Providing first aid advice and products is a central pillar of pharmacy practice but Carolyn Scott finds the public urgently need more knowledge in this area…

Research by the British Red Cross published last year found that the majority of people would not know how to respond to a first aid emergency situation. Only one in 20 people said they would feel knowledgeable, confident and willing to act in several first aid emergency scenarios they were asked about – 95% of people would not feel confident to deal with such situations.

·       Seven in 10 adults (71%) lack the knowledge and confidence to act if someone collapsed and was unresponsive, but breathing.

·       Nearly seven in 10 (69%) people polled lack the knowledge and confidence to act if someone was bleeding heavily.

·       Eight in 10 adults (81%) said they lack the knowledge and confidence to act if a baby was choking.

In addition, 60% of adults would be worried about knowing what to do if they witnessed someone having a cardiac arrest and only 20% of respondents were able to correctly identify the signs of a cardiac arrest (Source: YouGov Survey for British Red Cross, 2018).

In 2019, the British Red Cross, St John Ambulance and the British Health Foundation called for first aid skills to be taught in all schools, and the British Red Cross has established an education programme for young people in first aid, which can be used by educators. Two first aid apps offer tips, animations and video clips, and a quiz, on the skills needed to help an adult, baby or child in a first aid emergency (available at redcross.org.uk).

Employers have also been encouraged to give their employees the opportunity to learn first aid skills, during 2018’s Learning at Work Week.

Latest British Standard for workplace first aid kits

A new British Standard for workplace first aid kits, BS8599-1:2019, was published in January 2019 by the British Standard Institution (BSI), bringing some changes to the composition of the kits.

Both new and previous kits can both be sold this year during a 12-month transition period, said the charity St John Ambulance. The organisation has an online calculator (at sja.org.uk) to help employers to determine which first aid kits are appropriate for their workplace.

People should monitor the expiry dates of products in their kits and replace them when required, says the organisation.

Being the first on the scene

With stabbings, shockingly, becoming more common, the British Red Cross has issued advice to the public on the first aid response. The actions of the first person on the scene could prove lifesaving before emergency services arrive, says Joe Mulligan, head of first aid education.

“Put pressure on the wound, call 999 and make sure you keep pressing on the wound until help arrives. If there is an object in the wound, don’t remove it.”

If the victim is looking pale, raise their legs higher than their body and keep them warm.

Self harm

Regular purchase of plasters to cover wounds could be a sign of self-harm. The UK has the highest self-harm rate of any country in Europe, says the Mental Health Foundation.

https://www.nhs.uk/conditions/self-harm/

First aid in the pharmacy

Community pharmacies take their role seriously when people come in for advice about first aid – supporting and signposting as appropriate. “Generally, community pharmacy is first port of call, especially at this time of year when people get more active for the summer,” says Tania Meagher, Avicenna’s head of membership services.

Many common first aid queries, such as back strains and cuts and bruises, are the result of gardening, she suggests, in addition to sports injuries.

Take steps to check someone’s medication record before recommending a topical analgesic, to avoid any contraindications, and measure the limb correctly for knee supports and ankle supports to ensure that they offer the right amount of support, she says.

For minor cuts and scalds choose the right dressings – those that don’t stick and interfere with healing. Elderly people may have particularly delicate skin, and it may be better for them to see a GP. Pharmacies should also maintain messaging about sun protection and advise people with more serious sunburn to see their GP.

Community pharmacies also have a role to play in the prevention of injury due to falls in the elderly: 30% of people aged 65 and over will fall at least once a year, and this increases to over 50% for those aged 80 and over.1 Severe bruising will require referral.

Chronic wounds

In December 2018, Diabetes UK revealed a worrying statistic – a 19.4% increase in diabetes-related lower limb amputations – over 26,000 amputations in the three years from 2014 to 2017.

