On the Frontline 13: First aid for non-optical conditions in practice

Why do optical assistants need to know about first aid for non-optical conditions in practice, UK? 

Here are several key reasons why:  

1. Health and safety legislation: Under UK health and safety regulations (such as the Health and Safety at Work Act 1974), employers are required to ensure that staff have adequate training to deal with accidents and emergencies. This includes providing basic first aid training to staff. 
2. Patient and public welfare: Optical assistants interact with a wide range of people, including elderly or vulnerable individuals who may be more prone to non-optical health issues (eg falls, strokes or diabetic emergencies). Being prepared to manage these situations can help prevent further harm and support the wellbeing of patients. 
3. Professional duty of care: As part of the healthcare team, optical assistants have a professional duty to ensure patient safety. While their main duties may involve assisting with eye exams, dispensing eyewear and providing basic eye care advice, they may still be the first to notice a non-optical medical problem and act on it. 
4. Training requirements for employers: Many optical practices in the UK are expected to have at least one member of staff with first aid training available at all times. Even if the optical assistant is not the designated first aider, having basic knowledge allows them to support trained personnel or take initial steps until professional medical help arrives. 
5. Boosting confidence and response time: With first aid training, optical assistants can feel more confident in emergencies, potentially reducing response times and improving patient outcomes. In some cases, timely intervention can be critical in preventing further harm, especially in high-stress situations. 

This article aims to cover: 

•  A basic knowledge of first-aid emergency procedures
• Understand why it is important to know about emergency procedures
• Know how to obtain further information on first aid
• Understand how to place a collapsed patient in the recovery position
• Be able to name a number of non-ocular emergencies that may present in practice 

A significant proportion of your time at work is spent dealing with the public in a clinical setting. As an optometric clinical assistant you will perform procedures on patients of all ages, some of whom may be frail or suffering from any of a number of debilitating disorders. It is therefore a good idea for you to have an awareness and basic knowledge of some emergency first-aid procedures.  

You may never need to employ your first-aid skills at work, but you will find it useful to gain a more extensive knowledge of first-aid procedures as this will give you the confidence to deal with unforeseen situations and issues such as how to deal with burns or wounds, poisoning, bone and muscle injuries.  

First-Aid Kit 

A UK optical practice first-aid kit should adhere to British Standard BS 8599-1 guidelines for first-aid kits to be used in shop premises and contain: 

• Guidance leaflet: Providing basic first aid instructions
• Plasters: Assorted sizes and types (waterproof, fabric etc.) 
• Sterile dressings: Various sizes to cover wounds 
• Bandages: Triangular bandages for slings, and crepe/conforming bandages for securing dressings 
• Safety pins: For securing bandages 
• Cleansing wipes: Alcohol-free wipes for cleaning wounds 
• Disposable gloves: For hygiene and preventing infection 
• Face shield/mask: For CPR and preventing infection
• Scissors: For cutting bandages or clothing
• Foil blanket: For retaining body heat
• Eye dressings: For eye injuries
• Microporous tape: For securing dressings
• Burn dressing: For burns
• Clothing cutters/scissors  

Optional but recommended: 

• Tweezers: For removing splinters 
• Antiseptic cream/ointment: For wound care
• Antiseptic wipes or spray
• Aloe vera gel
• Cotton pads and swabs
• Distilled water
• Insect bite or sting relief cream
• Skin rash cream
• Eye wash
• Digital thermometer
• Crêpe rolled bandages
• Safety pins
• Tweezers
• Two sterile eye dressings 
• Cough medicine 
• Antihistamine: for allergic reactions.
• Painkillers: general sales list over the counter pain relief such as paracetamol or ibuprofen 

Local regulations may prohibit offering pain relief or other medicines, but where they are made available they should not be stored in the first-aid kit but separately using the same secure provision as for ophthalmic drugs. If offered, ensure you check whether the patient has already taken any, whether they have any allergies to, for example, paracetamol, and whether they have any medical condition or other medication that might cause an adverse drug reaction. 

A first-aid kit should enable minor wounds such as staff screwdriver injuries, cuts, grazes, etc, to be dealt with, or patients with more serious wounds such as burns, scalds, etc, to be more comfortable before attending the accident and emergency department. In addition to injuries, there are a variety of other medical situations optical assistants should know how to handle. 

Fainting 

You may never need to exercise your first-aid skills at work. However, it is likely that at some time in your career you will have to deal with a patient who has fainted. 

Although the tests and procedures performed in an optical practice are familiar to us, they may be unfamiliar, and hence potentially stressful, for many patients. This applies particularly to those who are attending for the first time or are having applanation tonometry or contact lenses fitted for the first time. Even for confident patients, these procedures can be an ordeal. 

