First Aid Trainers all know how to teach the first aid basics and anyone with a hint of common sense would be able to adapt their treatment according to the casualty and the situation. After, that is exactly what First Aid is, the absolute first treatment that a casualty receives, generally before they are handed over to a medical professional for full and specialised treatment.
Practising First Aider Trainers will most likely agree that first aid treatments are prioritised in order of breathing, bleeding, breaks, burns; however, in the situation of dealing with a chemical spill incident, the burns treatment will most likely be prioritised, with a high risk of breathing failure to follow.
Certain chemicals are generically categorised into acids and alkalis. Alkalis burn deeper than acids, however, the severity of a chemical spill burn is related to a number of factors such as the pH, concentration, length of contact time, volume and physical form of the chemical.
Whilst prompt burns irrigation is absolutely essential, the safe approach to a spill site and permission or handover of the casualty from a Scene Manager must remain the absolute priority to a First Aider. The site and nature of the chemical spillage may influence pre-treatment actions such as decontaminating the casualty, the First Aider to don PPE or that the First Aider can only guide the casualty from a distance to a clean area where they can instruct them on how to self-treat.
With a safe, efficient and effective on-site Spill Team with a competent Incident Controller and Scene Manager, the First Aider should be able to commence irrigation of both acid and alkali exposures within several minutes. Such swift action will lead to an immediate decrease in the chemical pH, begin to cool the skin and subsequently reduce the extent of injury significantly. It has been previously been documented that burns irrigated within 10 minutes have a 5-fold decrease in full-thickness injury and a 2-fold decrease in length of hospital stay.
In addition to burns injuries, casualties of chemical spill injuries may experience difficulties breathing with inhalation or choking injuries. Competent, skilled First Aiders are usually trained to follow a DRAB or similar procedure. Once they have checked the scene for Danger, they will proceed to evaluate the Response, Airway and Breathing of a casualty. This four-part procedure can become second nature to the point that a First Aider feels compelled to commence checks straight away.
Chemical Spill First Reponse
In the event of a chemical spill, a First Aider must be aware that their casualty may be highly contaminated. It is imperative that they do not begin treatment until they have received permission to do so, or, that the casualty has been handed over by a Scene Manager. At this time, even if dealing with a decontaminated casualty, the First Aider may choose to make a number of safe adaptations such as omitting CPR breaths or only moving the casualty when wearing non-corrosive PPE. If PPE is not available to them they may choose to adapt a make-shift recovery position without using the hands.
With all of the information and training in the world, it remains a fact that perfect practice makes perfect. A First Aider who has the possibility of dealing with casualty(s) involved in chemical spills should be practising their skills and procedures in context. Practice accessing and using site treatment areas and equipment, regular practise using emergency communication methods and regular practice working within the emergency response team with formal roles and responsibilities. It is only with regular practice that an action can become near perfect and it is only with perfect practice that an action can become perfect.
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