7. Present
In 2000 the American Heart Association in
collaboration with the International Liaison
Committee on Resuscitation began the first
step to evaluate guidelines in first aid.
8. NFASAB
In 2004, the American Heart Association and the
American Red Cross co-founded the
National First Aid Science Advisory Board
(NFASAB) to review and evaluate the scientific
literature on first aid to develop “evidence-
based medicine”.
9. Evidenced-Based Medicine
A movement to apply the scientific
method to the practice of medicine,
especially to long-established practices
that never have been subjected to
adequate scientific study
10. NFASAB Organizations
• American Academy of • Australian Resuscitation Council
Orthopaedic Surgeons • Canadian Red Cross
• American Academy of Pediatrics • International Association of Fire
• American Association of Poison Chiefs
Control Centers • International Association of Fire
• American Burn Association Fighters
• American College of Emergency • Medic First Aid International
Physicians • Military Training Network
• American College of • National Association of EMS
Occupational and Environmental Educators
Medicine • National Association EMS
• American College of Surgeons Physicians
• American Heart Association • National Association of EMTs
• The American Pediatric Surgical • National Safety Council
Association • Occupational Safety and Health
• American Red Cross Administration
• American Safety and Health • Save a Life Foundation
Institute
• Army Medical Command
11. Goals of NFASAB
Goals are to analyze the scientific data and answer the
following questions:
• 1. What are the most common emergency conditions
that lead to significant morbidity and mortality?
• 2. In which of these emergency conditions can
morbidity or mortality be reduced by the intervention
of a first-aid provider?
• 3. How strong is the scientific evidence that
interventions performed by a first-aid provider are
safe, effective, and feasible?
12. NFASAB
• NFASAB considered a wide range of
emergencies, e.g.
• Allergic reactions, contusions, fractures, how to
position a victim, oxygen delivery, seizures, severe
bleeding, snake bites, spinal injuries, sprains, etc.,
as well as chemical and thermal burns.
13. An example
• Emergency treatment of poisoning:
• Syrup of ipecac
NFASAB new guidelines state:
Do NOT give water, milk, or syrup of ipecac to
someone who has ingested poison.
14. Important References
• (1) A special supplement to Circulation [Dec. 12, 2005]
Part 14: First Aid, 2005, 112, IV-196—IV-203, freely available at
http://www.circulationaha.org
or
http://www.redcross.org/static/file_cont4913_lang0_1727.pdf
(2) The Canadian Centre for Occupational Health and Safety, “The
MSDS—A Practical Guide for First Aid.” CCOHS encourages the
widest possible distribution. Call 1-800-668-4284 or visit
http://www.ccohs.ca/products/publications/firstaid/
15. NFASAB statement for chemical burns
In their review of the science behind first-aid
practices, the American Heart Association
advises flushing chemical burns with large
amounts of cool running water and to continue
flushing until EMS personnel arrive.
16. N.B.
• This recommendation does not address the
question of how long flushing should continue.
• However, it makes sense to tailor the duration
of flushing to the known effects of the
chemical or product.
17. ○Adequate irrigation is difficult to define and
depends on the amount of exposure and the
agent involved.
○The first priority in treatment is to ensure
complete removal of the offending agent.
18. New Guidelines
• Flushing should start immediately following skin or
eye contact with a chemical.
• Longer flushing is required for corrosive chemicals:
60 min for strong alkalies
30 min for other corrosives
• A moderate or severe irritant requires 15-20 min.
• A mild irritant needs only 5 min.
19. Some considerations
• Using litmus paper to measure the pH of
the affected area or the irrigating solution is
helpful.
• Tap water is adequate for irrigation.
• Low-pressure irrigation is desired; high
pressure may exacerbate the tissue injury.
• It is preferable that complete
decontamination of the skin and eyes occur
on site.
20. More considerations
• Each emergency is unique.
• First-aid provider must be trained.
• It is important to know the physical and reactivity
properties of the chemicals involved.
• The MSDS is only a starting point for developing a
work-site first-aid program.
21. Physical Properties
• Is the chemical involved a solid, liquid, or gas?
This information helps determine which exposure routes
and first-aid measures are relevant for a particular
substance. E.g., first aid for a solid particle in the eye
may not be the same as for a liquid in the eye.
• Is the involved chemical soluble in water?
Substances that are not water soluble should be quickly
blotted or brushed from the skin before flushing with
water.
22. Reactivity Data
• Does the substance react with water to produce heat
or a more toxic substance?
