Code Blue

Responding to Injuries and Illnesses

An article in a series on medical emergency response

From the Bible

In the morning, when the wine had gone out of Nabal, his wife told him these things, and his heart died within him, and he became as a stone (1 Samuel 25:37).

Now Ahaziah fell through the lattice in his upper chamber in Samaria, and lay sick (2 Kings 1:2).

After this the son of the woman, the mistress of the house, became ill. And his illness was so severe that there was no breath left in him (1 Kings 17:17).

Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord (James 5:14).

Introduction

What do you do in these situations?

• You are sitting in the back of the sanctuary during the morning service and you see someone several pews ahead of you waver, then start to slump.
• As you are following the church van on the way to the Sunday School picnic, a car on a side street fails to stop and hits the van on the passenger side.
• In the church vestibule, an older man helps his wife sit down, and she just stares ahead, one side of her face drawn up.
• At a church picnic on a very hot day, a young man becomes weak while flush and sweating profusely.

We need to be trained and equipped to respond to many kinds of medical emergencies.

In the News

Even though the incidents in these news stories were not in church, the same kinds of medical emergencies happen in church or at church events.

Heart Attack

Las Vegas, Nevada, March 15, 2021 - A man suffered a heart attack - the kind called a "widow maker" - while at home. Four days earlier, his wife had completed a recertification course in First Aid and CPR. She immediately called 911, then she administered CPR until the EMTs arrived 11 minutes later. Explaining why she called 911 first, a doctor said, "Time is tissue" - the sooner medics arrive, the better. She couldn't have done the CPR much longer - it was amazing she kept it up for 11 minutes.[1]

Electric Shock by Lightning

Blue Ridge Parkway near Grandfather Mountain, North Carolina, July 22, 2013 - A storm came while a couple traveled the Blue Ridge Parkway on their motorcycle. With no shelter available, they pulled into an overlook pull-out. While they were there lightning struck and split a nearby tree. The current traveled through the ground and knocked the wife unconscious. Her husband saw she was not breathing and performed cardio-pulmonary resuscitation, saving her life.[2]

Choking

Little Rock, Arkansas, 2021 - A teenaged girl who had learned life-saving skills in a 2019 Safesitter class, saved a classmate during lunch at her school. The classmate was choking, and the girl executed the Heimlich Maneuver, dislodging the food in his windpipe.[3]

Injuries in Traffic Accident

Udairi Desert, Kuwait, March 25, 2008 - A convoy was taking supplies to Kuwait City to load equipment and supplies for Operation Iraqi Freedom. An SUV in the convoy veered off the road and into a utility pole. A scout section sergeant saw the mishap, stopped his vehicle, and jumped out to tend to any injured persons. While treating a severely-injured contractor, he also commanded soldiers to guide traffic around the scene so the convoy could continue its mission and make room for military emergency responders. His timely actions saved the life of the contractor.[4]

Stroke

Dilworth, Minnesota, 2020 - Two neighbors were working together in a yard when one of the men fell to the ground. His neighbor recognized the signs of a stroke. He called 911, put a pillow under the victim's head, covered him with a blanket, and stayed with him until medics arrived. [5]

Special Downloadable Resource

The special Sheepdog Church Security resource for May is the "Safety Member Training Record."[6] This Excel file has three tabs: Instructions, Training Info, and Record Template. When you click *HERE* to get it and enter your email address, you'll also be signed up for the monthly newsletter (The Church Guardian) and the weekly email update (that is, if you're not already subscribed).

Training Info (2nd tab) lists First-Aid, AED, and CPR under "Training Types" and Medical Emergency and Mass Trauma under "Drill Types." The Safety Member Training Record (3rd tab) covers "Yearly Training," "Training Every 2-Years," and "Yearly Drills." Relevant to our monthly topic, "Training Every 2-Years" includes First-Aid, AED & CPR, and Yearly Drills includes Medical Emergency (Life Threatening) and Mass Trauma (Severe Weather & Active Shooter).

Knowing What to Do for Code Blue

In each of the news stories, those responding to the medical emergencies had some level of training, or at least knowledge of what to do. In at least two cases, this training was in person, and for two it was on a professional level.

In a church, we need to have people there who know what to do for Code Blue. Some members of the congregation may be medical professionals, EMTs, firefighters, law enforcement officers, and others who receive this training as part of their jobs. Others may have also been trained through their own choice.

Since members of a Church Safety Team are there for the safety and well-being of the flock, they should also be trained in life-saving skills. Reading up on these and watching videos may help some, but in-person training will include some hands-on practice in First Aid, CPR, and the use of an AED (Automated External Defibrillator). Add renewal training and drills to this certification.

Having What You Need for a Medical Emergency

When a medical emergency happens, you not only must know what to do, you may also need supplies and equipment. The featured products for May are two medical kits from Mountain Man Medical (MMM), available through a Sheepdog Church Security partnership.

The first is the Sheepdog Belt IFAK[7]. This individual First Aid kit was developed in collaboration between SDCS and MMM. It can be carried on your belt and has what is needed for a Code Blue call.

