tag:theconversation.com,2011:/fr/topics/first-aid-2300/articlesFirst aid – The Conversation2024-02-16T01:03:35Ztag:theconversation.com,2011:article/2221412024-02-16T01:03:35Z2024-02-16T01:03:35ZIs it broken? A strain or sprain? How to spot a serious injury now school and sport are back<figure><img src="https://images.theconversation.com/files/573664/original/file-20240206-17-zgrilp.jpg?ixlib=rb-1.1.0&rect=8%2C26%2C5905%2C3910&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/side-view-portrait-focused-adult-man-1957830496">Shutterstock</a></span></figcaption></figure><p>Kids are back at school, playgrounds, sport and general mucking around. This can lead to two things: happy children and injuries. </p>
<p>Up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298088/">50% of boys and 40% of girls</a> will break a bone during childhood and adolescence. Around <a href="https://www.aihw.gov.au/getmedia/25a1c441-4946-4e6d-8d34-12c4f552aada/aihw-injcat-217.pdf?v=20230605182220&inline=true">50,000 children and young people</a> are hospitalised due to fractures in Australia each year and the rates of fractures in children <a href="https://pubmed.ncbi.nlm.nih.gov/29860609/">appear to be increasing</a>. </p>
<p>But it is not just broken bones that can hamper your children’s Olympic dreams – or just disrupt their play. What are the differences between strains, sprains and fractures? And how can you identify and manage these injuries? </p>
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Read more:
<a href="https://theconversation.com/what-makes-kids-want-to-drop-out-of-sport-and-how-should-parents-respond-195115">What makes kids want to drop out of sport, and how should parents respond?</a>
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<h2>Different doesn’t mean better or worse</h2>
<p>Sprains, strains and fractures are all different types of injuries – and the type doesn’t necessarily indicate the severity. </p>
<p>Sprains are injuries to ligaments and joints. So even a complete anterior cruciate ligament (ACL) rupture (when one of the ligaments of the knee is torn through) is technically a sprain. </p>
<p>Strains are injuries to the muscle. So whether you just pull the muscle (where the muscle is inflamed but not torn) or cause a bad tear, it is referred to as a muscle strain. </p>
<p>Finally, a fracture means any injury to bone. In children, whose bones are more bendy, this can vary from a small crack in the bone (sometimes called a buckle or <a href="https://www.ncbi.nlm.nih.gov/books/NBK513279/#:%7E:text=Pathophysiology-,A%20greenstick%20fracture%20is%20a%20partial%20thickness%20fracture%20where%20only,radius%2C%20humerus%2C%20and%20clavicle.">Greenstick fracture</a>) to a completely broken bone. </p>
<h2>Kids are at increased risk</h2>
<p>Children seem to be at a relatively high risk of breaking a bone (particularly of their forearm) as their bones are rapidly lengthening due to growth, and with that there is a <a href="https://pubmed.ncbi.nlm.nih.gov/34723233/">reduction in the overall bone strength</a>.</p>
<p>ACL ruptures are also common in children, with the highest rise in ruptures among 5–14-year-old females in Australia, <a href="https://pubmed.ncbi.nlm.nih.gov/35345847/">increasing by 10.4% from 1998 to 2018</a>.</p>
<p>Children’s formal <a href="https://www.abs.gov.au/articles/swimming-and-soccer-most-popular-sports-children">sporting commitments</a> may have a role to play in why <a href="https://pubmed.ncbi.nlm.nih.gov/28051335/">injury rates are increasing</a>. Some kids are not getting so much as a single physical recovery day per week and are training <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805065/">more than elite athletes</a> while their bodies are still lanky, uncoordinated and developing. We also see <a href="https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02707-9">fractures from trampoline play</a>, skateboarding, and extreme sports such as BMX riding. </p>
<p>In addition to muscle, tendon and bone injuries, children are also at risk of concussion and <a href="https://www.concussioninsport.gov.au/">clear guidelines now exist</a> to inform management of this condition. </p>
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<a href="https://images.theconversation.com/files/573660/original/file-20240206-17-prwobz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="young kids playing on soccer field" src="https://images.theconversation.com/files/573660/original/file-20240206-17-prwobz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573660/original/file-20240206-17-prwobz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573660/original/file-20240206-17-prwobz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573660/original/file-20240206-17-prwobz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573660/original/file-20240206-17-prwobz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573660/original/file-20240206-17-prwobz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573660/original/file-20240206-17-prwobz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Young athletes sometimes train as hard as professionals – but with growing bones.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1598880513655-d1c6d4b2dfbf?q=80&w=2713&auto=format&fit=crop&ixlib=rb-4.0.3&ixid=M3wxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8fA%3D%3D">Lars Bo Nielsen/Unsplash</a></span>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/concussion-in-sport-why-making-players-sit-out-for-21-days-afterwards-is-a-good-idea-222504">Concussion in sport: why making players sit out for 21 days afterwards is a good idea</a>
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<p>With all that energy and commitment going into sport and play, it’s not surprising some kids hurt themselves. Here’s what to do next …</p>
<h2>5 ways to assess the severity of an injury</h2>
<p><strong>1. What does it look like?</strong> </p>
<p>Is there an obvious visual deformity or huge amount of swelling? Injuries with bigger changes in physical appearance will be much more severe. </p>
<p><strong>2. Can they move it?</strong> </p>
<p>If they are unable to bend a joint or they are “guarding” the area and refusing to move it, it is a sign of more severe injury. Sometimes fear will prevent a child from moving the injured area – it’s important not to try to force movement in the early stages, even if you think fear is an issue. </p>
<p><strong>3. Can you touch or press on the injured area?</strong> </p>
<p>Obviously, the more severe the injury the more likely your child will recoil with pain when being touched – or not let you anywhere near them.</p>
<p><strong>4. Can your child bear weight on the injured area</strong></p>
<p>For leg injuries this means can they stand or walk. For arm injuries can they use the arm to push up off the floor or out of a chair. More severe injuries prevent people from being able to bear weight. You should not try to force your child to stand or walk – but if you note them doing so, you can be more reassured the injury is less likely to be serious.</p>
<p><strong>5. Is the injury improving over time?</strong> </p>
<p>If the injury does not seem to be changing or getting better within 24 hours it may be a more severe injury, even if the previous pointers do not suggest it is. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/573663/original/file-20240206-25-l01akv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="medical professional assesses child's knee" src="https://images.theconversation.com/files/573663/original/file-20240206-25-l01akv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573663/original/file-20240206-25-l01akv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573663/original/file-20240206-25-l01akv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573663/original/file-20240206-25-l01akv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573663/original/file-20240206-25-l01akv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573663/original/file-20240206-25-l01akv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573663/original/file-20240206-25-l01akv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">If pain or problems persist, get a medical check from a GP or physio.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/physiotherapist-working-patients-clinic-2301020583">Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">Hot pack or cold pack: which one to reach for when you're injured or in pain</a>
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<h2>Now what? Top tips to manage injury</h2>
<ul>
<li><p><strong>Do the basics well.</strong> No matter how severe an injury may be – the <a href="https://sma.org.au/resources/injury-fact-sheets/soft-tissue-injuries/#:%7E:text=The%20immediate%20treatment%20of%20any,and%20damage%20within%20the%20joint">RICE protocol will be useful</a>. RICE stands for rest, ice (with a pack or cold water if no ice is available), compression (with a bandage or fitted fabric) and elevation (position the body so the injury is above the level of the heart)</p></li>
<li><p><strong>if your child has an obvious deformity</strong> of the bone, joint or muscle, seek medical attention as quickly as you can. The best thing to do is take them to an emergency department for assessment. They will likely need imaging (an X-ray or CT scan) to assess the bone and joint. Treatment should happen as soon as possible as injuries are often very painful and may need relocation or splinting</p></li>
<li><p><strong>if your child is struggling to move the injured area</strong>, you are unable to touch the sore spot or they cannot tolerate taking weight on the injured area, a review with your GP or physiotherapist as soon as possible is your best course of action</p></li>
<li><p><strong>if your child is not improving within 24 hours</strong>, but pain levels are not too high, an appointment with a GP or physiotherapist can still be a good idea. The injury may not be that severe, but if your child is needing to walk in an unusual way or not using their arm we want to get them back to normal as fast as possible</p></li>
<li><p><strong>talk to your child and see what they want to do.</strong> If the problem is lingering and they are worried about getting back to sport or play, an assessment by someone qualified (usually the GP or physio) can be very reassuring. </p></li>
</ul>
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Read more:
<a href="https://theconversation.com/is-netball-actually-bad-for-knees-and-ankles-what-does-the-research-say-183619">Is netball actually bad for knees and ankles? What does the research say?</a>
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<img src="https://counter.theconversation.com/content/222141/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Myles Murphy receives funding from the Raine Medical Research Foundation, Western Australian Department of Health, Perth Wildcats, Western Australia Police Force, Defence Science Centre of Western Australia.</span></em></p>Accidents happen and kids get injured. But how can you tell if it needs an icepack, a physio or a trip to the emergency department?Myles Murphy, Postdoctoral research fellow, Physiotherapy, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028442023-06-07T02:23:49Z2023-06-07T02:23:49ZHow to treat jellyfish stings (hint: urine not recommended)<figure><img src="https://images.theconversation.com/files/530469/original/file-20230607-30115-psgkb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/box-jelly-fish-photographed-aquarium-68332459">Shutterstock</a></span></figcaption></figure><p>If you have been stung by a jellyfish at the beach, you’ll know how painful and unpleasant it can be. But how best to treat jellyfish stings has been debated over the years.</p>
