Equip and Train for Medical Response
An article in the May 2020 series, The Healthy Church
In the Bible
Luke was trained to be a physician:
Luke the beloved physician greets you ... (Colossians 4:14).
Instruction and learning is a basic concept in the Bible:
Your hands have made and fashioned me; give me understanding that I may learn your commandments (Psalm 119:73).
Several items and procedures were used in the Bible to treat injuries and illnesses. This is a sample:
- Medicine in general (Jeremiah 30:13).
- Cake of figs used for a poultice (2 Kings 20:7; Isaiah 38:21).
- Balm of Gilead (Jeremiah 8:22; 51:8).
- Oil and wine for cleansing wounds (Psalm 147:3; Luke 10:34).
- Eye salve (Revelation 3:18).
- Wine (unfermented or lightly fermented) to counteract the effects of bad water (1 Timothy 5:23).
- Bandaging cuts and wounds (Luke 10:34).
- Splinting broken bones (Psalm 51:8) This does not directly describe binding (splinting) broken bones, but refers to the practice of a shepherd dealing with a wayward lamb. The shepherd would break one of the lamb's legs, then set and splint the broken bone so it would heal right. The shepherd carried the lamb until it could keep up with the flock. By this time the lamb was bonded to the shepherd and always stayed close.
In the News
Someone there knew what to do --
Wrentham, Massachusetts, November 24, 2019 - During a Sunday morning service, a 75-year-old man collapsed. A nurse in the pew behind him immediately began CPR. Other nurses attending the service came to help until police and medics arrived, took over, and transported him to the hospital. The next day he was well enough to be transferred to a hospital in Boston.
Kenosha, Wisconsin, February 2, 2020 - During the Sunday morning church service, a man sitting in a pew slumped over. A nurse sitting next to him found he was unconscious and not breathing. She motioned to an EMT who was sitting with his family. The EMT administered CPR, and the man began breathing again and regained consciousness.
Pittsburgh, Pennsylvania, October 27, 2018 - When a gunman opened fire during Sabbath services, members of the congregation who had received Stop the Bleed training saved many lives. Out of the many shot, only eleven died.
A call for training --
Hartford, Connecticut, April 2013 - The American College of Surgeons convened a meeting of the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events. This committee considered, formulated, and issued The Hartford Consensus. This statement (and subsequent revisions) calls for widespread training in stopping severe and extreme bleeding, such as from gunshot wounds.
Being a First Responder at Church
There are many possible ways you can become a first responder to an injury or medical event in church or at a church event. You cannot predict what will happen or the time it happens, but when it does you need to know what to do and have what you need to do it.
Scenario 1: You are in the foyer during the Sunday morning service. Delicious aromas waft down the corridor from the fellowship hall and kitchen where the after-church dinner is being prepared. You are watching a car pull into the parking lot when you hear footsteps. Turning, you see Mary Mitchell.
"Hi, Mary. What's up?"
"You have to come quick. Sue Brown cut her hand. Real bad."
You go to the kitchen with Mary. Do you know what to do when you get there?
Scenario 2: The church dinner is a wonderful time of fellowship: everyone chatting as they go through the food line; smiles on faces as they sit down to eat. Even the children are both happy and well-behaved.
Later on, as some get up for seconds and others head for the desserts, you notice signs of concern at one table, so you get up and go over there. George Davidson is sitting there extremely still, staring blankly. His wife Sue stands at his left side speaking to him, "George. George. Are you OK?" He does not respond. "This is his bad ear," she says to Clara Smith. "I'll go to the other side."
Sue walks around the chair and speaks into George's right ear, "Can you hear me, George?"
The right side of George's mouth moves, trying to answer Sue. His right eye and eyebrow move, but not the left side of his face. In fact, the left end of his mouth seems drawn up.
You think, "This looks like a stroke." You know CPR and AED, but what should you do with a stroke?"
What Do We Need?
There are two categories of what we need to respond to injuries and medical emergencies in the church: Training and Equipment & Supplies.
