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Welcome to our 2018 blog!!

Cyber Safety

Posted by Steve at 13:30 on Monday, 15th January 2018.

Nine in ten children under ten-years-old go online.


Christmas is now slowly turning into a distant memory, the turkey’s been eaten, the presents unwrapped, and here we are back in the mundane routine of work.


Just a few weeks ago, more and more children and teenagers were given technological devices as their Christmas presents. Statistics show that 43% of twelve to fifteen-year-olds now own a tablet. This leads to a question…


What are the issues surrounding children using these devices?


With the advent of these devices being more and more accessible, social media and applications (apps) have become even more accessible, and in today’s world you’re perceived by some people as being a ‘nobody’ if you haven’t got the latest hot gadget, thus the beginning of the bullying culture. This in itself starts the issue of how safe and secure are our children.


Children went back to school, and would have excitedly been telling their friends of the joys that were to be found under the tree, that is all but the children whose families are struggling to make ends meet and provided their children with the best presents that they could afford and rightfully didn’t go to the extremes. These families will have provided their children with the best Christmas they could and of course the most important thing that they could give their children was love. Their children obviously haven’t got the latest hi-tech, all singing flashy device. This is how they become the target of the bullying, yet a valuable lesson could be learnt by the bullies, in that we are all different.


Bullying is another subject where technology has changed the world. In my day at school, should you be the ‘victim’ of the bullies, you would go home, close your front door and leave the bullies outside and forget about them until the following morning. Sadly, this is not the case in this ever-changing, fast-paced technology world. Now, all the bullies need are your mobile number or profile handle. You are always connected to the outside world and thus the bullies. Meaning the bullies can now get into the inner sanctum that was once safe.


Of course, we know that bullying has always been a problem in schools.


Social media, whilst it can be a tool for good, has in itself started further complications and issues for the world of early teenagers and children.


One of the ‘joys’ that most users of social media enjoy is the opportunity to share photographs with their friends or ‘followers’ of events that they are enjoying in life and special occasions they are celebrating. However, there are many occasions over recent years of the new phenomenon of children sending each other photographs in varying degrees of undress.


Did you know? The average twelve to fifteen-year-old has 272 social media friends.


There are several issues with this.


One such issue is that once something has been uploaded to the internet it is almost impossible to get rid of it; if it is possible to get rid of, it can be a painstaking process to get the site in question to remove the content. Just pressing the delete button is not enough, as it will remain on a server somewhere, or potentially another user somewhere has saved the image to their own computer, this is not something that can be traced and therefore who knows how many copies of the photograph exist.


Another issue, comes in later life when that child/teenager goes for a job interview and the employer does a search on the search engines, does that photograph show up and then what impression does the potential interviewer have of that person?


And more so than all of that there is the legal position of a child, also known as a minor, sharing photographs of themselves in various degrees of undress, it is a criminal offence for children under the age of 18 to send indecent photographs. There have been several stories in the news of children potentially being prosecuted for doing just that.


60% of teens have been asked for a sexual image or video of themselves!


Finally, on the subject of sending indecent photographs to other people on the internet, does the sender actually know who the receiver is? Even if s/he claims to be the same age as the sender, they could of course be an older person.


There are other concerns on the use of the internet, social media and children. There are many websites and apps that portray positive images of self-harm. This can be quite reassuring in some respects for people who are feeling that this is the way to deal with the emotional distress that they are feeling, however on the flip side of this is the aspect that it encourages children to self-harm and moreover actively encourages children to do this.


Events of the last eighteen months or so have also shown how the internet can be used for harm. The harm is caused when the internet and social media is used to radicalise people into many extreme idealisms. Most famously radicalisation has manifested itself in the UK with extreme situation attacks on the general public, possibly most notably in the last year at the Ariana Grande Concert in Manchester on May 22nd. This attack in itself has proved that not even the innocence of youth is now safe from being attacked from people who wish to do harm.


Of course, the kind of harm that we are discussing above is not the only type of harm that can be found if the ‘dark-web’ is searched thoroughly enough. Information can be found on lots of subjects, and can be used to help radicalise people to that way of thinking including on topics like, animal rights, the fur trade and of course information can be found on how to make devices that are able to cause significant harm to members of the general public.


No look into the internet, and issues around children accessing the web, would be complete without mentioning the easy access to pornographic material children have these days. Sometimes, children will access it totally by accident when searching innocently for something else on search engines, or sometimes they are told about these sites by their peers and then actively seek them out. In some respects, a report that came from the Houses of Parliament on Monday last week shows how easy it is to access this type of material. A study released last Monday stated that 24,473 attempts were made on the House of Parliament servers to access pornographic sites, which represents some 160 attempts in a day. The report stresses that these are only attempts to access and not actual visits to the sites. The report also stresses that the majority of these attempts are not deliberate. The number of attempts were for the period of June to October last year, and is down from the previous records. The reason we compare it is the wording in the report that mentions accessing such material as non-deliberate, which links to the fact that a lot of children accessing the material will absolutely be by accident.


Another use of the internet amongst children, especially girls, is the fretting about what people think of them, there are many apps and apps within apps that allow people to rate how someone looks in their pictures. One of the questions asked on some apps, is whether the person is Hot or Not, which in itself is a very vain outlook. The girls who use these sites are actively looking for approval and votes of hot. A common sense survey called Children, Teens, Media and Body identified this very issue. The findings show 35% are worried that people will tag them in unflattering photos, 27% are worried about how they look in photos and 22% of children feel bad about themselves if their photos are ignored. This just shows us that this is a worrying trend setting into the real world because of the cyber world.


What are children’s thoughts on how safe they are?


In 2017, a survey was carried out by the NSPCC and O2 which found that four out of five children who were polled felt that social media and website owners did not go far enough to protect them from self-harm, pornography, hatred and bullying. The study shows that children feel that the sites’ lack of strict controls exposes them to hurtful comments and makes them feel negative about themselves and even think about self-harm.


How much time are children spending on the internet?


26% of children aged ten to thirteen-years-old use internet for more than three hours or more a day. Whereas of all children of all ages who use the internet, 47% of parents worry about how much time their children are spending online.


How safe are our children when using these devices?


The simple answer to this question is that they can be fully safe with some very simple steps to be taken by their parents/carers.


Firstly, we need to look at what social media sites like Facebook say about children joining their sites, the age they say is acceptable for children to be on their site is thirteen. We know that children only have to lie about their date of birth in order to be accepted on the site. One in four children who are aged between eleven and twelve and are on social media say they have had an upsetting experience on it!


Lets look at things that parents can do to best support their children online, these will depend on the age of the child.


For children aged under five the following advice would be suitable for them:


Use Passwords


By using passwords on all your internet connected devices, you then need to unlock them and provide access to children, knowing exactly when and where children are online, also passwords ensure no unexpected purchases by little children.


Manage Access


Provide children with their own account on the computer, whereby setting up their own allowed access, and set their internet home page to a child-friendly page for example, CBeebies.


Help them to learn through games


Choose good quality child-friendly games online from companies that you trust; this could include Nick Jr or Disney Jr.


Set Boundaries


It is never too early to set boundaries, it is important the child has ground rules of what they are allowed to do whilst online and also how long they are able to spend online.


As the child gets older the safety measures will change slightly, next we consider what you could do for a child aged between six and ten years old.


Use Airplane Mode


Using Airplane mode will ensure that children are unable to make additional purchases on the devices as well as interact with anyone online without your knowledge.


Talk to older siblings


It is always good to include older siblings in the safety of their younger siblings, by having conversations with older siblings you are giving them some responsibility and showing that you trust and respect them. As well as discussing their use with them, remember to discuss with them what they show to the younger members of the family and encourage them to look out for their younger siblings.


Agree boundaries


Boundaries are just as important in the cyber world as they are in the real world. Firstly, your child may be asking for a mobile telephone of their own as well as a tablet, however it is the parents’ responsibility and decision when the child is ready for this. You may wish to discuss with your child when you believe is a suitable age for them to own their own devices.


Other boundaries to be discussed include the types of sites and content they are allowed to view as well as the length of time they are allowed to access the internet; some families have a ‘no devices’ at the dining table rule.


For children below the age of ten, in addition to the ideas we have discussed above, it may be prudent to ensure that the following advice is heeded.


Search Safely


It is important to make sure that children are searching the internet safely, one way to do this is by using child-friendly search engines for example Swiggle or Kids-search. As well as remembering to use the safe search facilities on other search engines and websites like Google and Youtube.


Explore together


One of the best ways to know what your children are doing online is to encourage the children to show you what sites they like to visit as well as what games they like to play while they are online. While exploring the internet with the children you can discuss what a good online friend is.


As children move on up past their tenth birthday, but still not older than the age to enter the ‘Facebook World’, there are additional tips that parents could consider as follows:


Have frank discussions


It is a good idea to prepare children for situations that they may come up against whilst using the internet, as well as providing them with the tools for what to do should things make them uncomfortable or worry about certain aspects. Generally, it is a good idea to empower them to turn to you should they experience something they do not like or want online; this will ensure that they won’t be worried about you finding something that they accidently clicked on that they know you wouldn’t approve of, and instead be open enough to tell you about their accident. A good time to have these frank discussions is when the child gets a new device or starts to visit new websites.


Manage their devices


Encourage your children to be using their technological devices in communal rooms in the house for example the lounge or dining room, thus being able to keep an eye on what they are doing. Allow them their own account on the family computer, giving them their independence, and obviously if you do not feel they are old enough or ready for their own devices, explain your reasoning but stay firm.


Have an agreement


Keep an agreement with the child as to how much internet access they can have, times that they are allowed to access the online world, where they must be within the household when they are on their devices as well as the types of websites and content they are allowed to view. Remember that you may need to review this agreement as they continue to grow and gain more independence.


Start social media discussions early


Before you allow children to join social media sites, it is a good idea to discuss with the children the advantages and the risks of using these sites. It is a particularly good idea to explain to the children how difficult it is to have any material they upload to be removed and how it may resurface in years to come.


For all children under the age of thirteen it is a good idea to put yourself in control.


A good way to be in control is to ensure that you have set parental controls on the household broadband connector, and all devices including mobile telephones, games consoles and tablets. As well as implementing safe search on search engines and websites and services like Youtube and iTunes.