<p>Is it best to use hot water or an ice pack? How about pouring on vinegar or rubbing with sand? Then there’s the popular myth about urinating on your leg, which health professionals have <a href="https://www.scientificamerican.com/article/fact-or-fiction-urinating/#:%7E:text=Back%20in%201997%20all%20the,the%20treatment%20and%20it%20worked.">debunked</a> <a href="https://health.clevelandclinic.org/pee-jellyfish-sting/">many times</a> but seems to resurface regardless.</p>
<p>We looked at the evidence for popular treatments and have <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009688.pub3/full">just published</a> our analysis in a Cochrane review. This is what we found.</p>
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Read more:
<a href="https://theconversation.com/when-we-swim-in-the-ocean-we-enter-another-animals-home-heres-how-to-keep-us-all-safe-193457">When we swim in the ocean, we enter another animal's home. Here's how to keep us all safe</a>
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<h2>Why do jellyfish stings hurt so much?</h2>
<p>Jellyfish are common in coastal regions around the world. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/524541/original/file-20230505-29-u5skut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Warning sign for marine stingers" src="https://images.theconversation.com/files/524541/original/file-20230505-29-u5skut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/524541/original/file-20230505-29-u5skut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524541/original/file-20230505-29-u5skut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524541/original/file-20230505-29-u5skut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524541/original/file-20230505-29-u5skut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524541/original/file-20230505-29-u5skut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524541/original/file-20230505-29-u5skut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Watch out, jellyfish about.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/yellow-black-warning-sign-dangerous-marine-168106508">Shutterstock</a></span>
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<p>They have tentacles covered with tiny stinging cells called nematocysts. When these cells touch your skin, they release venom that can cause burning, redness, swelling and sometimes more serious reactions, such as heart issues.</p>
<p>Fortunately, most jellyfish stings are not life-threatening. Symptoms differ depending on the species. And the best treatment for one species is not always the best for another.</p>
<p>By knowing which treatment works and which doesn’t, you can reduce your discomfort and avoid complications.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/want-to-avoid-a-bluebottle-sting-heres-how-to-predict-which-beach-theyll-land-on-179947">Want to avoid a bluebottle sting? Here's how to predict which beach they'll land on</a>
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<h2>What we did</h2>
<p>We found nine trials involving treatments for two types of jellyfish:</p>
<ul>
<li><p><strong>bluebottles</strong> or Portuguese man o’ war (<em>Physalia</em>)</p></li>
<li><p><strong>box jellyfish</strong> (<em>Cubozoa</em>), which are considered the most dangerous jellyfish. Some box jellyfish can cause Irukandji syndrome (a condition that may lead to severe pain, heart problems, and very occasionally death).</p></li>
</ul>
<p>These trials, involving 574 people, tested various treatments such as vinegar, hot water, ice packs, isopropyl alcohol, methylated spirits, ammonia and sodium bicarbonate.</p>
<p>The trials also looked at Adolph’s meat tenderiser (a powder thought to break down proteins) and Sting Aid (an over-the-counter treatment thought to help ease pain after a variety of stings).</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/welcome-to-australia-a-land-of-creatures-out-to-kill-you-maybe-71490">Welcome to Australia, a land of creatures out to kill you... maybe</a>
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<h2>So what works?</h2>
<p>Regardless of the jellyfish species, it’s reasonable to first remove any visible tentacles with tweezers or a gloved hand. What to do next depends on the species.</p>
<p><strong>For bluebottles, try heat</strong></p>
<p>The data in our included studies provides what’s described as low-certainty evidence for soaking the affected area in water about 45°C to ease the pain. This is thought to denature the venom protein. At the beach, you could apply a heat pack or take a hot shower.</p>
<p>There was not enough evidence to show whether other treatments, such as ice packs, were effective for bluebottle stings.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/524542/original/file-20230505-27-3vrruw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C648&q=45&auto=format&w=1000&fit=clip"><img alt="Bluebottle on sandy beach" src="https://images.theconversation.com/files/524542/original/file-20230505-27-3vrruw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C648&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524542/original/file-20230505-27-3vrruw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524542/original/file-20230505-27-3vrruw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524542/original/file-20230505-27-3vrruw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524542/original/file-20230505-27-3vrruw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524542/original/file-20230505-27-3vrruw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524542/original/file-20230505-27-3vrruw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Stung by a bluebottle? Try warm water or a heat pack.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bluebottle-portuguese-man-o-war-on-413370460">Shutterstock</a></span>
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<p><strong>For box jellyfish, try vinegar</strong></p>
<p>For box jellyfish stings, the evidence was more limited. Our review did not find sufficient evidence to support <a href="https://resus.org.au/download/guideline-9-4-5-jellyfish-stings-july-2010-43-kib/?wpdmdl=13756&masterkey">current</a> <a href="http://www.ilsf.org/wp-content/uploads/2012/07/MPS-05%20Envenomation.doc">recommendations</a> to apply vinegar to inactivate the nematocysts.</p>
<p>Nevertheless, it’s reasonable to try vinegar. That’s because <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.1980.tb134566.x">evidence</a> not considered as part of our review shows vinegar inactivates nematocysts when tested in the laboratory.</p>
<h2>When to seek medical care</h2>
<p>Most symptoms can be managed at the beach or at home. But always seek medical attention if you or the person you’re looking after has symptoms such as:</p>
<ul>
<li><p>difficulty breathing</p></li>
<li><p>chest pain</p></li>
<li><p>nausea</p></li>
<li><p>vomiting</p></li>
<li><p>weakness, or </p></li>
<li><p>drowsiness.</p></li>
</ul>
<p>Such severe symptoms mean monitoring and treatment in hospital may be needed. If the person stops breathing or has a heart attack, they need immediate basic life support.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/in-cases-of-cardiac-arrest-time-is-everything-community-responders-can-save-lives-126491">In cases of cardiac arrest, time is everything. Community responders can save lives</a>
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</em>
</p>
<hr>
<h2>What not to do</h2>
<p>Do not rub or scrape the area with sand or a towel because this might cause more nematocysts to release their venom.</p>
<p>When it comes to treatments, our review found some may be harmful or ineffective, so should be avoided. </p>
<p>These included ammonia, methylated spirits and fresh water, as they may cause burns on the skin or trigger more venom to be released from nematocysts. </p>
<p>Avoid pressure immobilisation bandaging (wrapping a bandage tightly around the limb) as this may also trigger more venom release from nematocysts. </p>
<p>We found vinegar, sodium bicarbonate, Sting Aid or meat tenderiser have no proven benefit and may cause irritation or infection.</p>
<p>Perhaps not surprisingly, there were no published trials looking at the effectiveness of urine as a treatment and so it’s not recommended.</p>
<h2>Prevention is best</h2>
<p>Remember, prevention is better than cure. Keep an eye on safety announcements from lifeguards, monitor the water for jellyfish and wear protective clothing to prevent stings where possible.</p><img src="https://counter.theconversation.com/content/202844/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hot water, cold water, rubbing with sand? What our new review says works best to treat jellyfish stings.Richard McGee, Senior lecturer in Paediatrics, University of NewcastleMichelle Welsford, Professor and Director of the Division of Emergency Medicine , McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1920512022-10-30T10:52:11Z2022-10-30T10:52:11ZEmergency services in South Africa are overwhelmed: how one community created its own<figure><img src="https://images.theconversation.com/files/489554/original/file-20221013-23-dr9ek2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source"> Kristin Palitza/picture alliance via Getty Images</span></span></figcaption></figure><p>In a medical emergency, the time it takes emergency services to respond could be the difference between survival or death. Ambulance response time is a global <a href="http://www.samj.org.za/index.php/samj/article/view/9818">benchmark</a> of efficiency.</p>
<p>But no healthcare system has an endless supply of ambulances. It’s always possible that an ambulance might be sent from too far away to get to the patient in time. Ambulances may struggle to get through difficult terrain; ambulance staff may be <a href="https://www.news24.com/news24/southafrica/news/emergency-service-crew-robbed-while-waiting-for-police-escort-20220918">targeted by criminals</a>. </p>
<p>Community-based ambulance services may be one way to improve response times and to support established healthcare systems. In a <a href="https://www.sciencedirect.com/science/article/pii/S2211419X22000210">recent study</a>, we tested this idea using a volunteer community-based ambulance service in the suburb of Hout Bay in Cape Town, South Africa.</p>
<p>We found that the <a href="https://www.houtbayems.org.za/">Hout Bay Volunteer Emergency Medical Service</a> had an average response time within its own area that was 42.3% faster than the Western Cape government’s emergency medical services. Its ambulances consistently beat the target time of 15 minutes for life-threatening calls in urban areas. Because the service is based within the community – which isn’t easy to reach from elsewhere in the city because of its mountainous topography – its ambulances are able to reach people in need faster than those coming from elsewhere. </p>
<p>We believe the model can be expanded to other communities across the African continent. This is a key need: less than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234167/">9%</a> of people across Africa are served by an emergency care system. Developing effective emergency care systems could potentially save lives. The World Health Organization estimates that more than <a href="https://www.who.int/news/item/27-05-2019-72nd-world-health-assembly-adopts-resolution-on-emergency-and-trauma-care">50% of deaths</a> in low- and middle-income countries result from conditions that could be managed by emergency care. This is not the only reason for high mortality and morbidity rates. But it’s a contributing factor. </p>