If you are sick and need to go to the doctor, you don't want to trust your health care to someone whose only training has been watching "Dr. Welby M.D," on TV. Likewise, if you have a heart attack, you want a first responder who knows when and how to perform Cardio-Pulmonary Resuscitation (CPR) or to use an Automated External Defibrillator (AED). If you are badly cut or have a concussion, you want someone properly trained in First Aid treating you.
Sheepdog Church Security does not have courses for First Aid, CPR, or AED. These are skills that need hands-on training where you actually practice the techniques. In this respect it is similar to learning unarmed self-defense.
Fortunately, there are courses available almost anywhere you live. The most widely available courses are by the AmericanRed Cross (ARC) and the American Heart Association (AHA). The ARC often combines First Aid with CPR and AED in a single course leading to the three certifications. The AHA focuses on heart-saving procedures, but also has courses including First Aid. The American Safety & Health Institute (ASHI) is geared toward certification of company employees in life-saving skills for meeting OSHA's safety and health standards in the workplace. Places with over a certain number of employees need to have some employees certified in First Aid and CPR.
Some local fire departments and colleges/universities offer life-saving skills classes. Don't forget to include them in your search for training
A Church Safety Ministry can find courses available locally and enroll its members in it or encourage them to enroll. Depending on the church and the locality, the church may be able to host these classes, enrolling not only Safety Team members, but also other people in the church and even from the community. In this case, it could be a community service event of the church.
Equipment & Supplies
While training may be called the "howwithal" of responding to illness and injury, equipment and supplies are the wherewithal. You can do CPR without anything but your hands and (if needed) mouth - but this would be safer with a CPR mask. You need an AED if the heart is fibrillating. If someone is seriously cut and bleeding badly, you can only do so much without having something to put on more pressure, something to soak the extra blood, something to clean around the cut, and something to bandage the cut.
Sheepdog Church Security has an Amazon marketplace store with several supplies for a Church Safety Team. Besides these there are other equipment and supplies needed which are not in the SDCS Store. Here are the recommended items.
Ready for Heart Attacks and Stopped Breathing
The illness-related conditions we will most likely need to respond to are heart attacks, strokes, and stopped breathing. The causes will vary. For instance, breathing may be stopped by COPD, severe asthma, emphysema, anaphylactic allergic reaction, bad air (smoke, dust, etc.), and choking. Heart attacks may include atrial fibrillation or thrombosis.
When a person has a heart attack, the first recommended response is cardio-pulmonary resuscitation (CPR), beginning with chest compressions. This force-pumps the heart. It also compresses and decompresses the lung for forced breathing. However, sometimes the responder needs to blow air into the windpipe. For this, the use of a CPR mask is recommended. They are no longer in the SDCS Store, but Amazon still has CPR masks, such as the ones by Archer in keychain pouches.
Sometimes, such as after certain injuries, the airway is obstructed. Intubation will bypass the obstruction to get air down into the lungs. The Moore Medical Nasopharyngeal Airway Kit in the SDCS Store has five sizes of nasopharyngeal respiration tubes. Four packs cost $24.99.
For atrial fibrillation we need to stop and restart the heart. On TV shows you may have seen emergency room defibrillators used. The doctor places two pads on the patient's chest and calls out, "Go!" The assistant presses a button, the patient's chest heaves, and the patient's heart may restart. If not, they do it again.
Now we can use an automated external defibrillator (AED). You no longer have to be in a hospital to use one. It is small enough to easily take to the scene. The Philips HeartStart Home AED Defibrillator is listed in the SDCS store. It's not cheap ($1,275.00), but can be used many times.
Basic First Aid
There are basic First Aid supplies that every organization should have on hand ready to use. The SDCS Store on Amazon has an emergency response duffel bag and a wall-mounted First Aid Cabinet.
The Ergodyne Arsenal 5215 Large Medic First Responder Trauma Duffel Bag can be carried to the scene of an illness or injury emergency. It comes with dividers which can be used in organizing the contents. It does not come filled, which means you can choose what you want in it. The price is now reduced to $49.49.
