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Interviewer: So what kind of first aid kit do you really need? I mean there are so many options at sporting good stores but do you really need the biggest and most expensive one? We'll examine that next on The Scope.

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Interviewer: So you know how when you go into a sporting goods store to buy a first aid kit because you've got some longer hikes planned or you want to go camping or something else outdoors. And then you get to the aisle and you're paralyzed by all the options, the prices, the sizes and then you just leave without one because you're so overwhelmed.

Well we're going to try to help maybe make your trip to the store a little bit more fruitful next time. Dr. A.J. Wheeler is from St. Johns Medical Center in Jackson, he's also the medical director and a member of the Teton County Search and Rescue Wyoming and he's going to help us out.

Actually let's step back for a second and ultimately what is the point of the first aid kit? What is its job, in your opinion?
Dr. Wheeler: Well my opinion and my experience with search and rescue, most first aid kits need to be able to treat the most common injuries which happen in the back country which is by far soft tissue injuries. Bumps, cuts, scrapes, bruises, strains and sprains.

Interviewer: Okay.

Dr. Wheeler: The majority of people will encounter one of those if they have a medical problem on their trip. So that's what I generally lead people towards stocking their first aid kits for.

Interviewer: So I'm standing in an aisle, which one should I get?

Dr. Wheeler: When I look at the first aid kits that are prepackaged, often the most valuable thing you get out of the prepackaged kit is the case itself. So I'm definitely looking for something that is a hearty case, some kind of bag and I would prefer it to be waterproof. Your supplies won't be much good if they get waterlogged and then aren't useful at all.

Once I get past that, I want to be able to actually open the kit up in the store and look at its contents. Many of these kits have questionable quality as far as the components that are in the kits are concerned. And so I like to go through and see that the dressings are substantial dressings, that the band-aids and the medications and stuff that they may include in there look like they will actually hold up to back country rigors that they're likely to encounter.

Interviewer: Yeah, so in that instance the cheapest one might not be the best one because they've used substandard materials.

Dr. Wheeler: Certainly. The other pitfall that I see that people buying over the counter first aid kits is that they buy the kit and they don't ever open it up. They think great I have this kit, I'm all set, they throw it in their pack and off they go. Which leads to several problems. First, they don't know what's actually included in the kit.

And then the second problem is, you really should check your kit at least once a year. Go through the contents of the kit to make sure you're familiar with what's in there, but then also to go through and make sure that over time the dressings haven't degraded. You definitely can find some pretty grody things inside a first aid kit that's been stuffed in the bottom of a backpack for two or three years and not opened.

And you're going to need to regularly change things out in those kits. And that gives you then the opportunity to say, "Last season when I was out I wanted..." whatever, "and it wasn't there so I'm going to add that to my kit this year."

Interviewer: Yeah, like maybe some sort of blister kit or something like that in case you get blisters. That's a good idea. So when I'm in the store and I'm looking at the small one versus the big one, is the big one pretty much... is there a base kit and then the bigger they get they just add more bells and whistles and things. Is that how they usually build those out?

Dr. Wheeler: That's what it seems like to me. Certainly, some companies do a better job than others. And really reading what they are describing that kit for is really useful. The companies will definitely market ultra light ones and those are perfect for the mountain biker. It's got some band-aids in it, some ibuprofen, nothing else.

The two to three day kit is going to have more bandages and that kind of thing in it, it's going to maybe have a bit more medications and some more wound care. When you go over the week type kits, those are going to tend to be a bit more inclusive and may actually include some survival gear in those kits that you might need if you get into some trouble on a week long trip.

Interviewer: What are the must have items in there? Could you just name a few of those?

Dr. Wheeler: There are some things that are just hard to improvise when you're in the back country and those are generally the things that I try to identify as the must haves. One of those is definitely tape. It is very hard to improvise tape when you need it. Tape is very, very versatile and you can use it for gear repair as well as for medical dressings if you need to. And so having a good durable tape in your kit, I think is very important.

Some of the other must haves, I definitely think some kind of self adhesive bandage. The co-band is a self adhesive bandage that is compressive, which can be quite useful or perhaps an ace wrap. These are things that you can use to help make a splint or bandage larger wounds.

The other things that I also consider to be pretty important would be PPE or personal protective equipment. Definitely if you're going to be bandaging somebody else's wound, it's nice to have a pair of nitrile or latex gloves so that you don't have to stick your fingers directly into their bloody secretions. Pain medications. Just simple ibuprofen for most cases is perfect. But if you are going on a longer trip asking your physician perhaps for a prescription for something a little bit stronger to carry.

