First aid for trip sitters and psychedelic therapists

First aid steps

1. First ensure your safety and the safety of the victim.
2. Assess the victim
3. Alert the necessary emergency services
4. Provide first aid for the injury.

Step 1: Ensure safety

First ensure that you are safe yourself or can approach the victim. If this is not possible, call 112 and wait for the emergency services. If you can approach the victim yourself, you can do so:

• Only remove a victim from an environment with smoke and gases when it is safe to do so.
• Move a victim only if the location of the victim is dangerous (risk of additional injury) and there is no possibility of protecting the victim from those dangers at that location.
• Allow the victim to move themselves if possible. If necessary, support them while hopping if they cannot use a leg. If the victim cannot walk or hop, perform an emergency transfer.
• If there is no other way to move a lying victim, drag him by his arms, ankles, or clothing over a short distance. Preferably do this on a flat surface.
• Have the victim undress in the presence of gases and vapors, as gas or vapor may linger in clothing. Avoid direct exposure to a hazardous substance through inhalation and skin contact.

Step 2: Assess the victim

Use the following methods to assess the victim's condition:

• Ask what happened.
• Listen if and what kind of sounds there are when breathing. (for example, wheezing).
• Look or if you can see swelling, bleeding, discoloration, or an abnormal position of a limb.
• Ask whether the victim can perform movements with their arms or legs without pain. Ask thorough questions, but do no physical examination.
• Observe the victim.
• Feel Touch an unconscious victim with your cheek to check for airflow.
• Smell whether you detect anything else (for example, the smell of gasoline or alcohol breath).

Step 3: Activate alarm services

If in doubt whether emergency services are needed, you can call 112. Various situations indicate that emergency services are needed:

• Drowsiness, rebelliousness, and aggression inappropriate for the situation and/or the person, and certainly in the event of hypothermia, hyperthermia, or alcohol and/or drug use;
• serious problems on the street, in businesses or in public spaces;
• a disturbance of consciousness after an accident (even after a few hours or a day);
• unconsciousness;
• severe shortness of breath, inhalation of hazardous substances or a severe allergic reaction;
• shock, coughing up blood and/or vomiting blood with severe blood loss;
• severe headache after an accident, stroke, epileptic seizure;
• in case of possible traumatic brain injury (skull base fracture);
• becoming drowsy due to hypothermia/hyperthermia;
• severe burns;
• chest pain or heart complaints unknown to the victim;

Step 4: Provide First Aid

After assessing whether emergency services are needed, you can proceed with providing first aid. Take the following into account:

• Follow any advice from the dispatcher or general practitioner immediately and exactly. Report any changes in the victim's condition to the general practitioner or 112.
• Ensure that you can continue providing assistance safely and try to remain calm while helping.
• Regularly check the victim's consciousness and breathing.
• Multiple victims: provide a general overview of the number of victims (lying down, sitting, and walking), so that the dispatcher can estimate the required deployment of emergency services.
• Support a victim in a position in which the symptoms are least severe and/or which he finds most comfortable. 
• Place an unconscious victim on their side (in the stable side position).
• If necessary, provide mental first aid and calm the victim.
• Leave someone lying down with a disturbance of consciousness, such as drowsiness.
• Do not allow the victim to eat or drink when their injury needs to be treated by a healthcare professional.

Unconsciousness

Does a victim need CPR? First, check if it is safe to approach the victim. Shake the shoulders and ask how they are doing. Call 112 if the victim does not respond and put the phone on speakerphone.

If the victim is responsive, leave them in the same position if the situation is safe. Now try to determine what care is needed. Do not turn pregnant women onto their backs, but preferably onto their left side.

Check breathing

First open the airway as follows:

• • Place one hand on the forehead.
  • Gently tilt the head back (head tilt).
  • Place two fingers of the other hand under the chin on the jawbone and lift the chin upwards (chin lift).

Then check the breathing as follows:

• Keep the airway open.
• Look or whether the chest rises.
• Listen Check your mouth and nose to see if you hear a sound.
• Feel with your cheek to check if there is airflow.

Do this maximum 10 seconds. If the victim is not moving, does not open their eyes, is not breathing or is not breathing normally, or if you have any doubts: start CPR.

Normal breathing
Normal breathing is regular and barely audible. During normal breathing, the chest and/or abdomen rises and falls regularly. 

Abnormal breathing
Snoring, deep yawning, or rattling indicates abnormal breathing. An agonal breathing or gasping (gasping for air, often noisy) is also not sufficient to stay alive. 

Abnormal breathing is more often seen just after the onset of cardiac arrest. If you start CPR immediately at that point, you have a greater chance of success!

Resuscitation of adults

Starting CPR quickly, and especially performing it properly, can limit significant damage to the brain, kidneys, and heart. The following steps are important:

1. Recognition and alerting.
   After assessing whether the victim can be approached safely, it involves recognizing the severity of the situation and ensuring that professional help arrives as quickly as possible. After calling 112 and having an AED retrieved, the airway is opened and breathing is checked.
2. Basic CPR.
   For an unconscious person without normal breathing, first give 30 chest compressions and two breaths; after a brief check, continue repeating (scroll down for explanation). As soon as the AED arrives, proceed to point 3.
3. Defibrillation with the AED.
   Follow the instructions of the AED.
4. Specialized resuscitation.
   This is the final link. Specialized resuscitation is always necessary. Thanks to the basic resuscitation you perform, the healthcare professional has a better chance of stabilizing the victim, so that the victim can be treated for their condition in the hospital. 

