Livedr.org

New Delhi, November 6: In ’05, 8-yr-old died of internal burns and infection after a ‘rare’ fire in a laser machine, treating a tumour in his larynx, burnt his airway; HC finds hospital negligent

The death of an eight-year-old boy due to an “accidental” laser spark during a surgery at the Indraprastha Apollo Hospital has left the company that runs the country’s leading healthcare centre facing criminal action. Charges made out against the Indraprastha Medical Corporation Limited are “culpable homicide not amounting to murder” and “causing death by negligence”.

Aditya Pal died of internal burns and infection in October 2005, 23 days after a “rare” fire in a laser machine that was used to treat a recurrent tumour in his larynx (voice box) burnt his entire airway. After the surgery on October 3, the boy was kept in the ICU under intensive paediatric care till he died there on October 26, his ninth birthday, said his maternal grandfather Tej Singh, who is fighting the case against the hospital.

It was Aditya’s fifth visit to the hospital where he had been undergoing treatment since November 2004 for ‘recurrent laryngeal papillomatosis’.

The postmortem conducted the very next day by a specialist board of doctors from the All India Institute of Medical Sciences (AIIMS) had found it a “case of gross criminal negligence, and the burn injuries that were the primary cause of death were unwarranted and speak of failure of taking required precautions, care and skill in adopted procedure”.

In a recent order, the Delhi High Court agreed with the postmortem report and refused to quash a metropolitan magistrate’s direction issued in March 2007 to the Sarita Vihar police to investigate the hospital authorities and the doctors concerned under Sections 304 Part II and 304 A of the Indian Penal Code.

The boy’s family named the company running the hospital, its managing director, medical superintendent Ritu Rawat and the ENT consultant who had conducted the laser surgery on October 3, as accused in the complaint.

Rawat and the ENT consultant had moved the HC, seeking to quash the criminal proceedings.

The punishment under Section 304 Part II is imprisonment up to 10 years, but under Section 304 A it is a maximum of two years in jail.

“Aditya’s father had died of kidney failure in February 2005, but my daughter continued to stay with her in-laws in Meerut. Whenever it was time for Aditya’s treatment, I would pick them up from Meerut and later drop them back,” recalls Tej Singh, a resident of Loni.

The hospital authorities defended in the court that the postmortem report was “preliminary” in nature, and brought the judge’s attention to the November 2005 findings of an AIIMS medical board that had inspected the same laser machine and found it “working normally”.

Appearing for the hospital, senior advocate Siddharth Luthra argued that the Delhi Medical Council, on inquiry in 2006, had already given his client a clean chit and absolved the hospital of any negligence.

The council’s inquiry report termed the laser spark that claimed the boy’s life as “rare, and known to occur with the incidence of 0.5 to 1.5 per cent in the USA”.

Dismissing Luthra’s pleas, the Bench threw its weight behind the postmortem report.

It said the board that conducted the postmortem “had the body of the deceased who is alleged to have died on account of medical negligence with them while the other boards did not have the advantage of examining the body”.

Besides, the court observed that the inspection of the laser machine was done “considerably after the incident”, rendering the exercise far less conclusive.

The Apollo management, meanwhile, said it regretted the unfortunate incident, calling it “rare but not a case of medical negligence”.

“We have extended full cooperation to the investigating agency and will continue to do so,” their statement read.

HOW TO SURVIVE A HEART ATTACK WHEN ALONE…

Cooking doesn’t have to be about slaving for hours in the kitchen. Dietician Nigel Denby’s recipes show how easy it is to create quick healthy meals.

We are Europe’s biggest consumers of ready meals. And no wonder: we’re all leading increasingly hectic lives and it can be hard to muster the energy after a long day at work to prepare a healthy, balanced evening meal.

But there are ways you can whip up tasty nutritious dinners without slaving over a hot stove for hours or constantly resorting to ready meals. Try my seven-day plan and find out how easy, and enjoyable, cooking can be.

In part two, you’ll find my guide to making the healthiest choices when you do buy ready meals.

Before you start

	On the side If you’re serving the main course with a side, use these quantities and cooking times as a guide: 50g couscous per person - 5 minutes 75g basmati rice per person - 10-15 minutes 75g brown rice per person - 25 minutes 85g vegetables is one portion of your five a day. Steam 3-10 minutes, boil 5-15 minutes.

• Planning is key - make a list of what meals you are going to eat during the week and go shopping with a list so you know exactly what you need.
  