<p>Collaboration and good working relationships are crucial for community-based ambulance services to work. Residents must work with each other, as well as with government departments and formal emergency medical service providers.</p>
<h2>Understanding Hout Bay</h2>
<p>Hout Bay has been <a href="https://www.houtbay.org/">recorded</a> as covering 32.3km². In the 2011 census, the official population was recorded as approximately <a href="https://www.statssa.gov.za/?page_id=4286&id=332">33,000</a> people. The umbrella term “Hout Bay” describes three sections: Hout Bay, Hangberg and Imizamo Yethu. These sections differ in terms of socioeconomic conditions, ranging from abject poverty (no bulk water, sewerage or electricity) to adequate housing and healthcare, and to luxury.</p>
<p>The Hout Bay Volunteer Emergency Medical Service was started by a group of residents in 1994. They were concerned about how long it took ambulances to respond to medical emergencies in the area. </p>
<p>Part of the reason for this is that the area is physically isolated. It is enclosed on three sides by mountains, and by the coastline on the fourth side. Vehicles can only get in and out on three two-lane roads via the mountains. This causes delays in medical emergency response times, especially in peak traffic, tourist season or bad weather. Without traffic, it takes at least 25 minutes to drive into the suburb from the central business district of the city. </p>
<p>The Hout Bay Volunteer Emergency Medical Service operates with one sponsored ambulance that’s staffed by at least two volunteers. The number of volunteers who regularly work shifts fluctuates depending on season, for example more volunteers are available over the festive season as they have leave from regular work. The average number of volunteers who contribute shifts in a year is 20. </p>
<h2>Trust, collaboration and partnerships</h2>
<p>Based on our study, we’ve identified various factors to consider when developing community-based response systems. First, these should suit the setting. One must consider the specific community needs and the disease profile. This may include the distance to the closest appropriate facility, and the number and type of emergencies commonly seen in the setting. For example, it may be an area that has a high number of road traffic accidents, requiring rescue equipment and capabilities. Or there may be a high number of pregnancies. </p>
<p>It also helps if the community-based response system is embedded within existing community programmes or systems. For instance, the first Hout Bay Volunteer Emergency Medical Service emergency care responders were volunteer members of the National Sea Rescue Institute Station 8 in Hout Bay. These volunteers organised a basic ambulance assistant course through the provincial ambulance college. The institute was already well established, and initially most members were volunteers with both organisations. This helped to develop a coordinated response to emergencies. </p>
<p>The two organisations still have a close relationship. The Hout Bay emergency services is also embedded in other community-based partnerships. These include the community policing forum, neighbourhood watch and sponsors like local businesses.</p>
<p>Identifying, establishing and maintaining stakeholder relationships is probably the most vital component when developing a community-based response system. These relationships need to be nurtured and maintained, and Hout Bay Volunteer Emergency Medical Service has seen the benefit of appointing a dedicated liaison officer within the executive committee to build and maintain stakeholder relationships. </p>
<p>While the community, other community-based organisations and sponsors are important stakeholders, the Western Cape Government Department of Health and Wellness Emergency Medical Service is the main enabler and a powerful stakeholder of the Hout Bay Volunteer Emergency Medical Service. An executive committee portfolio is dedicated to <a href="https://www.timeslive.co.za/sunday-times/opinion-and-analysis/insight/2022-07-03-how-to-rid-the-red-zones-of-fear-for-emergency-services/">maintaining this key relationship</a> and the service is permitted to function by a service level agreement between the two parties.</p>
<p>Trust is also key. Residents must know about and trust the service. This can partially be achieved simply by delivering a good, reliable service. The Hout Bay emergency service also interacts regularly with community leaders, offers community first aid training, facilitates fire prevention training, visits schools and provides medical support at community events.</p>
<h2>Conclusions</h2>
<p>Emergency medical services remain underdeveloped in many African countries, resulting in underserviced communities. The findings of this study suggest that volunteer services can have a meaningful impact in communities. This isn’t the only volunteer emergency medical service on the continent. But the longevity of the Hout Bay emergency services suggests that the model has been sustainable and provides valuable lessons for other communities.</p><img src="https://counter.theconversation.com/content/192051/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charmaine Cunningham used to be a member and executive committee member of the Hout Bay Volunteer Ambulance Service. She is no longer an active member of the service. </span></em></p>Collaboration and good working relationships are crucial for community-based ambulance services to work.Charmaine Cunningham, Senior Lecturer Emergency Medicine and Global Surgery, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1610862021-09-07T02:27:10Z2021-09-07T02:27:10ZHot pack or cold pack: which one to reach for when you’re injured or in pain<figure><img src="https://images.theconversation.com/files/419546/original/file-20210906-25-q9qpcm.jpg?ixlib=rb-1.1.0&rect=89%2C51%2C8461%2C5640&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/woman-using-ice-gel-pack-260nw-2001343205.jpg">Shutterstock</a></span></figcaption></figure><p>When you injure yourself, you may reach for a hot or a cold pack. Which option is better depends on the nature of your pain, what caused it and how long you’ve had it. </p>
<p>Heat therapy, sometimes called thermotherapy, involves applying heat to an injury or painful area on the body. Hot water bottles or pads that can be heated in a microwave oven are commonly used. Cold therapy, or cryotherapy, can come in the form of water bottles or pads cooled in a fridge or freezer. </p>
<p>Placing something cold at the injury site causes the blood vessels, arteries and veins, to narrow. This reduces blood flow through the area and helps reduce inflammation and swelling. Adding heat to the area has the opposite effect: opening the blood vessels up and increasing blood flow through injured tissue.</p>
<p>These opposite effects are useful in different situations. </p>
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Read more:
<a href="https://theconversation.com/feeling-sore-after-exercise-heres-what-science-suggests-helps-and-what-doesnt-150277">Feeling sore after exercise? Here's what science suggests helps (and what doesn't)</a>
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<h2>Cooling down to prevent inflammation</h2>
<p>We can treat injury or tissue pain with a hot or cold pack, or sometimes alternate the two. </p>
<p>Cold therapy should be used for injuries that result in swelling and inflammation such as joint sprains, muscle strains or bruises. The objective is to slow blood flow to the area and prevent the effects of the injury. Gel packs that can be kept in the freezer, coolant sprays or even a bag of frozen veggies will do the job. </p>
<p>It is important to avoid holding ice in direct contact with the skin for long periods as this can cause skin damage. It is best to wrap ice in a cloth and then apply it. </p>
<p>Cold therapy is most effective in the immediate or acute phase of pain when swelling and inflammation first kicks off. Typically, the treatment should be applied for <a href="https://meridian.allenpress.com/jat/article/48/4/528/191258/National-Athletic-Trainers-Association-Position">about 20 minutes and can be reapplied every two hours</a> for a few days. After that, the injury should be well into the healing phase and the swelling and inflammation will subside. </p>
<p>Cold therapy, or applying ice, is often used in conjunction with rest, compression and elevation, known in first aid by the acronym <a href="https://www.medicalnewstoday.com/articles/321469">RICE</a>.</p>
<p>So, ice can be useful when we want to limit the initial swelling and pain, since too much or prolonged swelling can impede the healing process. But with less severe injuries like minor sprains and strains, inflammation is part of the body’s healing process and continuing cold therapy can be a barrier to recovery.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/cant-face-running-have-a-hot-bath-or-a-sauna-research-shows-they-offer-some-similar-benefits-158552">Can't face running? Have a hot bath or a sauna – research shows they offer some similar benefits</a>
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<h2>When to warm up</h2>
<p>Heat therapy is generally thought of as being either dry or moist. </p>
<p>Dry heat therapy includes hot water bottles or heated pads. These are easy to apply and are effective for reducing pain. Moist heat therapy includes warm bath, hot wet towel and moist heat packs. </p>
<p>Heat therapy is not recommended for acute management of sprains, strains or contusions as this promotes blood flow and can increase swelling and pain. </p>
<p>Heat therapy can help chronic conditions such as recurring joint pain, neck or back pain. </p>
<p>If pain is due to a strain or sprain, cold therapy should be applied immediately, but heat therapy can help relieve pain from 72 hours post-injury. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/419542/original/file-20210906-24-zckl21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man holds ankle, sitting on kerb" src="https://images.theconversation.com/files/419542/original/file-20210906-24-zckl21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419542/original/file-20210906-24-zckl21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419542/original/file-20210906-24-zckl21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419542/original/file-20210906-24-zckl21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419542/original/file-20210906-24-zckl21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419542/original/file-20210906-24-zckl21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419542/original/file-20210906-24-zckl21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cooling down an injury immediately after it happens can reduce swelling but don’t do it for too long.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/sports-injury-marathon-runner-roadside-260nw-254471920.jpg">Shutterstock</a></span>
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<p>Heat therapy does not mean applying something very hot, rather it should be warm, pleasant and easily tolerated for long periods. </p>
