DOMESTIC ACCIDENTS & EMERGENCIES

OBJECTIVE: Medica Superspecialty Hospital proposes a certification course for the elderly and who stays at home regarding the preliminary management of domestic injuries and emergencies. In case of any emergencies the first few minutes are very crucial. So these trained persons can be of great help to the society before the patient reaches any health care facility. INTRODUCTION: In this age of changing demography we are becoming very prone to domestic injuries. Recent progress in industrialization & use of vehicles, increased number of people living in crowded & unsafe settlements, coupled with inaccessible & unaffordable emergency health services also contribute to the higher health burden of injury in the developing regions of the world. Accidents in the home as causes of injury & death are of great importance - the equivalent in public health terms - of a major epidemic. TYPES OF INJURIES: 1. In Children: a) Fall and trauma:  How? A child may get injuries like bruises, abrasions, fracture of arm or forearm bones while playing at home or may get injured due to any projected part of furniture.  What to do? Any abrasions should be cleaned with Betadine lotion. Bruises usually need pain relieve only. If there is any suspicion of fracture the part should be immobilized and immediate medical consultation to be undertaken.  Prevention The house should have adequate floor space left after placing the furniture. Furniture should be kept in such a way that no parts are left projected to the living area. The floor if get soiled should be mopped immediately.

b) Cuts How? The child may get a cut injury while toying with kitchen knife or razor or broken glasses left at the reach of the child. What to do? In case of a superficial cut bleeding may be stopped by pressing the area for a few minutes. After cleaning the wound with antiseptic lotion, coagulants like alam may be applied. If the bleeding cant be stopped or the cut is deep, immediate medical attention needed. Prevention: Any sharp instrument should be kept out of reach of children. Broken glasses should be replaced as soon as possible. c) Burn and scald How? Due to hot food and drink or accidental contact with hot cooking oil or hot water at kitchen or bathroom What to do? The affected part can be kept under running tap water of normal temperature. No ice should be applied. Antibiotic ointment can be applied. If it is a deep burn or the body surface area affected is more immediate medical help needed. Prevention: The child should not be allowed inside the kitchen while cooking. Foods and beverages to be cooled to room temperature before served to a child. d) Electrocution How? Due to accidental contact with unprotected wires and switchboards

What to do? In minor cases with no external wound the child should be reassured. If there is any external injury at the contact point or if the child looses consciousness immediate hospitalization may be necessary Prevention: The switchboards should be placed at a height that is out of reach of a child. Any unprotected point should be repaired immediately. e) Exposure to animate mechanical forces How? As the children are very much fond of pets they are more prone to be injured while playing with them. (e.g. dog bites, scratches, licks in a broken skin or mucus membrane). What to do? Minor scratches or licks in an intact skin are not of much harm. Bites causing active bleeding should be washed under running tap water with soap and immediate medical attention needed. Licks in broken skin or mucus membrane may also be harmful. Prevention: The pet should be vaccinated at a regular basis. Pre- exposure prophylaxis can be given to the family members. f) How? Children are curious about everything so accidental poisoning is more common among them. As toddlers have a habit of putting everything into mouth they are often affected. The substances may be the rat killers, acids, phenyls etc. What to do? First of all the quantity and the composition of the poison should be noted. In cases of noncorrosive poison vomiting can be encouraged by drinking a lot of salt-water. The colour of the vomitus should be noted. A medical consultation should be taken. Accidental poisoning

Prevention: Poisonous substances should be kept out of reach of children. g) Drowning: How? A child may be accidentally drowned in a bath tub (in cases of small babies) or swimming pool. What to do? The child to be brought out of water immediately and the goal should be to bring the victim to a stable ground quickly and then to start CPR. Once on ground chest compressions are performed if the patient is pulseless, and if they are not breathing rescue breaths to be given. After these an immediate medical attention is needed. Prevention: Children should never be left beside a bath tub or swimming pool without vigilance of an adult. 2. In elderly a) Fall and trauma How? In cases of elderly, the soft tissues as well as bones are more fragile. So very often bruises turn into hematoma and trivial trauma results into fractures. Specifically hip bone fracture is common in elderly. Elderly females are prone to wrist bone fracture after fall in outstretched hand. What to do? In cases of any suspected fracture the part is immobilized and patient to be immediately taken to medical care. Minor abrasions and bruises can be treated at home. Prevention: Elderly persons incapable of walking properly should be accompanied to toilet by some caregiver. Patients with history of black out should be taken to hospital for thorough cardiac evaluation.

b) Brain hemorrhages How? With advancing age our brain often shrinks in size. As the skull is a rigid bony cavity, brain becomes a more mobile soft tissue inside the skull. So with minor impact to head, brain may get injured. Specifically such elderly persons are prone to get subdural hemorrhage which often becomes chronic leading to altered sensorium. What to do? Such cases often need neurosurgical intervention. So any head injury after fall at home should not be neglected. Prevention: Elderly patients should be accompanied to toilet and any drowsiness should not be neglected and immediate medical consultation needed. c) Burn and scald How? As in elderly people the reflexes are not very swift they are prone to get injured while cooking. So burns and scalds are common in them if they are required to prepare their food themselves. What to do? The affected part can be kept under running tap water of normal temperature. No ice should be applied. Antibiotic ointment can be applied. If it is a deep burn or the body surface area affected is more immediate medical help needed. Prevention: Elderly people should be provided with house-help if possible. Any burns should be taken to medical attention. Adults & Housekeepers are the groups who are most prone to domestic accidents. The incidences are somewhat more in females as they stay at home more like:    fall and trauma cuts and struck burn and scald

contact with noxious substances

From the above discussion we can understand how important it is to have a training regarding prevention and preliminary management of such accidents. We invite all to this certification course. Those who are interested can contact: Dr. Sanjit Saha (H.O.D - Emergency, Medica Superspecialty Hospital) & Dr. Dulal Kiran Mondal (E.M.O. Emergency, Medica Superspecialty Hospital) Tel: +91 33 66520000