  
• Choose seasonal ingredients - they are likely to be fresher, in abundance, cheaper and higher in nutrients than imported out-of-season foods.
  
  
• If you have some spare time at the weekend, have a cooking session and fill the freezer with ready portioned healthy meals that you can defrost and heat in a matter of minutes.
  
  
• You could also make a habit of always cooking a double batch of whatever meal you are making and freeze half - this can work out cheaper, too.
  
  

All these recipes serve two people, but can easily be increased to serve more.

Monday

• • 2 salmon fillets
    
    
  • 100g couscous
    
    
  • handful sun-dried tomatoes, sliced
    
    
  • bunch spring onions, sliced
    
    
  • 1 lemon
    
    
  • handful fresh dill
    
    
  • 1 garlic clove crushed
    
    
  • seasonal vegetables to serve
    
    
  • Prepare the couscous according to the instructions on the packet. Flavour with a squeeze of lemon juice and garlic.
    
    
  • Heap the couscous into the centre of two large sheets of greaseproof paper. Top with a handful of sun-dried tomatoes, spring onions and a salmon fillet.
    
    
  • Squeeze more lemon juice over the salmon and sprinkle with dill.
    
    
  • Wrap up the salmon to form a parcel.
    
    
  • Place on a baking tray and bake in the centre of the oven for 20 to 25 minutes.
    
    
  • Serve salmon in the paper bag with seasonal vegetables (steamed is best).
    
    

Salmon with couscous and seasonal vegetables



Ingredients


To cook



	Time guidelines Preparation: 10 minutes Cooking time: 20-25 minutes Oven temperature: 180°C / 160°C fan / gas mark 4

Tuesday

• • 2 chicken or turkey breasts - or houmous for veggie option
    
    
  • Mix of any of these vegetables: one pepper, onion, courgette, aubergine or sweet potato, half a butternut squash or 150g mushrooms
    
    
  • Cajun, jerk or five spice seasoning
    
    
  • 2 tablespoons (tbsp) olive oil
    
    
  • 4 flour tortillas
    
    
  • Chop vegetables into 2cm chunks.
    
    
  • Toss in 1 tbsp olive oil and seasoning of your choice.
    
    
  • Cube two skinless chicken or turkey breasts and toss in 1 tbsp olive oil and seasoning.
    
    
  • Roast the vegetables in a hot oven for 10 minutes.
    
    
  • Add the chicken and roast for a further 15-20 minutes or until lightly browned.
    
    
  • Serve vegetables and chicken in warmed tortilla wraps.
    
    

Chicken fajitas with roasted vegetables



Ingredients


To cook



	Time guidelines Preparation: 10 minutes Cooking time: 25 minutes Oven temperature: 200°C / 180°C fan / gas mark 6

For a vegetarian option, omit the chicken and spread the tortilla with houmous before filling with roasted vegetables.

Wednesday

• • 250g mushrooms, sliced
    
    
  • 1 onion, sliced
    
    
  • 1 garlic clove crushed
    
    
  • 130ml hot vegetable stock
    
    
  • 2 teaspoons (tsp) wholegrain mustard
    
    
  • 1 tsp tomato puree
    
    
  • 1-2 tbsp half-fat crème fraiche
    
    
  • 2 tsp olive oil
    
    
  • handful flat leaf parsley
    
    
  • brown rice or couscous
    
    
  • seasonal vegetables to serve (optional)
    
    
  • Heat the oil in a saucepan. Add onion and then cover pan with lid. Fry onion for five minutes until softened.
    
    
  • Add the garlic and mushrooms. Stir in the vegetable stock, mustard and tomato puree.
    
    
  • Bring to the boil and cook with the lid on for two minutes.
    
    
  • Remove the lid and boil rapidly to reduce the liquid to a syrupy consistency.
    
    
  • Stir in the crème fraiche and a handful of chopped parsley.
    
    
  • Serve on a bed of rice with the seasonal vegetables.
    
    

Mushroom stroganoff



Ingredients


To cook



	Time guidelines Preparation: 5 minutes Cooking time: 10 minutes (25 minutes if served with brown rice)

Thursday

• • half an onion
    
    
  • 250g lean or extra lean minced beef
    
    
  • 1 small garlic clove crushed
    
    
  • 1 tsp grated ginger (approx 2cm piece)
    
    
  • leaves from one sprig of fresh thyme
    
    
  • 1 tsp soy sauce
    
    
  • 2 tsp olive oil
    
    
  • pinch black pepper
    
    
  • 2 granary buns
    
    
  • fresh tomato salsa and rocket leaves to serve
    
    
  • Finely dice half an onion and soften for five minutes in olive oil. Remove from heat.
    