<p>Heat therapy can be very effective for muscle tension or joint stiffness — increasingly blood flow and heating muscles or joints for around 15 minutes before physical activity as a kind of warm up. This approach can also help people engage in activities that might aggravate a chronic injury by loosening and relaxing injured muscles. </p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-do-joint-and-muscle-aches-get-worse-in-the-cold-81260">Health Check: do joint and muscle aches get worse in the cold?</a>
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<p>Heat is used differently for bluebottle stings. These are best treated by a medical professional in a hospital emergency department. But, as a first aid intervention, pain can be reduced by <a href="https://www.racgp.org.au/afp/2013/june/bluebottle-stings/">applying hot water</a> (42–45°C) to the area for 30–90 minutes. </p>
<p>Alternating hot and cold to an area of pain has been used for decades but there has not been a great deal of research assessing the practice. One <a href="https://pubmed.ncbi.nlm.nih.gov/27888788/">study</a> assessed hospital inpatients with heel pain and found greater improvement in foot function after hot/cold therapy compared with a group who underwent standard therapy. </p>
<h2>Soaking in it</h2>
<p>Athletes commonly use water immersion therapy for recovery. </p>
<p>However, this practice is also not without controversy. One review of the evidence <a href="https://journals.lww.com/nsca-jscr/Fulltext/2017/05000/Effects_of_Cold_Water_Immersion_and_Contrast_Water.32.aspx">found</a> cold water immersion improved performance, measured by jumping and all-out sprint ability 24 hours after a sporting event. Fatigue was also reduced at 48–72 hours after sports events. </p>
<p>This type of temperature control therapy may also help with recovery after undertaking some sustained physical exertion such as a day of hiking.</p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-my-muscles-ache-the-day-after-exercise-41820">Health Check: why do my muscles ache the day after exercise?</a>
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<h2>So, cold first and maybe heat later</h2>
<p>The take-home message is that cold packs work well for reducing pain and inflammation in the acute phase of a strain, sprain or bruise — especially when used in as part of the RICE method. </p>
<p>Heat packs are useful for reducing muscle tension and stiffness and pain in the joints, but never in the initial phase of an injury. There is not enough evidence to show alternating the two is particularly useful, while cold water immersion therapy may help recovery after sport or sustained physical exertion.</p><img src="https://counter.theconversation.com/content/161086/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Lavender does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When to use an ice pack or heat pad depends on the timing and severity of injury and pain.Andrew Lavender, Senior Lecturer, School of Science, Psychology and Sport, Federation University AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/816142017-07-30T20:10:53Z2017-07-30T20:10:53ZSnakebites are rarer than you think, but if you collapse, CPR can save your life<figure><img src="https://images.theconversation.com/files/180118/original/file-20170727-28974-7lutuk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bites from brown snakes like this one were the most common, followed by
tiger snakes, then red-bellied black snakes.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Eastern_Brown_Snake_(Pseudonaja_textilis)_(8582601994).jpg">Matt Clancy/SunOfErat/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Despite the common belief that Australia has some of the most venomous snakes in the world, our <a href="http://www.mja.com.au">new research shows</a> being bitten by a snake is uncommon in Australia and dying from a snakebite is very rare. </p>
<p>And of the few unlucky people to collapse after venom enters their bloodstream, a bystander performing cardiopulmonary resuscitation (CPR) is the most likely thing to save them.</p>
<p>These are just some of the findings from 10 years of data from the Australian Snakebite Project published <a href="http://www.mja.com.au">today</a> in the Medical Journal of Australia.</p>
<p>Although many people go to hospital with a suspected snakebite, many do not turn out to have envenomation (when venom enters the bloodstream) after all.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/12675626">In more than 90% of cases</a> people are bitten by a non-venomous snake, venom is not injected when the snake bites (known as a “dry bite”) or are not even bitten by a snake (known as a “stick” bite).</p>
<p>Our analysis of about 1,548 cases of suspected snakebites from all around Australia, showed there were on average just under 100 snake envenomations a year, and about two deaths a year. </p>
<p>The most common snakebites were from brown snakes, then tiger snakes and red-bellied black snakes. Brown snakes were responsible for 40% of envenomations. Collapsing, then having a heart attack out of hospital was the most common cause of death (ten out of 23), and most deaths were from brown snakes.</p>
<h2>What happens after a snakebite and how can CPR help?</h2>
<p>Venom from a snakebite travels via the <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lymphatic-system">lymphatic system</a> to the bloodstream. There, it circulates to nerves and muscles where it can cause paralysis and muscle damage. In the blood itself, the venom destroys clotting factors, which makes the blood unable to clot, increasing the risk of bleeding. </p>
<p>In the most severe cases, most commonly in brown snake bites, someone can collapse because they have low blood pressure (we don’t know for certain what causes the low blood pressure). In this situation, insufficient blood is pumped around the body for the brain and other vital organs. </p>
<p>Clearly the accurate diagnosis of snake envenomation and the timely administration of antivenom are essential to treating snakebites in hospital.</p>
<p>But when people collapse, CPR will keep the blood circulating to the vital organs – and is life-saving – however inexpertly a bystander performs it.</p>
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<a href="https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">If a snakebite victim collapses, CPR is vital to keep the blood circulating to the vital organs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/657810997?src=gSIYdvpfkdaGnxGsgex89A-1-50&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>In other words, we found basic first aid <em>before</em> people reached hospital, of which bystander CPR is one, may be more important than any changes in how people are treated <em>in</em> hospital to improve people’s chance of survival. People who survived after collapsing received CPR on average within one minute of being bitten compared with 15 minutes for those who died.</p>
<p>Our study also showed that in most cases, people used <a href="https://theconversation.com/explainer-what-should-you-do-if-youre-bitten-by-a-snake-34238">other first-aid measures</a> (pressure bandages and immobilising both the limb and the patient). These aim to prevent the venom travelling from the bite site, via the lymphatic system, to the bloodstream.</p>
<h2>Antivenom saves lives for those who need it</h2>
<p>Our study confirmed the role of antivenom in treating snakebites and the need for it to be administered before irreversible damage is done to the nervous system and paralysis occurs. </p>
<p>However, we found one in four patients given antivenom had an allergic reaction to it and about one in 20 have severe anaphylaxis requiring urgent treatment. </p>
<p>So it is essential only patients with snake envenomation, and not just a suspected snakebite, are treated with antivenom. We found 49 patients (around 6%) were given antivenom unnecessarily, out of the total 755 patients who received it.</p>
<h2>What needs to change?</h2>
<p>We know <a href="https://www.ncbi.nlm.nih.gov/pubmed/27903075">the earlier</a> someone receives antivenom <a href="https://www.ncbi.nlm.nih.gov/pubmed/21143062">the better</a>. Yet our study found that the time from being bitten until receiving antivenom had not improved over the study period.</p>
<p>So we need to find ways to make sure patients get antivenom as early as possible. This requires laboratory tests that can identify patients with snake envenomation in the first couple of hours after the bite. </p>
<p>It is also essential anyone bitten by a snake or suspected to be bitten by a snake seeks immediate medical attention and goes to hospital by ambulance.</p>
<p>But the best thing is to avoid being bitten in the first place:</p>
<ul>
<li><strong>avoid snakes</strong>, difficult if you’re a snake handler (up to 11% of cases in our study), and take care if trying to catch or kill a snake (which led to a bite in 14% of cases)</li>
<li><strong>wear long pants and sturdy shoes</strong> when walking in the bush or rural areas (47% of snakebites were when people didn’t know one was nearby) or when gardening (8% of cases)</li>
<li><strong>be alert inside too</strong>, with 31% of snakebites near houses and 14% in buildings.</li>
</ul>
<p>Our study confirms Australian snakes <a href="https://theconversation.com/a-venomous-paradox-how-deadly-are-australias-snakes-79433">don’t really deserve</a> their deadly reputation, <a href="https://theconversation.com/yes-australian-snakes-will-definitely-kill-you-if-youre-a-mouse-51809">unless you’re a mouse</a>. But if you are bitten, or think you have been, hospital is still the best place for you.</p><img src="https://counter.theconversation.com/content/81614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geoff Isbister receives funding from the National Health and Medical Research Council. </span></em></p>Don’t hold back. Performing CPR on a snakebite victim who has collapsed can save their life, however imperfect your technique.Geoff Isbister, Director, Clinical Toxicology Research Group, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/758362017-04-07T06:50:24Z2017-04-07T06:50:24ZThe truth about spider bites in Australia – they’re unlikely to eat your flesh<figure><img src="https://images.theconversation.com/files/164363/original/image-20170406-16685-7ldj6s.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The largely harmless white-tailed spider has copped a lot of flak.</span> <span class="attribution"><span class="source">Robert Raven</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Recent news reports that a man had both his legs amputated after being bitten by a <a href="https://australianmuseum.net.au/white-tailed-spider">white-tailed spider</a> have again cast this relatively harmless spider in a negative light. Experts have since said amputations <a href="https://www.theguardian.com/environment/2017/apr/05/spider-bite-double-amputation-likely-to-be-mistaken-identity-says-arachnologist">may have been wrongly blamed</a> on a spider bite, and authorities now consider a <a href="http://www.heraldsun.com.au/news/victoria/man-has-legs-amputated-after-being-bitten-by-whitetail-spider-in-victoria/news-story/7bb8c09c919768f9716ecff2376c5f8a">bacterial infection</a> to be responsible for the man’s injuries. Despite this, the damage to the largely harmless white-tail may have been done.</p>
<p>The venom from the white-tailed spider is <a href="http://www.toxinology.com/fusebox.cfm?fuseaction=main.spiders.display&id=SP00192">listed as non-lethal</a>.