The Rapid Care First Aid ANSI/OSHA Compliant All Purpose First Aid Cabinet comes with 2, 3, or 4 shelves. It also comes with First Aid supplies. Prices are 2 shelf $71.98, 3 shelf $109.46, 4 shelf $139.98.
When it comes time to fill the bag or refill the cabinet, be sure to get what you need most. Some items, such as small strip bandages, gauze pads, adhesive tape, antiseptics in squeeze packs, etc. have to replenished frequently since they are used for the most common injuries. You will also need to keep on hand ace bandages, instant-heat and instant-cold gel packs, and other like items.
For bee stings and other allergy-inducing incidents, have anti-allergic items, such as Epi-Pen and diphenhydramine (generic for Benadryl).
Also, to keep both you and the patient safe when responding to an injury, have nitrile gloves on hand in at least three sizes: Small, Medium, Large. Now we can add masks to the required gear.
A general use item which can come in handy when responding to injuries or medical incidents is a knife, It can cut someone free, open a box, cut fabric strips, etc. The SDCS Store has the Schrade SCHA3BS Assisted Opening Folding Knife. The 7.3" blade is released with the push of a button. It locks in place until you push a button to let you close it. Its price is $34.97.
Tourniquets and Pressure Bandages
Applying pressure is an ages-old procedure to stop bleeding. Press on the arteries supplying blood to the wound. Almost as old is using a tourniquet to stop bleeding on a limb. The first tourniquets were strips of cloth or leather belts tightened around the leg or arm between the wound and the body. This left the hands free to clean the wound. This also kept the patient from bleeding to death if the limb had to be amputated.
Now we have ready-to-use tourniquets and pressure bandages. The SDCS Store has the C-A-T Resources CAT Combat Application Tourniquet and the Dynarex Emergency Pressure Bandage (Israeli Type).
The CAT is the official U.S. Army issued tourniquet. It has a windlass for tightening and a place to write the time applied so that it is not left on too long. It is available in 1-pack, 2-Pack, 3-pack, and 4-Pack packages ranging in price from $27.75 to $105.99.
The Dynarex Israeli type pressure bandage is placed directly on the wound toward the upstream side. It not only applies pressure, but keeps the wound itself closed with the 4" wide pad pressed on it. This can be used for wounds which are not on limbs, but on the head or torso. The price is $7.25 per package.
Sometimes we need patient handling devices for moving an injured or ill person, or for putting them into a more comfortable or safer position. These devices include stretchers, wheelchairs, and - for the very small - cribs. Two of these devices are in the SDCS Store, a wheelchair which can be used to carry a person up or down stairs, and a crib designed for regular use as well as for evacuation.
A wheelchair is always handy for moving a conscious adult able to sit who has mobility issues. It also can be brought to the scene when an ill or injured person needs to be placed in a sitting position. The LINE2design Stair Chair is designed to be more than a wheelchair. Thanks to the extendable arms, it can be used to carry the person up or down stairs. It also has safety straps to secure the patient. The price is $269.95, but in an evacuation it would pay for itself.
The primary use is for transporting the person, though it can be used for sitting relief in an emergency. For instance, if a person has been cut on the head, sitting them up will reduce bleeding. It will also make it easier for a responder to treat the wound.
In an evacuation, the LA Baby Condo Metal Evacuation Window Crib makes it easy to take several infants out at the same time. Price $249.99. This crib also put an injured or ill infant at a level where a responder can work on him or her.
The Boy Scout motto is Semper paratus, always prepared. Since we never know when someone at church will become ill or injured, we need to always be ready to respond - trained and equipped.
There Is More
This series - The Healthy Church - has four articles. The other three articles are "Proactive Response" (Make the Church a Safe and Healthful Place), "Have a Heart" (Responding to Heart Attacks, Strokes, Choking, and Seizures), and "Help the Hurting" (Responding to Injuries).
