Mom's Day One

Are you really rescuing your child if you swoop them off the ground, after they ‘accidentally’ roll off the bed?

Before I discuss this further, here’s some preamble.  If you know me or have been in my 2HEALTH CPR/ First Aid courses, you know I cut to the chase, have little tolerance for gray area and conservative with safety.  In other words, pardon my boldness.  With this out there, hope you will see where I come from when I respond to this situation.  

First, let’s deal with the prevention of the situation.  It’s not an accident when the situation is preventable or predictable.  I know this happens in households, however it’s not an accident.  Non-accidental falls will also happen [child learning to walk], and the rescue approach is the same.

Second, what is a head injury (for our purposes)?  This could be a concussion where the brain hits the skull and suffers a bruise.  The consequence of a bruise, depending on severity of the bruise, varies from feeling dizzy to going unconscious, and many symptoms in between. The head injury could also be compounded by a neck or spinal injury.  You cannot rule this out either.  And sometimes symptoms appear hours after the incident.  Hours!

My answer: no, you are not rescuing them in the optimal way, when you swoop them up!

As a first aider, timing is everything, life-threatening conditions need to be considered and only ESSENTIAL actions steps need to be taken. 

It’s safe to over-protect and over-treat and assume there is a head injury.  I always say, even paramedics and ER staff play it safe and even get it wrong at times.  Over cautious doesn’t hurt.

Let’s speak about an unconscious child, then we’ll address a conscious situation.

UNCONSCIOUS situation

As soon as you hear/ see the fall, 

1. check for response [child’s unconscious]
2. check breathing for about 10 seconds [breathing detected, seen or heard], if not heard jump to #6
3. if breathing, call EMS/ 911 immediately [they will hopefully continue to stay on phone]
4. keep assessing child’s breathing and keep them warm
5. again, DO NOT move them
6. if no breathing AND you’re alone AND you know CPR, child needs to be on their back - carefully roll child, with head and spine aligned as best as possible [yes, it’s okay to move them if CPR is needed and you are comfortable with this!]  If someone is there with you, call EMS/911 OR if you’re alone, help for 2 minutes then call.
7. start CPR with 30 compressions on chest and give 2 breaths.  After 2 minutes of this, STOP and call EMS/911, if not already done by someone.  CPR continues until EMS arrives.

CONSCIOUS situation

This is tougher, since there are more variables and there’s the perception that things are okay if they are conscious [furthest from the truth].

1. Are they moving? This is good sign.  However, you still can’t rule out a head injury.  A concussion can still be an issue.  Some concerning signs: vomiting, uncoordinated, headache, withdrawn, unusual thirst, fatigue.  If the child initiates movement and gets up then comfort/ hold them gently.  In your arms, encourage them to move minimally and comfort.
2. Call EMS/ 911.  Please do not take them to the hospital.  It’s best and faster to stay home and let medical help come.  If they pass out in the car, will you know how to handle that? Use EMS/911, that’s their job in an emergency and this is an emergency.
3. If the child DOESN’T move and cries [or not], establish eye contact and / or verbally encourage them to get up.  If they remain still, it could mean they are hurt. This is the toughest thing [I had to do this too], however it’s the safest and most prudent.  Remember, what I said initially about doing the most essential actions only.  Grab the phone and call EMS/911 [for the same reasons above].  If they don’t move, KEEP THEM AS THEY ARE and comfort them with your warmth, kisses, hugs, voice, and repeat.  We are avoiding picking them up, because we are being overcautious.  Keep talking to them and ensure they remain conscious.

If they are babies, you are watching for motor skills they can do, like head lifting, reaching, etc.

If they move, and flails limbs to be picked up [possibly good sign], do so gently and still call EMS/911.

Why do I advocate calling EMS/911?  Because the alternate, of putting them in a car seat, driving to the nearest ER, removing them from a car seat, waiting at a hospital takes way more time and moves the child too much!  Remember, they may have a head injury.  Why am I putting the child through all this?  I’ll let the EMS dispatch tell me it’s not an emergency before I go to the hospital myself.  I warned you I was bold!

As a summary:

• PREVENT falls. 95% of “accidents” are preventable.
• If it happens, be prudent and ONLY move: to provide CPR; when child seems they want to be held, if area is unsafe
• Call EMS/911 or your local emergency number – don’t feel guilty, this is an emergency!
• Picking them up helps you feel better about helping them, however it may be too much movement for your child. 
• Keep watching your child for the next few days [even after leaving the hospital] for changes in signs and symptoms.
• If something falls on the child, do you have a good reason to remove it? Or will it cause more damage?

As you can see, it’s not an easy situation.  Fear not. I’ve always had comfort in feeling knowing that overcaring is always better than undercaring.  Calling EMS/911 is almost always followed by paramedics or fire people coming to help, and they can certainly help comfort you as you comfort your little one!

Questions? Issues?  Kavita Chauhan welcomes comments at firstaid@2health.com and on Twitter @2HEALTHfirstaid.  Be safe. Be strong. Be prepared.