Between the ages of ten and sixteen some good advice tips include the following things:


Stay safe on the move


On their mobile telephones and tablets safe settings should be set, however as responsible parents you have to bear in mind that connecting onto some public access WiFi networks, they may not have filters on to block inappropriate content from your children’s devices. While out and about you should look out for signs that indicate safe networks that have filters to block content for example Mumsnet Family-Friendly WiFi and RDI-Friendly.


Keep private details private


Remind children who are posting images to social media to ensure that they are keeping their settings to private, allowing only their friends to search, tag and comment on their posts.


Additional advice for children who are turning fourteen and above includes:


Be responsible


It is a good idea to remind children to behave in the cyber world as they would in the real world, remembering that if they wouldn’t be unkind to their friends to their face, then why would they want to be unkind through a screen. Empower your growing teenager to have respect for themselves as well as others whilst they are on the internet.


Discuss online reputations


Start their experience online thinking about creating a digital footprint that they would be proud of. A good rule of thumb is to keep them thinking about whether what they post they would want you, their teacher or a future suitor/employer to see. Parents need to keep reminding their children that once something has been uploaded or written it is there for all to see, potentially you could use the experiences of celebrities who posted things before they were famous and how they have come to haunt them in their life now they are famous.


Adjust controls


As the child grows up you may need to review and amend the parental controls that you have set up for your children, the best way to do this is to decide how mature you believe your child to be, and then discuss with them the level of controls you feel they need and then listen to their ideas and come to a mutual agreement whilst maintaining the control.


Show that you trust your child


There will come a time when children will get to a stage when they will want to purchase content from available services online, for example iTunes or Google Play. If this is something that you can afford and you believe your child to be mature enough for a small allowance, you may consider allowing them to do this.


Don’t give in


Remind children that they are in control of themselves and just like in the real world, they do not have to do anything that they feel is inappropriate or you as the parent would not want them to do. Just like the real world they must not give in to peer pressure and should they be pressured into something they could discuss it with you or another trusted adult. You could also signpost them to apps like Send this Instead and/or Zipit, which will help them to deal with requests they are unhappy to fulfil.


For children of all ages there are other good tips that could be followed:


Check if the content is age suitable


A good way to check if the content your children is accessing is suitable is to take note of the age guidance on each product, much like you would if you were to take the children to buy a DVD in the shop. Remember that social media sites like Facebook state thirteen or older is the age to join.


Be involved


The area where the children are using the technology can be very important to remain involved in their cyber world experience, for example the children being in a communal area like the lounge or dining room, it may be that you are not sitting over the child but you are able to be involved and interested as you walk past them to do other chores.


One of the best ways to know what your children are doing in the cyber world is to ensure that you keep talking to them and stay interested in their online activities. Don’t be afraid to bring up challenging issues like sexting, pornography and cyberbullying. It could be embarrassing, but you’ll both benefit from the subjects being out in the open.


Finally, we would highly recommend that one of the rules of the children being allowed their own social media profiles, is that they have to have you as a friend on the site. This will allow you to be able to see all that they share and then you are able to pick up on anything that they may be sharing that you don’t approve of, or think is inappropriate, or that they may regret in future life, meaning that you are able to discuss these things openly as they arrive rather than when someone tells you about it later on.


The last thing that we thought we would do while talking about children’s safety is to give you a quick guide to some of the abbreviations that are being used online by children, however, please bear in mind that these are regularly changing and you should discuss any ‘codes’ you see with your children that you are unfamiliar with.


143                  I love you

2Day                Today

4EAE                For ever and ever

AND                 Any day now

AFAIK              As far as I know

AFK                 Away from keyboard

ASL                 Age/sex/location

ATM                At the moment

BFN                 Bye for now

BOL                 Be on later

BRB                 Be right back

BTW                By the way

CTN                Can’t talk now

DWBH             Don’t worry, be happy

F2F or FTF      Face to face

FWB               Friends with benefits

FYEO              For your eyes only

GAL               Get a life

GB                 Goodbye

GLHF             Good luck, have fun

GTG              Got to go

GYPO             Get your pants off

HAK               Hugs and kisses

HAND             Have a nice day

HTH               Hope this helps/Happy to help

HW                Homework

IDK                 I don’t know

IIRC                If I remember correctly

IKR                 I know, right?

ILY/ILU           I love you

IM                   Instant message

IMHO              In my honest opinion/In my humble opinion

IMO                In my opinion

IRL                 In real life

IWSN              I want sex now

IU2U               It’s up to you

IYKWIM          If you know what I mean

J/K               Just kidding

J4F               Just for fun

JIC               Just in case

JSYK             Just so you know

KFY               Kiss for you

KPC               Keeping parents clueless

L8                 Late

L8r                Later

LMBO             Laughing my butt off

LMIRL            Let’s meet in real life

LMK               Let me know

LOL               Laugh out loud

LSR               Loser

MIRL             Meet in real life

MOS              Mum over shoulder

NAGI             Not a good idea

NIFOC           Nude in front of computer

NM               Never mind

NMU             Not much, you?

NP                No problem

NTS              Note to self

OIC               Oh I see

OMG             Oh my God

ORLY            Oh, really?

OT               Off topic

OTP             On the phone

P911            Parent alert

PAW            Parents are watching

PCM             Please call me

PIR              Parent in room

PLS or PLZ   Please

PPL             People

POS             Parents over shoulder

PTB             Please text back

QQ              Crying. This abbreviation produces an emoticon in text.

RAK             Random act of kindness

RL               Real life

ROFL           Rolling on the floor laughing

RT               Retweet

RUOK          Are you okay?

SMH           Shaking my head

SOS            Someone over shoulder

SRSLY         Seriously

SSDD          Same stuff, different day

SWAK         Sealed with a kiss

SWYP         So, what’s your problem?

SYS            See you soon

TBC           To be continued

TDTM        Talk dirty to me

TIME         Tears in my eyes

WYCM       Will you call me?

TMI           Too much information

TMRW       Tomorrow

TTYL         Talk to you later

TY or TU   Thank you

VSF          Very sad face

WB           Welcome back

WTH         What the heck?

WTPA        Where’s the party at?

WYCM        Will you call me?

YGM           You’ve got mail

YOLO          You only live once

YW             You’re welcome

ZOMG         Oh my God (sarcastic)

182             I hate you

420              Marijuana

ADR            Address

CD9            Code 9  it means parents are around

ILU             I love you

KOTL          Kiss on the lips

LMIRL         Let’s meet in real life

NIFOC         Nude in front of the computer

P999           Parent alert

PAL             Parents are listening or Peace and love

RU/18          Are you over 18?

WYRN          What’s your real name?


We hope that this month’s blog article allows you and your children to remain safe online and has helped with some good advice to continue your child’s online activity and reduce the amount of worry that a parent has with their children spending more and more time in the cyber world.

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Seizures

Posted by Steve at 11:00 on Thursday, 15th February 2018.


Around 87 people are diagnosed with epilepsy every day


Seizures are much more than just being classed as epilepsy seizures. There are many different causes of seizures, we thought this month we would have a look at the different causes and also how seizures portray themselves, in case you ever need to be dealing with a seizure as a First Aider.


Causes of Seizures


Acute Illness


Acute illness, viruses and bacteria may lead to a seizure, especially if the person who is taking anticonvulsants suffers from vomiting and diarrhoea, which will reduce or prevent the effect of the anticonvulsants.


Alcohol


The opinions on whether alcohol can cause a seizure are varied. However, consuming alcohol may temporarily reduce the risk of a seizure occurring, however when the blood alcohol levels drop the chances may actually increase, even in non-epileptics.


In epileptics, studies have shown that heavy drinking can actually increase the chances of a seizure occurring, but light drinking doesn’t seem to have too much of an effect on the seizure likelihood. Consuming alcohol with food is likely to reduce the risk of a seizure occurring.


However, taking anticonvulsants with alcohol, can reduce the effectiveness of the medication working and therefore actually increase the chances of a seizure.


Breakthrough Seizures


A breakthrough seizure is an epilepsy seizure which occurs even though anticonvulsants have successfully prevented the seizures in patients. Patients may even consider themselves to be free from seizures and therefore patients may not take precautions; this can make breakthrough seizures more dangerous than non-breakthrough seizures. Usually when a breakthrough seizure occurs there is a new trigger to the person’s seizure.


Diet


Malnutrition and overnutrition can cause a seizure in some people. Deficiency in certain vitamins are known to cause seizures, these include B1, B6 and B12.

B1 deficiency has been known to cause seizures especially in alcoholics. B6 is linked to Pyridoxine-dependent seizures which is a rare genetic disorder first recognised in the 1950s. The deficiency of B12 has been reported as commonly causing seizures in children and some adults.


Fever (Febrile Convulsion)


Fever is a common cause of seizure in children due to the fact that the body’s hypothalamus is not fully developed until the age of about 4 years old, although these types of seizures can occur anywhere from 6 months to 6 years of age. Usually they are caused by the rapid rising of the child’s temperature. Any infection that gets into the body, the body will try to fight off, usually a temperature is a by-product of this fighting process, which the hypothalamus is not able to fully deal with, therefore causing a seizure which is called a febrile convulsion.


Head Injury


A severe head injury such as caused by a car accident, fall or sports injury can trigger seizures in a casualty. It can take days, months or even years following the event for the seizures to commence however. Usually these types of seizures are caused as a result of the brain trying to deal with the extreme force that has discharged across the brain. If the damage affects the temporal lobe, it can cause the brain to be starved of oxygen.


Hypoglycaemia


Hypoglycaemia is a diabetic emergency where the body’s blood glucose level has dropped to dangerous levels. The lack of sugar or energy getting to the brain is also called neuroglycopenia. The lack of glucose in the blood can cause a seizure in the casualty.


Insect Stings


Insect stings have been known to cause seizures in some people. There are reports of stings from red imported fire ants and Polistes wasps causing seizures due to their venom.


Medical Conditions


Angelman Syndrome


Angelman syndrome is a genetic disorder that mainly affects the nervous system. Symptoms include:

 Small head

 A specific facial appearance

 Severe intellectual disability

 Developmental disability

 Speech problems

 Seizures

 Sleep problems.

