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Archives for : May2014

Shocking

One of the things that winds me up about reporting of accidents in the news is the use of the word “shock”.

A recent example is a report that said “there were no serious injuries, and the driver is being treated for shock”. My first reaction is, “well that’s bloody serious for a start!”.

My perspective is somewhat different though. I’ve been a work-place first-aider / first-responder / BHV’er (as the Dutch call it) for quite a while. While I’ve luckily never had to use all that training, shock is one of the most serious conditions I am ever likely to have to face. When I hear or see the word used therefore it’s one of those things that make me cringe.

The reason why it winds me up when the news uses the word shock is because what they really mean is “Acute Stress Reaction”. Basically the person is freaked out and distraught.

The symptoms can be similar, some of them at least, like racing pulse, rapid, shallow breathing, anxiety. That’s though where the similarities end. If you don’t treat someone with acute stress reaction immediately they might start crying, or hyperventilate and pass out, but that’s it; that’s not to say they don’t need or deserve care, they just don’t need it right now. If you don’t treat someone with shock, then in a couple of minutes they’ll be dead.

The human body goes into shock when the brain and other vital organs are short of oxygen.  The body starts shutting everything else down, that’s why one of the major symptoms is cold and clammy hands and arms; the body stops sending blood to the extremities and you start sweating as the body loses control of the sweat glands.

Blood loss from injury  is the most common type of shock encountered by first-responders; there simply isn’t enough blood left to carry the oxygen the body needs. Others include some types of heart conditions (e.g. not pumping correctly) and also anaphylactic shock (i.e. an acute alergic reaction).

During my certification here in the Netherlands, the course tutor told us the Dutch emergency services response to someone in shock was to send two ambulances, police out-riders and a helicopter if they can. I’ve not reason to doubt this, and living quite close to a hospital I’ve actually myself seen police outriders twice clearing the junction in front of my house for ambulances.

If you so much as suspect shock, e.g. because of bleeding or internal injuries (shock can set in slowly, e.g. the day after an injury happens, when you’re bleeding internally), call the emergency services at once. If you’ve already called them once, call them again and tell them it’s shock. Get the person to lie down flat, raise their legs to increase blood flow to the brain, keep them warm.

Someone in shock will be very thirsty. Under no circumstances give them something to drink or to eat, no matter how much they beg. Their stomach has already shut down, they will just vomit it back up and may choke; especially once they stop breathing. Then keep them calm and keep them company; according to my trainer the person will already know they are dying. Keep a very close eye on them until the ambulance arrives, they can stop breathing any time, so be ready for it and try to send someone for an AED, so you have it there when you need it. Don’t be surprised, when the ambulance shows up, that the crew just run in, grab the patient, and run out again.

The reason the Dutch emergency services (and I presume those of other countries as well) make such an effort with shock is that if you can get someone to a hospital quickly then you can save them, and they can make a fairly full recovery. Every second counts, literally.

So maybe if the next time you read about “shock” in the papers and you remember this post and what shock really is and how to recognise and respond to it, this post will have done some good.