    
  • In a large bowl mix together the beef mince, softened onion, garlic, ginger, thyme and soy sauce. Season with black pepper.
    
    
  • Wet your hands and shape into two even-sized patties about 1cm thick.
    
    
  • Grill the burgers for five minutes each side. Take care not to overcook because they will dry out easily.
    
    
  • Serve in a granary bun with rocket leaves and tomato salsa.
    
    

Beef burgers



Ingredients


To cook



	Time guidelines Preparation: 10 minutes Cooking time: 15 minutes

Friday

• • 250g fresh pasta or 150g dry pasta
    
    
  • 1 can tuna in spring water or brine
    
    
  • 400g can chopped tomatoes
    
    
  • pinch of dried mixed herbs
    
    
  • 6 tbsp frozen peas
    
    
  • 2 tsp crushed garlic or garlic puree
    
    
  • 2 tsp capers or black olives
    
    
  • 1 tbsp grated parmesan and salad leaves to serve
    
    
  • Cook your favourite pasta shapes, drain and toss back into the pan.
    
    
  • Drain can of tuna.
    
    
  • Stir in tuna, tomatoes, mixed herbs, peas, garlic and capers or olives.
    
    
  • Reheat gently.
    
    
  • Serve with a light sprinkling of parmesan and a large mixed green salad.
    
    

Easy tuna pasta



Ingredients


To cook



	Time guidelines Preparation: 5 minutes Cooking time: 12 minutes (5 minutes if using fresh pasta)

Saturday

• • 2 lean pork chops
    
    
  • half an onion
    
    
  • 1/2 tsp ground cumin
    
    
  • 1/2 tsp ground coriander
    
    
  • 1/4 tsp chilli powder
    
    
  • half a lemon
    
    
  • 2 tbsp olive oil
    
    
  • seasonal vegetables or mixed green salad to serve
    
    
  • Roughly chop the onion. Tip into a food processor or a bowl if using a hand blender.
    
    
  • Add cumin, coriander, chilli powder, olive oil and the juice and rind of half a lemon.
    
    
  • Blend into a paste.
    
    
  • Place the pork chops into a robust freezer bag and add the paste.
    
    
  • Seal the bag and shake well to make sure the meat is well covered.
    
    
  • Place in a bowl and refrigerate for at least two hours or leave overnight.
    
    
  • Grill or BBQ the chops for 6-10 minutes each side, depending on thickness, until cooked through.
    
    
  • Serve with vegetables or salad.
    
    

Aromatic pork chops



Ingredients


To cook



	Time guidelines Preparation: 10 minutes plus 2 hours to marinade Cooking time: 15-20 minutes

Sunday

• • 250g lean steak
    
    
  • 100g mushrooms, sliced
    
    
  • 1 red pepper, sliced
    
    
  • 1 small pack mangetout
    
    
  • 100ml half-fat crème fraiche
    
    
  • 1 garlic clove crushed
    
    
  • 1 tsp wholegrain mustard
    
    
  • 1 tbsp sunflower or vegetable oil
    
    
  • basmati rice, wild rice or couscous
    
    
  • Cut the steak into strips. You can also use other meat such as chicken breast or turkey.
    
    
  • Heat oil in a wok or large frying pan.
    
    
  • Fry meat for about five minutes until it starts to brown.
    
    
  • Add red pepper, mushrooms and garlic.
    
    
  • Cook for a few minutes more until softened.
    
    
  • Add a large handful of mangetout, the crème fraiche and mustard.
    
    
  • Stir well and cook for a few minutes more until bubbling.
    
    
  • Serve on a bed of rice or couscous.
    
    

Beef, red pepper and mushroom stir fry



Ingredients


To cook



	Time guidelines Preparation: 5 minutes Cooking time: 15 minutes

Healthy desserts

Always choose a dessert that includes plenty of fruit. This helps to keep the calories down and makes it nutritious and filling. All these recipes serve two.

• • 2 pears
    
    
  • 2 tbsp Greek yogurt (fat free works well too)
    
    
  • handful raspberries
    
    
  • 2 tsp caster sugar
    
    
  • Half the pear and scoop out the core, place cut-side up in a flame proof dish.
    
