EMERGENCY FIRST AID FOR HEART ATTACK

EMERGENCY FIRST AID FOR HEART ATTACK

Reviewed by Dr Neal Uren, consultant cardiologist and Dr Reginald Odbert, GP
Important: this is a brief guide to the emergency help that can be given in the event of a heart attack or cardiac arrest before the arrival of emergency services. It is not intended as a replacement for a first aid or resuscitation course.

What should you do if someone has a heart attack? If someone has a cardiac arrest or heart attack, there are only a few minutes to act before it is too late. It is vital to know what to do beforehand. To perform CPR (cardiopulmonary resuscitation) and artificial respiration (mouth to mouth resuscitation) effectively, training and frequent practice on resuscitation dummies are essential. How can you tell if someone is having a heart attack? If the person is unconscious:

• Are they breathing? Look at the patient's chest to see if it is rising and falling. • Do they have a pulse? Place two fingers on one or other side of the person's voice box in their throat to feel if they have a carotid pulse. If the patient has a pulse but is not breathing: • Could it be because of suffocation? Feel inside the mouth with a finger to see if there is anything blocking it or the windpipe and remove any food or other objects. Provided that dentures are not broken, it is better not to remove them. • Call for help immediately, stating that the casualty is not breathing, and provide resuscitation (see below) until the patient begins to breathe or the ambulance arrives.
If there is no breathing or pulse, the patient has had a cardiac arrest. What help is needed? • If possible, raise the legs up 12 to 18 inches to allow more blood to flow towards the heart • Immediately place the palm of your hand flat on the patient's chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again.
If these actions do not restore a pulse or if the subject doesn't begin to breathe again: • Call for help, stating that the casualty is having a cardiac arrest but stay with the patient. • Find out if anyone else present knows CPR. • Provide artificial respiration immediately. • Begin CPR immediately.
How to give artificial respiration• Tilt the head back and lift up the chin. • Pinch the nostrils shut with two fingers to prevent leakage of air. • Take a deep breath and seal your own mouth over the person's mouth. • Breathe slowly into the person's mouth - it should take about two seconds to adequately inflate the chest. • Do this twice. • Check to see if the chest rises as you breathe into the patient. • If it does, enough air is being blown in. • If there is resistance, try to hold the head back further and lift the chin again. • Repeat this procedure until help arrives or the person starts breathing again.
Artificial respiration and CPR should both be performed at the same time • If possible, get someone else to help - one person to perform artificial respiration and the other to perform CPR. (This is not easily done without prior practice and it is well worth attending sessions on CPR training to become familiar with the technique.) • The ratio of chest compressions to breaths is 15:2 for both one-person and two-person CPR. • Continue until the ambulance arrives or the patient gets a pulse and starts to breathe again. • If the pulse returns and breathing begins but the person remains unconscious, roll them gently onto their side into the recovery position. This way mucus or vomit can get out of the mouth and will not obstruct the patient's breathing. It also prevents the tongue from falling back and blocking the air passage.

Make sure the patient continues breathing and has a pulse until the ambulance arrives • If you succeed in resuscitating the person who has been taken ill, he or she may be confused and alarmed by all the commotion. Keep the patient warm and calm by quietly, but clearly, telling them what has happened. Again, it needs to be emphasised that the only way to provide proper first aid and resuscitation is through learning the technique, then regular practice and guidance. How to Perform CPR (Cardiopulmonary Resuscitation)There is no substitute for learning cardiopulmonary resuscitation (CPR), but emergencies don't wait for training. These instructions are for conventional adult CPR. If you've never been trained in CPR and the victim collapsed in front of you, use hands-only CPR.

There are three types of CPR that we will cover in this manual:
1. CPR for infants (0 – 1 year)
2. CPR for children (1- 8 years)
3. CPR for adults