The ‘common faint’ is known technically as ‘vasovagal syncope’ and occurs when there is a temporary reduction in the blood flow, and hence oxygen supply, to the brain. Dilation of the blood vessels (vasodilation) is a natural reaction to overheating and stress, sending the blood nearer to the surface of the skin and as a result away from the brain. It is thought fainting is the body’s way of placing the head on the same level as the heart so blood supply can be restored to the brain. Fainting causes a brief loss of consciousness, which usually lasts a few seconds. If it lasts longer than one minute, it is unlikely to be a simple faint and the patient should be advised to seek medical tests. 

We cannot predict whether a particular individual is likely to faint, it makes sense to keep patients who are very nervous, and particularly new contact lens patients, under observation. 

A patient who is about to faint may:

• Have a pale or grey-looking complexion  
• Report feeling giddy or nauseous
• Report feeling faint or weak
• Have a slow pulse and lose consciousness
• Have clammy skin 

A patient who feels as though they are about to faint should: 

•  Lie down with their legs raised – if not possible, then sit with their head lowered between their knees
• Drink some water
• Eat something
• Take some deep breaths 

Your aim in dealing with someone who has fainted is to ensure the supply of blood, and hence oxygen, reaches the brain, make the patient as comfortable as possible and offer reassurance. 

• Elevating the feet will aid blood supply to the head 

• Make sure that the patient has plenty of air (open a window, if the room is warm) and loosen any tight clothing, particularly around the neck
• When they come round, offer them water 

Collapse 

Before you do anything, call for help. Now check to see if the patient is conscious by shaking the person gently and talking to him or her. If there is no response, ask someone to call an ambulance, while you follow the current guidance for the public on dealing with this type of emergency. 

Check the person’s airway, breathing and circulation, then put the person in the recovery position (if no suspected spinal injury). 

  Follow these steps:

1. With the person lying on their back, place the patient’s nearest arm down to the side 
2. Check pockets for sharp objects or medication or medical cards
3. Bend the furthest leg at the knee so the foot is flat on the floor
4. Hold the knee with one hand and bring the furthest arm across to the side of the face
5. Holding the knee and the elbow, gently roll the patient on to your knees
6. Once on your knees, bend the top leg towards you
7. Gently adjust the head to ensure an open airway is maintained
8. Check the pulse in the lower wrist to ensure circulation is still there 

Heart attack 

Optical practices are increasingly involved in cardiovascular checks, offering blood pressure screening as part of routine eye examinations to identify people at risk of stroke or heart attack. 

A ‘heart attack’ (myocardial infarction or MI) is a sudden blockage of one of the arteries supplying blood to the heart muscle, usually by a blood clot. A heart attack is life-threatening and therefore a serious medical emergency. 

If a patient has suffered a heart attack, it is important for the patient to receive medical intervention as quickly as possible. You should be aware of the nearest defibrillator to your practice – they are found in public places with instructions on who to call and how to use them. They basically reset the heart, and a person in the call centre will talk you through how to help the patient. An ambulance must be called to take the patient to hospital as quickly as possible. 

The likelihood of heart attack increases with age and, although rare, can occur in younger people. If a heart attack occurs it is likely that it will come on quite quickly. 

The classical symptoms of heart attack are:   

• Central chest pain or discomfort that is often described as ‘it feels like someone is standing on my chest’ 
• Anxiety and a feeling of impending doom
• Sweatiness
• Pain into the jaw or arm
• Difficulty breathing 

When dealing with someone who has just experienced a heart attack, your aim is to:  

• Ease any effort that the heart is required to make – lie the patient down and loosen any tight clothing 
• Arrange for the patient to be taken to hospital as soon as possible
• Make the patient as comfortable as possible and offer reassurance
• St John’s ambulance research has shown that the chances of a person surviving a heart attack is doubled if a member of the public can intervene effectively 

Even if you are not first-aid trained, chest compressions (hands-only CPR) are better than no intervention in a case of heart attack. 

Stroke 

Another form of collapse related to cardiovascular disease is stroke (acute ischaemic attack). A stroke is when blood stops flowing to a part of your brain, usually because of a blood clot. It can affect things like speech and movement, and take a long time to recover. A stroke needs urgent medical help in hospital because it can be life-threatening and often leaves permanent disability if the patient does not get emergency treatment within an hour. The main symptoms of a stroke can happen suddenly.

Remember FAST: 

•  Face weakness – one side of your face may droop (fall) and it might be hard to smile
• Arm weakness – you may not be able to fully lift both arms and keep them there because of weakness or numbness in one arm
• Speech problems – you may slur your words or sound confused
• Time to call 999