With the onset of the tourist season and more people on the island, we will now unfortunately see an increase in the amount of accidents and illnesses occurring. These incidents, ranging from motorcycle accidents to heart attacks require an immediate response if lives are to be saved.

Phuket still remains ill prepared in the pre-hospital setting, with most of the Thai community not knowing how to perform First Aid and no centralized, professional ambulance service to respond to emergencies. Of all of the accidents and medical emergencies that happen on the island, over 90% of them arrive at my hospital’s emergency department by private transport, such as a private car, motorcycle or Tuk Tuk, and nearly all of them have had no First Aid or resuscitation efforts applied prior to arrival.

So what can the general community do if they happen to come across an emergency situation where someone’s life is in the balance? Being prepared is the first answer, and following these guidelines would certainly assist.

In an emergency where people are injured or ill, follow the emergency action plan, commonly known as DRABCD. This emergency action plan is recommended by most reputable international resuscitation organizations, such as the American Heart Association, Red Cross, St John Ambulance etc.

D = Dangers
R = Response
A = Airway
B = Breathing
C = Compression
D = Defibrillation

Before entering any accident scene, make sure it is safe to do so by eliminating any dangers. Turn off any electricity and be aware of fallen power lines. Beware of traffic, fire, smoke, gas and noxious fumes. If people are smoking around a traffic accident where petrol has been spilled, extinguish cigarettes before entering the scene. Do not become another victim.

Get a response from the patient and see if they are conscious or unconscious. Unconscious people need immediate help. Get assistance by calling for help. Know the emergency numbers for ambulance, hospitals, police and fire brigade in the area that you are staying, and put them in your mobile phone as speed dials.

Open the airway of unconscious people by tilting the head back and lifting the chin. If you suspect a spinal injury, open the airway gently, but always open the airway as this is a priority.

Check for breathing by looking, feeling and listening for rise and fall of the chest. If the patient is not breathing, or breathing is inadequate, give two rescue breaths. This involves pinching the patient’s nose and making a good seal around the patient’s mouth with your mouth, and blowing air into the patient’s lungs.

If the patient does not show any signs of life, does not cough or there is no movement after giving the rescue breaths, immediately begin chest compressions by placing your two hands in the center of the chest and push hard and fast, at a rate of 100 per minute, and push 30 times. You should depress the chest around 1/3 rd the chest depth.

Repeat the cycle of 2 rescue breaths and chest compressions, and immediately transport the patient to a hospital. Survival will depend on how quickly they can get to the final part of the emergency action plan, defibrillation. This is where an electrical stimulation is applied to the heart by a machine, and is a life saving treatment, not commonly available in Phuket outside of hospitals, but readily available in many community areas in Western countries.

Finally, if a patient is bleeding, apply direct pressure over the wound and use a bandage or clothing to maintain this pressure until you reach hospital.

If all victims were to have someone immediately commence the emergency action plan and control bleeding prior to arrival at a hospital, there would certainly be an improvement in the outcome of life threatening illnesses and injury.

There are organizations that teach First Aid and resuscitation on Phuket and the above information does not replace the need to learn and practice these skills. If you are not a certified First Aider, or have not practiced the emergency action plan and how to do Cardio Pulmonary Resuscitation, I strongly recommend that you learn. In an emergency situation, you maybe the only person who would be able to perform those skills, until a patient was able to get to a hospital with professional care.

Peter Davison is the Manager International Services at Phuket International Hospital. Questions or comments may be sent by email to peter@phuket-inter-hospital.co.th or by fax to 076 210936