- Juli McDonald, "Parishioners Save Man Who Had Heart Attack During Sunday Mass,"WBZ4 CBS Boston, November 25, 2019 [https://boston.cbslocal.com/2019/11/25/nurses-rescue-man-cpr-heart-attack-wrentham-st-marys-sunday-mass/].
- Deneen Smith, "Quick action by Kenosha churchgoers saves man who collapsed during service," The Journal Times, February 9, 2020 [https://journaltimes.com/news/local/quick-action-by-kenosha-churchgoers-saves-man-who-collapsed-during/article_70a9f608-aacb-5eb6-aae3-d52d95b314c4.html].
- Dr. Matthew D. Neal, "OP-ED: 'Stop the Bleed' training saved lives in Pittsburgh," Observer-Reporter, November 7, 2018 [https://observer-reporter.com/op-ed-stop-the-bleed-training-saved-lives-in-pittsburgh/article_d3a7a240-e1df-11e8-8f61-afc2d163d383.html].
- Anon, "The Hartford Consensus," American College of Surgeons, on or after October 16, 2015 [https://www.facs.org/about-acs/hartford-consensus].
- American Red Cross, "Take a Class" [https://www.redcross.org/take-a-class].
- American Heart Association, "Course Catalog, CPR & First Aid Training Classes" [https://cpr.heart.org/en/course-catalog-search].
- American Safety & Health Institute, "American Safety & Health Institute CPR AED Classroom Course" [https://startcpr1st.com/heartsaver-first-aid-cpr-aed/].
- American Safety & Health Institute, "Start the Heart (Pediatric)" [https://starttheheart.com/courses/american-safety-health-institute/].
Equipment and Supplies
- Recommended Equipment for Safety Ministries, Sheepdog Church Security [https://www.amazon.com/shop/instructor_moloney].
- CPR Mask for Pocket or Key Chain, CPR Emergency Face Shield with One-Way Valve Breathing Barrier for First Aid or AED Training, Archer MedTech (6) [https://www.amazon.com/Emergency-One-way-Breathing-Barrier-Training/dp/B074B9LCW8/ref=sr_1_13?crid=14Y2A9524TKJU&dchild=1&keywords=cpr+mask&qid=15877 7394&sprefix=cpr+mask%2Caps%2C177&sr=8-13].
- Airway Kit - Nasopharygngeal Respiration Tubes In 5 Sizes - With Surgilube Jelly Packets [https://www.amazon.com/dp/B0015TF4G0/?ref=exp_instructor_moloney_dp_vv_d#feature-bullets-btf].
- Philips HeartStart Home AED Defibrillator with Slim Carry Case [https://www.amazon.com/dp/B00064CED6/?ref=exp_instructor_moloney_dp_vv_d].
- Ergodyne Arsenal 5215 Large Medic First Responder Trauma Duffel Bag [https://www.amazon.com/dp/B001AYGFO0/?ref=exp_instructor_moloney_dp_vv_d].
- Rapid Care First Aid 2 Shelf ANSI/OSHA Compliant All Purpose First Aid Cabinet, Wall Mountable [https://www.amazon.com/dp/B01E17HNGQ/?ref=exp_instructor_moloney_dp_vv_d&th=1].
- Schrade SCHA3BS Assisted Opening Folding Knife [https://www.amazon.com/dp/B00BCMPYQ0/?ref=exp_instructor_moloney_dp_vv_d].
- C-A-T Resources CAT Combat Application Tourniquet - GEN 7 (Gray Time-Stamp) [https://www.amazon.com/dp/B01ITAKG6A/?ref=exp_instructor_moloney_dp_vv_d].
- Emergency Pressure Bandage (Israeli Type) Dynarex [https://www.amazon.com/dp/B01MT17QJU/?ref=exp_instructor_moloney_dp_vv_d].
- LINE2design Stair Chair 70010-BL EMS Emergency [https://www.amazon.com/dp/B01GIL1W3I/?ref=exp_instructor_moloney_dp_vv_d].
- LA Baby, The Condo Metal Evacuation Window Crib [https://www.amazon.com/dp/B005U78RFI/?ref=exp_instructor_moloney_dp_vv_d].