“Unhealed ulcers and foot infections are the leading cause of diabetes-related amputations, with diabetic foot ulcers preceding more than 80% of amputations. It is vital that all people living with diabetes know how to look after their feet, and check them regularly to look out for the sign of foot problems,” says Diabetes UK.2

People with diabetes are 30 times more likely to have an amputation of a lower limb than people without diabetes, and those who have had an amputation are 80% more likely to die in the next five years.

Yet, four out of five of amputations are preventable. Diabetes UK is campaigning to reduce the number of unnecessary amputations by 50%. Among other resources, its ‘Putting Feet First’ campaign offers a downloadable leaflet:  ‘10 simple steps to prevent foot problems’.

Chronic wound care is typically led by district nurses or practice nurses in primary care but, with the incidence of wounds increasing and financial pressures on the NHS, local prescribers may find market leading wound dressings being replaced with cheaper, alternative generic brands. New ways of working, and increasing attention on prevention, are key to the effective management of wounds.

Trudie Young is director of education and training for the Welsh Wound Innovation Centre (http://www.wwic.wales). She was lead author in a recent project involving nurses working in general practice, which improved healing rates and brought cost savings.

Such wound clinics in general practice can improve healing rates of wounds such as venous leg ulcers, surgical wounds, traumatic wounds and leg wounds, with healing rates of around 70% achieved, with comparable cost, found the study.3

Focus on prevention

Prevention is always the best strategy, says Ms Young. For people with diabetes who may not be aware of soreness or cuts on their feet because of diabetic neuropathy, regular visual inspection – keeping an eye out for problems that could develop into a chronic wound – and swift treatment, are key, and community pharmacy teams can help to improve awareness of this.

Potential problems can be hard to spot, making a range of preventive approaches important. “These wounds can be small and look minor, but bone infection can be present, and the visual inspection can trick health care professionals in this patient group. Regular podiatry, correctly fitting shoes, no use of over-the-counter corn treatment that can cause burns, attending an annual foot inspection and the control of blood sugars, all help to prevent diabetic foot complications,” says Ms Young.

Venous leg ulcers are the most common type of leg ulcer, accounting for more than 90% of all cases. They must be correctly assessed and diagnosed, and then treated with compression. Pharmacy teams can help encourage concordance with compression therapy. A key study from 2015 suggested also that approximately 30% of wounds lacked a differential diagnosis.4

Pressure ulcers are “a pain in the butt”, says a Welsh Wound Network campaign. People of any age who are immobile because of ill health, who sit for a long time or who use a wheelchair, should look out for the signs, as should their carers.

Pressure ulcers usually start on the bony parts of the sacrum, buttocks or heels. Carers can help prevent problems by ensuring the person’s skin is kept clean, dry and moisturised, and that any equipment, such as pressure redistributing cushions and mattresses, are used.

Stop Pressure Ulcers awareness day is on 21 November 2019. The European Pressure Ulcer Advisory Panel (epuap.org/stop-pressure-ulcers) offers materials to help inform communities about pressure ulcers and their impact.

Elderly people, such as those living in nursing homes and care homes, are at high risk of developing skin tears – a wound caused by shear, friction or blunt force. The ISTAP Skin Tear Tool Kit provides advice on skin tear prevention, risk assessment, assessment and treatment.

Prevention includes the regular use of emollients to keep the skin in good order. Polypharmacy should be considered as a risk factor for falls, which are highly likely to lead to such injuries.

It is a long-standing myth that wounds should be exposed to the air, says Ms Young – advise patients that wounds heal three-times faster in a moist environment. If wounds are not healing, encourage the person to visit a practice nurse.

References

1.     Falls in older people: assessing risk and prevention. NICE Clinical Guideline 161. June 2013

2.     https://www.google.co.uk/amp/s/www.diabetes.org.uk/about_us/news/lower-limb-amputations%3famp)

3.      https://www.wounds-uk.com/journals/issue/570/article-details/initiative-improve-effectiveness-wound-healing-within-gp-practices)

4.     Julian F Guest, et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open, 2015: https://bmjopen.bmj.com/content/5/12/e009283