Infant CPR (0 – 1 year)1. Stay SafeChildren may be infected with contagious diseases. If you are concerned about possible exposure to contagious disease, take universal precautions and wear personal protective equipment, if available. 2. Try to wake the infantLittle babies respond well having the soles of their feet rubbed or tapped. For infants more than 2 months old, tap their shoulder or chest. In either case, call out his name in a loud voice. Don't hurt the baby but be aggressive; you're trying to wake him up. If the infant does not wake up, have someone emergency services immediately. If no one else is available to call, continue to step 3 and do CPR for about 2 minutes before emergency services. 3. Open the airway and check for breathingPut the baby on a flat, hard surface like a table or the floor. Tilt the infant's head back a little to open the airway. Put an ear to the baby's mouth and listen for breathing sounds. While listening, watch the chest to see if it's rising and falling. If you don't see or hear any signs of breathing, go to step 4 immediately. If the baby is breathing, then emergency services immediately if no one else has already done it. If the baby vomits, turn him to the side to keep him from choking on the vomit. If the baby stops breathing, go to step 4. 4. Give the baby two breathsIf the baby is not breathing, give him two breaths. Cover the baby's entire mouth and nose with your mouth and gently blow until you see his or her chest rise. Let the air escape - the chest will go back down - and give one more breath. If no air goes in when you try to blow, adjust the baby's head and try again. If that doesn't work, then go to step 5. 5. Begin chest compressionsPut two fingers on the breastbone directly between the baby's nipples. Push straight down about an inch and then let the chest all the way back up. Do that 30 times, about twice per second. After 30 pushes on the chest, give the baby two more rescue breaths (as described in step 4). Keep going - 30 chest compressions followed by 2 breaths - for about two minutes. If you still haven't called 911 yet, do it now. Keep doing 30 chest compressions followed by 2 breaths until the baby starts breathing on his own, or until help arrives.Tips:1. When checking for breathing, if you're not sure then assume the baby isn't breathing. It's much worse to assume a baby is breathing and not do anything than to assume he or she isn't and start rescue breaths. 2. Put a book under the baby's shoulders -- if you have time -- to help keep his head tilted back. 3. When asking someone else to call emergency services, make sure you tell them why they are calling. If not, they may not tell the emergency services exactly what's going on. If the emergency services knows the baby isn't breathing or responding, the dispatcher may be able to give you instructions to help over the phone.

Child CPR (1 – 8 years of age)

1. Stay SafeChildren may be infected with contagious diseases. If you are concerned about possible exposure to contagious disease, take universal precautions and wear personal protective equipment, if available. 2. Try to Wake the ChildGently tap or shake the child's shoulders and call out his or her name in a loud voice. Don't hurt the child, but be aggressive, you're trying to wake them up. If the child does not wake up, have someone call emergency services immediately. If no one else is available to call emergency services, continue to step 3 and do CPR for about 2 minutes before calling emergency services. 3. Open the Airway and Check for BreathingPut the child on a flat, hard surface, such as a table or the floor. Tilt the child's head back a little to open the airway. Put an ear to the child's mouth and listen for breathing sounds. While listening, watch the chest to see if it's rising and falling. If you don't see or hear any signs of breathing, go to step 4 immediately. If the child is breathing, then call emergency services immediately if no one else has already done so. If the child vomits, turn the child to the side to keep him or her from choking on the vomit. If the child stops breathing, go to step 4. 4. Give the Child Two BreathsIf the child is not breathing, give him or her two breaths. Cover the child's mouth with yours, and pinch his or her nose closed with your hand. Gently blow until you see his or her chest rise. Let the air escape; the chest will go back down. Then give one more breath. If no air goes in when you try to blow, adjust the child's head and try again. If that doesn't work, then go to step 5. 5. Begin Chest CompressionsPut the heel of one of your hands on the child's breast bone (directly between the child's nipples). Push straight down about 1.5 inches, then let the chest retract all the way back up. Do that 30 times, about twice per second. After 30 pushes on the chest, give the child two more rescue breaths (as described in step 4). Keep going -- 30 chest compressions followed by 2 breaths -- for about two minutes. If you still haven't called emergency services yet, do it now. Keep doing 30 chest compressions followed by 2 breaths until the child starts breathing on his or her own, or until help arrives.Tips:1. When checking for breathing, if you're not sure then assume the child isn't breathing. It's much worse to assume a kid is breathing and not do anything than to assume he or she isn't and start rescue breaths. 2. Put a book under the child's shoulders, if you have time to help keep his or her head tilted back. 3. When asking someone else to call emergency services, make sure you tell them why they are calling. If not, they may not tell the emergency services exactly what's going on. If the emergency services knows the baby isn't breathing or responding, the dispatcher may be able to give you instructions to help over the phone.

