An update on first aid treatments

Summer is on the way and soon kids will be running barefoot and bare-legged across the land. Keep the first aid kit on hand to tend to the inevitable cuts, scrapes and abrasions.

For the most part cuts and abrasions are a fact of life that will be fixed by a kiss, cuddle and a wound plaster. But what sort? Ask most people and they’ll say that the best way to treat a cut or an abrasion is to leave the wound open so that a nice healthy scab can form. However, modern first aid practices and knowledge about the treatment of wounds have changed.

Twenty first century bandages are now of the spray on, leave on, hyper-this, colloidal-that variety that can leave even the most astute mother confused. So what’s new – cuts and scrapes haven’t changed, so why the new technology?

What has changed is the understanding of the medical profession about how wounds heal. In the past, wounds were left to ‘breathe’ and dry out to form a protective scab which was thought to keep out bacterial infection. However, wounds don’t heal best like that.

Contrary to popular belief, a wound heals more effectively in a moist environment. Epithelial (new skin) cells move across the moist skin surface so the wound heals faster and without a scab. The formation of a scab on an uncovered wound actually impedes the movement of epithelial cells and they must also travel further down into and across the wound site.

Hydrocolloid dressings and hydrogels are two types of wound dressings that have been developed on the premise of moist wound healing.

It’s hard to understand how hydrocolloid dressings work by their appearance, which is usually a soft, gel-like almost plastic substance which actually adheres to the surface of the wound. The dressing draws any oozing of fluids from the wound into the bandage area, which is absorbed and converted into a soft gel.

A reassuring fact for children anxious about the bandage coming off is that this type of dressing loses its adhesiveness where it is in contact with the wound, resulting in easy, non-painful removal.

Hydrogels are made up of 95% water proving a non-toxic and non-adherent moist environment for wound healing. Available as a sheet or gel, hydrogels also have a cooling and soothing effect on skin which can significantly reduce pain. This makes them extremely useful for burns, but they are also suitable for abrasions and lacerations.

Treatment

When a child comes to you bleeding and crying, before anything else you need to stop the bleeding. After that it’s a matter of a three-step process of ‘clean it’, ‘treat it’ and ‘cover it’.

First, locate the wound (this isn’t as silly as it sounds – a child may have blood on various parts of their body and the wound might not be immediately obvious). Bleeding wounds can be either puncture wounds or abrasions; once located stop the bleeding by applying pressure with a sterile gauze pad or an available clean cloth.

Abrasions are caused by rubbing or scraping the skin – typically they are the result of a fall off a bike or running and tripping over. They are often on the bony parts of the body such as knees, elbows and palms of the hands. These wounds can be very painful and may contain dirt particles that are hard to clean out.

Incised wounds caused by sharp cutting instruments such as knives, broken glass or tin can cause profuse bleeding if blood vessels are cut. If the edges of the wound are gaping, it will need further medical attention, which may include stitches or glue. Small puncture wounds such as those caused by nails, splinters, thorns or exposed wire may not bleed freely unless a large blood vessel has been injured.

If you are faced with a more serious puncture wound or cut that is freely bleeding, keep applying firm pressure, elevate the injured part, lay the injured person down and call an ambulance.

First aid for more minor wounds is simple.

Wash your own hands first. If the wound is just oozing, flush with clean water, saline or a mild antiseptic wash that will eliminate dirt and bacteria – the common causes of infection. If using an antiseptic, wash off after three or four minutes. (Because small puncture wounds are difficult to clean there is also a risk of tetanus. You may need to see a doctor for a tetanus booster shot in this case).

Finally, dry and cover the wound to promote faster healing, to keep out harmful bacteria and to protect it from further injury. A kiss and a cuddle and they’ll soon be as good as new.

First Aid Kits

Every home should be equipped with at least a basic first aid kit. You can buy first aid kits from the Red Cross or St John’s Ambulance, or make your own kit from supplies purchased at your local pharmacy.

A typical list of contents includes:

• Band aids in various shapes and sizes
• Tweezers
• Steri-strips
• Wound dressings
• Gauze pads
• Wound cleansing wipes
• Eye pads
• Triangular bandage
• Paracetamol or ibuprofen
• Measuring cup or spoon
• Scissors
• Antiseptic wash
• Betadine or other antiseptic salve
• Adhesive tape (fabric or paper)
• Saline solution
• Disposable gloves
• Crepe bandages
• First Aid manual
• Safety pins and bandage clips

Check the contents regularly – replenish as necessary and replace out-of-date products.

Resources

Australian Practical First Aid - Published by Dorling Kindersley rrp $19.95

A handy glove box size book containing up to date information on all likely first aid scenarios. Each section has step-by-step instructions and accompanying images showing correct procedure, symptoms to be aware of and when to call an ambulance.

References

The Proper Treatment of Wounds and Ways to Minimise Scarring, white paper authored by the Editor Group (2002), based on interviews with leading Australian medical experts in dermatology, burns and wound management.

This article was first published in Australian Family Magazine, November 2004. Updated July 2009.