Emergency Help

Someone who collapses or chokes in a public place needs help before they reach the hospital, and this chapter covers two methods anyone can learn: CPR and the Heimlich Manoeuvre p. 19. In Malaysia, the 999 emergency helpline combines five agencies: the Malaysia Civil Defence Force, Royal Malaysia Police, Ministry of Health Malaysia, Fire and Rescue Department of Malaysia and Malaysian Maritime Enforcement Agency p. 19. Each call is free and the caller’s number is recorded so that prank calls can be traced, so contact this number only when you require emergency services p. 19.

2.1 Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation, or CPR, is an emergency aid that combines chest compressions and breathing into the mouth of the victim to restore their heartbeat and breathing p. 20. CPR is needed when an individual does not respond to stimulus, is not breathing, or has no heartbeat or pulse p. 20. These situations might be caused by a heart attack, electric shock, drowning or a lightning strike p. 21.

CPR is a simple procedure that does not require any equipment, and the public is encouraged to learn it correctly so they can save a life before the paramedics arrive p. 22. Done wrongly, the victim’s ribs may be fractured or the air blown into the victim’s mouth may not reach the lungs p. 22. The textbook gives the CPR steps for an adult p. 22.

1. Check the victim’s responses. Make sure the surrounding area is safe, tap the victim’s shoulder and ask, “Are you OK?”; if there is no response, shout “Help” and ask any bystander to contact the 999 emergency helpline p. 22.
2. Open the airway. With the victim lying on a flat surface, chest facing upwards, tilt the head back and lift the chin, then listen for breathing from the mouth or nose and observe the movement of the chest p. 22.
3. Chest compressions. If no pulse or breath is detected, place the heel of one hand on the centre of the victim’s chest, cover it with your other hand and interlock your fingers, keeping your arms straightened p. 23. With your shoulders vertically above the victim’s chest, press down at least 5 cm and not more than 6 cm, and let the chest return to its normal position p. 23. Chest compressions are performed at a rate of 100 – 120 compressions per minute p. 23.
4. Mouth-to-mouth resuscitation. If there is still no breath, pinch the victim’s nose and blow air into the victim’s mouth for 1 second, so oxygenated air enters the trachea and reaches the lungs p. 23.
5. Repeat. Perform 30 chest compressions followed by 2 mouth-to-mouth resuscitations until the ambulance arrives or the victim regains consciousness; if the victim breathes but is still unconscious, position the victim’s body on his side p. 23.

CPR restores the victim’s blood circulation and supplies oxygen to the body p. 24. Chest compression produces artificial blood circulation by pumping blood through the heart, which matters most for a victim whose heart has stopped functioning after a heart attack p. 24. Mouth-to-mouth resuscitation lets the victim receive oxygenated air into the lungs, and the oxygen reaches the brain and the whole body p. 24. Brain damage could happen if oxygen does not reach the brain within a certain period of time p. 24.

2.2 Heimlich Manoeuvre

The Heimlich Manoeuvre is an emergency procedure that is carried out to save an individual who is choking p. 25. Choking happens when the respiratory tract is blocked because of food or a foreign object p. 25. When someone swallows food, the epiglottis folds and blocks the trachea so the food moves on into the oesophagus; if food blocks the respiratory tract instead, the person will choke p. 25. Dr. Henry Heimlich, a thoracic specialist surgeon, invented the method in 1974 p. 25.

The Heimlich Manoeuvre must be performed immediately when someone is holding the neck with both hands, is unable to speak or cough, has skin, lips and nails that appear bluish or blackish, or has difficulty in breathing p. 25. A blocked respiratory tract stops oxygen reaching the lungs, so the brain gets too little oxygen; if help comes too late, the victim can suffer brain damage or death p. 25.

Like CPR, the Heimlich Manoeuvre does not require any equipment p. 26.

1. Stand behind the victim and bend his body slightly forward p. 26.
2. Put your arms around the victim from behind and clench a fist with your right hand p. 26.
3. Place your right fist between the navel and below the ribs of the victim, with your left hand on top of your right fist p. 27.
4. Press and jerk upwards with quick force; the pressure increases pressure in the lungs and the foreign object is ejected p. 27.

If you are choking and no one is around, place your hands between the navel and below the ribs and exert pressure on that area by bending your body p. 28. If you have no strength, bend forward over an object about the height of your waist, such as a chair or table, and push your body against it with all your strength p. 28.