It has not been shown to cause necrotic ulcers, which could result in the need for amputation. And there has never been any clear evidence necrotising arachnidism – the name give to a syndrome where the skin blisters and ulcerates following spider bites – has been seen in <a href="https://www.mja.com.au/journal/1999/171/2/necrotising-arachnidism">Australia</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"849520575156539393"}"></div></p>
<p>There is currently no clinical test to determine if you have been bitten by a spider. And there is no blood or swab test that can be performed to positively identify what spider it is if a bite is suspected. Whether it is a bite from a spider or another insect, <a href="https://www.nps.org.au/australian-prescriber/articles/spider-bite-a-current-approach-to-management">the management is the same</a> – most will get better without any medical treatment.</p>
<h2>Spiders in Australia</h2>
<p>The majority of spiders in Australia are voracious predators of insects. For the most part, they play a useful role in lowering insect numbers.</p>
<p>The venom transmitted through <a href="http://www.livescience.com/37974-he-surprising-cause-of-most-spider-bites.html">bites</a> of some Australian spiders can cause harm to humans and even be life-threatening. The better known of these are the redback spider (<em>Latrodectus hasselti</em>), and the funnel-web spiders (genera <em>Atrax</em> and <em>Hadronyche</em>). Antivenom is available for both spiders. </p>
<p>Redback spider venom can cause a lot of pain. Advice would be to go to hospital if pain lasts for longer than a few hours and simple pain relief is not helping. Funnel-web spider venom can cause local swelling in addition to increasing heartbeat, salivation, muscle spasms and <a href="http://www.toxinology.com/generic_static_files/cslavh_antivenom_funweb.html">respiratory distress</a> (trouble breathing).</p>
<p>Without appropriate first aid, quick access to hospital and antivenom, these bites can be lethal. For the “big black hairy” funnel-webs, appropriate first aid needs to be applied and it is advisable to call 000. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/164376/original/image-20170407-16663-zgodmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/164376/original/image-20170407-16663-zgodmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164376/original/image-20170407-16663-zgodmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164376/original/image-20170407-16663-zgodmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164376/original/image-20170407-16663-zgodmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164376/original/image-20170407-16663-zgodmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164376/original/image-20170407-16663-zgodmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The redback spider is considered one of the most venomous to humans in Australia.</span>
<span class="attribution"><a class="source" href="http://www.flickr.com/photos/graibeard/4178747700/in/photolist-7ngb79-6fSHdG-dC3uow-9BrYc3-6fSHgU-6fSHrC-fAvBeJ-cFNiJu-cFNeVf-FMCC5d-5Pc4a-7y73tv-6fNEVF-dC3xaq-o2M55G-65sxdZ-9KDMGh-dLc7YQ-83atP9-6fNDXH-dC3wZU-dL6BSD-6fSQWL-6fSRMQ-dC3wMq-6fSQvm-6fNFWV-6fSRbC-6fNCaP-6fNBFH-F1mNaY-a28fsE-dC3v8S-avqgAh-8A1TA7-dC3s19-6fNBBp-6fSS4o-6fNFir-dBX8HH-dC3ztQ-dC3wBd-b6MSBZ-dC3tP7-dBXaaX-dBX7bi-dBX886-dC3t77-6fNKXc-brqv5i">graibeard/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Other spiders that have concerning bites include the trapdoor, whistling, sac, ground, orb and huntsman spiders. These may cause milder symptoms such as headache, swelling and pain, which does not last for a long time.</p>
<h2>The white-tailed spider</h2>
<p>White-tailed spiders (<em>Lampona sp.</em>) can be recognised by their cylindrical body shape and a white or grey spot on the end of their abdomen. They are found in eastern and most southern areas of Australia and New Zealand.</p>
<p>These spiders are active hunters, preying on other types of spiders and insects. They may transiently roam inside houses, especially in warmer weather, where they may be found in bedding or clothing that has been left on the floor.</p>
<p>One study of over 70 spider bite cases in which white-tailed spiders were identified showed patients experienced only a <a href="https://www.mja.com.au/journal/2003/179/4/white-tail-spider-bite-prospective-study-130-definite-bites-lampona-species">mild localised reaction</a>, such as swelling, local pain or headache. To date clinical research has not been able to associate tissue loss with the venom of these spider bites.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/164399/original/image-20170407-29410-9asod5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/164399/original/image-20170407-29410-9asod5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/164399/original/image-20170407-29410-9asod5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=454&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164399/original/image-20170407-29410-9asod5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=454&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164399/original/image-20170407-29410-9asod5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=454&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164399/original/image-20170407-29410-9asod5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=571&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164399/original/image-20170407-29410-9asod5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=571&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164399/original/image-20170407-29410-9asod5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=571&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">White-tailed spiders can be recognised by their cylindrical body shape.</span>
<span class="attribution"><span class="source">Robert Raven</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Flesh-eating bacteria</h2>
<p>The man at the centre of the recent story linking amputations to a white-tail spider bite was <a href="http://www.thecourier.com.au/story/4579872/white-tail-spider-only-a-point-of-entry-for-flesh-eating-infection/">said to have</a> a “flesh eating” infection. But there is a very <a href="https://www.mja.com.au/journal/2003/179/4/white-tail-spider-bite-prospective-study-130-definite-bites-lampona-species">low probability of an association</a> between spiders and <a href="https://en.wikipedia.org/wiki/Necrotizing_fasciitis">necrotisisng fasciitis</a> (commonly known as flesh-eating disease).</p>
<p>Of course, any injury that causes a break in our skin leaves the capacity for bacteria to enter our body. Therefore be sure to keep an injury area clean. Questions have been raised as to the possibility of a <a href="https://www.ncbi.nlm.nih.gov/pubmed/21485377">spider introducing infections</a>, but again, despite it being theoretically possible, it is unlikely. </p>
<p>Contributing factors to infection are if people have conditions such as diabetes or take medications, such as steroids like prednisolone, that lessen the body’s ability to fight infection.</p>
<h2>How to prevent spider bite</h2>
<ul>
<li>Leave them alone</li>
<li>wear gloves if gardening</li>
<li>humanely remove spiders from your home and limit hiding spaces where possible inside the home</li>
<li>knock out shoes before putting them on; these are nice quiet homes for spiders.</li>
</ul>
<p>For <a href="http://www.seqirus.com.au/bites-app">first aid</a> after a spider bite, please see the <a href="https://resus.org.au/guidelines/">Australian guidelines</a>. Many bites don’t result in envenoming and death is very <a href="http://onlinelibrary.wiley.com/doi/10.1111/imj.13297/abstract">rare</a>, so it is important to remain calm. But seek medical attention if there are concerning symptoms such as those described above: difficulty breathing, increased heartbeat and pain lasting longer than an hour.</p><img src="https://counter.theconversation.com/content/75836/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ronelle Welton receives funding from the NHMRC.</span></em></p><p class="fine-print"><em><span>Bill Nimorakiotakis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether it’s a bite from a spider or another insect, the management is the same - most will get better without any medical treatment.Ronelle Welton, Scientist AVRU, The University of MelbourneBill Nimorakiotakis, Associate Professor, Epworth HospitalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/754012017-04-05T02:15:45Z2017-04-05T02:15:45ZThere are many ways to treat jellyfish stings – peeing on them isn’t one<figure><img src="https://images.theconversation.com/files/163762/original/image-20170404-21963-i8k8ky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Careful where you step ... how best to treat bluebottle jellyfish stings at the beach?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/aidan_jones/1859859534/in/photolist-3QmgrG-4dj8vJ-95S3xM-2EXY3A-2EXZhW-2EY2Tm-5RjMEe-5Rp5Em-zfyp7-5Rp5Bb-D3Yy7-dQytez-qJYYfD-bjPsbw-6rstRb-e8grNe-zjGwNd-8Qngsw-5UgtFH-3QmfHW-8Htj5h-9cjcS-3s5weF-8Qjbd4-3sa6ME-CvhYj-34jR2C-CvhUN-dQE4Qm-CvhVJ-4qFggf-e1Z3qM-8Jpbxz-hN25vn-gFaXxX-gFaYer-4iL76q-B1Qg5-9RZ9J-B1Qba-7akBe2-eKH7ek-9dM8wo-5JbsjN-5WwYd-95S1hz-4iADo5-df21cG-dTVWCi-5JwHc5">Aiden Jones/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>It’s easy to be confused about how to treat a jellyfish sting. Is it best to use grandfather’s slurry of bicarbonate of soda or a douse of vinegar? Is it best to use an ice pack, take a hot shower or ask someone to urinate on your leg?</p>
<p>Even experts disagree about the right first aid. And guidelines about how to treat the stings can seem confusing because of different types of jellyfish in different parts of Australia.</p>
<p>For instance, first aid differs between temperate and tropical waters (north and south of Bundaberg in Queensland), as <a href="https://www.mja.com.au/journal/2017/206/6/are-we-using-correct-first-aid-jellyfish">highlighted</a> earlier this week.</p>
