With the clock change to BST on the horizon we made an early start to get as much light as possible for our Wednesday task at Makespace.

We had a task list to try and get through, and did really well on it - many hands can work magic in a short time.

We hefted pallets, weeded raspberry canes, shovelled leaf mould, cleared the compost area of weeds and rubbish, watered thirsty plants, and started sanding down the picnic benches. As a lovely post-task bonus we had a twilight run over Port Meadow (where the bats were dancing around) and along the canal.

Welcome to GoodGym Joe!

Our Wednesday group session looked a little different this week - We were very fortunate to be offered Basic Life Support training by the lovely Nikki and Elaine at Manor Hospital in Headington. It was a really valuable hour and a half which gave us knowledge and confidence to help in life-or-death situations.

A brief recap of what we covered is below:
The Chain of survival - Early recognition, Early compression, Early defibrillation (ideally in first 5 minutes), early hospitalisation.

Recognising heart attack vs Cardiac arrest.
When someone is having a heart attack they will still be able to talk to you and describe their symptoms. They may complain of pain in their left arm, chest tightness, shortness of breath, and women will often describe a feeling like terrible indigestion.

What to do for a patient with a suspected heart attack:
* Call for help.
* put them into the 'W' sitting position.
* If you know for certain that they are not on any kind of blood thinners give them Asprin 300 mg (crush it if necessary).
* Monitor them closely. If they collapse go to DRS ABC (below).

Someone experiencing a cardiac arrest is effectively dead at that moment. Their heart has stopped. Implement the DRS ABC (detail below). Only 8% of cardiac arrest patients are saved in the community. It is always worth trying CPR and defibrillation in this situation - if you do nothing, nothing changes and they definitely die.

DRSABC
D - danger - is it safe?
R - response - do they respond to voice or stimulus?
S - Shout for help - Emphasise the word HELP.
A - Airway - Ensure airway is clear by tilting head back and lifiting the chin (the full head tilt is only for adults).
B - Breathing - assess for breathing for 10 seconds (look, listen, feel), but don't be fooled by 'agonal gasping'. You are looking for regular normal breaths.
C - CPR - start chest compressions.

Top Tips for CPR for adults:
* Get the patient onto a hard surface.
* Aim for compressions in the centre of the chest just below the armpits.
* Aim for compressions about 5-6cm deep (or 1/3 the depth of their chest) at a rate of about 120 compressions per minute. Nellie the Elephant or Stayin' Alive both work well as songs to keep you about the right pace.
* Adults have 3-4 minutes worth of oxygen in the blood, so compressions are the priority. If you aren't happy to give rescue breaths focus on the chest compressions.
* Continuous compressions are very important, so if you are taking turns with another person then count down to them taking over so that there is no break between compressions.
* If the patient is in cardiac arrest due to drowning rescue breathes ARE important. Start with 5 good rescue breaths (tip their head back, pinch their nose, put your mouth over their mouth and the chest should rise when you breath out into them), then begin CPR.
* If you are comfortable administering rescue breaths then do 30 compressions - 2 breaths and repeat until help arrives and takes over or tells you to stop.

Top tips for CPR for children:
* Children and babies are unlikely to go into a sudden cardiac arrest unless they have an undiagnosed heart condition. It is more likely that they will have gradually deteriorated over a period of several hours.
* When working through the DRS ABC you should not tilt a child's head far back to assess breathing as it can actually restrict the airway. Just tip it a tiny bit as if they were sniffing the air a little!
* Before starting compressions children need 5 good rescue breaths.
* Start compressions at a depth of 4-5cm (or 1/3 of their chest depth) at a rate of about 120 compressions per minute.
* Continue on a pattern of 30 compressions to 2 breaths.

Top tips for CPR on babies
* Babies very rarely go into cardiac arrest unless they have been deteriorating for several hours or have an undiagnosed heart condition.
* To assess responsiveness you can scratch their palm or foot
* Do not tilt the head back at all when assessing breathing.
* Start with five good rescue breaths - put your mouth over their nose and mouth area to administer the breaths
* Then do a minute of CPR before dialling 999 unless there's someone else able to make the call - in babies a few seconds delay before starting compressions can be a killer.
* Use 2 fingers, or your thumbs, in the mid chest area, and keep the same pattern of 120 compressions per minute and 30 compressions to 2 rescue breaths. Be careful not to let the babies head knock around on the floor while you do the compressions.
* If you are alone but in walking distance to help, you can pick a baby up and cradle it in the crook of your arm, administering CPR and rescue breaths as you walk to get help.