    
  • Sprinkle with a little caster sugar and grill for 3-4 minutes until starting to brown.
    
    
  • Put the yoghurt into a bowl and stir in a handful of fresh raspberries or blend the raspberries first to make a coulis.
    
    
  • To serve, spoon the raspberry yogurt into the centre of the each pear half.
    
    

Grilled pears with raspberry yogurt



Ingredients


To cook



	Time guidelines Preparation: 5 minutes Cooking time: 15 minutes

• • 1 small melon
    
    
  • 1 small lime
    
    
  • 2 tbsp fresh orange juice
    
    
  • 1 kiwi, sliced
    
    
  • 2 handfuls of strawberries, sliced
    
    
  • 2 tbsp Greek yogurt
    
    
  • Slice melon lengthways and scoop out the flesh into a bowl.
    
    
  • Add strawberry and kiwi slices, orange juice and a squeeze of lime.
    
    
  • Share the fruit between the two melon shells and serve with yogurt.
    
    

Strawberry and melon salad



Ingredients


To cook



	Time guidelines Preparation: 10 minutes

• • 2 large apples
    
    
  • 2 tbsp raisins
    
    
  • 2 tsp light brown sugar
    
    
  • 1/2 tsp cinnamon
    
    
  • 2 tbsp low fat yoghurt or half fat crème fraiche
    
    
  • Remove the core of the apple.
    
    
  • Cut the skin of the apple right around the middle - but don’t cut the apple in half.
    
    
  • Place the apple upright in an ovenproof dish.
    
    
  • Add enough cold water to cover the base of the dish.
    
    
  • Mix the raisins with sugar and cinnamon, then fill the empty cores of the apples with the raisins, pushing them right down.
    
    
  • Bake in oven for 40 minutes.
    
    
  • Serve with low fat yoghurt or half-fat crème fraiche.
    
    

Baked apple with raisins



Ingredients


To cook



	Time guidelines Preparation: 10 minutes Cooking time: 40 minutes Oven temperature: 190°C / 170°C fan / gas mark 5

Reviewed by Dr Stuart Crisp, paediatric specialist registrar

Many toddlers are seriously injured in accidents around the home. These can include: falling down stairs, banging their heads, pulling objects on top of themselves, getting seriously scalded or burnt, or even falling out of windows that have not been properly shut or locked.

Making your home as safe as possible will allow your child a better opportunity to explore their world in safety and give you peace of mind. However, it cannot be emphasised strongly enough that no matter how safe your home appears to be, parents should always keep an eye on their children. It is important to know where they are and what they are doing at all times.

The kitchen

The kitchen can seem like an exciting place for a child, but it is full of dangers: electrical appliances with trailing cords, kettles full of boiling water, hotplates or gas burners on the stove, hot saucepans and kitchen drawers full of sharp knives.

The drawers and cupboards themselves can also be dangerous. If a drawer can be pulled out completely it could land on top of a child. It is also very easy for children to get their fingers trapped in drawers or doors. Because they don’t have complete control over their actions, they can easily slam a drawer shut on their hands.

There are two ways to secure drawers and cupboards. You can fix a stopper to the drawers to prevent them being pulled out completely or fix a safety catch to prevent a child from opening the drawer or cupboard at all.

It is also a good idea to fix a catch on the fridge door so that a child can’t get their fingers trapped, or even worse, climb inside. If the door closed by accident they would quickly suffocate or suffer from hypothermia.

Cleaning products and household chemicals

It is especially important to lock all cabinets that contain harmful or toxic products. Dish-washing agents, cleansing agents, detergent, petroleum, turpentine, flammable liquids and fertilizers are all toxic if swallowed. Dish-washing powder is also dangerous if it comes into contact with skin - for example, if a child spills a packet over themselves.

Electrical cords

It is very easy for a child to grab hold of an electrical cord and pull a kettle, blender, or other appliance onto themselves causing severe scalding or serious injury.

This can be prevented by installing a cord holder, which will make the cord too short to reach over the edge of the table or work surface. You can also simply make electrical cords shorter.

Stoves and ovens

To prevent a child burning their fingers on hotplates or grabbing a saucepan handle and pulling the contents over him or herself, you can fix a grating at the edge of the stove. Always make sure that saucepan handles are turned inwards so children can’t reach them.

You can also safeguard the knobs on the stove to prevent the child from turning on the stove or changing the temperature.