And then my personal favorite is the cellphone. I think cell phones are amazingly useful and you can put information on the cellphone, you can call for help from your cell phone and with the GPS capabilities most cellphones have you can even locate yourself.

Interviewer: I've heard that having some sort of something in case you get diarrhea while your out in the back country might be good. What's your opinion on that?

Dr. Wheeler: You know what, I do think that that is a good consideration. That's going to be I think more for those longer trips. Obviously, if you're out on a two hour bike ride, you probably don't need to carry the over the counter diarrheal aid with you for that. But if you're planning on being out for three or four days, copious diarrhea certainly could slow you down or perhaps even prevent you from continuing that trip.

Interviewer: What are some other things for those longer trips that you definitely want to take along? I like your thinking that there are just some things that you can't improvise.

Dr. Wheeler: For longer trips we definitely like to have something along for allergic reactions and so carrying some Benadryl, over the counter Benadryl is a great medication to take with you and that can also be used as a sleep aid if you have a noisy tent partner. And we also like to think about medications that people may already be on, you definitely want to continue your regular medications when you are on a trip like that and so carrying your normal medications. And probably planning a day or two extra, just in case with those medications.

Interviewer: Is there a resource that you would like to recommend for somebody that's maybe doing a little research?

Dr. Wheeler: There are definitely a lot of resources out there. The Wilderness Medical Society, WMS.org has some guidelines on first aid kits and that's where I learned a lot of what I recommend. And then a blog by a physician named Chris Van Tilburg who also taught me a lot of the stuff that I've passed on is also quite useful.

Interviewer: All right, any final thoughts on this topic? Anything you feel compelled to say or anything I forgot to ask?

Dr. Wheeler: Carry a first aid kit. I think the most common mistake I see, especially in those people who are planning shorter trips that maybe go a ways back is that they don't carry anything. The trail runner who plans to only be out two hours but then sprains his ankle six miles back without any supplies. Really those are the cases where I find people aren't prepared at all.

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Interviewer: A lot of us when we go hiking or camping take a first aid kit, but what are the three most important things that you should have with you at all times, like if you were on a desert island of hiking and space was a consideration? We'll find out next on The Scope.

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Interviewer: Dr. Troy Madsen is emergency room medicine at University of Utah Healthcare. Let's talk about the three things that you would absolutely want to have with you if you were out in a wilderness situation?

Dr. Madsen: Three things I'd want to have with me, and I've thought about this because you always think about this whole desert island scenario. Who knows if any of us will ever be on a deserted island, but for whatever reason we always like to think of these scenarios. I've thought, knowing what I know and doing what I do, what are the three most useful things I would like to have? There are three things.
Number one is an antibiotic. This antibiotic would be one that typically is going to treat skin infections or pneumonia or even a urinary tract infection, just the common things. If I had to name one I'd probably name levofloxacin. That's a common antibiotic we use for pneumonia. It can also help with skin infections if I were to get a skin infection there and also with urinary tract infections, so kind of some of the more common things. That's one of those things if you're out on your own and you've got access to no medical resources that can make a huge difference and potentially could save your life if we're talking a very severe infection where you can't get medical help for an extended period of time, for days or weeks. That would probably be the first thing.
The next thing would be a nausea medication. There's one called Zofran. The generic name is Ondansetron. This is one that used to be used a lot for chemotherapy patients, but has become much cheaper. It's essentially very cheap now just in pill form. It requires a prescription, but it's one of those things where if you had vomiting and were very sick, this could make a huge difference. Just being able to take one of these pills, you're going to prevent yourself from severe dehydration and a lot of the complications that come from that.
The last thing would be something for lacerations or injuries that come up. In my mind, I'd kind of think maybe some sutures where I could stitch myself up. But the thing that's super easy to use for lacerations that aren't huge but are still pretty big is something called Dermabond. That's the brand name, but quite honestly, Dermabond is nothing more than super glue.

Interviewer: Really?

Dr. Madsen: It's just super glue. They just changed it a little bit so it doesn't sting as much, but it's the same stuff. I would just take a tube of super glue. You can use that on a wound, or personally I would carry Dermabond just because I've used it. If you have a wound, even if it's a gaping wound, you can just wash it out really well, hold the edges together, put a line of this stuff over it and it dries within 30 seconds. Put another line to kind of hold things together, and you could make a big difference for a laceration, potentially preventing complications and infection just by having this available.

Interviewer: Wow, it sounds like when you're out the three big concerns, I think this is telling in another way, are dehydration because of some sort of a stomach issue, infections and infections again.