The second is the Mass Casualty Kit[8]. It is a carry bag with what is needed to treat multiple severe injuries, such as in a disaster (natural or manmade) or an active shooter incident. The number of kits needed depends on how many people are in your church.

Recognizing and Treating Medical Emergencies

Medical emergencies can be illnesses or injuries.

Injuries

Unless a person is injured while alone, the cause of injury is usually observed and known. A common cause of injury is slips and falls, usually resulting in any of the last five injuries described below, rarely burns. The injuries usually encountered in a church or at a church-related event are burns, cuts, bruises, concussions, sprains, and fractures. Basic First Aid tells us how to treat each of these:

• Burn - The first act is to cool the burn to minimize damage using ice or a cold gel pack. If you clean it, use cold running water - do not scrub. Most burns should not be dressed and actually need air to cool and heal. If it must be dressed to protect it, dress it lightly, not tightly.
• Cut - How badly is it bleeding? If it is bleeding much, the first priority is to stop the bleeding. The blood coming out usually keeps contaminants from getting in. Once bleeding is stopped, then it can be cleaned. The first dressing should be to stop further bleeding. Severe bleeding on a limb or an extremity may require using a tourniquet. Torso and junction cuts/tears/wounds require wound packing.[9][10]
• Bruises - Use ice or a cold pack to stop or retard swelling.
• Concussion - This is bruising of the brain. Keep the person quiet, have them sit or lie down. Cover them. Use ice or a cold gel pack to cool the brain. According to experts, ice is better. As it melts, it cools more evenly. This limits swelling on the brain, which in turn, reduces damage.
• Sprain - Immobilize the sprained joint and cool with ice or cold pack. Put the person in a position which puts the least stress on the joint.
• Fracture - Number One, don't try to set the break yourself. Let the doctor do that. Keep the person still. Place them where the fracture is supported. If they can stay there until medics come, that's good. Splint a broken arm or leg if they have to be moved (as in an evacuation) or carry them on a board or stretcher.

Some accidents, such as falls and vehicular collisions, may result in spinal injuries. If a spinal injury is suspected, try as much as is practical to not move them. Only move them if you must, and take care to not bend or twist the spine. Use a board if one is available, and take care in moving them onto the board.

Illnesses

There are several emergencies resulting from a person's own medical condition. There are others resulting from allergies, extreme temperatures. To these, we can add choking.

Heart Attack - What makes you think someone is experiencing a heart attack? They may appear to have chest pains, or be unsteady, dizzy. The person may say they have pain in their shoulder going down their arm, or that they are nauseous. They may also be gasping for breath. Often, we realize it is a heart attack when the person collapses.[11]

As soon as you reasonably believe it is a heart attack, call 911 or have someone else call 911. On the radio call, "Code Blue, 911, [location], heart attack." Stretch the person out on the floor and begin CPR. If the church has an AED, have someone get it while you administer CPR. That way, it is there if you need it, such as if the patient is unconscious. If you are tiring, switch of with someone else who knows CPR.

Stroke - According to the American Heart Association (AHA), the signs of stroke are:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

If it is a stroke, time is important to minimize brain damage. Recognizing and responding to a stroke are combined in the acronym F.A.S.T. -

• Face drooping.
• Arm weakness.
• Speech Difficulty.
• Time to call 9-1-1.[12]

Epileptic Seizure - Epilepsy is the result of a head injury which damages part of the brain. This results in seizures. Sometimes the seizure is only a "brain freeze," disorientation, or a headache. A grand mal seizure, on the other hand, causes the epileptic to lose consciousness and fall. According to the CDC, it rarely requires medical attention unless the person is hurt while falling, has one seizure after another, it is in water, or the person has certain health conditions or is pregnant.

What can you do? Stay with them until they revive. Stay calm. Clear the area around them of anything that can injure them if they trash around, keep people back a ways. Help them when they come to.

Anaphylactic Allergic Reaction - This is a general reaction, and it can be deadly. Each year, several people are killed by reactions to insect stings and bites, such as a man in the Chattanooga Tri-State area in 2015.[13] If someone is experiencing anaphylaxis (severe allergic reaction), call 911 and give them an epinephrine shot. If they can swallow give them diphenhydramine (aka Benadryl®), that is if it is not included in the injection with the epinephrine.

Heat Exhaustion - During hot weather, we should try to prevent heat exhaustion and heat stroke by keeping out of extreme heat and drinking enough water or electrolyte beverages. If someone becomes overheated - heat exhaustion - quick attention can keep it from becoming heat stroke.

Signs of heat exhaustion are flushed face, profuse sweating, weakness, fatigue. Get them out of the heat. Give them water to drink. Also give them electrolytes, either as a salt tablet or as a beverage (such as Gatorade®). Use wet cloths to cool their head.

If they become very faint or pass out, it is heat stroke. Call 911. Get them out of the heat. Put ice in their mouth a little at a time. Cool them with cold, wet cloths.