Put a catch on the oven door so a child can’t open it. The glass window on the oven door may also get hot enough for your child to burn him or herself. You can prevent this by putting a fireguard or grate over the door.

Living rooms and bedrooms

Drawers and cupboards in the living room and bedroom can be secured in the same way as kitchen cupboards.

There are many sharp, pointed edges in the living room - on tables and shelves for example - that a toddler could accidentally fall against. Low corners that could poke a child in the eye are especially dangerous. The best way to make them safe is to put plastic corners on them, or if you can’t find these, foam rubber secured with a rubber band. This may not look very attractive, but could save your child from serious injury.

Use a wedge or hook on doors to hold them permanently open so that a child can’t get their fingers trapped.

Windows

As soon as toddlers are able to get around and explore their surroundings, they may start trying to climb up and look out of windows. If windows are not locked, put stoppers on them so they can’t be opened by more than 10cm. The best place to put them is at the top of the window so your child can’t reach them.

Move furniture away from windows, so children can’t climb up in the first place.

Shelving

Some children may try to use book shelves as a climbing frame. Make sure all shelves are fixed securely to the wall so they can’t topple onto a child.

Floor coverings

Loose carpets and rugs are dangerous for children who are just learning to walk because they could easily trip over them. Put rubber matting or stoppers under the carpets and don’t put down loose rugs until the child is older.

Tablecloths

Toddlers will naturally grab hold of a dangling tablecloth to help themselves stand up. If you are using a tablecloth, make sure you fasten it to the table with pegs or clips so a child can’t pull the cloth and everything on the table over him or herself.

Power points

Electrical accidents are always very serious. They can cause severe third degree burns or even death.

All power sockets should be secured with a plastic covering that a child can’t remove.

Find out if there is a safety relay or circuit breaker in the house and if there isn’t, have one installed.

The bathroom

Children love playing with running water but it only takes 10cm (4in) of water for a small child to drown. If a small child’s face goes underwater, they will automatically breathe in so that they can scream and this will fill their lungs with water. Children also lose their sense of direction underwater, so they can’t react by pulling their head out or standing up as an adult would do.

Put bath and basin plugs out of reach so that a child can’t fill up the bath or basin.

The toilet lid can be held down with a clip attachment so a child can’t open it.

You may want to adjust the thermostat on the boiler while your child is still a toddler so that if they turn on a tap, they won’t be scalded with very hot water.

All medicine, tablets, vitamins and herbal remedies should be locked in a medicine cabinet or other cupboard so a child can’t get to them and swallow them - colourful pills are very attractive to children. Remember that medical poisonings can be extremely serious.

Stairs

Stairs are dangerous for children until the age of about four years. You can safeguard against falls by putting gates in front of the staircase.

If there are openings between the steps, these should be blocked up to prevent your child from falling out underneath or getting their head stuck. A child’s head can also get lodged between the banister rails if they are more than 7.5cm (3in) apart.

Based on a text by Christel Bech, nurse

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.

First aid courses are offered all over the country at night schools or by voluntary organisations such as St John Ambulance or The Red Cross.

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 any one else present knows CPR.
  
  
• provide artificial respiration immediately (see below).
  
  
• begin CPR immediately (see below).
  
  

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.
  
  

How do I perform CPR (cardiopulmonary resuscitation)?

See if there is breathing. If not, start artificial respiration as described above. Checking for a pulse in the neck (carotid artery) may waste valuable time if the rescuer is inexperienced in this check. The procedure is:

• place your fingers in the groove between the windpipe and the muscles of the side of the neck. Press backwards here to check for a pulse.
  
  

If there is no pulse, or if you are unsure, then proceed without delay thus:

• look at the person’s chest and find the ‘upside-down V’ shaped notch that is made by the lower edge of the ribcage. Place your middle finger in this notch and then place your index finger beside it, resting on the breastbone. Take the heel of your other hand and slide it down the breastbone until it is touching this index finger. The heel of your hand should now be positioned on the middle of the lower half of the breastbone.
  
  
• now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only.
  
  
• keep your elbows straight, and bring your body weight over your hands to make it easier to press down.
  
  
• press down firmly and quickly to achieve a downwards movement of 4 to 5cm, then relax and repeat the compression.
  
  
• do this 15 times, then give artificial respiration twice, and continue this 15:2 procedure until help arrives.
  
  
• aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud ‘one and two and three and four …’ etc.
  
  

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.