Dr. Madsen: And injuries and lacerations. Yes, exactly. I figure a lot of the other stuff. You think, "Okay. What if I broke my arm?" Well, you've got sticks out there. You could make a splint.

Interviewer: You could make a splint.

Dr. Madsen: You could do that. That's the sort of thing you could deal with. It's always hard to say. There are other things that would be nice to have, like maybe an ace bandage or some Band-Aids and that, but I can make do with that. These are the three things I've thought it would be great to have these things if I ever needed them and were ever in a situation out in the middle of nowhere and needed them. These can make a huge difference.

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Dr. Cindy Gellner: So there are some foods that you might think are okay to give your child just a little taste of. It's not going to hurt them, just a little taste. Well guess what, it could hurt them. I'm Dr. Cindy Gellner and today we'll talk about choking hazards on The Scope.

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Dr. Cindy Gellner: So a lot of parents when they are thinking about foods for their children, especially older infants and toddlers and preschoolers, they're really not thinking that much about choking hazards as they are thinking about, "Oh let's let our child try this new food or this new food to try and expand their horizons."
But you got to remember certain foods are notorious for being choking hazards. Hot dogs, grapes, raisins, foods that you think would be really, really good to give a child, a tiny piece of apple, can cause a child to choke.

When you're giving your children any foods like this, you got to watch them. If you turn your back, they can choke and pass out in as little as 1 or 2 minutes and then they can't breathe, they can't cry, they can't let you know what is going on.

So what are some symptoms of choking? The first thing is, again, they won't breath, cry, speak. They might actually have a tiny little whistle come out of their throat. They'll look at you with this face of absolute fear.

Older kids, if they actually get something stuck, they'll hopefully know to put their hands over their neck, and that's when you need to stop, think, "Okay, let's get into first aid mode. What do I need to do?"

The most important thing is how old is your child? Because that determines how you're going to get that foreign object out of their throat. If your child stops breathing a child over 1 year old, you're going to give something called abdominal thrusts.

You're going to grab the child from behind and put your thumb just underneath the ribs, but above the belly button. Kind of give them a bear hug. You're going to make that fist with the one hand and put the other hand over it and give a sudden jerk upwards. Do it at a 45 degree angle and try to squeeze all the air out of the chest, that's what you're trying to do.

You're trying to get all the air that's in the lungs to push that object out of the throat and get it to come flying out of the child's mouth.
If the child is too heavy for you to do that, they're larger, you're going to lay them on the floor with the child on their back. Put your hands on both sides of the belly, just below the ribs, and again, so that sudden burst of upward pressure and hope it comes out.

If your child is not breathing and you don't know if you can do this or not, the first thing you're going to do is find help and have them call 911. If you are by yourself, call 911 and have them on speakerphone next to you while you are doing the choking, Heimlich maneuver cause if for some reason you can't get that out, you're going to need the EMS workers to come in and help get your child's airway established.

If your child chokes on a liquid, turns blue, passes out, you might not be able to get that out, you're going to need EMS's help.

If your child is under one years old, you're going to do a modified Heimlich maneuver. You're going to actually place that child on your forearm, face down, with the head in the hand, and you're going to put the baby down so that your wrist is on your knee and your elbow is up by your chest and you're going to give five blows with your hands between the shoulder blades, in a fast manner, and then if your child doesn't start breathing, turn the baby over and do the chest thrusts, and then flip the baby over and alternate. The back blows and the chest thrusts until the child starts breathing again.

If your child does pass out, start doing CPR. Mouth to mouth breathing. Even if there is a little bit of air waiting, you're at least going to get a little bit of air to the lungs. If doing mouth to mouth breathing does not move the chest, start over with trying to get it out with the abdominal thrusts and chest compressions to get that foreign body out.

One thing I tell parents is take a first aid course. You can hear me telling you how to do the Heimlich maneuver and how to take care of a choking child, but with you actually take a first aid course, you get the training to be confident if something like that happens, you know exactly what to do and you can go right into first aid mode.

The most important thing to take away from the message today is child proofing. If you are with your child when they are at the table, if you make sure that tiny toys are picked up by older siblings, if you make sure that anything your have is uncluttered and put away so that if you happen to turn your back, your child doesn't grab it and put it in their mouth, because little kids put a lot of weird things in their mouth, then you know that your child is going to be safe.

Again, it's always a good idea to have first aid training, but the best thing you can do to help your child is to prevent the choking in the first place.

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Today we are talking about first aid kits. You may think of a first aid kit, you go online you buy something and it has all kinds of different things ranging from band-aids to Benadryl, to different creams and all these sorts of things. Tell you what, when I travel I don't carry any of those things. I figure a lot of things I can just buy in a pharmacy. If I need cold medicine I can go buy it. If I need Tylenol or Benadryl I can go buy it.