Children with Angelman syndrome are usually happy in nature with a keen interest in water and are usually identified by the symptoms at the age of one. This syndrome affects 1 in 15,000 children and is the deformity of chromosome 15.

Seizures generally occur in 7 or 8 out of 10 sufferers.


Arteriovenous Malformation


Arteriovenous malformation is an abnormal connection between the arteries and the veins, bypassing the capillaries. Seizures are common in this condition usually because the arteriovenous malformation is supratentorial which is in the temporal lobe of the brain.


Brain Abscess


Brain abscesses are caused when inflammation and infected material collects in the brain tissue. The collection can come from local infectious sources, for example ear or dental abscess, or from remote sources for example the kidneys. It can also be caused by a head injury or surgery that involves a skull fracture. Seizures can be an indicator of a brain abscess.


Brain Tumour


A brain tumour occurs when abnormal cells form within the brain. These tumours can be malignant or cancerous or can be benign tumours. As with Brain Abscess above, seizures are a potential sign of a brain tumour.


Cavernoma


Cavernoma is a condition where a collection of blood vessels form a benign tumour. Because of this malformation of the blood vessels, blood through the cavities is slow, additionally the cells that form the vessels do not form necessary junctions with surrounding cells. It is the haemorrhage of the blood from these vessels that causes a variety of symptoms associated with the disease, of which seizures are a symptom.


Cerebral Palsy


Cerebral palsy is a group of permanent movement disorders that appear in early childhood. Symptoms vary from child to child, these symptoms include:

 Poor coordination

 Stiff or weak muscles

 Tremors

 Problems with:

 Sensation

 Vision

 Hearing

 Swallowing

 Speaking.

Often children with cerebral palsy will not roll over, sit or crawl as other children their age would be doing as per the developmental norms.

Seizures and problems with thinking or reasoning affect about one third of cerebral palsy children.


Down Syndrome


Down syndrome is a genetic disorder caused by the partial or full appearance of a third copy of the chromosome cell 21. It occurs in about 1 in 1000 children born every year. It affects the child’s physical growth, and their IQ which is typically at about 50, the equivalent of an 8 or 9-year-old.

Approximately 8% of people with Down syndrome have seizures.


Eclampsia


Eclampsia is the onset of seizures or convulsions in women who have pre-eclampsia, which generally occurs in the second half of pregnancy.

Pre-eclampsia is a disorder in which there is high blood pressure in the pregnant woman as well as high levels of protein in the urine and other organ dysfunctionality. The onset can be before, during or after the delivery of the baby. Usually these seizures last up to a minute and are mostly tonic-clonic seizures, and usually are followed by a period of confusion and or coma.


Encephalitis


Encephalitis is the inflammation of the brain. The severity of the condition is variable. The signs and symptoms of encephalitis include:

 Headache

 Confusion

 Fever

 Stiff neck

 Vomiting.

Seizures can be a complication of the inflammation of the brain. Encephalitis in 2015, was responsible for 150,000 deaths in the world with a total of 4.3million people affected by the condition.


Epilepsy


No review of the causes of seizure would be complete with the mention of epilepsy. This is the one condition that everyone will discuss at the sheer mention of the word seizure.


So, what is Epilepsy?


Epilepsy is a group of neurological disorders characterised by epileptic seizures. They can vary from brief nearly undetectable episodes to the full-on body shaking vigorously which can last several minutes. As of 2015, 39 million people have epilepsy, 80% of these in the developing world.


Fragile X Syndrome


Fragile X syndrome is a genetic disorder. It is usually due to the expansion of the CGG Triplet repeat within the Fragile X mental retardation 1 (FMR1) gene on the X chromosome.


The Fragile X mental retardation 1 (FMR1) gene is a protein most commonly found in the brain and is essential in the normal cognitive development and the female reproductive system.


Seizures occur in 10 to 20% of people with Fragile X syndrome.


Meningitis


Meningitis is the inflammation of the meninges, which are the lining of the brain and the spinal cord. We have written a blog in detail on meningitis which you can view here.


Multiple Sclerosis


Multiple sclerosis (MS) is a disease in which the insulating covers of the nerve cells in the brain and the spinal cord are damaged. This disrupts the ability of the parts of the nervous system to communicate which results in a wide-ranging array of signs and symptoms.

It has been found that people with multiple sclerosis are more likely than the general population to suffer from epilepsy, it is somewhere in the region of 2 – 3% of multiple sclerosis sufferers.


Systemic Lupus Erythematosus


Systemic lupus erythematosus also known as lupus is an autoimmune disease in which the body’s immune system mistakenly attacks healthy cells in various parts of the body. The signs and symptoms therefore are wide-ranging. Seizures are a common manifestation of this condition.


Tuberous Sclerosis


Tuberous sclerosis is a rare multisystem genetic disease. This causes benign tumours to grow in the brain, and on other vital organs including the heart, lungs, liver, kidneys and the skin. Seizures remain one of the most common neurological issues of this disease occurring in 85% of individuals.


Medicinal Drugs


Seizures can be a side effect of many drugs that are prescribed by the doctors, the doctor prescribing will always ensure that the patient is aware of this side effect as they prescribe to the person. A few examples of these drugs include:

 Caffeine

 Insulin

 Procaine

 Propofol

 Venlafaxine.


Menstrual Cycle


A subset of epilepsy is a condition called catamenial epilepsy which can make seizures more common during a woman’s menstrual cycle.


Musicogenic Epilepsy


Musicogenic is a rare form of epilepsy. Music is a part of everyday life and usually is pleasurable. For 1 in 10million people, although some statistics say it is more common than this, music is actually the cause of a seizure.

Routinely there is no test for musicogenic seizures like there are for photosensitive seizures.


The stimulus for sufferers varies but includes:

 Choral

 Classical

 Instrumental

 Jazz

 Popular Music.

As well as listening to these types of music other triggers include playing, thinking of or dreaming of music.


Nocturnal Seizures


Nocturnal seizures are a type of seizure which only occurs whilst the person is asleep. This is by definition a difficult type of seizure to diagnose due to its occurrence. The casualty may need to consider other symptoms and signs including:

 Headache

 Having wet the bed

 Bitten the tongue

 Bone or joint injury

 Muscle strains or injury

 Fatigue or drowsiness.


Missed Anticonvulsants


A missed or incorrectly timed dose of an anticonvulsant can be a trigger for a breakthrough seizure, we discussed these earlier in the blog. One single missed dose can be enough to cause a seizure in some patients.


Parasites


Certain parasites are known to cause seizures in humans. For example, pork tapeworm and beef tapeworm, can cause seizures when the parasites create a cyst on the brain. Parasitic diseases that can cause seizures include:

 Echinococcosis

 Malaria

 Toxoplasmosis

 African Trypanosomiasis.


Photosensitive


Photosensitive seizures are caused by flashing lights or with contrasting light and dark patterns. Around 1 in 100 people have epilepsy, and of these around 3% have photosensitive seizures. These type of seizures are less likely to be diagnosed beyond the age of 20 years of age.


Recreational Drugs – Taking


The taking of recreational drugs can seem like a good idea to some, however the taking of certain drugs at high levels of dosage and for long periods can cause some adverse effects which include seizures. The list of these drugs includes:

 Amphetamines

 Ecstasy

 Cocaine

 GHB.

It is important that the medical staff are clear on what has been taken and what the dosage was as being treated with the wrong antiepileptic drugs can actually make the seizures worse, and/or increase. The use of convulsant drugs, which have the exact opposite effect as anticonvulsants of which examples could be strychnine and picrotoxin will increase seizures and some have been used clinically and are also found naturally.


Recreational Drugs – Withdrawal


The withdrawal of recreational drugs, if not controlled, can actually cause seizures to occur as the body has got so used to the substance being put into the body that it struggles to work effectively without getting the hit of the substance that it has grown so used to.


Sleep Deprivation


This is the second most common cause of seizures and has been known to be the cause of the only seizure a person ever has. The exact reason why deprivation of sleep causes a seizure is unknown, but the most common theory on this is to do with the amount sleep one gets affecting the amount of electrical activity in the brain.


Stress


Stress can cause seizures in people who have epilepsy and is also a risk factor for developing epilepsy. It is thought that the hippocampus in the brain is the most susceptible to stress and prone to seizures.


In May 2017, The International League Against Epilepsy introduced a new method to group seizures. The idea was to group them to:


 Where they start in the brain.

 Whether the casualty’s awareness is affected.

 Whether the seizure involves other symptoms e.g. movement.


Focal Seizures


What happens during the focal seizure completely depends on where in the brain the seizure occurs and what that part of the brain usually does. Some focal seizures involve movement whereas some involve sensations and feelings.


Motor Symptoms (movements) include:


 Making a loud cry.

 Making lip smacking or chewing movements.

 Making strange postures or repetitive movement e.g. cycling or kicking.

 Repeatedly picking up objects or pulling at clothes.

 Repetitive jerky movements that affect one or both sides of the body.

 Suddenly losing muscle tone, limbs going limp, or stiff.


Non-motor Symptoms (sensations and feelings) include:


 A feeling of numbness or tingling.

 A sensation that the arm or leg feels bigger than it actually is.

 A strange feeling or a wave going through the head.

 A sudden intense feeling of fear or joy.

 Changes or a rising feeling in the stomach, a sense of déjà vu.

 Getting an unusual smell or taste.

 Stiffness or twitching in a part of the body.

 Visual disturbances such as coloured or flashing lights.

 

Focal Aware Seizure


A casualty who is having a focal aware seizure will be conscious, and therefore awake and alert. They will know that something is happening to them and will remember the seizure once it has passed. Some sufferers find it hard to put their seizure into words and often they just describe them as feeling strange. Because they are unable to describe their feelings or put them into words to describe it they may be frustrated and upset by it.


You can view a video of how it might feel to have a Focal Aware seizure here, thanks to the Epilepsy Society.


Focal Impaired Awareness seizure


During a focal impaired awareness seizure, a bigger part of one side of the brain is affected. The casualty’s consciousness is likely to be impaired. They are likely to be confused, whilst being able to hear you but not necessarily be able to communicate or understand what you are saying. They may not react as they normally would and may perceive your loud talking as you being aggressive and therefore be aggressive back to you.