Prevention and recognition of cardiac arrest

If a victim feels unwell, this may indicate a disorder of the heart or circulation. As with:

• Pressing chest pain.
• Radiating pain to the arms, shoulder blades, neck, jaw, or stomach area.
• Sweating.
• Nausea or vomiting.

Less clear signals are:

• Pain in the upper abdomen, jaw, neck, or between the shoulder blades, without chest pain.
• Shortness of breath.
• Extreme fatigue.
• Dizziness.
• Restless feeling or feelings of anxiety.
• Rapid breathing.

If multiple signs occur or you are in doubt, call 112.

Think of a possible cardiac arrest if someone:

• Loses consciousness within a few seconds.
• Has no normal breathing: breathing is completely absent or there is snoring, deep yawning, or rattling (gasping). 
• Looks 'dead'.
• In a few cases, convulsions resembling an epileptic seizure occur immediately after circulatory arrest.

Take immediate action and check if the victim is responsive.

The resuscitation

Start with 30 chest compressions:

• Sit down next to the victim at the level of the upper arm.
• Do not undress the victim.
  Expose the chest only if there is strong doubt about the correct placement of the hands. Do not waste time removing clothing.
• Place the heel of your hand on the middle of the chest.
• Place the heel of your other hand on top of the first.
• Interlock your fingers.
• Straighten your elbows (arms straight).
• Bring your shoulders above your hands by bending slightly forward, so that your arms are perpendicular to your chest.
• Push the sternum in approximately 5 to 6 cm with each compression in an average-sized adult.
• Allow the sternum to return fully – this prevents leaning – but maintain contact with the sternum.
• Do this 30 times. You can count along out loud.
• The correct speed is between 100 and 120 times per minute.
• Make sure you always press straight down. 
• Pressing down and raising the chest must take the same amount of time.

Do the following 2 breaths in less than 10 seconds:

• Place your hand on your forehead.
• Place two fingers of your other hand under the chin on the jawbone and lift the chin up.
• Gently tilt the head back.
• Pinch your nose shut.
• Take a deep breath, seal the victim's mouth tightly with your mouth.
• Blow air into the victim for 1 second.
• Check if the chest rises as with normal breathing.
• Let go and let the victim exhale: the chest drops.
• Give the second breath in the same way.

A effective ventilation is a ventilation where you see the chest rise. If the chest does not rise, proceed as follows:

• Briefly check the airway.
• Remove any loose object.
• Lift your chin a little further and tilt your head back a little further.

Do not give more than 2 breaths or attempt more than 2. If this is unsuccessful, proceed to the next series of chest compressions.

As long as no AED is available and as long as there is no professional help to take over the resuscitation, continue. Alternate 30 chest compressions with 2 breaths.

Switch every 2 minutes if possible.
Giving chest compressions is tiring, and it is known that their quality deteriorates after 2 minutes. This weakens the link in the chain of survival and is therefore undesirable.

Therefore proceed as follows:

• If you have the help of someone who knows CPR, switch every 2 minutes. If an AED is present, it will analyze the situation every 2 minutes. This is a good time to switch.

Using the AED

As soon as the AED arrives:

• The rescuer who retrieved the AED operates the AED, unless he/she does not know how to do so. The other rescuer continues with CPR. 
• Place the AED near the victim's head.
• Turn on the AED using the 'On' button. Some AEDs turn on automatically when the lid is opened.
• Listen to the spoken instructions from the AED. It is important to place electrode 1 on the upper right side of the chest (left for the rescuer), below the collarbone. Patch two goes under the left armpit on the side of the chest.

Only stop resuscitating when

Continue resuscitation until:

• Professional care providers indicate that they are taking over or that you may stop. Do not stop upon the arrival of the ambulance.
• The victim regains consciousness. The return of circulation through chest compressions and artificial respiration alone is very rare. You can only assume that circulation has been restored when the victim regains consciousness, moves, opens their eyes, and breathes normally.
• You are exhausted.
• You find a do-not-resuscitate order belonging to the victim.

When resuscitation no longer seems necessary

If the victim is breathing normally again after resuscitation:

• Place the victim on their side to keep the airway open. The stable side position is a good starting point.
• Leave taped electrodes in place.
• Leave the AED switched on.
• Continuously check if breathing is still normal.
• Remain alert to immediately restart CPR.

Burns

There are different degrees of burns, namely superficial partial or complete burns.

Skin wounds

The skin has multiple layers, namely the epidermis, dermis, and underlying tissues such as fat and muscle. There are various skin wounds and actions that must follow.

When you need to call in professional help

Sometimes it is difficult to judge when to seek professional help and who to call. Do you go to the GP or the out-of-hours GP service, straight to the hospital's emergency department, or do you call 112? Here you can read a summary of when and who to call in case of skin wound.

Call the GP or out-of-hours GP service if: 

• The wound is not clean or cannot be cleaned sufficiently.
• It involves a major wound.
• Bones, muscles, or other subcutaneous tissues are visible.
• There are wounds on the face, eyes, or genitals.
• The wound is caused by a bite from a human or animal.
• An object is stuck in the wound.
• It involves a stab wound with a dirty object.
• This concerns non-healing wounds (for example, due to corticosteroid use, diabetes, impaired immunity due to radiation or infection, cardiovascular diseases).
• A wound keeps bleeding.
• It concerns a cut with separating edges.

It is not a problem if 112 is called instead of the GP or the GP emergency post, or vice versa. The healthcare professionals ensure the appropriate assistance is provided.

Types of wounds and actions

Scrape:

Cut:

Bite wound

Friction blister

Splinter wound