There are three things that I found as an emergency physician are potentially essential to keep you out of the ER. There are some reports out there, and I've talked to some people, who talk about ten hour waits in the waiting room. That is the absolute last thing you want to do over the holidays. So there are three things I carry. I'm going to tell you what those are. These may be a little surprising for you.
Item #1 to Include in Your Travel First Aid Kit: Antibiotic

The first I carry is ciprofloxacin. This is an antibiotic. You're going to need a prescription for it. You're going to need to talk to your doctor. But I will tell you why this can keep you out of the ER. If you have family members, and it's particularly females who may be more prone to urinary tract infections. That's just a horrible thing for a person to go through. You feel miserable and you need treatment.

I find when someone comes to the ER, particularly females, and they tell me, hey I feel like I have a urinary tract infection, they are right 89% of the time. The only reason they are in the E.R. is because they know they need an antibiotic. If you can just get a prescription and have a few pills of ciprofloxacin, just a simple antibiotic or if there is another antibiotic that has worked for you in the past. As long as you have a few of those pills available you can save your self an incredible amount of headache and a trip to the ER.
Item #2 to Include in Your Travel First Aid Kit: Anti-nausea Medication

The second thing I carry is an anti-nausea medication called Ondansetron. The generic name is Zofran. It's a generic medication now. It's very cheap. Again, you have to have a prescription for it. The absolute last thing you want to do, let's say you are traveling, you are in a hotel, you're feeling miserable you're vomiting, just imagine trying to get everything together, get a cab, get down to an ER, sit in a waiting room for six hours just to get back in a room, get and IV in, get some fluids and then get that same medication in an IV. That is what you're going to get. If you can just have a tablet or two of Ondansetron, again the brand name is Zofran. It is a generic. It's very cheap. If you can just have that in your travel kit, you can save yourself and incredible amount of headache. A lot of studies out there have shone that if you can just keep the pill down and drink some fluids you don't need an IV.
Item #3 to Include in Your Travel First Aid Kit: Superglue

The last thing I carry is going to sound a little bit strange but this will save you a whole lot of trouble and that is superglue. I actually take the medical form of superglue that we use for lacerations is almost the same thing as over the counter superglue. The medical form of superglue has a little bit of a chemical mixture that makes it so it burns less and irritates the skin a little less. You can even buy that online. You can find it under the brand name Derma Bond. The reason I carry this is because the third reason you don't want to have to go to the ER is for a laceration. Say you have a glass in your hand or something. It falls and breaks. You go to pick it up and a piece of glass cuts your hand. It's a simple thing that otherwise you would just put a band aid on.

You're thinking okay my tendons are all working fine. This isn't a dirty wound. I don't have a lot of stuff in there where I am concerned about tetanus or anything like that. You try to put a band-aid on or bring it together and it's just not going to work. You also want to make sure it's not a cosmetic concern. There is nothing on your face or anything like that. You are just thinking I need something to hold this wound together. Superglue will do the trick. The way you put it on is just hold the wound together, put a little bit across it, that's going to hold it in place. Then you can add a little bit more to hold that wound together. You don't want to get a lot of it in the wound. The biggest risk here is a little bit of skin irritation. It may burn a little bit. It's going to do the trick. It's going to fall off after about a week. The wound is going to heal up under that and should do just fine.

Anyway, these are my tips. I'll be honest here I am going a little bit rogue. You are not going to hear every doctor talk about these sorts of things. From my experience as an emergency physician I find pretty much everything else I can go out and by at a pharmacy if I need it. These are the things that are going to keep me out of the ER. Help me to avoid that ten hour wait or whatever I might be facing wherever I am and make life a little bit easier while I am traveling.

updated: December 9, 2022
originally published: December 23, 2013

Dr. Troy Madsen: So, let's say you're sitting at work and the person next to you falls to the ground and starts shaking over their entire body. They're having a seizure, what do you do? I'm Dr. Troy Madsen, emergency physician at the University of Utah hospital and that's next on The Scope.