This type of seizure generally occurs in the temporal lobe part of the brain but can affect other areas of the brain.


After the seizure the casualty may be confused, this could last a while post seizure, although you may not be able to tell if the seizure has actually ended. The casualty is likely to be tired after the seizure and may not remember what has happened.


You can view a video of how it may feel to be in a Focal Impaired Awareness Seizure here, with thanks to the Epilepsy Society.


Sometimes a focal seizure can lead to a bilateral tonic-clonic seizure, when this happens the casualty will become unconscious very quickly and have a tonic-clonic seizure. If this happens very quickly they may not be aware that it started as a focal seizure.


General Onset Seizures


General onset seizures affect both sides of the brain at once and without any warning. With the exception of the myoclonic seizure the casualty will be unconscious even if for just a short space of time, and will not remember the seizure after the event.


Tonic-Clonic Seizures


These are the most common type of seizure suffered by an epileptic.


At the start of the seizure the casualty will:

 Become unconscious.

 Cry out.

 Go stiff and fall over if standing.

 Possibly bite their tongue or cheek.

During the seizure the casualty will:

 Change colour and become very pale or become cyanosed.

 Jerk and shake as their muscles relax and tighten rhythmically.

 Have affected breathing which will become difficult or sound noisy.

 Potentially wet themselves.

After the seizure the casualty will:

 Return to normal colour and breathing.

 Potentially feel lethargic, confused, have a headache or want to sleep.


You can view a video of how it may feel to be in a Tonic-Clonic Seizure here, with thanks to the Epilepsy Society.


Clonic Seizures


Clonic seizures involve the jerky motions of the body which can be just one side or both sides of the body, this will depend on where the seizure starts. If they start in one side of the brain, they are called focal motor and if they affect both sides of the brain, they are called generalised clonic.


Tonic and Atonic seizures


Tonic seizures tend to be brief in nature and happen with little warning. These types of seizures involve the casualty’s body becoming stiff and if they are standing they are likely to fall backwards to the floor and injure the back of their neck and head.


An atonic seizure is otherwise known as a drop attack. Usually these casualties will fall forward, potentially causing harm to their face. The reason for the drop is that their muscles have relaxed and gone floppy. Like tonic seizures they usually happen with little or no warning and are brief in their duration.


Other than the possible injuries which have been caused by the drop to the floor, the casualties are likely to recover from the seizure very quickly.


You can view a video of how it may feel to be in an Atonic Seizure here, with thanks to the Epilepsy Society.


Myoclonic Seizures


Myoclonic simply means muscle jerk.


Muscle jerks should not always be assumed to be epilepsy as some people have them as they go to sleep and are completely unrelated to epilepsy. Myoclonic seizures however, can occur in clusters whereby there are a lot in a short space of time and are usually brief in their duration. If they do occur in clusters, the next one is likely to occur shortly after the casualty awakes from their previous seizure.


The casualty is likely to be conscious through these seizures, but they are still classed as generalised seizures as the casualty is likely to have other types of seizure as well as myoclonic.


You can view a video of how it may feel to be in a myoclonic seizure here, with thanks to the Epilepsy Society.


Absence Seizures


Absence seizures are very common in children, they can happen frequently and can be very difficult to identify. The come in two types, typical absence and atypical absence.


Typical Absence


The typical absence seizure portrays itself in the person becoming blank and unresponsive for as short a time as a few seconds. The casualty may stop what they are doing, stare into space, and their eyelids may flutter and blink. They will be totally unaware of what is happening around them, should they occur as the person is walking the casualty will continue to walk but have no awareness around them.


Atypical Absences


These are very similar to the typical version of an absence seizure however they tend to start and end more slowly. The other big difference being the change in the muscle tone and the limbs could go limp, also the casualty could drop to the floor.


You can view a video of how it may feel to be in an absence seizure here, with thanks to the Epilepsy Society.


Unknown Onset Seizure


This is a term that is used by doctors if they are unsure as to where in the brain the seizure occurred. This could be because the casualty was alone, asleep or the seizure went unwitnessed.


Finally, let’s look at what you can do as a First Aider for a casualty who is having a seizure, but do remember that the best way to know what to do for your casualty is to attend a First Aid course.


The treatment you shall provide will vary depending on if the casualty is having a muscle jerky seizure or a non-motion seizure.


General Onset Seizures


1. As the casualty is falling, try to catch them and clear the area that they are going to land in.

2. Allow the seizure to occur DO NOT hold them down.

a. Time the seizure and call an ambulance if:

i. The seizure is 3 minutes long or

ii. Is 2 minutes longer than is normal for the casualty or

iii. They hurt themselves as they fell to the floor or

iv. They have a second seizure or

v. It’s their first ever seizure or

vi. You’re not sure.

b. Loosen any tight clothing from around the neck.

NEVER:

 Put anything in the casualty’s mouth.

 Try to restrain the casualty.


After the seizure,

1. Open the Airway and check breathing

a. If necessary:

i. Place in Recovery Position or

ii. Start CPR.

2. Move bystanders to protect dignity and modesty of casualty.

3. Call 999/112 for emergency help if you cannot wake them after 5 minutes.


Focal and Absence Seizures


1. Guide the casualty away from possible danger.

2. Help the casualty to sit or lie down in a quiet place.

3. Be calm and reassuring, don’t do anything that could frighten them.

4. Stay with the casualty until they are fully alert.

5. If the casualty is unaware of their condition advise them to seek medical advice.


DID YOU KNOW…..


St. Valentine is also the patron saint of Epilepsy?

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Poisoning

Posted by Steve at 14:00 on Thursday, 15th March 2018.


With the events in the news over the last few days of the poisoning of former spy, Sergei Skripal and his daughter Yulia, we thought we would take a closer look at poisoning and its treatment.


It seems to stand to reason that we start this blog with what is known about Sergei Skripal, as this is the news event of the last week.


Who is Sergei Skripal?


If like us, until a few days ago you hadn’t heard of Sergei Skripal, you are probably asking who on Earth is this man?


Skripal worked in the Russian GRU military intelligence until 1999, where he reached the rank of Colonel. Between 1999 and 2003 he worked for the Russian Foreign Ministry’s Office in Moscow until 2003, before going into business.


Skripal was arrested and convicted of the charge of high treason in the form of espionage in 2006 for passing on the identities of Russian agents working across Europe to MI6. Skripal was sentenced to 13 years for his crime.


After his arrest it is said by FSB agents, the Russian Security Agency, that Skripal commented, ‘You outplayed me’. An FSB spokesperson compared Skripal to Colonel Oleg Penkovsky, who was executed in 1963 having supplied the United States of America during the Cuban Missile Crisis.


During his court case, prosecutors said that he had been paid $100,000 by MI6 for the information he provided to them, dating back to the 1990s when he was a serving officer in his homeland. Russia’s security agency, FSB, said that the information Skripal was passing on to MI6 amounted to State secrets.


Skripal arrived in the UK in 2010 as part of a high-profile spy swap with 10 deep cover sleeper agents planted in the US by Moscow, being swapped with 4 spies. It was assumed that he had been provided with a new identity, house and pension, having been deemed as the more important spy of the 2 swapped that arrived in the UK.


Skripal is believed to have moved to Salisbury, Wiltshire in 2011 where he bought a house.


Sergei’s personal life appears to be full of sadness in that his wife, Lyudmila, died in 2012 at the age of 59 from disseminated endometrial carcinoma, which is a type of cancer which originates in the endometrium, the lining of the womb. His son, Alexandr also died while on a trip to St. Petersburg in 2017, both Alexandr and Lyudmila are buried in a cemetery local to Salisbury. Within the last 2 years, Sergei’s older brother has died also. In 2014, his daughter Yulia, returned to Russia, where she worked in sales in Moscow.


Since March the 4th Salisbury has been taken over by the Police and media following the deliberate poisoning of Sergei and his daughter, Yulia, who was visiting him from Russia, with a nerve agent, which has subsequently been identified as Military Grade and is part of a group of nerve agents known as Novichok.


The BBC reported that the pair were found unconscious on a park bench by a passing doctor and nurse. Paramedics took the pair to Salisbury District Hospital where the pair remain, at time of writing, in a critical condition and a major incident was declared due to the determination of poisoning by nerve agent. The Police Officer, Detective Sergeant Nick Bailey, was also affected having been first to render aid and has been admitted to hospital in a serious condition, although is now conscious.


In total, 21 people have been treated for symptoms of this attack.


On Tuesday 6th March 2018, Foreign Secretary, Boris Johnson, seemed to claim that the attack was carried out with State responsibility of Russia, although at the time of writing there is no public evidence of this. In a statement, Johnson said the UK would respond robustly should this be proven. Russia however has stated that it has no information as to what could have led to the incident but is open to co-operating with British Police if required.


The Prime Minister on Monday the 12th in a statement to the House of Commons said, due to the Nerve Agent being a part of the group of agents called ‘Novichock’ it is ‘Highly Likely that Russia is responsible for the attack.


What is a poison?


A poison is described as any substance, whether liquid, solid or gas, which enters the body in sufficient quantity to cause damage.


How does a poison enter the body?


Ingestion: A substance has been swallowed, it takes about 20 minutes to enter the bloodstream via this method of poisoning.


Inhalation: A substance has been breathed in, entering the bloodstream in as little as 30 seconds as it passes through the lungs.


Absorption: A substance being absorbed through the skin can poison a person after anywhere between 3 to 8 minutes.


Injection: A substance goes directly through the skin into the tissues of the body or the blood vessel, and can be in the bloodstream immediately.


Are there different types of poisons?


Indeed, there are 2 different types of poisons. These are corrosive and non-corrosive.


What is a Corrosive poison?


A corrosive poison includes:


Acids,

Bleach,

Ammonia.


What is a Non-Corrosive poison?


A Non-corrosive poison includes:


Tablets,

Medication,

Drugs,

Alcohol,

Perfume,

Plants.


How do I know if a substance is poisonous and how to treat it?