<p>But we do not only need to consider the type of jellyfish and where in Australia people are stung. We also need to consider if a treatment works (is effective), is safe and ultimately whether it is practical.</p>
<h2>Hot water (but not too hot) for bluebottle stings</h2>
<p>Treating <a href="http://www.australiangeographic.com.au/topics/wildlife/2016/11/australian-bluebottles">bluebottle</a> (Physalia) stings is a good example of the balance of effectiveness, safety and practicality.</p>
<p><a href="https://theconversation.com/the-blue-bottles-are-coming-but-what-exactly-are-these-creatures-48675">Bluebottle</a> stings occur throughout Australia, more commonly on exposed beaches after onshore winds. They are responsible for thousands of stings each year in the warmer months. They cause immediate intense local pain lasting for an hour, or more in severe cases. At the sting site there is a characteristic raised red line that remains for hours to days.</p>
<p>There is <a href="https://www.mja.com.au/journal/2006/184/7/randomised-controlled-trial-hot-water-45-c-immersion-versus-ice-packs-pain-relief">good evidence</a> immersing someone in hot water works when treating bluebottle stings. Hot water inactivates the jellyfish toxins and so stops the pain; it is effective in about 90% of cases after 20 minutes.</p>
<p>But there is less evidence hot water treatment is safe as there is a risk that if the water is hotter than 46°C it can burn. It might also not be practical to immerse someone in hot water on a beach.</p>
<p>So what happens in the real world? Surf life-savers might put victims in a hot shower. This is because the risk of a burn is low (if they test the water first), it is practical and still likely to be effective.</p>
<p>If your child is stung and you are close to home, head home, run a hot bath (test your child can tolerate the temperature) and get your child to soak for about 20 minutes.</p>
<h2>Advice changes as we head north</h2>
<p>Things become more confusing as you go <a href="https://www.mja.com.au/journal/2017/206/6/are-we-using-correct-first-aid-jellyfish">north</a>. Here, beach goers face major box jellyfish (<em>Chironex fleckeri</em>) stings, which can be <a href="https://www.mja.com.au/journal/2017/206/6/hot-water-immersion-v-icepacks-treating-pain-chironex-fleckeri-stings-randomised">life-threatening</a>, and Irukandji syndrome, which can cause such <a href="https://www.mja.com.au/journal/2003/178/1/severity-irukandji-syndrome-and-nematocyst-identification-skin-scrapings">severe pain</a> you need to be treated in hospital. </p>
<p>For these, is it best to use vinegar or hot water? Again it’s mainly a question of safety.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/163764/original/image-20170404-21933-ugs5hh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/163764/original/image-20170404-21933-ugs5hh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/163764/original/image-20170404-21933-ugs5hh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1067&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163764/original/image-20170404-21933-ugs5hh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1067&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163764/original/image-20170404-21933-ugs5hh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1067&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163764/original/image-20170404-21933-ugs5hh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1340&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163764/original/image-20170404-21933-ugs5hh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1340&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163764/original/image-20170404-21933-ugs5hh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1340&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Treating box jellyfish stings with ice is more practical than using hot water.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/of_guido/1285937237/in/photolist-7Zrh6G-7ZrhwA-2XCLkF-4LxB5N-68ipwP-4tG6xC">gautsch/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>A study published earlier this week found that for treating box jellyfish, immersion in hot water is <a href="https://www.mja.com.au/journal/2017/206/6/hot-water-immersion-v-icepacks-treating-pain-chironex-fleckeri-stings-randomised">no more effective</a> than using an ice pack. </p>
<p>So, while we have seen hot water is best for bluebottle stings, it doesn’t seem to work so well for box jellyfish in northern waters. This may simply be due to the delay in application of hot water in the emergency department with box jellyfish compared to treatment on the beach for bluebottle stings. Or it may be a species difference.</p>
<p>So how should we interpret this? Currently the recommendations in hospitals are to use ice packs to relieve the pain of box jellyfish stings. This seems to be as effective as immersing in hot water in the <a href="https://www.mja.com.au/journal/2017/206/6/hot-water-immersion-v-icepacks-treating-pain-chironex-fleckeri-stings-randomised">recent study</a>, and certainly easier to do and safer. So, we should continue to use ice packs in the emergency department.</p>
<p>What about for major box jellyfish stings on the beach in Darwin, or Far North Queensland? This is more difficult to answer.</p>
<p>In <a href="https://www.mja.com.au/journal/2002/177/11/temperature-effects-box-jellyfish-venom-possible-treatment-envenomed-patients">animal studies</a> hot water inactivates its venom. So it is likely that hot water will be effective if administered early. So, on the face of it, it might be reasonable to put people in a hot shower.</p>
<p>But, if you are stung by a box jellyfish in tropical waters, the initial priority is not to treat the pain but to prevent severe <a href="https://en.wikipedia.org/wiki/Envenomation">envenomation</a>, a process that’s not clearly understood but can lead to cardiac arrest and death.</p>
<p>So, the current recommendation is to use vinegar, which we’ll come back to, and an immediate transfer to hospital. If the person stops breathing or has a cardiac arrest, they need immediate, basic life support.</p>
<h2>Vinegar for tropical box jellyfish, for now</h2>
<p>This brings us to the question of <a href="https://www.mja.com.au/journal/2017/206/6/are-we-using-correct-first-aid-jellyfish">whether to use vinegar</a> to treat box jellyfish in tropical waters.</p>
<p>Vinegar has been recommended for decades to treat box jellyfish stings based on a <a href="http://europepmc.org/abstract/med/6102347">single study</a>. The idea is vinegar prevents the further firing of stinging cells. But there’s little evidence to suggest applying vinegar has improved victims’ health or likelihood of dying from a sting.</p>
<p>Then, there’s conflicting evidence about whether vinegar is harmful. A laboratory <a href="http://www.eubs.org/documents/DHM%20Vol44%20No1.pdf#page=32">study</a> found vinegar may actually increase the release of venom. </p>
<p>Clearly we need further evidence to see if vinegar is effective <em>and</em> harmful in a real-life situation.</p>
<p>But with no real-world evidence of harm in treating box jellyfish stings, and the potential benefits in preventing life-threatening envenoming, it should remain the initial first aid for these stings.</p>
<p>We just assume if the venom is inactivated it will decrease the severity of the sting.</p>
<h2>Jury’s out on vinegar for Irukandji syndrome</h2>
<p>Next comes first aid for Irukandji syndrome, caused by being stung by a <a href="https://www.mja.com.au/journal/2003/178/1/severity-irukandji-syndrome-and-nematocyst-identification-skin-scrapings">range of jellyfish</a> including <em>Carukia barnesii</em>. These jellyfish are found mainly in tropical waters in the north. Although some species occur in southern waters, these rarely sting.</p>
<p>Treating Irukandji syndrome is more difficult because in most cases people do not recognise they’ve been stung until about 30 minutes later. The pain is severe and generalised (chest, back and abdomen), needing treatment with strong opioid painkillers. A small proportion of people may develop heart problems.</p>
<p>Using vinegar to treat Irukandji syndrome is again controversial. The evidence may weigh more toward it causing harm, <a href="https://www.mja.com.au/journal/2017/206/6/are-we-using-correct-first-aid-jellyfish">with little evidence of benefit</a>. There is no evidence for using hot water.</p>
<h2>No evidence for urine or bicarbonate of soda</h2>
<p>Then there’s the old myth of using urine to treat jellyfish stings, popularised in the TV series Friends.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/W6uxK_6FImc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The TV show Friends helped spread the myth about urinating on a jellyfish sting.</span></figcaption>
</figure>
<p>There’s no evidence to back that, or for using a slurry of bicarbonate of soda.</p>
<h2>Where to next?</h2>
<p>Current guidelines might appear confusing, but are based on the best available evidence. In some cases this evidence is a randomised-controlled trial, where victims are chosen at random to receive a treatment and compared with others who receive another treatment (or no treatment). But in other cases, guidelines are based on anecdote and expert opinion, which require challenging.</p>