Man: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Troy Madsen: So, you're sitting next to someone, and this is something I've actually seen in the ER. So, you're at a play, Pioneer Theater, it's a great play, and then the person next to you just starts to shake. At first, you're trying not to pay attention, like "I'm not quite sure what they're doing". The big question you ask yourself first is "Is this a seizure"?
Typically, if someone is shaking all over their body and they are not responding to you, that is a seizure. There may be cases where people have abnormal seizures. You may have heard of people just staring off into space. If you have kids maybe sometimes you've wondered if they're having a seizure. They just stare off and they don't respond to you.
Other seizures where just one part of a person's body will shake, maybe their arm or leg. So, kind of some unusual seizures, but the classic thing we see is someone shaking all over their body.
So, the big question too, is then, what is it that really causes a seizure? Really, a seizure is abnormal electrical activity in the brain. You could just think of the electricity going haywire, just kind of going all over the place in the brain.
We'll do things called EEGs on these patients where we actually put electrodes on their head to measure the electrical activity. You look at these EEGs and you're just seeing this electrical activity all over the place, just much different than what we see in a normal person. So, that's what's causing a seizure.
It's always hard to say exactly what part of the brain may have sparked that or what may have caused it. It's interesting; I find that people that come in the ER with seizures, for a lot of them it's the first time they've had a seizure. For most of them, they'll never have another seizure in their life.
I may not know exactly what caused it, we'll do tests to try and figure it out, but sometimes it just happens. Just because you've had one seizure, doesn't mean you're going to have epilepsy, or have seizures for the rest of your life requiring medication.
Again, back to that situation, you're sitting next to this person, they're having a seizure. You look over and they're shaking all over, they're not responding to you or anyone else. What do you do?
Well, the first thing is to get help because this is someone who needs to get an ambulance there. They may need an IV to give them medication to stop the seizure and then get them to the ER to get additional treatment for the seizure and additional testing.
So, in terms of what you're going to do right there, you may think "Okay, I've called for help, but I'm concerned this person is going to bite their tongue." You may have heard at some point "Well, I've got to put a wallet in their mouth". Some people have even said that they were at a restaurant and they actually saw someone put a spoon in someone's mouth to keep them from swallowing their tongue.
The biggest thing I'd tell you here is "Don't do it!" Don't put anything in their mouth because that could just make things worse. Now, this is someone who is not aware of what's in their mouth, something could easily slip out, go down their airway, and block if off.
The good news is with most seizures, they're going to stop in less than five minutes. It's very rare that a seizure goes on beyond that. As long as you can keep this person safe, you don't need to put something in their mouth, just kind of help them so they are not hitting their head violently against the ground or against a chair or something like that.
Just help them so that they're safe so they're not going to hurt themselves further with the seizure. Like I said, it's generally going to stop fairly soon. At that point, the person is often times going to be really sleepy, they may not respond to you. It may take ten to fifteen minutes for them even to respond.
They'll have no idea what happened. They don't know, oftentimes, where they are or what happened what they were doing and that's all part of the seizure and it's something we expect.
So, keep in mind, if you're in a situation where someone has a seizure, less is more. The less you do, the better. Keep them safe, get help there, don't feel like you have to do a whole lot besides that and once you get them the help they need, they're in good hands.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Scot: Somebody's choking on some food, what do you do? Do you give the Heimlich maneuver? Do you even know how? We're going to find out the answers to those and other questions right now, with Dr. Troy Madsen, Emergency of Medicine at University of Utah Hospital.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to the Scope.

Scot: Let's talk about the Heimlich maneuver. Is an effective tool.

Dr. Madsen: It is. You know, the Heimlich maneuver actually works, and we talk about CPR sometimes, and we talk about well maybe CPR works, maybe 5 to 10% of the time. The Heimlich maneuver, in my experience, works most of the time. And it's really surprising to me, because we think about all this research we have on CPR. I just can't find much research at all on the Heimlich maneuver. But I can tell you, I've seen many cases in the E.R. of people who have been brought in, who are say at a restaurant or at home, something happened. Someone administered the Heimlich maneuver, it got that piece of meat or food out, and they came in the E.R. and were fine. You know, they walked out of the E.R. later. So there's no question in my mind it works and it works the majority of the time.

Scot: So there are likely all sorts of videos online, if you want to learn how to do the Heimlich maneuver.

Dr. Madsen: Sure.

Scot: Can you do a brief overview of what you should do? And then I'd like to find out from your perspective, how do I know I'm doing it right?

Dr. Madsen: Yeah. Yes, so the big thing you want to do is number one, stand behind the person. So as long as you can get behind them, that's a great position to be in. And then reach around the front, make one hand into a fist, the other hand on top of it. Place that fist just down below the rib cage in the midline, so you're right over the stomach there, and then with both hands force that stomach up. And so if you really think about what you're doing, like I said, you're thinking you're forcing the stomach. The big thing I'm trying to do is just put lots of pressure on the lungs, because we've got food stuck in the trachea, in the breathing tube. So if I can get a lot of force on the lungs by pushing up on the stomach into the diaphragm, that's going to force that air out of the trachea, and hopefully make that piece of food pop right out.