The easiest way to know if a substance is poisonous, harmful or otherwise is to read the packaging and label that the product comes in. It is always advisable to be familiar with The Globally Harmonised System (GHS) of classification and labelling of chemicals which is an international standard for identification of labelling chemicals, replacing the Chemicals (Hazard Information and Packaging for Supply) Regulations (CHIP) in 2015. The European regulation on the classification, labelling and packaging of substances and mixtures, the CLP, meets the GHS system. For more on the GHS you can view our COSHH page by clicking here.


In commercial settings, suppliers of potentially hazardous substances have a duty to provide a Control of Substances Hazardous to Health (COSHH) data sheet, when requested.


What are COSHH Data Sheets?


COSSH data sheets, otherwise known as Safety Data Sheets, are required as part of the Registration, Evaluation, Authorisation and restriction of Chemicals (REACH) regulations introduced in the UK on June the 1st 2007. Although they are not a Risk Assessment in themselves, they carry the key information that an employer will need to consider when introducing or asking his/her employees to use a substance, whilst reducing the risk to themselves, the public or the environment. The Risk Assessment that an employer undertakes will meet the needs of the COSHH regulations.


A COSHH data sheet will contain:


The date and the following headings:

Identification of the substance/mixture and of the company/undertaking,

Hazards identification,

Composition/information on ingredients,

First-aid measures,

Firefighting measures,

Accidental release measures,

Handling and storage,

Exposure controls/personal protection,

Physical and chemical properties,

Stability and reactivity,

Toxicological information,

Ecological information,

Disposal considerations,

Transport information,

Regulatory information,

Other information.


Other sources of information as to whether you should be concerned or not about the poison include:


The NHS non-emergency Health Helpline available on telephone number 111.

The Ambulance Service can also provide advice, but this should be a last resort when calling for an ambulance.


Poisonous Plant Lists


Childcarers should be aware of plants that are classified as poisonous, you can view a list of poisonous plants compiled by the Royal Horticultural Society by clicking here.


First Aid for Poisoning


The First Aid treatment varies depending on the type of the poison they have been poisoned by, whether it be corrosive, non-corrosive or inhalation of smoke, fumes and other substances.


Corrosive Poisoning


Be aware of your own safety, do not put yourself at risk in order to aid someone.

Dilute the substance or wash it away if it is possible to do so:

Wash any substance away off the skin,

Should the casualty be able to swallow, encourage the casualty to rinse out their mouth, and then give frequent sips of water or milk, this can help as long as the casualty doesn’t feel sick and can swallow.

Call 999 or 112 for emergency help, give them as much information as you can about the poison.

Take and follow any advice from the Paramedic operator.

Should the casualty become unconscious:

And is breathing, roll the casualty into the Recovery Position and continue to monitor their airway and breathing,

And is not breathing, commence CPR as necessary, remembering that it may be a good idea to use hands only CPR, as opposed to normal CPR in case the poison can corrode your face shield.


Non-Corrosive Poisoning


Call 999 or 112 for emergency help, giving them as much information as you can about the poison.

Take and follow any advice from the Paramedic operator.

Should the casualty become unconscious:

And is breathing, roll the casualty into the Recovery Position and continue to monitor their airway and breathing,

And is not breathing, commence CPR as necessary, using a face shield to protect yourself.


Inhalation of smoke, fumes or other substances


Move the casualty away from the fumes/smoke and into fresh air.

Check their airway and breathing, if the casualty is:

Breathing, roll the casualty into the Recovery Position and continue to monitor their airway and breathing,

Not breathing, commence CPR as necessary, using a face shield to protect yourself.

Call 999 or 112 for emergency help.

An upright position may help the casualty if they are conscious but having particular difficulty with their breathing.

Check and, if necessary, treat any burns the casualty may have.

Continually monitor their airway and breathing and respond as necessary.


With all types of poisons, it is important that you do NOT encourage the casualty to vomit as this can cause further damage to the casualty’s oesophagus, as well as potentially put the casualty’s airway in danger.


If you are able to, it is advisable to provide the paramedics with:

The container or COSHH sheet of the substance.

Any further information you have about the particular substance.

The amount of the poison you suspect the casualty has actually taken.

The time of the dose of the poison being taken.

Any samples of vomit that the casualty may produce for hospital analysis.



Whilst, we have taken you through First Aid for poisoning, obviously the best way to keep up to date with First Aid protocols is to attend a course and practise these lifesaving skills.


If we return to where this blog began, it is important for us to stress that attacks of this type are extremely rare in the UK and over the coming days and weeks more information will be made public, and we are sure the UK Government will make the right decisions on sanctions on the forces responsible for this act on our shores.

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Anaphylaxis

Posted by Steve at 14:00 on Thursday, 12th April 2018.

This month, we thought that we would take a look at anaphylaxis.


Anaphylaxis is a severe reaction to a range of allergens and is a life-threatening illness that can kill very quickly if the casualty is not treated in a timely manner. The reaction in the body affects more than one system of the body for example, the circulatory system, respiratory system and the digestive system as well as organs not included in these like the skin. An anaphylactic reaction usually occurs within minutes of an exposure but in some cases can take hours to portray itself and affect the casualty.


What is the Circulatory System?


The circulatory system is an organ system that allows blood to travel around the body, as well as transporting vital nutrients, oxygen, carbon dioxide, hormones and blood cells to and from the various cells of the body, providing nourishment, helping to stabilise temperature and PH levels, fighting diseases and maintaining homeostasis (the equilibrium of an organism’s state and internal environment).


What is the Respiratory System?


The respiratory system is a biological system that consists of specific organs and structures used for gas exchange in animals and plants.


What is the Digestion System?


The digestion system consists of the gastrointestinal tract, along with the organs of digestion:

Tongue,

Salivary glands,

Pancreas,

Liver,

Gallbladder.

The process of digestion takes many stages and starts in the mouth with chewing, working its way down the gastrointestinal tract.


What happens in an Anaphylactic shock?


In an anaphylactic shock reaction, the immune cells of the body release a massive quantity of a chemical known as histamine to try to deal with the body’s overreaction to the allergen. The release of the chemical causes a rash on the skin and causes some itching for the casualty. In severe cases where the body has released extreme quantities of histamine the casualty can suffer from extreme life-threatening Airway, Breathing and Circulation issues.


Airway Problems:


Anaphylaxis can make the blood capillaries leak causing swelling which can cause the airway to swell, therefore affecting the casualty’s breathing as the airway is swelling and blocking the air route.


Breathing Problems:


Just like an asthma attack, anaphylactic shock can constrict the alveoli in the lungs causing difficulty with breathing.


Circulation Problems:


Anaphylaxis can result in a life-threatening blood pressure fall because of the blood vessels dilating to 3 times their normal size, any fluid loss from the leaking capillaries will make the fall of blood pressure even worse. Should this event happen the casualty must lie down. If the casualty is in any other position, this situation can result in a lack of blood to the heart that will stop it instantly.


What triggers an allergic reaction?


There are many triggers of an allergy which include:


Food


In December 2014, the Food Information Regulations came into force which list the 14 major allergens which must be listed on pre-prepared food items and menus when they are used as ingredients in food. The Food Standards Agency published guidelines on these 14 allergens.


So, what are the 14 allergens?


1 – Celery


Celery or Apium graveolens is a marshland plant in the Apiaceace family that has been cultivated since antiquity. Celery has a long fibrous stalk which tapers out into leaves. Celery seed is used in herbal medicine.


Celery includes celery stalks, leaves, seeds and the root called celeriac. Celery is found in a lot of foods some of which include celery salt, salads, some meat products, soups and stock cubes.


2 – Cereals containing gluten


Gluten is a composite of storage proteins termed prolamins and glutelins and stored together with starch in the endosperm of various cereal grains.


The allergen here includes:

Wheat,

Spelt,

Rye,

Barley,

Oats.

These allergens are usually found in things like baking powder, flour, batter, breadcrumbs, bread, cakes, couscous, meat products, pasta, pastry, sauces, soups, fried foods which are dusted with flour.


3 – Crustaceans


Crustaceans form a large diverse anthropod taxon which includes such familiar animals such as crabs, lobster, prawns, scampi, krill, woodlice (not normally food!), and barnacles. Other sources of this allergen will include shrimp paste, Thai and South-East Asian curries and salads.


4 – Eggs


Eggs are laid by female animals of species, including birds and fish and have been eaten by humans for thousands of years.


Eggs are found in many products for example, cakes, mayonnaise, mousses, pasta, quiche, sauces, pastries or foods brushed or glazed with egg and some meat products.


5 – Fish


Fish are gill-bearing aquatic craniate animals that lack limbs with digits.


Fish are found in various obvious places like fish dishes and fish sauces, but can also be found in pizzas, relishes, salad dressings, stock cubes, and Worcestershire sauce.


6 – Lupin


Lupin more commonly known as Lupinus is from the Legume family of flowering plants and is also used in food. Lupin beans are the yellow legume seeds and are often used as a pickled snack or ground into flour which can enhance the flavour and leads to a rich creamy colour to resulting foods.


Lupin can be found in certain breads, pastries and even flour.


7 – Milk


Milk is a white liquid produced by the mammary glands of mammals.


Milk is a very common ingredient in cuisine including in butter, cheese, cream, milk powders, and yoghurts, as well as being found in food that has been brushed with milk or when powdered milk has been used in soups and sauces.


8 – Molluscs


Mollusca is a large phylum (a classification level) of invertebrate animals whose members are known as molluscs or mollusks, around 85,000 extant species are recognised with the fossil species taking that number up to between 60,000 to 100,000 species.


In food, molluscs include mussels, land snails, squid and whelks, but can also commonly be found in oysters or as an ingredient for fish soups and stews.


9 – Mustard


Mustard is a condiment that is made from the seeds of the mustard plant.


This category, as defined by the Food Standards Agency, includes liquid mustard, mustard seeds and mustard powder. You are likely to find this allergen in foods like breads, curries, marinades, salad dressings, sauces, soups and meat products.


10 – Nuts


A nut is a fruit that consists of a hard-inedible shell, with an edible inner seed, and is not to be confused with peanuts which are actually a legume and grow underground. In this category we are discussing nuts which grow on trees for example,

Cashew nuts,

Almonds,

Hazelnuts.