This information allows modification of the
recommendation to reduce contact of the chemical
with water by quickly blotting or brushing the chemical
away, prior to flushing.
• Is the substance an oxidizer?
Oxidizers create a fire hazard. Care must be taken
with contaminated clothing.
Knowledge of the properties of chemicals involved
determines the first-aid intervention.
23. MSDSs
• The MSDS should not exclusively describe first- aid
recommendations written for the "worst case"
exposure imaginable.
• Usually, first aid is given for mild to moderate
exposures. If the MSDS places too much emphasis
on extreme exposures, which rarely occur, the first-aid
procedures will be overstated.
• Inappropriate first aid could further harm the victim.
24. Because of their properties, the following
chemicals need special consideration.
• Hydrofluoric Acid*
Because HF can penetrate tissues deeply and can
cause fatal systemic toxicity even in small burns,
exposures need special attention.
• Flushing with water should be limited to no more
than 5 min. Then treatment with benzalkonium
chloride or calcium gluconate gel should begin.
• For eye contact: Immediately flush the contaminated
eye(s) with lukewarm, gently flowing water for 15-20
min., while holding the eyelid(s) open. Do NOT use
benzalkonium chloride (Zephiran®) for eye contact.
• *Details can be found in the updated “Recommended Medical
Treatment for Hydrofluoric Acid Exposure.”
25. Phenol
• Phenol is not water-soluble and is difficult to remove
with water alone. Dilution of phenol with water may
enhance skin absorption .
• If available, immediately and repeatedly wipe the
affected area with a 50% water solution of PEG 300
or PEG 400 (polyethylene glycol of average molecular
weight 300 or 400). If PEG is not available, quickly
blot or brush away excess chemical. Then flush
affected area with lukewarm water at a high flow rate
for at least 30 min. Quickly transport victim to an
emergency care facility.
26. Sodium and Potassium
• These metals can ignite spontaneously on contact
with moisture and react with water to form very
corrosive sodium and potassium hydroxides.
• Do NOT flush with water. Use forceps to carefully remove any
metal fragments embedded in the skin and submerse them in
mineral oil. If all particles cannot be removed, cover affected
area with nontoxic mineral oil or cooking oil (Na) / tert-butyl
alcohol (K) and transport victim to an emergency care facility. If
all particles have been removed, flush the affected area with
lukewarm, gently flowing water for at least 30 min. Then,
immediately transport victim to an emergency care facility
27. White Phosphorus
• White phosphorus is spontaneously oxidized in air to
P2O5 which reacts violently with water to evolve heat.
• Keep the area immersed in water and manually
remove any P particles seen.
28. Are other flushing solutions effective?
Four eye-irrigating solutions were evaluated for comfort
as flushing solutions:
• normal saline
• lactated Ringer’s
• normal saline with bicarbonate, and
• Balanced Saline Solution Plus
• Diphoterine
• Neutralizing agents
29. Neutralization
• Neutralization of a chemical on the skin seems logical;
• e.g., treat an acid with a base or a base with an acid.
There are, however, consequences which could increase
the injury:
• a delay in flushing while first-aid personnel search for
neutralizing agents
• thermal burns from the heat of reaction of the chemicals
involved
• further injury due to contact with the neutralizing agent
30. Evidence-based medicine
• The conclusion is that there is no clear benefit in
using neutralizing agents instead of water following
exposure to acids or bases.
31. An Admonition
• Delays of even seconds can dramatically affect the
outcome following contact with a corrosive chemical.
There is no justification for waiting for another solution
if water is the first available agent.
32. Help is available
• Decision trees: decision-making processes presented
in flowcharts, one for each route of exposure.
• Use of the decision trees allows a step-by-step
determination or evaluation of first-aid
recommendations for a specific product.
• A worksheet is provided to gather the information
required for making first-aid decisions.
34. NFASAB Statement
• NFASAB strongly believes that education in
first aid should be universal; everyone can
and should learn first aid.
35. Next Step
• Every major national and international training
organization is in the process of developing evidence-
based training materials to reflect the new treatment
recommendations.
• Training material revision, publication, and rollout are
expected to continue to the end of the year.
36. Conclusion
Very little research on first aid for chemical exposure is
being done
Thus, there is a lack of evidence-based medicine on
skin/eye first aid
Extrapolations by health professionals are being made
More research must be undertaken
37. Conclusion
• However, what we do learn as scientific fact should
be accepted.
• Life would be much simpler if the K.I.S.S. principle
were in effect,
• Our world is not simple
• NFASAB strongly believes that education in first aid
should be universal; everyone can and should learn
first aid.