Scot: So how hard am I doing this? Am I lifting somebody off the ground with each. . . what do you call that when you, each thing.

Dr. Madsen: Yeah so with each thrust there . . .

Scot: Thrust.

Dr. Madsen: You are lifting this person.
Scot: Okay.

Dr. Madsen: If you can you know, it's a lot of force.

Scot: All right.

Dr. Madsen: And again, you're thinking the more force the better. It's kind of like you know, you think about you're in grade school and you got like a . . . you're shooting spit wads at the ceiling or something. It's the same concept. It's just lots of air pressure all at once. Immediate force that shoots something straight up, and that's what you're trying to do with that force down there.

Scot: So how do you actually know if you should start administering the Heimlich maneuver to somebody?

Dr. Madsen: So this is a great question, because you know, the Heimlich maneuver is not without harm. There are plenty things that have shown you put that much force on a person's stomach, you can cause injury to their spleen, their liver, their large vessel, their stomach. So you really need to know this person is choking, and a universal sign of chocking is a person is holding their hands over their throat. Often times they may be turning blue. If a person can speak to you, that means they are moving air through their airway, they do not need the Heimlich maneuver, but that person generally, well they should not be able to speak because their airway is completely blocked, which means they can't get any air through there. You know, if they are speaking to you but feel like something's stuck in there you can call 9-1-1, but you don't need to start doing thrusts or forcing air into their lungs, or pushing on their stomach.

Scot: When we talked about CPR you tell your students that if you're not hearing ribs cracking, you're not doing compressions hard enough. Is there anything equivalent in the Heimlich maneuver?

Dr. Madsen: You don't want to crack ribs. You're going to be down lower there.

Scot: Okay.

Dr. Madsen: But I'm just . . . it's just got to be much force . . .

Scot: Much force.

Dr. Madsen: As you can push there. Yeah.

Scot: So channel any anger that you had towards . . .

Dr. Madsen: Yeah.

Scot: . . . relative right in there.

Dr. Madsen: Channel anger, fear, whatever emotions running through you at that point, channel it into those thrusts to really try and get some pressure there.

Scot: How long do I keep doing that?

Dr. Madsen: Keep doing it until they're responding.

Scot: Okay.

Dr. Madsen: And if they get to a point where they are unresponsive, where they lose a pulse, then you have to start CPR.

Scot: Okay.

Dr. Madsen: And often times, once you're doing in those chest compressions, those nice deep chest compressions, that sometimes will generate enough force on the lungs to make that food pop out. But you keep doing it until they respond.

Scot: What about the balance of somebody starts choking, somebody starts giving the Heimlich maneuver. Do you call 9-1-1 at that point? I mean at what point would you make that phone call?

Dr. Madsen: I would make it immediately. And if you're in a situation where you have other people there, that's one thing you're going to say, call 9-1-1. I'm doing the Heimlich maneuver. If I'm in a situation where it's just me and another person, I'm going to do the Heimlich maneuver.

Scot: Okay.

Dr. Madsen: But then if it gets to a point where you are administering CPR, then you call 9-1-1. But usually most of the time, if you just get the Heimlich maneuver going, you're going to be successful.

Scot: And then do you call 9-1-1 back and say cancel it or . . .

Dr. Madsen: I would still have them come.

Scot: Okay.

Dr. Madsen: And at the very least, the EMTs are going to come. They're going to evaluate the patient. In my experience, they will sometimes transport that patient to the emergency department, just depending if the patient still feels like something may be lodged in there. If the patient is completely symptom free, they may just release them. But at least you can get a medic to check their vital signs and check them out.

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Dr. Troy Madsen: You're driving down the interstate. You see an accident. What do you do? I'm Dr. Troy Madsen, emergency physician at the University of Utah Hospital. That's what we're going to talk about today on The Scope.

