The relationship between poisoning and accidental first aid

Statistical Report of the Chinese Society of Emergency Medicine in 2023), and the practical experience of poisoning first aid has in turn filled in a large number of blind spots in general accident first aid.

I used to think that poisoning was an extreme scenario in TV dramas where people drank pesticides and were poisoned. It wasn’t until I followed the team from the city’s 120 Center in the past two years that I discovered that most poisoning incidents are ridiculously close to ordinary people’s lives. On a night shift in late autumn last year, we responded to the police and went to a family home in the old city. A family of four ate beef stew with sprouted potatoes that had been stored for three days. The old man thought it was just a normal stomachache at first, so he endured it for four hours. It was not until his 10-year-old grandson suddenly convulsed and foamed that he thought to call 120. Dr. Li, who treated the patient, sighed and said that they encountered more than a dozen cases every month in which they regarded poisoning as a common gastrointestinal discomfort and did not realize that it was an accident that required immediate treatment.

Interestingly, there are actually two different views on the relationship between the two in the first aid community. The mainstream is the "universal school", which is composed mostly of front-line emergency doctors. Their core logic is that most ordinary people cannot tell the situation at the scene when calling the police. They should give priority to the general emergency first aid process of "judging consciousness-opening the airway-monitoring vital signs". At least they can save the patient's vital signs first and avoid making fatal mistakes. After all, whether it is a car accident, falling from a building, or poisoning, follow-up treatment is possible only if a person is alive. The Centers for Disease Control and Prevention and researchers in the field of poisoning prevention and control even support the "idiosyncratic" view. The statistics they produced show that 17% of poisoning death cases were precisely because they copied the general trauma first aid procedures at the first time, such as inserting ventilation tubes into patients who swallowed strong acid, which caused irreversible esophageal and airway burns. ； Or when encountering a leak of volatile poisonous gas, the rescuer is anxious to check the patient's condition and rushes in without taking any protection. In the end, he himself is poisoned and collapses, which increases the rescue burden.

The current 2024 version of the "National Civilian First Aid Guide" actually takes the middle value of the two parties and adds a provision that was not available before: the first step in all accidental first aid is to spend 10 seconds to conduct an environmental investigation to see if there are any empty medicine bottles, pesticide bags, spoiled food, or pungent abnormal smells around, confirm that there are no signs of poisoning, and then follow the general process. If there is suspected poisoning, cut off contact with the poison before rescuing people. Speaking of which, this change was implemented because of the carbon monoxide leakage accident at the construction site in Jiangsu in 2022: the first security guard who arrived had only learned trauma first aid before, and rushed in to carry the unconscious worker, but he was also poisoned and fainted. Later, the second batch of rescuers opened the window to ventilate and cut off the source of poisoning, and then lifted the person out, so that no more serious casualties were caused.

When I was doing first-aid science popularization for the community last year, many aunts gathered around and asked, if a family member took the wrong medicine, could they just pick their throat to induce vomiting? I have to explain it over and over again every time: If you eat corrosive disinfectant, strong acid and alkali, inducing vomiting will cause the digestive tract to be burned again. If the person is already unconscious, the vomit caused by the induced vomiting will choke into the trachea and suffocate in minutes. You see, this is the most tangible manifestation of the relationship between the two: poisoning is a subset of accidental first aid, but it has its own special treatment logic, which cannot be fully applied to the general trauma first aid process. However, if there is a situation of suffocation or cardiac arrest, general accidental first aid operations such as the Heimlich maneuver and cardiopulmonary resuscitation are still the core means of saving lives.

Let’s talk about a very intuitive change. In the past few years, everyone bought first-aid kits, which basically contained band-aids, bandages, iodophors and other trauma treatment tools. Now if you search for regular household first-aid kits, most of them will be equipped with medical activated charcoal, emetic tubes, and gas masks. This is because More and more people are realizing that the probability of daily poisoning is actually higher than the probability of being cut or falling and breaking a bone. According to the Centers for Disease Control and Prevention, of the 120 accidental first aid calls in China every year, 27% are due to various types of poisoning, which is 1 percentage point higher than the proportion of traumatic injuries in car accidents.

I was chatting with Dr. Li, who has been working in emergency medicine for 12 years. He said that after so many years of working in emergency medicine, the most regrettable thing is never the critically ill patients who cannot be saved, but the tragedies that are clearly avoidable: For example, if you mix toilet cleaning liquid and 84, you will be poisoned and think it is a cold, and you will feel dizzy.； For example, if an old man takes the wrong antihypertensive medicine, his family members must give him some "detoxifying" mung bean soup first, missing the best time for gastric lavage. To put it bluntly, I want to clarify the relationship between poisoning and accidental first aid. I don’t want ordinary people to become first aid experts, but I hope everyone will pay more attention when encountering an abnormal situation: first check whether there is poisoning, and then rescue people. Don’t do bad things out of good intentions. After all, for ordinary people, when it comes to first aid, making no mistakes is much more important than "doing it perfectly".