<p>We also need more research, for instance on the effectiveness and safety of vinegar, both for <em>Chironex fleckeri</em> stings and Irukandji syndrome.</p><img src="https://counter.theconversation.com/content/75401/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geoff Isbister receives funding from the National Health and Medical Research Council. </span></em></p>If you’re confused about how best to treat a jellyfish sting, you’re not alone. Even the experts disagree. So, here’s the best advice we have.Geoff Isbister, Director, Clinical Toxicology Research Group, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/752532017-03-28T12:44:09Z2017-03-28T12:44:09ZRun, hide, tell – treat? The public now has a role to play in Westminster-style attacks<p>While debate continues about whether the events that unfolded in London on March 23 amounted to an <a href="https://theconversation.com/what-if-the-london-attack-wasnt-an-act-of-terrorism-75232">act of terrorism</a>, it has many people thinking about how they would react in a similar situation. </p>
<p>The British government is <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/97995/strategy-contest.pdf">constantly reviewing</a> how prepared it is for terrorist incidents. Its <a href="http://www.npcc.police.uk/NPCCBusinessAreas/WeaponAttacksStaySafe.aspx">official advice</a> to those caught up in major incidents is to “run, hide, tell”. They are to run as far away as possible, but if they cannot reach a place of safety, they should hide, and if it’s safe to do so, they should use their mobile phone to call the emergency services.</p>
<p>However, the UK charity <a href="http://citizenaid.org/">CitizenAID</a> has suggested extending this advice to “run, hide, tell, treat”. Given recent changes to how the police respond to potential terrorist incidents, the idea is that the general public should be encouraged to do what they can to help injured people around them until ambulance crew can access the scene. </p>
<h2>Evolving threat</h2>
<p>Over the past few years, numerous attacks have shown how vulnerable we can be in public and in confined spaces. In 2013, 67 people were killed and more than 175 injured in the Westgate Mall siege in Nairobi, Kenya. In July 2016 a lone actor carried out a small arms attack at the Olympia shopping mall in Munich, killing ten people and <a href="https://www.theguardian.com/world/2016/jul/22/munich-shopping-centre-evacuated-after-reported-shooting-germany">injuring 36</a>.</p>
<p>Following the attacks in Paris in November 2015, which resulted in 130 people being killed and 360 injured, mainly by small arms fire, the UK armed police <a href="https://www.theguardian.com/uk-news/2015/dec/02/uk-counter-terror-plans-revised-to-ensure-police-tackle-gunmen-as-priority">changed their tactics</a> for dealing with an attack by terrorists using small arms.</p>
<p>If such an incident now happens in the UK, armed police will ignore the dying and injured. Their primary aim is to eliminate the threat first. Training exercises carried out in British shopping malls, including the <a href="http://www.manchestereveningnews.co.uk/news/greater-manchester-news/terror-training-exercise-trafford-centre-11322135">Trafford Centre</a> in Manchester in May 2016, and in <a href="http://www.thestar.co.uk/news/terror-exercise-police-nullify-meadowhall-attackers-armed-with-simulation-explosives-and-firearms-1-8448112">Meadowhall</a> in Sheffield in March 2017, revealed that it can take over 100 minutes before armed police are able to eliminate the threat. And only once that has happened can paramedics be let onto the scene to treat the injured. Such a lengthy wait can result in many severely wounded people dying before they receive medical treatment. </p>
<p>CitizenAID’s recommendation that those caught up in a terrorist incident – many of whom may not be trained in first aid – should treat others with severe, life-threatening wounds by triaging and applying tourniquets is potentially controversial. But if it can take up to two hours before trained paramedics can get to the scene it becomes more of a pragmatic solution.</p>
<p>The suggestion is based on the military’s operational experiences in Iraq and Afghanistan in cases of severe injury. It has been found that first aid applied in the first ten minutes of a person sustaining the injury can save their life. Soldiers applying tourniquets and packing to life-threatening gunshot and bomb blast wounds has been shown to save many lives.</p>
<p>The charity has produced a <a href="http://citizenaid.org/features/download-citizenaid-app/">free app</a> to help people in this situation. Using mainly icons rather than words, it is has been designed to reduce anxiety from making difficult decisions in what would clearly be an unfamiliar situation.</p>
<p>People are willing to help others. We saw as much in the Westminster attack, when Conservative MP <a href="http://www.bbc.co.uk/news/uk-39363660">Tobias Ellwood</a> gave mouth-to-mouth resuscitation to police officer, Keith Palmer. Medically approved guidance like the one provided by CitizenAID could help those applying first aid in such situations.</p>
<p>Their advice shows how those treating the wounded can improvise with what equipment is available to hand. Tourniquets, for example, can be made with scarves, socks or belts and clothing can be used as packing for life-threatening wounds.</p>
<p>Even though a person my not have any first aid experience, it’s important that severe bleeding is treated immediately. A victim can literally bleed to death within a few minutes, and bleeding from limbs in particular can be effectively stopped. CitizenAID is even looking to place medical equipment to treat such wounds at various locations such as shopping malls.</p>
<p>If the British government extended “run, tell, hide” to “run, tell, hide, treat” it could help save lives when an attack happens in a public place. If a similar approach was used at the likes of the Westgate Mall or Olympia Mall incidents, maybe the number of fatalities would have been reduced.</p><img src="https://counter.theconversation.com/content/75253/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Lowe does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A charity is recommending the public be advised to help each other in emergency situations.David Lowe, Senior Lecturer Liverpool Centre for Advanced Police Studies, LJMU, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/211002013-12-10T14:32:04Z2013-12-10T14:32:04ZSilly ambulance call-outs are just the tip of the iceberg<figure><img src="https://images.theconversation.com/files/37339/original/c7b77fkj-1386669124.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1022%2C654&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bit of first aid wouldn't go amiss.</span> <span class="attribution"><span class="source">Lester Public Library</span></span></figcaption></figure><p>We expect just as much from our ambulance services as we do from accident and emergency departments. But under-resourced and overstretched health systems mean ambulance staff are increasingly under pressure to deliver timely quality care. They also feel the knock on effect of emergency department congestion, hospital overcrowding and escalating demand, and even recent reports in the UK <a href="http://www.theguardian.com/society/2013/dec/09/patients-wait-hours-ambulances-emergency">that some patients</a> were being forced to wait in ambulances for several hours before being seen. </p>
<p>Calling an ambulance for non-urgent issue just adds more pressure to what could well be untenable in the near future. We’ve no doubt heard some of the <a href="http://www.dailymail.co.uk/news/article-2079741/Can-come-unblock-toilet-The-stupidest-999-calls-Christmas-holidays.html">incredible call-outs</a> that ambulances sometimes publicise to deter people from calling for no reason. </p>
<p>They include cigarette smoke blown at a woman’s eye at a bar, a patient with <a href="http://www.thisislocallondon.co.uk/news/10773204.Ambulance_called_to_nosebleed_in_Bexleyheath_Cineworld/?commentSort=score">a nosebleed</a> and a call for help to <a href="http://www.bbc.co.uk/news/uk-northern-ireland-14924766">get a ring off</a> a finger. In these instances, not only are ambulance crews diverted from serious cases that require their expertise, it is also profoundly demoralising to crew who put themselves at risk racing under light and sirens to attend minor illness.</p>
<h2>Most people show common sense</h2>
<p>But in reality, the majority of people show common sense and these are unusual. It is difficult to reliably anticipate whether a condition is sufficiently threatening to life or limb and whether you really need an ambulance. The majority of people do it <a href="http://www.ncbi.nlm.nih.gov/pubmed/23758304">because they are worried</a>. And on the whole, compared to walk-ins, patients transported by ambulance do tend to have more acute, severe and complex illness. </p>
<h2>Deeper problem</h2>
<p>Nevertheless, it’s clear that ambulance staff being diverted from genuine emergencies to people who don’t really need them isn’t great for the efficiency of the system. </p>
<p>One way we could tackle the problem is by cutting down on inappropriate use of ambulances – whether knowingly or unknowingly. Most studies that have looked at this issue have employed the use of a retrospectoscope, when an emergency doctor determines that a patient only has a minor illness after they have had already had a thorough assessment. Until then it is hard to know whether the chest pain you’re having is a case of indigestion or a major heart attack.</p>
<p>Inappropriate ambulance requests for transport of patients with non-urgent and minor conditions can lead <a href="http://www.griffith.edu.au/__data/assets/pdf_file/0011/389567/Ambulance-Ramping-Study.pdf">to ambulance overcrowding</a> on approach bays to the hospital. </p>
<p>A lack of beds within emergency departments and hospitals can also <a href="https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CD0QFjAB&url=http%3A%2F%2Fwww.collemergencymed.ac.uk%2Fcode%2Fdocument.asp%3FID%3D6296&ei=WdamUpCvAeuA7Qb5tYFQ&usg=AFQjCNFksMIohXWwSqb4Ladlg00-36OaMw">have a ripple effect</a> [pdf download] in ambulance overcrowding and, which then oblige crews to repeatedly circle a hospital or divert to another hospital. These delays are known to negatively affect patient outcome, especially for sicker patients stuck at the end of an ambulance queue. And crews are unable to attend another call while they are caring for a stretchered patient.</p>
