Duty Beckons – BASIC LIFE SUPPORT

As a doctor, I work in different departments of health care. One of my jobs is my association with Lifesavers Foundation Pakistan, that operates here in collaboration with Sindh Medical College Alumni Association of North America. The purpose of this Foundation is to teach some very important skills to general public and doctors alike. These life saving skills are abbreviated as BLS, ACLS, and BTLS.
BLS is Basic Life Support, and the person who learns it and provides it to the victim in times of any emergency health situation, is called a BLS provider. Any bystander can extend the ‘basic life support’ help to any victim and can improve the chances of his survival by almost sixty percent. The certification of this BLS course is a prerequisite for job applications being accepted, in most parts of the developed world.
I will here give you a brief description of what one learns during a BLS course that helps in improving the chances of survival of victims of a cardiac arrest, due to whatever the cause. The second important case, that you can help with, after learning the BLS skills, is that of choking, that we come across rather more frequently, especially among the infants.
The idea at the back of providing a BLS assistance to someone is to help them survive longer. This, is of utmost importance to us, if the victim happens to be a dear one. There are certain steps that one must have thorough knowledge of, in order to be of some help to others.
The brief stepwise description of measures that one must take is as follows:
1. Ensure safety
2. Check response
3. Shout for help
4. Call 1122
5. Check carotid pulse
6. Begin CPR
7. Two rescue breaths
Starting from a situation where you come across somebody, who you think needs help, the first step is NOT to run to him to help. ASSESS the situation. ENSURE your safety and then approach. This assessment should not take more than a few seconds. If the victim is collapsing because of some poisonous gas in the environment or some other imminent danger, try to remove the victim from that surrounding. I am not talking about a physical trauma victim here, in which case moving a victim might require an expert assistance. Especially in cases of spinal cord injuries, the victim MUST NOT be moved without stabilizing his body first, or else you might end doubt more of a harm than benefit to him. So, ensure your own safety, as well as that of the victim’s, is Step No. 1.
Step No. 2, is to check the responsiveness of the victim. Gently shake his shoulders and ask him, if he is all right. If he responds, well and good, leave him and return later to reassess. If he does not respond, SHOUT for help. Yes, do not leave the victim to run to neighbours, or to get the car or to call for an ambulance, BUT shout for whoever is around, to get the help for you. This help could be calling for an ambulance, calling 1122, or any other local emergency service, getting the automobile started or calling the neighbours or whoever is around and you understand will be of help in that situation.
Meanwhile, you check the carotid pulse of the victim. The carotid pulse is the pulse that can be located below the angle of the mandible or below the jaw. It is a strong pulse and could not be missed by any lay person, or a non medic if it is there. In case the pulse could not be felt, and we assume here, the pulse is absent, and not that the BLS provider is unable to locate the pulse, the next step is to BEGIN CPR. CPR means CardioPulmonary Resuscitation. To a non-medic it can be described as an emergency procedure consisting of external cardiac massage and artificial respiration or the first treatment for a person who has collapsed and has no pulse and has stopped breathing. It is an attempt to restore circulation of the blood and prevent death or brain damage due to lack of oxygen. How to do an effective CPR is a skill that you are taught to master during a BLS course. The chest massage is basically chest compressions, to keep the heart as effective functionally as possible, in a case where it has stopped pumping blood on its own. You give thirty chest compressions alternating with two rescue breaths, and you keep doing that until your help arrives, or the pulse of the person, you are doing CPR on, returns, that we call ROSC, i.e., Return Of Spontaneous Circulation.
(To be continued……)