Top Tips for Using a Defibrillator
* One person should continue CPR while the other gets the defibrillator. CPR buys time, but the survival rate starts to drop steeply after 5 minutes without a defibrillator.
* The 999 operator will give you the code to unlock the nearest defibrillator. They will also tell you where your nearest one is. Always go to the one they send you to (they might know your nearest one is out of service, for example).
* Defibrillators on private land should have the code to unlock them on the bottom left.
* SWITCH IT ON! The machine will then tell you exactly what to do step-by-step. Don't rush and get ahead of the machine - just follow it's instructions step by step.
* Continue CPR while the defibrillator is prepared and pads are stuck on the patient.
* You will need to remove the patient's clothing, and you may need to dry the person off or shave a patch of chest hair to get the shock pads to stick properly. 70% of people will sweat profusely when they go into cardiac arrest.
* The machine will tell you not to touch the patient while it assesses whether the heart is shockable or non-shockable and will advise a shock if appropriate. You should pause CPR while it assesses.
* If the heart rhythm is not shockable continue CPR until further medical help arrives.
* If it is shockable loudly warn everyone around you (TWICE) are about to shock & not to touch patient. “3-2-1 shocking”

What to do if you or another adult is choking
If you are alone and start to choke don't waste time - go and get help from a neighbour or passerby.
If you notice someone else choking patient still has a productive cough then encourage them to keep coughing - it is the most likely way to dislodge the object. If that fails follow the steps below for adults.

Choking protocol:
* 5 effective back slaps
* If that doesn’t work move to 5 sharp jabs in a J shape in the abdominal area
* Then shout or dial 999 for help
* Repeat
* If the patient collapses go to DRS ABC as above
* If they start breathing put in recovery position until help arrives.

Children Choking:
* As above, if they have a productive cough encourage them to continue coughing.
* If you need to move to back slaps get them in a position where they are face down along your thigh with the head supported but hanging over your knee - this will mean gravity is assisting you. Unlike with adults check for the patient response between each of your 5 back slaps
* If that doesn't work then move to the J shape abdominal thrusts.
* Dial 999 if the first set of back slaps and jabs do not work, then continue to repeat the above until the patient responds, medical help arrives, or if they collapse in cardiac arrest you move to the DRS ABC and CPR/defib
* Even if you manage to dislodge the object and the patient starts breathing normally advise the parents/guardian to take the child to A&E to be checked over, as you can inadvertantly cause damage.

Babies choking
* If they are choking on liquid do not intervene, but do monitor them. It is very likely they will be fine without intervention.
* If the baby is choking on something solid and coughing has not worked then lay them face down over your knee, supporting the head, and do 5 back slaps checking for response between each one.
* If that doesn't work do 5 small chest jabs with a finger around the same area where you would do chest compressions. * Dial 999 if the first set of slaps and chest thrusts don't work.
* Repeat the above until the patient responds/medical help arrives/they go into cardiac arrest and you move to the DRS ABC and cpr/defib. * Even if you manage to dislodge the object and the patient starts breathing normally advise the parents/guardian to take the baby to A&E to be checked over, as you can inadvertantly cause damage.

In our previous session we also covered Anaphalaxys, so I have included that recap below.

Anaphalaxys
In anaphalaxys a massive amount of histamine plummets the blood pressure. Most patients with known allergies will have 2 epi-pens which they should carry at all times.
1. Call for help
2. Get the patient on the floor with their feet up
3. If patient is still responsive get them to administer their own epi-pen
4. If have to administer take off cap push against outer upper thigh. Hold for 10 seconds.
5. Monitor for 5 minutes
6. If there's no improvement after 5 minutes give the 2nd pen in their other leg
7. If the patient doesn't have a pen you should do steps 1 and 2 and closely monitor them until help arrives.

MANY thanks to Elaine and Nikki for giving us this valuable training.

Find your nearest defibrillator here.

DRSABC here.

What3Words app will give you a very accurate location to tell the 999 operator.