Diabetes Mellitus

In Diabetes Mellitus (DM) the body fails to produce sufficient amounts of insulin, the hormone that converts blood sugar to stored glycogen. Diabetes Mellitus comes in two varieties - insulin dependent (IDDM) and non-insulin dependent (NIDDM). Traditionally these were also know as Juvenile Onset and Mature Onset respectively, but because of downward trends in diet and lifestyle NIDDM can now occur at a much younger age. Those with IDDM have to have regular injections of insulin, whereas those with NIDDM are treated by oral medication and dietary control.

In DM the blood sugar (BS), which has a normal value around 4 - 6 mmol/litre, is either raised due to too much sugar/not enough insulin (hypergycaemia) or lowered due to not enough sugar/too much insulin (hypoglycaemia).

If a known diabetic casualty appears unwell and you are unsure if they are hyper- or hypoglycaemic give them sugar - this will rapidly correct hypoglycaemia and will do little harm in the case of hyperglycaemia.

Hyperglycaemia (BS too high):

Recognition:

• Recent history of eating excessively.
• Casualty is thirsty but not hungry, may vomit and may urinate excessively.
• Breathing is rapid.
• Breath smells fruity/sweet
• Pulse rapid and weak.
• Skin warm and dry.
• Casualty does not usually have a seizure.
  
• Casualty appears drowsy.
• Symptoms usually develop gradually.
  

Aim:

• Arrange urgent medical treatment for the casualty.

Treatment:

• Dial for an ambulance immediately.
• Monitor the casualty's breathing, pulse and level of responsiveness.
• Be prepared to resuscitate if the casualty stops breathing.

Hypoglycaemia (BS too low):

Recognition:

• History of under eating, missed or irregular meals.
• Casualty is thirsty but not hungry, doesn't (usually) vomit and urinates normally.
• Casualty is disoriented and acts unusually.
  
• Breath smells normal.
• Pulse rapid and strong.
• Skin pale, cold and clammy.
• Casualty may have a seizure.
  
• Casualty rapidly loses consciousness.

Aims:

• To raise the casualty's BS.
• To get medical help if necessary.

Treatment:

• Help the casualty to sit or lie comfortably. Give him/her a sugary drink, sugar lumps or anything else sweet. Alternatively, some diabetics carry a glucose gel for use in a 'hypo' - help them to use this.
• If the casualty responds quickly give more food and advise the casualty to rest until they feel better. Advice him/her to see their own doctor even if they feel fully recovered.
  
• If they do not respond look for alternative causes.
• Monitor the casualty's airway, breathing and responsiveness.
• If the casualty is unconscious place them in the recovery position and dial for an ambulance.
  
• Be prepared to resuscitate if the casualty stops breathing.
  

DO NOT GIVE FOOD/DRINK TO A CASUALTY WITH IMPAIRED CONSCIOUSNESS - GET HELP.

First Aid Regulations

Mr Justice First Aid - not to be confused
with a poorly dressed transvestite.

This article relates to UK law. If you are elsewhere, you are advised to check local rules.

One of the main concerns that people express on my first aid courses is the fear of litigation if they carry out their first aid wrongly in the heat of an emergency situation. Some of my students have even expressed their intention to turn a 'blind eye' to an injured person in the street for fear of being accused of some sort of wrong doing. Very sad but a true indication of the nauseating 'ambulance chasing' culture that is now rife in the UK. Luckily, in English law (until Europe declare otherwise), there is the concept of a 'reasonable man' who performs reasonable actions in a given situation. First aid falls into this category - if you are treating someone sensibly, in the manner you honestly believe is best for them at the time, you should be okay.

In the workplace and at mass gatherings there is specific legislation that governs the first aid provision required. The first aid training providers are also closely monitored to ensure they deliver a consistent, high level of accurate training across the board.

Workplace:
The Health and Safety (First Aid) Regulations 1981 place a duty on employers to make first aid
provision for their employees in case of illness or injury in the workplace. The Health and Safety Executive provide an Approved Code of Practice (ACOP) in relation to workplace first aid. The number of first aiders in a workplace is determined by a local risk assessment of the buildings and facilities. Every workplace is required to maintain a book recording the details of accidents (incident book). The following details are to be entered in to the incident book:

• Full name and address of the casualty.
• The casualty's occupation.
• Date that the entry was made.
• Date and time of the incident.
• Place and circumstances of the incident.
• Details of any injuries sustained and treatment given.
• The signature of the person making the entry.

Mass gatherings:
As a result of the Hillsborough football ground disaster in 1989, when 96 football fans were crushed to death, new rules were implemented governing the provision of first aid at mass gatherings. The minimum requirements are:

• One trained first aider for every 1000 people in attendance.
• An approved and designated first aid room.
• A doctor for events with more than 2000 in attendance.
• A fully equipped ambulance, approved by one of the Voluntary Aid Societies or local NHS ambulance service, for events with more than 5000 in attendance.

The local licencing authority, eg. the local council, are responsible for ensuring these standards are implemented.

Training and certification:
Certificated first aid training must be carried out be either:

• One of the Voluntary Aid Societies (St. John Ambulance, St. Andrew's Ambulance, the British Red Cross or the Order of Malta).
• A private company that is registered and approved by the Health and Safety Executive (HSE). That company should display their HSE registration number clearly on any certificate they issue.
• The National Health Service.

That is not to say that reading the 'Layman's Guide to First Aid' isn't an acceptable method of learning first aid - just it couldn't be counted towards a full HSE first aid certificate (for use in the workplace).

There are four common types of first aid course on offer:

• Basic First Aid (usually about 8 hours of training)
  
• First Aid at Work (usually 36 hours of training)
• First Aid at Work Requalification (usually 18 hours of training)
  
• Appointed Person (usually about 4 hours of training)

There are other specialist courses in addition to these, but these are the big four. First Aid at Work (FAW) is also referred to as the 'Full First Aid Certificate'. As the name implies, you need FAW to act as a first aider in the workplace. You aren't really a proper first aider unless you have the FAW. The main aim of AP is to train someone about the administrative aspects of first aid - what they need in their first aid kits, where these should be placed, legal aspects and incident reporting. The AP course also provides some very elementary first aid training.

First Aid trainers, like me, are people who have held the FAW for several years, have teaching experience or qualifications (in my case I am an NVQ trainer and assessor) and are kept up to date with the latest first aid developments. Quite a lot of first aid trainers have other first aid related qualifications - I am trained at automated external defibrillation (AED). We also have to keep an up to date portfolio of our experience and undergo regular reassessment.