<p>A recent <a href="https://theconversation.com/keogh-report-tackles-aande-supply-but-not-deeper-demand-20176">major report</a> into emergency care in the UK recommended that ambulances be seen more as “treatment centres” to help unload some of the pressures on hospital emergency departments. However, this recommendation depends on being able to train ambulance crews to a degree that they can confidently make diagnoses and offer outpatient treatment in a safe way. They also require the costly reconfiguration of existing ambulances. The ultimate barrier may be overcoming the wide public perception that ambulance care is inferior to that able to be delivered at a hospital.</p>
<h2>Taking it for granted?</h2>
<p>Although most of the community use ambulances for good reason, a substantial minority regard this costly and skilled resource <a href="http://www.ncbi.nlm.nih.gov/pubmed/16997778">as an entitlement</a> as their taxes have already paid for it. The public should be made aware that patients with serious illness <a href="http://www.dailymail.co.uk/news/article-2333083/Overstretched-A-amp-Es-turning-away-ambulances-Diversions-hospitals-happened-357-times-past-year.html">suffer worse outcomes</a> and death rates at 30 days if they are subjected to delays in ambulance and emergency care.</p>
<p>Until the public recognises ambulance <a href="https://theconversation.com/aande-is-in-crisis-because-we-all-take-it-for-granted-14458">care as scarce</a>, costly and highly trained health care providers, it will continue to be overused (and at times abused). We need to be reminded that although it may cost nothing to call an ambulance, the service doesn’t really come for free – something gives somewhere. And ambulance services wouldn’t have to pay out for costly publicity campaigns just to tell us about someone who called the ambulance at Christmas because the turkey was burnt. </p><img src="https://counter.theconversation.com/content/21100/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Assoc Prof Joseph Ting is an emergency, prehospital and aeromedical physician as well as adjunct associate professor for clinical research methods and prehospital care at Queensland University of Technology’s School of Public Health and Social Work. He is the coauthor of several publications on ambulance use and is a member of the Emergency Health Services Qld Group (EHSQ). EHSQ received an Australian Research Council Linkage Grant for a programme of research into ambulance and emergency care. Dr Ting recently worked for Helicopter Emergency Medical Services in the United Kingdom.
</span></em></p>We expect just as much from our ambulance services as we do from accident and emergency departments. But under-resourced and overstretched health systems mean ambulance staff are increasingly under pressure…Joseph Ting, Clinical Senior Lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/51602012-02-13T03:24:43Z2012-02-13T03:24:43ZBe prepared – thinking of your health during natural disasters<figure><img src="https://images.theconversation.com/files/7596/original/kddbsgcr-1329102470.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People tend to think about sentimental items they'd collect when evacuating, rather than useful ones, such as medicines.</span> <span class="attribution"><span class="source">Ralph Sanderson</span></span></figcaption></figure><p>Disasters and extreme weather events often affect populated areas and yet few people consider that they’d be required to act as a “first responder” in their community before, during or after such events. But there are measures that both members of the public and governments can do to mitigate the effects of disasters.</p>
<p>As Cyclone Yasi was making landfall on the Northern Queensland coast in February 2011, Queensland Premier Anna Bligh and Deputy Commissioner Ian Stewart set expectations about the response of emergency services to persons within disaster affected communities. Deputy Commissioner, Ian Stewart said, “… depending [on] how far away you are from that eye [of the cyclone], it will be impossible for the emergency services to respond to you… people have to understand that they need to become first responders themselves to ensure the safety of their family, themselves and their neighbours.” <a href="http://www.cabinet.qld.gov.au/MMS/StatementDisplaySingle.aspx?id=73489">(Press conference: 2nd February 2011)</a>.</p>
<p>But how does someone even become a first responder? And, do governments support and assist people to prepare for the role?</p>
<p>It seems reasonable to suppose that if large numbers of people were trained in first-aid principles, they might be able to support their community with health issues during and following disastrous events. And while an accurate number of recently trained first-aiders in Australia doesn’t exist, it seems reasonable to assume that the number of people in Australia who aren’t first-aid trained exceeds <a href="http://www.stjohn.org.au/index.php?option=com_content&view=article&id=14&Itemid=25">the number who are</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/7595/original/p23h2s3q-1329102079.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/7595/original/p23h2s3q-1329102079.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/7595/original/p23h2s3q-1329102079.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/7595/original/p23h2s3q-1329102079.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/7595/original/p23h2s3q-1329102079.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/7595/original/p23h2s3q-1329102079.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/7595/original/p23h2s3q-1329102079.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Michael Roper</span></span>
</figcaption>
</figure>
<h2>What the government can do?</h2>
<p>So something the government could do to enhance community resilience, from a health perspective, is support and promote first-aid training as a compulsory component of school curricula in all year groups. It could also make such training a required component of obtaining and renewing drivers’ licences. </p>
<p>In addition to increasing the number of trained first-aiders nationally, regularly undertaking <a href="http://www.ncbi.nlm.nih.gov/pubmed/22008363">first-aid training may enhance the willingness and confidence of first responders</a>. Naturally, the training should be coupled with an awareness of the realities and expectations of what action would need to be taken during disasters.</p>
<p>Community nurses and <a href="http://www.racgp.org.au/disasterresources">general practitioners</a> are particularly valuable members of the community during and following disastrous events, but attention is often focused only on frontline emergency service and health providers. Community nurses and general practitioners tend to have existing knowledge of vulnerable members of the community, and know how to access local health services and pharmacies. So, they should be actively involved in health planning for disasters at local, state and national levels.</p>
<h2>What you can do?</h2>
<p>People who arrived at evacuation centres during disasters, such as the Canberra Bushfires (2003), Black Saturday and the Victorian Bushfires (2009) and the Queensland extreme weather events (2011), were not all “health prepared”. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/7594/original/6xrsbrth-1329101883.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/7594/original/6xrsbrth-1329101883.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/7594/original/6xrsbrth-1329101883.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/7594/original/6xrsbrth-1329101883.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/7594/original/6xrsbrth-1329101883.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/7594/original/6xrsbrth-1329101883.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/7594/original/6xrsbrth-1329101883.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Taking medicines when evacuating can only help.</span>
<span class="attribution"><span class="source">Jackson Kuruvilla</span></span>
</figcaption>
</figure>
<p>This is because most people think about sentimental items they’d collect when evacuating, such as photo albums and computers, and forget their health needs. Items people should take when evacuating include:</p>
<ul>
<li><p>a current list of medications and aliments;</p></li>
<li><p>list of medical, including surgical history;</p></li>
<li><p>personal medications and;</p></li>
<li><p>first-aid kits.</p></li>
</ul>
<p>These things can help health professionals in evacuation centres, particularly when a person presents with an exacerbation of underlying conditions or requests medication. Health professionals can help with this by ensuring their clients are adequately prepared for disasters with updated lists of personal health information.</p>
<p>More education about the need to be personally health prepared should be integrated with other disaster decision-making messages, such as the <a href="http://www.ruralfire.qld.gov.au/Fire%20Safety%20and%20You/Prepare%20Act%20Survive/2773QFRS_PAS_DL_3%20fold_LR.pdf">“Prepare Act Survive”</a> campaign. This information may help alleviate the pressure on health resources during disasters as well as inform and prepare first responders about their possible role in a disaster.</p><img src="https://counter.theconversation.com/content/5160/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Ranse does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Disasters and extreme weather events often affect populated areas and yet few people consider that they’d be required to act as a “first responder” in their community before, during or after such events…Jamie Ranse, Assistant Professor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.