Hypothermia and Frostbite - Hypothermia can happen anytime it is cold, especially if someone gets into cold water. Frostbite happens during freezing temperatures.

Hypothermia is the body's temperature dropping too low. The body cannot produce heat faster than it is lost until it is below 95ºF. Shivering is a sign that a person either has hypothermia or is close to it. Their speech may be slurred, and they may be confused. Their pulse will be weak, their breathing shallow, and they become drowsy. They lose their coordination and become clumsy. It is extremely serious if they become unconscious.

Get the person into a place that's warm but not hot. Call 911. If they are conscious, give them something warm to drink, even hot tap water (but not too hot.). This will warm their core. After they start to warm up inside, then you can warm their hands and feet gently.

Frostbite is when part of the body are frozen, Usually this is fingers, toes, ears, and nose. Use cool water to begin thawing the frostbitten parts. When these are thawed, then you can use slightly warm water, then medium warm water. We do not want to shock the tissues with too great a temperature change.

Choking - Most of us know when someone is choking. Most times it is when the person is eating, but people can choke on chewing gum or anything else they put into their mouths. It's like they're gagging, but they cannot talk because the substance is in their windpipe (trachea). Saving time is essential, because they cannot breathe and the brain will soon be deprived of oxygen (hypoxia).

Dr. Heimlich invented the procedure named for him (the Heimlich Maneuver) to use the diaphragm to force the choking object out with air from the lungs. Grab the choking person from behind with a fist just under the ribs and the other hand over the fist. Force the fist suddenly in and up. This pushes the diaphragm into the lungs. Repeat until the offending object is expelled. If the person passes out, call 911.

Conclusion

We need training, practice, and drills to know how to respond to a medical emergency in the church, whether it is an injury or an illness.

There Is More

The topic for May is responding to medical emergencies and mass casualty events. The other articles this series are "Mountain Man Medical" (Equipping Groups for Medical Emergencies) and "Many Down" 911 (Mass Casualties). The last article of the month is "The 2005 Living Church of God Shooting" from the series Lessons Learned from Church Shootings.

References

1. Steve Wolford, "Southern Nevada woman urges others to learn CPR after saving husband's life," News3LV (KSNV), March 18, 2021 [https://news3lv.com/news/local/southern-nevada-woman-urges-others-to-learn-cpr-after-saving-husbands-life].
2. Station News Staff, "Woman says husband saved her after being struck by lightning," WSOC-TV, July 22, 2013 [https://www.wsoctv.com/news/local/woman-says-husband-saves-her-after-being-struck-li/334208486/].
3. Beth Hunt, "Teenager uses skills from babysitting class to save a choking classmate," KATV, March 4, 2021 [https://katv.com/news/health/teenager-uses-skills-from-babysitting-class-to-save-a-choking-classmate].
4. Spc. David Hodge, "Soldier's quick action saves man's life," Defense Visual Information Distribution Service (DVIDS), April 5, 2008 [https://www.dvidshub.net/news/18190/soldiers-quick-action-saves-mans-life].
5. Mick Garry, "Stroke victim saved by quick-thinking neighbor," Sanford Health, November 13, 2020 [https://news.sanfordhealth.org/neurology/quick-thinking-neighbor-detects-stroke/].
6. Kris Moloney, "Safety Member Training Record," Sheepdog Church Security, © Copyright 2020 [https://sheepdog-church-security.ck.page/4bdb00c915].
7. "Sheepdog Belt IFAK," Mountain Man Medical [https://www.mountainmanmedical.com/product/sheepdog-belt-ifak/?aid=18].
8. "Mass Casualty Trauma Kit," Mountain Man Medical [https://www.mountainmanmedical.com/product/the-mass-casualty-trauma-kit/?aid=18].
9. Scotty Bolleter (BS, EMT-P), "Wound Packing Essentials for EMTs and Paramedics," Journal of Emergency Medical Services, April 1, 2017 [https://www.jems.com/patient-care/trauma/wound-packing-essentials-for-emts-and-paramedics/].
10. Mike Shertz, "Junctional Hemorrhage: The next frontier for hemorrhage control," Crisis Medicine, March 30, 2021 [https://www.crisis-medicine.com/junctional-hemorrhage-the-next-frontier-for-hemorrhage-control/].
11. Mayo Clinic Staff, "First Aid: Heart Attack," Mayo Clinic, February 11, 2021 [https://www.mayoclinic.org/first-aid/first-aid-heart-attack/basics/art-20056679].
12. AHA Staff, "What Are the Warning Signs of Stroke?" American Heart Association, © 2015 [https://www.heart.org/-/media/files/health-topics/answers-by-heart/what-are-the-warning-signs-of-stroke.pdf].
13. Station News Staff, "Bradley County man dies from wasp sting: A man in Bradley County was found dead after being stung by a wasp," WRCBtv, July 14, 2015, Updated July 15 [https://www.wrcbtv.com/story/29547234/bradley-county-man-dies-from-wasp-sting].