Science to the Rescue: Learning What Works in First Aid: The Science Behind First Aid Guidelines Has Been Reevaluated, and, as a Result, Changes Are Coming in Training Practices and Real-World Applications

Article excerpt

Injury and illness on the job kill more than 2 million people around the world each year. That's 6,000 people a day. If a co-worker experienced chest pains or breathing difficulties, or severed an artery in an industrial accident, would you know what to do?

Every layperson who receives training in basic first aid hopes that he or she will never have to use it. When injury or sudden illness strikes, however, effective first aid can make a significant difference between life and death, rapid versus prolonged recovery and temporary versus permanent disability. By first aid, we mean "assessments or interventions that a bystander or the victim can perform with minimal or no medical equipment."

But what is effective first aid? Which common first aid procedures are truly helpful? Are familiar first aid procedures actually safe to perform? Conversely, are any of the currently recommended procedures harmful? Most importantly, what is the scientific evidence behind first aid?


You may have heard the phrase "evidence-based medicine." It refers to a movement to apply scientific method to the practice of medicine--especially to adequate scientific study. The advantage of basing medical treatment, including first aid protocols, on scientific evidence is that it is less subject to personal or professional bias.

In an attempt to answer some of the many questions concerning current first aid treatment recommendations, the American Safety & Health Institute (ASHI) joined 25 other nationally recognized organizations on the 2005 National First Aid Science Advisory Board (NFASAB). Co-founded by the American Heart Association Inc. (AHA) and the American Red Cross (ARC), NFASAB was charged with reviewing and evaluating the scientific literature on first aid.

NFASAB members agreed that first aid recommendations should be medically sound and based on scientific evidence. To this end, we reviewed data from the U.S. Centers for Disease Control and Prevention, Cochrane Reviews (evidence-based evaluations of the effects of various health care treatments), the U.S. National Library of Medicine, medical journals, textbooks and other sources.

Our research topics spanned a wide range: positioning a victim; oxygen delivery; asthma; allergic reactions; seizures; severe bleeding; wounds and abrasions; thermal, chemical and electrical burns; spinal injury; sprains; strains; contusions; fractures; snakebite; dental injuries; drowning; emergencies involving exposure to hot and cold environments; and poisoning.


What we found--or, more accurately, what we did not Find--didn't surprise us. Scientific evidence for first aid treatment is scarce or lacking in many critical areas. As a result, much of what is recommended today is based on practical experience and the consensus of experts. While experience and expert opinion are valuable, treatment recommendations unaccompanied by reliable scientific facts can simply be wrong.

For example, the medical community has long recommended keeping syrup of ipecac on hand for the emergency treatment of poisoning. In fact, syrup of ipecac never has been proven effective and even can be harmful.

During the NFASAB evidence evaluation process, controversy emerged in critical areas such as the use of tourniquets, pressure points and extremity elevation to control life-threatening bleeding. Similarly, issues arose in less-critical areas, such as a preference for triple-agent antibiotic ointment over double- or single-agent antibiotic ointment for superficial wounds.

Although debate ensued on some topics, in many cases there simply was not enough evidence to argue for or against the currently recommended first aid protocol. This was frustrating because it often prevented us from defining which first aid treatments work and which ones fail to stand up to the rigors of scientific scrutiny. …