Nuts are used widely across cuisine, but most commonly found in breads, biscuits, crackers, desserts, nut powders, stir-fried dishes, ice-cream, marzipan, nut oils and various sauces.


11 – Peanuts


As mentioned above in allergen 10, the peanut is a legume and is grown underground, which is why it is often referred to as ground nut or goober. The peanut is a part of the Fabaceae family.


You are most likely to find peanuts in things such as biscuits, cakes, curries, desserts, sauces most noticeably satay sauce, and in groundnut oil and peanut flour.


12 – Sesame Seeds


Sesame is a flowering plant in the Sesamum genus.


Sesame seeds are likely to be seen in bread or commonly on top of sesame seed buns, breadsticks, houmous, sesame oil and tahini. They are often toasted and tossed into salads as well.


13 – Soya


Glycine max is more commonly known as soybean in North America or soya bean and is native to East Asia and part of the legume family.


Soya is often found in bean curd, edamame beans, miso paste, soya flour, textured soya protein, or tofu. Soya is a staple ingredient of oriental food. Soya can also be found in desserts, ice-cream, meat products, sauces and vegetarian products.


14 – Sulphur Dioxide or Sulphates


Sulphur dioxide is a chemical compound with the chemical formula SO2, it is a toxic gas with a pungent, irritating smell. If you have asthma you have a higher risk of developing a reaction to sulphur dioxide.


You can find sulphur dioxide in dried fruits, meat products, soft drinks, vegetables, as well as in wine and beer.


We used the Food Safety Agency guidelines as guidance for this list.


There are many more food-related allergens, which can be very individual to each anaphylactic sufferer, including coconut, kiwi fruit, strawberry and bananas etc.


Insect Stings


Bee Stings


A bee sting is acidic and can cause anaphylactic issues in a casualty. Even if it doesn’t cause a reaction, the bee can leave their sting in the casualty’s body where they have been stung; this can be removed by scraping a blunt straight edge over the affected area, elevating the injury if possible and using ice in a tea towel can help to reduce the swelling and pain on the casualty.


Wasp Sting


The wasp sting is the opposite to the bee and is therefore an alkali. The wasp rarely leaves its stinger in its victim, therefore, elevating the injured part of the body and applying ice in a tea-towel on the affected part of the body can help to reduce the swelling and pain.


With both a bee and wasp sting it is important that you keep a close eye on the casualty in case they should have a reaction to it.


Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)


Non-Steroidal Anti-Inflammatory Drugs are a drug class that are designed to reduce pain, decrease fever, prevent blood clots, and in higher dosages can reduce inflammation.


They include:

Aspirin,

Celecoxib,

Diclofenac,

Ibuprofen,

Indomethacin,

Naproxen,

Oxaprozin,

Piroxicam.


Penicillin


Penicillin is a group of antibodies that includes Penicillin G, Penicillin V, Procaine Penicillin, and Benzathine penicillin. The chemical formula is C9H11N2O4S.


Perfumes


Perfume is a mixture of fragrant essential oils and/aroma compounds designed to give the human body, environment, food, objects and living spaces an agreeable scent.


How can I recognise an Anaphylactic Shock?


There are 3 main characteristics of an anaphylactic shock.


A rapid onset, as discussed earlier onset can in rare cases be hours rather than minutes.

Life-Threatening:

Airway complications:

o Swelling of the tongue, lips, or throat,

o Casualty may feel the throat closing up,

o A hoarse voice,

o Loud pitched, noisy breathing.

Breathing complications:

o Difficult, wheezy breathing,

o Tight chest.

Circulation complications:

o Dizziness,

o Feeling faint or passing out, (if sat upright),

o Pale, cold, clammy skin,

o Fast pulse,

o Nausea,

o Vomiting (capillaries leaking in the gut),

o Stomach cramps (capillaries leaking in the gut),

o Diarrhoea (capillaries leaking in the gut).

A skin rash, flushing and/or swelling, which may disappear and come back, not all casualties will have this.


Other signs and symptoms of anaphylactic shock include:

o Anxiety,

o A ‘Sense of impending Doom’.

Not all casualties will have all the airway, breathing and circulation complications but casualties can also have all three.


How do I treat Anaphylactic Shock?


The correct order of treatment for a casualty who is in anaphylactic shock is as follows:


1. Call 999/112 for emergency help.

2. Lay the casualty down in a comfortable position

a. If the casualty feels light-headed, lie them down immediately and raise their legs, DO NOT sit them or stand them up as this can be fatal.

b. If you find that the casualty ONLY has airway and breathing complications, they can be sat up, they may even prefer this and it can make breathing easier, however, if they begin to feel light-headed, then you must lie them with their legs elevated.

3. If the casualty carries an Adrenaline Autoinjector, it can help to save their life. Ideally, they should administer this on their own however, should they need assistance, you can assist them. Prompt use saves lives.

4. If the casualty becomes unconscious, follow the basic life support skills you are taught on one of our courses, check airway and breathing and then if necessary start Cardio-Pulmonary Resuscitation.

5. If the casualty has a second Adrenaline Autoinjector, this can be administered after 5 to 15 minutes if there is no improvement or symptoms return.


What is an Adrenaline Autoinjector?


An Adrenaline Autoinjector, or an epinephrine autoinjector to use its real name, is a medical device for injecting a measured dose of epinephrine (adrenaline) by means of auto-injection technology. They were first brought to the market in the 1980s.


Epinephrine (adrenaline)’s chemical formula is C9H13NO3.


There are 3 main makes of Adrenaline Autoinjectors these are:

o EpiPen

o Jext

o Emerade.


EpiPen


The EpiPen like the other 2 adrenaline autoinjectors has similarities and differences. The EpiPen has an 18-month shelf life and is administered to the casualty for a duration of 10 seconds. The dosage inside the autoinjector depends on the size of the casualty:

15 to 30 kg patients = 150mcg

>30kg patients         = 300mcg.

The EpiPen is the most commonly used autoinjector on the market, and comes complete with visual instructions on the pen, making it easy to follow in an emergency. There is also a viewing window, which means you can check whether the epinephrine is good or bad. If the fluid is clear it is good to use, cloudy would indicate that it is past its best and shouldn’t be used. The EpiPen also comes complete with a rhyme:

‘Blue to the sky,

Orange to the thigh.’

This relates to the blue safety cap and the orange thigh that needs to be used to inject the medication in to the casualty’s thigh.


Emerade


The Emerade pen is the one which is mostly aligned to the Resuscitation Council of the United Kingdom (RC(UK)), with a slightly larger needle than the other 2 autoinjectors. The pen has a shelf life of 30 months and is administered to the casualty for a duration of 5 seconds. Like, the EpiPen, the Emerade pen dosage depends on the size of the casualty:

15 to 30 kg patients = 150mcg

>30kg patients         = 300mcg.

The safety cap of the Emerade pen is at the needle end, and like the EpiPen this pen has visual instructions on the barrel to aid easy administration.


Jext


The Jext pen, like the EpiPen, has a shelf life of 18 months and takes a duration of 10 seconds into the casualty’s body. Like the other 2 pens the dosage inside the autoinjector depends on the size of the casualty:

15 to 30 kg patients = 150mcg

>30kg patients         = 300mcg.

The Jext pen like the EpiPen has a viewing window and, as with the other 2 pens, has got visual instructions on the barrel in order to assist in easy administration of the pen.


All of the 3 pens must be injected into the thigh muscle, as this is the biggest muscle of the body and therefore the quickest route of the epinephrine into the body.


If this blog has caught your interest or you want to know more about Anaphylaxis there are several ways that you can learn more on our courses, we cover Anaphylaxis in brief in most of our First Aid courses, as well as having a specific course that focuses wholly on Anaphylaxis. Why not visit our First Aid courses page on our website to see what we can offer?

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The Summer and the Human Body

Posted by Steve at 14:00 on Tuesday, 15th May 2018.

As we start out on this month’s blog article, we would like to begin by saying that we hope you are all enjoying the warm weather we have been experiencing over recent weeks, and although it may have started to cloud back over, we are hoping that the sun returns to us sometimes soon.


We know however that there will be those of us who are suffering because of it, maybe in more ways than one.


Firstly, let’s focus on the enjoyment of the sun and what appears to be a favourite pastime of people whilst the sun is blazing a warm heat across the country; yes, we are referring to sunbathing.


It has been said that the sunshine makes you feel happy and alive


Whilst sunbathing can be something that helps you to feel relaxed and happy whilst in the sun, without taking reasonable responsible steps to stay safe it can result in long-term damage to the skin. One such step is to avoid getting burnt in the sun because small amounts of sunburn damage can lead to the development of skin cancer or melanoma.


When we consider the phrase we hear a lot of the time about tanning which is ‘it makes me look good’ we need to consider the long-term health issues and damage that is happening to the skin and body. Tanning itself is a natural process when the skin creates a brown coloured pigment called melanin in order to protect itself from the effects of the harmful UV rays from the sun. A suntan is evidence of skin damage. Having said that a tan is the skin’s way of protecting itself from the harmful rays of the sun, if the damaged cells are unable to repair themselves, they can and often turn cancerous. A tan, although a way of the skin and cells protecting themselves, is not a sure-fire way of avoiding skin cancer in later life; the number of cases of skin cancer has doubled over recent years.


It is important to remember that, even with the knowledge that a tan is the skin protecting itself, there are things you can do in order to help the skin protect you.


Here we look at a few simple tips that can help you stay safe in the sun:


Avoid being out in the sun between 11:00 and 15:00


During this time frame between March and October each year, the sun and its rays will be at their strongest and this makes it more likely that you will tan and/or burn in the rays.


Cover up with suitable clothing and sunglasses


The idea here is to prevent your skin from being too exposed to the sun, the best type of clothing here would be clothing which is loose fitting to help the air flow and keep you cool. The sunglasses, if they have a good UVA protection, will help to prevent damage to your eyes.


Take extra care with children


You could encourage children to play in the shade, particularly at the high-risk times of the day, be it under trees or canopy etc, you could make this an exciting game for the children to keep them in the shade.


Children under the age of six months should be kept out of direct sunlight particularly at around midday.


Children (and adults for that matter) should be wearing some kind of hat while out in the sunshine, the best type of hat will have a flap that comes down to cover the wearer’s neck.