Man: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Troy Madsen: So I'm driving into work the other day, and this person just goes flying past me 90 miles an hour, going down Interstate 80. And then I come around the corner. This is about 5 miles later, and I see that same car overturned on the side of the road.
I think we've all had situations where we come upon a scene of an accident, and the big question we have is, "What do I do in this situation?" That's the question that ran through my mind in that scenario. You know, I'm used to seeing people in the ER who are brought in by the medics.
But when you're at the scene of an accident, it's a whole different situation there, and it's good to know what do I do, number one, to help this person, but more importantly, what do I do not to hurt this person. This is some harm in trying to do too much at these sorts of scenes.
The number one thing, of course, is get help. Call 911. Get an ambulance there because they're the experts in this situation. When you call 911, it's very helpful to let them know, obviously, where you are, kind of what's going on, how many people seem to be involved in the accident. If it's a multi-car accident, at least give them some information to work with so they know how much to send there in terms of resources.
If we've got a ten-car pileup, they're going to need to send a whole lot more than if it's a single car rollover and one person who got out of the car and walking around now and looks okay. A little bit of information goes a long way when talking to them.
But then the next question becomes, "What do I do while I'm waiting for the ambulance to get there?" The biggest piece of advice I would give is, number one, first of all, make sure you're safe. Don't put yourself in a situation where you are going to become a second victim in this accident. If there's a fire or anything like that, obviously, you want to help victims. You want to make sure everyone's safe, but keep yourself safe.
Number two. The next biggest piece of advice is something we always think about as physicians, and that is, "Do no harm." If this is not something that is absolutely necessary to do, don't do it. Don't be dragging people around and pulling them out, potentially making things worse with some sort of spine fracture if that's not something you need to do and if you've got time to get an ambulance there.
So let's kind of walk through them, what you would do. Let's say I come up to that car that's rolled over, the biggest thing I'm going to do is, number one, if that person's still inside their car, I'm going to go up to it and say, "Is this person safe in there? Can they get out of their car? What do I need to do to help them?"
If it's something where we can wait for the medics to get there, great. If it's something where there's imminent danger but I can get them out of the way safely, I'm going to help them get out of that car. Again, I always have to be careful about their spine. If it's something where I can wait for the ambulance to get there, it's better to wait and let them immobilize their spine and make sure everything's in the right position so we're not making things worse.
Probably the best thing you can do for anyone at an accident is to talk to them. This is going to accomplish a couple of things. First of all, it's going to help the person kind of calm down and know that there's someone there who's going to help them out.
The second thing it's going to do is, by talking to them, you know they're okay. If they can talk to you, if they can answer your question, I know they're breathing, I know their heart's beating, I know they've got enough blood profusion in their brain where their brain's working fine, then I can feel a little more comfortable that I don't have to jump in there and do something really quickly.
That can go a long way, just having a simple conversation. Now, if you're with this person and you find that they are not responding, again, assess the situation. If they need to get out of the car, get them out of the car to a safe place. If they can wait until the medics get there, then that's okay.
The next issue, of course, is if they're not breathing and they don't have a heartbeat. If they don't have a pulse, you want to do CPR. Do what you can. Do chest compressions. Give them the help they need until we get the ambulance there.
So if someone is in their car and they are not breathing, the spine is a secondary concern. My number one concern is airway, breathing, and circulation. If they don't have any of those, I need to get them out of there where I can start doing CPR on them to get them the help they need. The spine is a concern, but it's a secondary concern at that point.
So if we do get someone out of a car or let's say they're walking around and they're just, like, "My neck is just really hurting me," that's a good situation where we kind of want to sit them down. Again, talk to them. Help them calm down. Put them in a situation where they're just not walking around and moving their head around a lot because if they do have possibly a fracture there, that fracture can get much worse by moving their head around and then could potentially cause spinal issues and possibly affect their spinal cord.
The next thing we think about beyond all this stuff, beyond the airway, CPR, and spine injuries is bleeding. If someone's bleeding, put pressure on it. If you do put pressure on it, just hold that pressure there. You don't need to take that rag off every 30 seconds or so to see if it's still bleeding. Just hold the pressure there.
Make sure you're not holding so much pressure where it cuts off the blood circulation to their hand. You want to make sure they can move their fingers, their toes, or whatever the situation is. Just hold pressure, and once the ambulance gets there, they can do something more definitive.
When you're at the scene of an accident, these are the big things to think about. Like I said, number one, keep yourself safe. Number two, do no harm. But if you're in a situation where you can offer help, talk to the person and see if they're responding. If they need CPR, don't hesitate to give it, and help them out while you're waiting for the help to arrive.
Hopefully, you're never in this situation. Hopefully, you never come up on an accident, but if you are, these are some things to keep in mind to where you can give some help where help is needed.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: When you watch your favorite TV show, you see somebody collapse and then somebody else comes to the rescue and administers CPR and they come back to life and everything's good. But is it really that effective in real life? With Dr. Troy Madsen, emergency physician at the University of Utah Medical Center. Does CPR work?

Dr. Madsen: I think the short answer to that question is yes. Does it work as well as we think it works based on TV shows? The answer there is no. Unfortunately, TV shows have kind of created an unrealistic expectation for us. I saw something that said when people perform CPR on TV shows or in movies, 75% of the time that person lives. That's not the case.

