September 10th, 2012

Fresh Air Matters... with Capt. Yaw

In my daily walk-drive-fly I come across many cases of ‘un-informed basic wound care’. It is therefore important to get the message out to as many of the people of the world as possible, that; ‘simple first aid saves lives’. It really does. One of the biggest challenges is that many of the pharmacy, and so called ‘chemical sellers’, are not even equipped with anywhere near the complete basics of first aid provisions. Furthermore, the majority of the businesses and organisations in West Africa are not equipped properly, nor do they have the competencies amongst their staff to handle even the simplest minor injury in the workplace. Many schools and homes also fail miserably at holding the basics for the needs of the daily scrapes.

In the aviation world we are keenly aware of the need for an outstanding first-responder facility both in equipment and trained personnel. So, let us consider what I like to have in my first aid kits, and then feel free to let me know what you think.

First of all, the first aid kit should be in a suitable container. Make it appropriate: from wall cabinets through transportable cases to simple plastic bags with lock-tops. Mobile ‘first aid kits’ can be very basic, fixed ones in the company first aid room (do you have one?) need to be more complex, and adapted to the work environment.

Gloves: it is important to protect yourself from infection, as well as the person you are treating. We keep three sizes of gloves and in the mobile units have a few pairs of each size in sealed plastic bags. 

Alcohol/individual alcohol wipes: Even a little scratch in our environment can quickly become infected. A simple wipe of a scratch with an alcohol pad can reduce the infection risk, and depending on the depth, may not even need any more treatment than that. Where we have just the alcohol bottle, we ensure that there is a sealed bag of cotton wool balls to dampen with alcohol and use to wipe those minor scrapes. Alcohol is also a great ‘disinfectant’ for other items.

Irrigation bottle and clean water: Being able to wash out a wound is a priceless asset. The simplest wound irrigation bottles are available all over Ghana! Any plastic ‘bottled water’ can have a simple hole punched in the top of the bottle and be used to gently irrigate a wound to clean it. I am always distraught with frustration when I see the tro-tro drivers using brake fluid to irrigate a fresh wound – a very negative, common practice which needs to be stopped – clean water is the best fluid, it is cheaper and helps to prevent infection!

Antiseptic cream: There are so many available on the market. I get through a small tube every month, just on insect bites and minor cuts! One or two applications of a good antiseptic cream can prevent serious infections and complications. 

Plasters (Band-Aids). These are the basic ‘cover-ups’ to protect a cleaned wound. Even a minor wound, once clean and, if appropriate ‘antiseptic creamed’, is best covered to prevent further exposure to infection. The ‘band-aid’ type is a sticky strip of material with a cushioned pad, generally non-stick, and at times with its own antiseptic included on the pad. They come in boxes of 20 or more, each in a little SEALED packet. You tear it open, peel back the covering and, without touching the pad itself, cover the wound with the pad, and then stick the material part to the skin around. So many people in Ghana have never seen these – everybody should have some. Simple, effective and inexpensive – if you don’t have some at the office or in the home, pick up a little box of them, assorted sizes is best. Remember, if the wound is bigger than the pad, your need a bigger plaster – or a dressing.

Dressings: I struggle in Ghana to find good ‘sterile gauze pads’. I can find some cheap and nasty ‘gauze on a roll that is definitely not sterile’ in most places. You can purchase some pads at larger pharmacies in the bigger towns and the cities. Sadly, in my experiences, in the rural areas you have a better chance of finding a five-legged sheep than a sterile gauze pad! These can be used in cleaning a wound, and in dressing it too. Be ready to cut it to size and avoid getting it contaminated prior to applicaiton!

Bandages: rolls of stretchy bandage are common, as are the gauze one that you can wrap over a dressing, be sure not to wrap too tight – blood flow is an essential part of healing!

Tape: Proper medical tape. There is a good distribution of a pinky-very-sticky-tape around the country, and it does its job. I have used it to fix mechanical things and for packaging too! The biggest problem with very-sticky-tape is when it is time to take it off.
Remove it gently or you may cause additional wounds. To lift the sticky residues, try some of the alcohol on a cotton pad. If that fails, and the wound is not open, try some acetone, but do not let such chemicals come into contact with the wound – it will sting and is not good!

Tweezers: Ideal for SMALL debris in the wound, or a small ‘foreign body’. Whether it is a spine from a bush, a grass seed, splinter of wood or glass, or a piece of swarf (small bit of metal); STERILE tweezers are essential for the removal of the same. Haemostats are great too, and can be purchased in some medical outlets in Ghana, they are like blunt scissors-tweezers and can lock closed. I have a selection of these versatile tools!

Scissors: I like a pair of really sharp scissors, which may be needed to cut a dressing to size, or if needing to snip-off some small damaged skin in doing the dressing. I also like to have ‘lister-scissors’ the type which is meant for cutting bandages and for cutting off clothing; it has a blunt arm that is intended for sliding along the skin in order to cut off shirts or trousers in emergencies, and is shaped to keep your hand away from the body as you do so. There is nothing worse than inflicting a scissor wound whilst trying to remove a dirty, blood stained garment to get to the wound in order to treat it.

I could go on… eye-wash bottle, saline solution, irrigation syringe, burn pads (or cling film as a back-up), disposable scalpel, cotton tipped applicators, iodine, calamine lotion, antiseptic liquid, butterfly stitches, a thermometer and more. 

If you don’t have somebody in your organisation that is first aid savvy – send them to the Red Cross, or similar, on training. If you don’t have well equipped first aid kits – then get them sorted out – and fast, BEFORE you need them.

Remember, it is always a good idea to get seriously injured people to the nearest, equipped, medical clinic. Knowing your own limitation is essential in such things – perhaps you need to change where that limitation is - right now? 

Capt. Yaw is Chief Flying Instructor and Chief Engineer at WAASPS, and lead Pilot with Medicine on the Move, Humanitarian Aviation Logistics (www.waasps.com www.medicineonthemove.org e-mail capt.yaw@waasps.com)