Ensure that you use sun cream on the child, particularly paying attention to their shoulders, see below for more information on sun cream.


If the child is playing in the water, it is important that they are wearing a waterproof sun cream AND that it is reapplied after drying the child from their fun in the water.


Sun cream


There are things that you will need to check when you are purchasing and/or using sun cream. Although it may sound really obvious, you should always check that the product is fully in date. Sun cream that has gone out of date is likely to be less effective and therefore cause you to burn even though you had applied it in the first place.


You should check that the sun cream you are buying and using has an SPF factor of 15 or above, it is often recommended that children have a higher SPF, usually advised is one of 30 or above.


What is SPF?


SPF is an abbreviation for Sun Protection Factor, and has a rating scale from 2 to 50+. The higher the number the more protection that the product will provide. The SPF rating relates to the amount of Ultraviolet B radiation protection offered by using a product.


Also, when buying sun cream you should also be checking that the particular bottle you are buying has at least a 4-star UVA rating.


What is the star rating?


The star rating is a rating that demonstrates how well the sun cream being applied will protect from Ultraviolet A Radiation. In the UK the rating is a rating of up to 5 stars that you should see on the bottle, the higher the rating the better. In the EU the rating has the letters UVA in a circle, this means that the UVA protection is one third of the SPF rating and meets current EU recommendations.


If a sun cream offers both UVA and UVB protection they are often called broad spectrum.


Avoid being outside any longer than you would if you didn’t have protection on


This is a good measure of whether you have been outside too long or not, if you wouldn’t normally be outside the length of the time you have been in the sun without protection on, then it is an indicator that you should be heading back into the shade.


REMEMBER, even on a cloudy day you can burn


On a cloudy day, you may feel that it safe for you to be outside in the sun, the problem with this however is that in actuality even on a cloudy day 30 to 50% of the sun’s rays can still reach your skin and therefore cause burning.


Applying sun cream


Research has shown that sun cream has been applied incorrectly for many years.


First thing of note is that sun cream should be applied 30 minutes BEFORE going outside into the sun, and if you think you are going to be out long enough to risk burning the sun cream should be applied again directly before heading outside. This is something that people do not realise.


It is important that you use enough sun cream, if you do not apply it in a thick enough layer the protection that it offers just won’t be sufficient. As a general rule of thumb an adult should use:


2 teaspoons if you are only using it to cover head arms and neck OR

2 tablespoons if using to cover the whole body for example when wearing a bikini etc.


Sun cream should be reapplied frequently and liberally, as well as according to the manufacturer’s instructions. This even applies if the sun cream is ‘water resistant´, the cream should be reapplied after towelling dry, sweating or it may have rubbed off. Failure to reapply is likely to make the sun cream ineffective and therefore you may tan and/or burn.


We have included a link to the NHS How to apply sunscreen video for your reference:


How to apply Sunscreen

Dealing with sunburn


The NHS offers advice for people who have been sunburnt as follows:


Sponge the sore skin with cool water,

Apply either some cooling aftersun or calomine lotion.


The NHS suggests that painkillers e.g. paracetamol or ibruprofen may help to ease the pain by helping to reduce any swelling that may be around the burn.


If you are feeling unwell, or blisters and swelling occurs you should seek medical attention. And you should ensure that you stay out of the sun until all the redness has disappeared.


Although the sun and burning is one issue whilst out in the heat, there are other health issues that should be looked at and considered, and again some of the tips that we have already provided can help to prevent you from suffering the effects of these other conditions.


We are talking about the body getting too hot at the core and causing the body to start to overheat and become very ill. The 2 health issues in question are:


Heat Exhaustion,

Heat Stroke.


So, let’s have a look at these separately, and consider how you would know if someone was suffering from these and how you may treat each one.


Heat Exhaustion


Heat exhaustion is the body’s natural reaction to losing water and body salts (electrolytes) through excessive sweating. The most common cause of heat exhaustion is working or exercising in hot weather conditions, for example playing sport, hiking, construction work on very hot days.


Heat exhaustion occurs when the body’s core temperature has risen above 38˚C, if this is not treated it can, and very often does, quickly lead to heat stroke.


What are the Signs and Symptoms of Heat Exhaustion?


The signs and symptoms of heat exhaustion are:


Sweaty, pale skin,

Nausea,

Loss of appetite,

Vomiting,

Fast, weak pulse and breathing,

Cramps in the arms, legs and abdomen,

Saying ‘I’m cold’ but actually feeling hot to touch.


How should I treat Heat Exhaustion?


Find the casualty a cool place to rest,

Remove excessive clothing,

Lay the casualty down,

Give the casualty plenty of water to drink to rehydrate, (oral rehydration solutions for example, ‘Dioralyte’ or Isotonic drinks are a good idea as they will help to replenish lost body salts (electrolytes)),

Obtain medical advice, even if the casualty recovers quickly,

If the casualty’s responsive levels drop, place in recovery position and call 999/112 for an ambulance,

If necessary, treat for heat stroke.


You should always stay with your casualty until they are feeling much better and are back to ‘normal’ for them, this should take about 30 minutes but can take even longer.


If heat exhaustion is not treated quickly it can, and very often does, turn very quickly into heat stroke:


Heat stroke is a very serious condition, which is caused by the malfunction of the hypothalamus, which is the body’s thermostat.


During heat stroke the sweating mechanism of the body fails, therefore the body is unable to cool down and the body’s core temperature can reach dangerously high levels of over 40˚C within as short a time span as 10 to 15 minutes.


Heat stroke is caused by high fever, or prolonged exposure to heat, it very often follows on from heat exhaustion. The thing to remember about heat stroke is that the casualty’s brain is overheating.


What are the Signs and Symptoms of Heat Stroke?


Dizziness,

Confusion,

Restlessness,

Fainting,

Throbbing headache,

Lower levels of response,

Seizures,

Nausea,

Flushed, hot and dry skin (NO sweating).


How should I treat Heat Stroke?


Find the casualty a cool place and move them to it,

Call 999/112 for emergency help,

Cool the casualty RAPIDLY, using whatever methods you can, these can include:

Remove outer clothing,

Wrap the casualty in cold, wet sheet,

Keep the sheet wet and cold until the casualty’s temperature falls to normal levels,

Then replace the sheet with a dry one.

o Other methods of cooling may include:

Continually sponging the casualty with tepid water and fanning the casualty to help it evaporate,

Place in a cool shower, providing that the casualty is conscious enough to do so,

Spraying with cold water from a garden hose.


The last health issue that we would like to consider whilst we are talking about the summer and its enjoyment, is one that is very close to us, and that is the summer phenomenon that is hay fever!


Hay fever medically speaking is called Allergic Rhinitis.


Generally speaking, hay fever affects sufferers mostly between late March and September when the weather is mostly warm, windy and humid. During these periods the pollen count is at its highest. The type of pollen that a sufferer is allergic to, will also have an effect on the time period that a sufferer will feel the effects of the pollen. For example, some people are only allergic to tree pollen, whereas others are allergic to more grass related pollens, which have their own seasons. The tree pollen season is typically March through to May, with the grass pollen season being May through to July, which also gives a crossover between the 2 seasons. Of course, in very hot weather the pollen levels will be high and that can last all the way through to September.


Met Office Pollen Count Forecast.


Hay Fever Signs and Symptoms


There are various signs and symptoms of hay fever and although we have provided a list below, please bear in mind that each allergy and sufferer may portray other signs and symptoms.


Sneezing,

Coughing,

Runny or blocked nose,

Itchy, red, watery eyes,

Itchy throat, nose, and eyes,

Loss of smell,

Pain around the temples and forehead,

Headache,

Earache,

Feeling tired,

Tight feeling in chest (more common with asthma as an additional health issue),

Short of breath (more common with asthma as an additional health issue),

Wheeze (more common with asthma as an additional health issue).


It is important to remember that hay fever will last for a period of a week or months as opposed to a cold that will only last for 1 to 2 weeks.


There is no current cure for hay fever, nor can you prevent it, however the NHS provides helpful tips to help ease the symptoms as follows:


Dos:


Put Vaseline around the nostrils to trap pollen,

Wear wrap-around glasses to stop pollen getting in your eyes,

Shower and change your clothes after you have been outside to wash pollen off,

Stay indoors whenever possible,

Keep windows and doors shut as much as possible,

Vacuum regularly and dust with a damp cloth,

Buy a pollen filter for the air vents in the car,

Use a vacuum cleaner with a HEPA filter.


Don’ts:


Cut grass or walk on grass,

Spend too much time outside,

Keep fresh flowers in the house,

Smoke or be around smoke as it makes the symptoms worse,

Dry clothes outside, they will attract and catch pollen,

Let pets into the house as they carry pollen indoors.


Doctors can prescribe medication for the symptoms of hay fever, as well as the pharmacist who may be able to advise on possible treatments that you can use to help ease the effects of hay fever. As with venturing outside in the sun and finding prevention for sunburn, sufferers should prepare themselves for hay fever by starting medication before the season begins.


We hope that you enjoy the warm weather as and when it comes and stays over the coming weeks, and hope that you have a safe and fun time in the sun.


If you want to learn more about the treatment of burns or heat stroke and heat exhaustion, then why not book a First Aid course with us.








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Choking

Posted by Steve at 15:15 on Friday, 15th June 2018.

‘I choked on a carrot this afternoon and all I could think was ‘I bet a donut wouldn’t have done this to me.’’

Quote author unknown


Whilst choking is a deadly subject, we saw this quote and it made us laugh, hence why we started this month’s blog with this quote. Does it matter whether the choking obstruction is a carrot or a doughnut? Obviously, no it doesn’t.


Humans are 500 times more likely to choke than any other animal


What is Choking?


The dictionary definition of the word choke is:


(of a person or animal) have severe difficulty in breathing because of a constricted or obstructed throat or a lack of air.

fill (a space) so as to make movement difficult or impossible.


The word choke is classified in the Oxford English Dictionary as a verb.


What is the Airway?


An airway consists of 4 key components as follows:


Nose,

Mouth,

Trachea,

Lungs.


