of the chest, more or less at the height of the nipples. There are 15 for every 2 insufflations.
Incised: if CPR maneuvers (insufflations and chest compressions) have to be performed, the patient has very few possibilities.
Once we have controlled points 1 and 2, we go to point 3. Hemorrhage control.
We must firmly compress every bleeding wound we see. If compressing we can not stop the bleeding, apply tourniquet.
The tourniquet should be placed above the bleeding point. (Image via @StopTheBleed)
Before, tourniquets were discouraged except in very specific cases such as limb amputations.
The experience of war medicine in Iraq and Afghanistan is bringing them back into account, as mortality decreases.
So if with the firm compression of the wound we do not manage to reduce heavy bleeding, it may be useful to place a tourniquet.
And with these measures, we can help or at least avoid increasing the existing damage, until the professionals arrive.
Summarizing: not mobilize unless you have the necessary means and knowledge or there is imminent risk to life.
I add this great text from @SEMES_ on how to act in case of an attack. Via @txushh 😊
And finally, if there are many victims, it is better to focus on the recoverable ones: those that They are NOT in cardiorespiratory arrest.
It should be mandatory that all schools teach children first aid within the curriculum content and that parents also be more prepared. Just thinking that our children could suffer a serious accident, makes us tremble.
In Babies and more | An application for first aid in cardiopulmonary resuscitation: Pediatric CPR, First aid: cardiopulmonary resuscitation to a baby (I) and II