Interviewer: That's not real life.

Dr. Madsen: It doesn't happen that way, unfortunately. That number is probably closer to 5% realistically. A lot of it depends where the CPR occurs and who's doing it.

Interviewer: So, 5%, that doesn't sound very successful. Should people even bother to learn CPR?

Dr. Madsen: Well, those aren't great odds but it's all you can do. You figure the person's chance is 1 in 20 of surviving, but on the other hand you could save that person's life. So, absolutely I think it's worth doing and it's worth trying to see if you can make a difference.

Interviewer: So, even myself as a civilian who maybe took a CPR class two, three years ago, I don't exactly remember what I'm doing. Should I start pounding on the chest or not?

Dr. Madsen: Go for it. Jump in and do it.

Interviewer: Really?

Dr. Madsen: The wonderful thing about CPR that's come out in the last couple of years, maybe even since you had your last CPR class, is that they've made it really simple. Forget the breaths. Forget trying to blow in a person's mouth. I think people think about that; it just grosses them out. Just do chest compressions. And when you do them think of the song "Staying Alive." So, you think about that '70s disco song, it's 100 beats a minute and that's what you're going for. You're doing deep chest compressions, 100 beats a minute and just keep pushing on that person's chest until the ambulance gets there.

Interviewer: And just for a refresher course, you put your hands right on their heart? Is that where you're pressing?

Dr. Madsen: So, you're going to put it right over their sternum. So, if you feel on their chest, the hard bone . . .

Interviewer: More in the center.

Dr. Madsen: So, right in the center of the chest, exactly.

Interviewer: Okay.

Dr. Madsen: So, you're going to get right over the center of the chest, right over that really hard bone about halfway up and then get right over them with your fists down on the chest with your arms straight out and locked. Get your full force over them. We say to our medical students when you're doing CPR if you're cracking the person's ribs, you're doing the right thing.

Interviewer: Wow, really?

Dr. Madsen: Because you have to get that much force. You have to get down and really push on the heart. If you're breaking ribs, it's fine. Again the person's chances of living are 1in 20. We can easily treat broken ribs. You're saving their life potentially.

Interviewer: Absolutely.

Dr. Madsen: Another thing to keep in mind is you can get really tired doing CPR, you know. People tire out in maybe two minutes with those chest compressions, so if there are other people there, rotate out. Have people swap in. Keep the chest compressions going. Studies that have been done have shown that good chest compressions save lives. So, if you're doing the right thing, the right compressions, you could make a difference.

Interviewer: And how long should you keep that up before you just stop?

Dr. Madsen: Keep going until the ambulance gets there.

Interviewer: Gotcha.

Dr. Madsen: Once they get there they may find something that they could do quickly to potentially do something different. The big thing they're looking for is something where they can shock the heart. So, this is the other thing to keep in mind too. If you're in a place that has an AED, or an automated external defibrillator, like a school or a public building, get that. Put it on there. It's pretty much fool proof. It'll tell you if you can shock and if it says shock you push a button, it shocks the heart and that's the number one thing that can make a difference.

Interviewer: So, as I'm doing these chest compressions and I'm just going and going and going, am I looking for any signs of consciousness or am I just really doing the heart's job at that point, keeping the blood going around?

Dr. Madsen: So, as you're doing the chest compressions, you're going to take a very short break every minute or two, see if the person's breathing. You can just kind of lean over, you can feel for a pulse as well. And if it's not, you just keep going. So, that's the thing you're watching for, any sort of breathing, and any sort of a pulse. But in most of these situations, you're probably not going to get that, and hopefully in most situations you're going to have an ambulance there within five minutes.

Interviewer: If you're not getting that are you doing any good?

Dr. Madsen: You are. You are pushing blood to the body and to the brain.

Interviewer: So, you are. You are actually doing the heart's job at that point.

Dr. Madsen: Yeah. You are. You are doing the heart's job because you're pushing down, causing the heart to squeeze that blood out, and you're making a difference. And I can tell you I've had cases, certainly I've had many cases where we've done CPR and the person hasn't come back. But I've had cases where they have started CPR, person has been completely unresponsive, they've been out for 10, 15 minutes basically dead, doing chest compressions. We were able to shock the heart, get it back in rhythm. And the one case I'm thinking of in particular, the guy walked out of the hospital two days later, totally back to normal. Just absolutely remarkable. So, that can happen, and that's the reason you do CPR all these times is hopefully to have that one case where you save a life.

Announcer: We're your daily dose of science, conversation, and medicine. This is The Scope, University of Utah Health Sciences Radio.