Adult CPR:Difficulty: EasyTime Required: CPR should start as soon as possible

1. Stay Safe! The worst thing a rescuer can do is become another victim. Follow precautions and wear personal protective equipment if you have it. Use common sense and stay away from potential hazards. 2. Attempt to wake victim. Briskly rub your knuckles against the victim's sternum. If the victim does not wake, emergency services and proceed to step 3. If the victim wakes, moans, or moves, then CPR is not necessary at this time. Call emergency services if the victim is confused or not able to speak. 3. Begin rescue breathing. Open the victim's airway using the head-tilt, chin-lift method. Put your ear to the victim's open mouth: • look for chest movement • listen for air flowing through the mouth or nose • feel for air on your cheek If there is no breathing, pinch the victim's nose; make a seal over the victim's mouth with yours. Give the victim a breath big enough to make the chest rise. Let the chest fall, then repeat the rescue breath once more. Begin chest compressions. Place the heel of your hand in the middle of the victim's chest. Put your other hand on top of the first with your fingers interlaced. Compress the chest about 1-1/2 to 2 inches (4-5 cm). Allow the chest to completely recoil before the next compression. Compress the chest at a rate equal to 100/minute. Perform 30 compressions at this rate. Repeat rescue breaths. Open the airway with head-tilt, chin-lift again. This time, go directly to rescue breaths without checking for breathing again. Give one breath, making sure the chest rises and falls, then give another. Perform 30 more chest compressions. Repeat steps 5 and 6 for about two minutes. Stop compressions and recheck victim for breathing. If the victim is not breathing, continue chest compressions and rescue breaths. Keep going until help arrives.Tips:1. Chest compressions are extremely important. If you are not comfortable giving rescue breaths, still perform chest compressions! 2. It's normal to feel pops and snaps when you first begin chest compressions - DON'T STOP! You aren't going to make the victim any worse. Cardiac arrest is as bad as it gets. 3. When performing chest compressions, do not let your hands bounce. Let the chest fully recoil, but keep the heel of your hand in contact with the sternum at all times.

Reference:2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005 Dec 13;112(24 Suppl):IV1-203. Epub 2005 Nov 28

Heroes At The Taj - Michael Pollack

Heroes At The Taj
Michael Pollack, 12.01.08, 07:40 PM EST

My story begins innocuously, with a dinner reservation in a world-class hotel. It ends 12 hours later after the Indian army freed us.

My point is not to sensationalize events. It is to express my gratitude and pay tribute to the staff of the Taj Mahal Hotel in Mumbai, who sacrificed their lives so that we could survive. They, along with the Indian army, are the true heroes that emerged from this tragedy.

My wife, Anjali, and I were married in the Taj's Crystal Ballroom. Her parents were married there, too, and so were Shiv and Reshma, the couple with whom we had dinner plans. In fact, my wife and Reshma, both Bombay girls, grew up hanging out and partying the night away there and at the Oberoi Hotel, another terrorist target.

The four of us arrived at the Taj around 9:30 p.m. for dinner at the Golden Dragon, one of the better Chinese restaurants in Mumbai. We were a little early, and our table wasn't ready. So we walked next door to the Harbour Bar and had barely begun to enjoy our beers when the host told us our table was ready. We decided to stay and finish our drinks.

Thirty seconds later, we heard what sounded like a heavy tray smashing to the ground. This was followed by 20 or 30 similar sounds and then absolute silence. We crouched behind a table just feet away from what we now knew were gunmen. Terrorists had stormed the lobby and were firing indiscriminately.

We tried to break the glass window in front of us with a chair, but it wouldn't budge. The Harbour Bar's hostess, who had remained at her post, motioned to us that it was safe to make a run for the stairwell. She mentioned, in passing, that there was a dead body right outside in the corridor. We believe this courageous woman was murdered after we ran away.

(We later learned that minutes after we climbed the stairs, terrorists came into the Harbour Bar, shot everyone who was there and executed those next door at the Golden Dragon. The staff there was equally brave, locking their patrons into a basement wine cellar to protect them. But the terrorists managed to break through and lob in grenades that killed everyone in the basement.)
We took refuge in the small office of the kitchen of another restaurant, Wasabi, on the second floor. Its chef and staff served the four of us food and drink and even apologized for the inconvenience we were suffering.

Through text messaging, e-mail on BlackBerrys and a small TV in the office, we realized the full extent of the terrorist attack on Mumbai. We figured we were in a secure place for the moment. There was also no way out.

At around 11:30 p.m., the kitchen went silent. We took a massive wooden table and pushed it up against the door, turned off all the lights and hid. All of the kitchen workers remained outside; not one staff member had run.

The terrorists repeatedly slammed against our door. We heard them ask the chef in Hindi if anyone was inside the office. He responded calmly: "No one is in there. It's empty." That is the second time the Taj staff saved our lives.