Based on a text by Dr Henrik Omark Petersen

First-aid kit

Reviewed by Christine Clark, pharmacist  and Dr John Pillinger, GP

First-aid kit basics

A first-aid kit contains emergency supplies and medication for unexpected minor illnesses or accidents.

While it is vital for people who suffer from a chronic disease or condition to take their medication with them at all times, it is also a good idea for everyone to keep a first-aid kit in the home or car, or take one with them on holiday in case of emergencies.

If going abroad, talk to your doctor before leaving about arrangements for vaccinations or special medication such as malaria tablets.

Although it is possible to buy additional items for your first aid kit when you are abroad, it is a good safeguard to purchase extra supplies and medication before your departure. Emergency situations occur unexpectedly and you may find yourself unable to obtain essential items just when you need them most.

Remember that medicines suitable for adults are not always suitable for children as well. Always read the label to check who can take the medicines in your first-aid kit, and at what dose.

Motion sickness

Medication to prevent motion sickness caused by car, air or sea travel can be bought over the counter without prescription. If necessary, this should be taken before starting a journey.

Diarrhoea, irregular bowel movements or indigestion

It is a good idea to be prepared for diarrhoea. Medication to treat it is available both on prescription or over the counter at your local pharmacy.

If diarrhoea or vomiting occur despite these precautions you will need to make sure the patient gets enough liquid. This is especially important where children are concerned.

Cola drinks are particularly helpful since they replace essential salt and sugar as well as provide a source of liquid, but a first-aid kit should also contain a rehydration medicine (a powder or large tablet that is dissolved in clean water, for example Dioralyte) to prevent dehydration.

Many people get constipation when travelling. A mild laxative, available from a pharmacy, usually relieves most symptoms.

For people who suffer from indigestion or heartburn when eating spicy food, it is a good idea to keep a supply of antacid preparation in the first-aid kit.

Pain relievers

Aspirin (eg Aspro clear), paracetamol (eg Panadol) or ibuprofen (eg Nurofen) can be bought over the counter. They come in different forms including soluble tablets, ordinary tablets or suppositories, and can relieve headache, muscle pain, toothache and period pain. Aspirin should not be given to children under 16 years of age, unless on the advice of a doctor.

Fever

Fever is most commonly caused by viruses that cannot be treated with antibiotics. Even though antibiotics can be bought in some countries without a prescription, they should be avoided. If antibiotics are necessary, a GP should be consulted. A doctor will be able to prescribe the appropriate antibiotics or other medication.

Sunburn

A sunblock to be applied prior to exposure to the sun should always be included in a first-aid kit, along with cream and lotion for use after sunbathing. The pharmacist should be consulted as to the appropriate screening (SPF-sun protection factor) level.

Insect bites

Antihistamines and soothing lotions such as calamine are effective at controlling the itching of insect bites or stings.

Cuts and grazes

The following items are all useful for treating minor cuts and grazes:

• sticking plasters
  
  
• cotton wool
  
  
• safety pins
  
  
• a gauze bandage and supportive bandages
  
  
• antiseptic lotion or saline to clean wounds.
  
  

Do I need to take everything wherever I go?

There is no need to take everything with you. Indeed, a longer trip might require more supplies than a shorter one. Buy products in small sizes that fit easily into your luggage. Remember that all drugs have a ‘use by’ date and should be thrown away after they have expired.

Based on a text by Dr Per Grinsted, GP and Dr Erik Fangel Poulsen, specialist

Reviewed by Dr Stuart Crisp, specialist registrar

Why learn first aid?

	WARNING! This advice is a general guideline for use in an emergency. It is not intended to replace professional classes in first aid and resuscitation.

First aid is an important skill. By performing simple procedures and following certain guidelines, it may be possible to save lives by giving basic treatment until professional medical help arrives.

Remember, too, that practice makes perfect. In an emergency there is no time to read instructions. If you’ve memorised some of the basic procedures, it will help you react quickly and efficiently.

Breathing difficulties

If someone stops breathing, see if the person replies if talked to or touched on the shoulder. If not, call an ambulance and then begin first aid.

• Place the person on his or her back on the floor.
  
  
• Tilt the head so that the chin is pointing upwards. Do this by placing the fingertips under the jawbone, then lift gently while pressing down softly on the person’s forehead. This is done to make sure the tongue is not blocking the throat.
  
  
• Keep holding the head in this way while checking for breathing: see if the chest is rising and falling, or place your ear next to their mouth to listen for breathing.