After about 20 minutes, other staff members escorted us down a corridor to an area called The Chambers, a members-only area of the hotel. There were about 250 people in six rooms. Inside, the staff was serving sandwiches and alcohol. People were nervous, but cautiously optimistic. We were told The Chambers was the safest place we could be because the army was now guarding its two entrances and the streets were still dangerous. There had been attacks at a major railway station and a hospital.

But then, a member of parliament phoned into a live newscast and let the world know that hundreds of people--including CEOs, foreigners and members of parliament--were "secure and safe in The Chambers together." Adding to the escalating tension and chaos was the fact that, via text and cellphone, we knew that the dome of the Taj was on fire and that it could move downward.

At around 2 a.m., the staff attempted an evacuation. We all lined up to head down a dark fire escape exit. But after five minutes, grenade blasts and automatic weapon fire pierced the air. A mad stampede ensued to get out of the stairwell and take cover back inside The Chambers.

After that near-miss, my wife and I decided we should hide in different rooms. While we hoped to be together at the end, our primary obligation was to our children. We wanted to keep one parent alive. Because I am American and my wife is Indian, and news reports said the terrorists were targeting U.S. and U.K. nationals, I believed I would further endanger her life if we were together in a hostage situation.

So when we ran back to The Chambers I hid in a toilet stall with a floor-to-ceiling door and my wife stayed with our friends, who fled to a large room across the hall.

For the next seven hours, I lay in the fetal position, keeping in touch with Anjali via BlackBerry. I was joined in the stall by Joe, a Nigerian national with a U.S. green card. I managed to get in touch with the FBI, and several agents gave me status updates throughout the night.

I cannot even begin to explain the level of adrenaline running through my system at this point. It was this hyper-aware state where every sound, every smell, every piece of information was ultra-acute, analyzed and processed so that we could make the best decisions and maximize the odds of survival.

Was the fire above us life-threatening? What floor was it on? Were the commandos near us, or were they terrorists? Why is it so quiet? Did the commandos survive? If the terrorists come into the bathroom and to the door, when they fire in, how can I make my body as small as possible? If Joe gets killed before me in this situation, how can I throw his body on mine to barricade the door? If the Indian commandos liberate the rest in the other room, how will they know where I am? Do the terrorists have suicide vests? Will the roof stand? How can I make sure the FBI knows where Anjali and I are? When is it safe to stand up and attempt to urinate?

Meanwhile, Anjali and the others were across the corridor in a mass of people lying on the floor and clinging to each other. People barely moved for seven hours, and for the last three hours they felt it was too unsafe to even text. While I was tucked behind a couple walls of marble and granite in my toilet stall, she was feet from bullets flying back and forth. After our failed evacuation, most of the people in the fire escape stairwell and many staff members who attempted to protect the guests were shot and killed.

The 10 minutes around 2:30 a.m. were the most frightening. Rather than the back-and-forth of gunfire, we just heard single, punctuated shots. We later learned that the terrorists went along a different corridor of The Chambers, room by room, and systematically executed everyone: women, elderly, Muslims, Hindus, foreigners. A group huddled next to Anjali was devout Bori Muslims who would have been slaughtered just like everyone else, had the terrorists gone into their room. Everyone was in deep prayer and most, Anjali included, had accepted that their lives were likely over. It was terrorism in its purest form. No one was spared.

The next five hours were filled with the sounds of an intense grenade/gun battle between the Indian commandos and the terrorists. It was fought in darkness; each side was trying to outflank the other.

By the time dawn broke, the commandos had successfully secured our corridor. A young commando led out the people packed into Anjali's room. When one woman asked whether it was safe to leave, the commando replied: "Don't worry, you have nothing to fear. The first bullets have to go through me."

The corridor was laced with broken glass and bullet casings. Every table was turned over or destroyed. The ceilings and walls were littered with hundreds of bullet holes. Blood stains were everywhere, though, fortunately, there were no dead bodies to be seen.

A few minutes after Anjali had vacated, Joe and I peeked out of our stall. We saw multiple commandos and smiled widely. I had lost my right shoe while sprinting to the toilet so I grabbed a sheet from the floor, wrapped it around my foot and proceeded to walk over the debris to the hotel lobby.

Anjali and I embraced for the first time in seven hours in the Taj's ground floor entrance. I didn't know whether she was dead or injured because we hadn't been able to text for the past three hours.

I wanted to take a picture of us on my BlackBerry, but Anjali wanted us to get out of there before doing anything.

She was right--our ordeal wasn't completely over. A large bus pulled up in front of the Taj to collect us and, just about as it was fully loaded, gunfire erupted again. The terrorists were still alive and firing automatic weapons at the bus. Anjali was the last to get on the bus, and she eventually escaped in our friend's car. I ducked under some concrete barriers for cover and wound up the subject of photos that were later splashed across the media. Shortly thereafter, an ambulance came and drove a few of us to safety. An hour later, Anjali and I were again reunited at her parents' home. Our Thanksgiving had just gained a lot more meaning.

Some may say our survival was due to random luck, others might credit divine intervention. But 72 hours removed from these events, I can assure you only one thing: Far fewer people would have survived if it weren't for the extreme selflessness shown by the Taj staff, who organized us, catered to us and then, in the end, literally died for us.

They complemented the extreme bravery and courage of the Indian commandos, who, in a pitch-black setting and unfamiliar, tightly packed terrain, valiantly held the terrorists at bay.

It is also amazing that, out of our entire group, not one person screamed or panicked. There was an eerie but quiet calm that pervaded--one more thing that got us all out alive. Even people in adjacent rooms, who were being executed, kept silent.

It is much easier to destroy than to build, yet somehow humanity has managed to build far more than it has ever destroyed. Likewise, in a period of crisis, it is much easier to find faults and failings rather than to celebrate the good deeds. It is now time to commemorate our heroes.

Michael Pollack is a general partner of Glenhill Capital, a firm he co-founded in 2001.

DISASTER MANAGEMENT TRAINING

DISASTER MANAGEMENT TRAINING

“In the recent terror strikes on the Taj, Trident and CST in Mumbai, our casualties may have been lower if we citizens knew how to protect ourselves and those around us.”
– Ex Captain Vinod Nair

How prepared are you and your employees / family members for unforseen disaster?

Objective
To make individuals capable of taking care of themselves and those around them when unforeseen disaster and / or danger strikes.

Duration: 2 to 2.5 hours

Contents

Module 1: Medical Emergencies
· First aid
· Dealing with heart attacks
· Asthma attacks
· Injuries, bullet & stab wounds
· Bleeding
· Burns
· Chemical disasters
· Fractures
· Administering CPR
· Road traffic accidents

Module 2: Air & Sea Emergencies
Survival and rescue in office emergencies
Survival and rescue in home emergencies
Sea disaster survival
Air disaster survival
· Drowning
· Fire extinguishers
Ordinance recognition and handling procedures

Module 3: Terror Attacks & Miscellaneous disasters
Pre-emptive automatic preservation processes
How to think during a disaster
Recognising and identifying potentially dangerous situations
Dealing with panic (own and others)
Managing others who may get hysterical, traumatised
Basic health and fitness
· Terrorist strike
· Mob handling
Post Traumatic services and management
Protecting yourself and others


The expected learning outcomes are:
· Participants will understand how to protect themselves during disasters
· Participants will understand how to protect others around them during disasters
· Increased level of confidence
· Less dependence on others
· Enhanced leadership traits

Pedagogy
1. Activity based, full of situation reaction tests, demonstrations, case studies, role plays, group discussions, interventions & concept explanation by Faculty
2. Participants would be put through various activities in leadership and team member roles, they methods would be observed and feedback will be shared along with guidelines for improvement.
3. Activities will be individual and team based.
4. Participants will perform and learn under situations varying from mild to intense pressure.
5. Every participant will submit an action plan after the program.
6. Regardless of seniority, every participant must participate in activities.
7. Workshop will be conducted by KIMMAYA trainers who are experienced and have expertise in fitness, health, safety and other relevant areas. Every safety precaution will be taken to ensure a wonderful yet safe experience.

Requirements
· Participants must be dressed comfortably in their daily wear with adequate protection from the sun.
· Participants must carry writing material.

Faculty
1. Module 1 will be conducted by a Doctor.
2. Module 2 will be conducted by a professional trained on air and sea safety including ex army personnel.
3. Module 3 will be conducted by an ex army officer, trained in commando warfare and experienced in live combat.

Kimmaya is run by Captain Vinod Nair, an ex army officer who has undergone commando training, has served in Jammu & Kashmir for 2 years (during which he saw plenty of action) and has a Sainya Seva Medal for meritorious service.

Warm regards, Vinod Nair Director
Kimmaya Consulting Pvt. Ltd.
+919833514159
Web: www.kimmaya.com