The nose and mouth are obviously the most visible part of the airway and are the air intake parts of the airway as well as the main entrance for foreign objects to get stuck in the trachea. The trachea is the major part of the airway that has the biggest role to play in whether a casualty chokes or otherwise. A fully developed adult trachea has an open diameter of just 14 to 15 millimetres, compared to just 5 millimetres in young babies. As the child develops, the size of the diameter of the trachea never exceeds the child’s age. So you can see from that statistic alone, even an adult can choke on quite small objects. The last part of the airway to discuss is obviously the lungs. The lungs are the organ of the body that deals with the gas exchange in the body, providing oxygen to the blood for the heart then to deliver around the body.


Why does choking happen?


The reason that humans are so much more likely to choke than other species of animal is because we talk. This may sound like a strange thing, but what it means is that our voice box is higher up in the body than in other animals, and this causes an issue as it brings our trachea (windpipe) and oesophagus (food pipe) closer together. Nature has tried to prevent choking with the ‘invention’ of the leaf shaped piece of cartilage called the epiglottis which is meant to close over the trachea as you swallow, meaning you cannot swallow and breathe and also objects can only enter the oesophagus. The epiglottis works when it receives a message from the brain telling it to close as the body is about to swallow.


So, in summary choking occurs because the brain gets distracted and then doesn’t have time to tell the epiglottis to close.


In 2016, 289 people died from choking in England, Scotland and Wales, up 17% from the previous year

Office for National Statistics


What causes choking?


According to the American Academy of Pediatrics (AAP) there are 9 most common foods that children choke on. In the US the AAP reports that 1 child under 14 dies every 5 days from choking. The AAP is calling for the food industry to change the design and label of foods that pose a risk of choking. This would be a good idea and something that potentially the UK Government could look into in the future too in our opinion.


The 9 foods most at risk of causing choking according to the AAP are as follows:


1 – Hot Dogs (Sausages in general)


Hot dogs have been found by research to be the most common cause of choking, with 17% of deaths from choking because of a hot dog.


The problem with hot dogs/sausages is the shape and size of the sausage makes it a perfect plug in the trachea. The consistency of the hot dog also, ensures that the sausage plugs the airway and doesn’t allow any air to flow through into the lungs.


Paediatricians in the United States say that parents should be reminded to mince or thinly slice the hot dog before giving it to children. Other advice, like other foods on this list, is that they are recommended to be withheld from children until they turn 4.


2 – Chewing Gum/Boiled Sweets


Most boiled sweets or other hard sweets otherwise referred to as hard candy (particularly in the US) is formed by the manufacturer into a perfect circle shape which encourages it to get stuck in the airway.


Should a chid laugh, take a deep breath, get distracted or try to swallow the sweet whole, it can easily get lodged into the trachea. We mustn’t forget lollipops when we look at these issues as children have a bad habit of not holding onto the sticks and as they suck in, they can easily get the lollipop stuck in the trachea. A parent or first aider may be able to see the stick and consider it a good idea to try to remove the lollipop by pulling on the stick, however this is a big no-no as there are many complications that this can cause, including removing the stick but leaving the lolly in place and having wasted the time to help the child.


This type of hazard is the second biggest killer, and research shows it accounts for 10% of all choking deaths.


3 – Grapes


According to a United States survey, grapes are the 3rd biggest killer with 9% of child deaths of choking on a grape behind only hot dogs and hard-boiled sweets or hard candy as they call it.


Naturally as a grape grows, they are the perfect shape, size and consistency to get blocked in the child’s airway.


Simply cutting the grape without thinking about what you are doing is not enough, when preparing a grape you have to think about the direction of the grape you are cutting. We advise that the grape is cut from pole to pole rather than across the equator, providing the grape is not a round grape but rather an oblong. Should the grape be a round shape, it is best to cut this into quarters.


4 – Nuts


Nuts’ shape and size make them very dangerous for children and should therefore be avoided for young children.


Nuts are the 4th most common cause of child death from choking at 8%.


5 - Carrots


Carrots again, when traditionally sliced, form the perfect shape and size to plug the child’s airway, and therefore prevent air from flowing into the lungs and stop the lungs from fulfilling their normal working roles.


Simply cooking the carrots until they are of a mushy consistently or slicing them into batons rather than the traditional disc will reduce the choking risk of these orange vegetables of goodness.


6 – Apples


One of the issues with an apple is the skin, which can keep the apple in a size which will then fall into and block the casualty’s airway. Other issues with the apple is how it is prepared and then provided to the child.


It is a good idea to chop the fruit into small manageable pieces or cook to mushy throughout.


7 – Peanut Butter


Peanut butter has several issues when it comes to serving this to anyone firstly, and not choking related, it is important that peanut butter, just like nuts, can actually cause an allergic reaction and therefore you will need to ensure that the person you are serving this to is not allergic to the food.


When we look at peanut butter as a choking hazard it may seem strange that it is on the list as it is a smooth spread. The thing which makes peanut butter so dangerous for children and adults in terms of a choking risk is that a large dollop can coagulate in the mouth and make it difficult to swallow, and therefore when it goes down the back of the throat, it gets stuck in the trachea and prevents air from passing through to get to the lungs.


The safest way to eat peanut butter is thinly spread on a slice of bread or a cracker and with a drink, to help keep the mouth moist while consuming the snack.


8 – Marshmallows


A marshmallow is made of a mixture of sugar, air, water and gelatine, which therefore makes the item soft and easy to get lodged into the child’s throat. Simply, they should be avoided where children are concerned.


Parents should also consider what they are purchasing if and when they go out for a coffee with friends, especially as some coffee shops offer hot chocolate with the works, which usually includes mini marshmallows which are already starting to melt because of the temperature of the drink. This will lower the awareness of the choking hazard and in actuality this is a dangerous situation as they are starting to melt and subconsciously they are seen as being safe.


9 – Popcorn


The last on the 9 biggest causes of choking deaths is popcorn.


Popcorn seems to be the fun and exciting food stuff and often given to children as a treat. The issue comes when you realise that the size and shape of the popcorn makes it a really easy food to choke on.


Of course there are many more things that can cause choking, we have purely focused in this blog on the 9 most common choking death causes.


Choking is the 4th leading cause of unintentional injury death

Injury Facts 2017


How can you prevent choking?


Preventing choking in our opinion is much better than having to do first aid on a casualty who is choking. However, it is not guaranteed that choking will not occur even if you reduce the risk, but you have done all you can to minimise the risk and potentially saved a life by taking a few seconds to think.


Our first prevent choking advice would be to continue to follow all the good ‘table manners’ rules that we have been using as a society over many years. By this we mean things like:


Sit when eating.

Chew food carefully.

Don’t ram too much in your mouth.

Don’t talk as you eat.

Supervise children when they are eating.

Try not to do too many things at the same time as eating.


Just to pick up on one of those points above, we have heard of some people having chewing rituals which include chewing your food a certain number of times before swallowing; the number changes each time we hear it but some people swear by it.


Some very simple advice that we can provide is to remember to cut food, the direction that you cut food will be important so as it is not the same shape and size as the trachea itself. As we referred to earlier when discussing grapes, it is important that they are cut in vertical direction from pole to pole and not horizontally, so that if the grape gets stuck in the trachea, there will be a gap between the obstruction and the wall of the trachea allowing air to flow through the trachea.


When we are talking about cutting foods, it is not just the grape that we need to think about. When you are preparing food, it is important to consider the shape of the food, should the food be a circular shape, it is better to slice the food object into an oblong shape, allowing it to have air flow around it in the trachea should it get stuck.


Other advice we can give is to ensure that you read the instruction manual and heed any warnings that are written on the label. A lot of labels will state ‘Choking hazard – Not Suitable for children under 3 years’ in this situation you should heed this warning as it has been deemed the perfect size to cause a choking hazard to children.


We have one other piece of advice which we feel can save many lives. This advice would be to avoid feeding children while there are in a moving car. We appreciate that some parents do this to pacify the child allowing them to focus on driving the vehicle. The problem with this practice is that the force involved in hard braking will lurch the child’s body forward, and once the pressure on the brake is released the reflex action in the body will force the food in the child’s mouth to fly backwards into the throat of the child, more likely ending up in the child’s trachea. This will obviously result in the child choking. Choking is a silent killer, and as the child in the back seat will be pacified and quiet, it is not unheard of for the parent to think the child is simply asleep.


Sadly, over recent years, children have died in their car seats due to choking on something that they have been given to eat while in the car. We hope that by including this piece of advice we can prevent more children from dying in this manner.


Along with not providing children with food whilst they are in a moving vehicle, adults should also consider what toys they are providing the children to entertain them whilst the vehicle Is motion, as any small parts that can become detached can also cause choking.


To finalise our advice on children in cars, we would like you to consider:


 How long will it take you to:


1. Safely pull the car off the road.

2. Remove your seatbelt.

3. Exit the car.

4. Open the car door next to the choking child.

5. Release the car straps of the child.

6. Follow the treatment steps below?


Choking is a silent killer,

From the second you start to choke to the second you end up on the floor is as little as 30 – 45 seconds.


Signs and Symptoms of Choking


Choking usually occurs when the casualty is eating or drinking, which would make it fairly easy to distinguish as the event that is happening. If your casualty is old enough to answer questions and understand what is being asked of them you should ask ‘Are you choking?’


There are 2 types of choking. These are Mild and Severe choking.


Mild Choking


If the casualty’s choking is mild, the casualty will be able to cough and answer ‘yes’ to your questions.


Severe Choking


Attempts to cough not working.

Unable to talk or cry - may ‘nod’ in response to your question.

Breathing sounds wheezy or absent.

Distressed look on the face.

Skin may flush but then goes pale/blue.

Rapid reduction in consciousness as oxygen runs out.


85% of all choking deaths are caused by food obstructions

Injury Facts 2017


Treatment of Choking


Treatment for a baby Under 1


The baby who is choking may attempt to cough. If the choking is only mild, the cough should clear the obstruction, this may then allow the baby to cry and they should now be able to breathe effectively.


Should the cough not work the following steps should be followed:


Back Blows:


Shout for help! – Do not leave the baby yet.

Sit or kneel the baby over your lap, face down with their head lowest, ensuring that you are supporting the child’s head.

Give up to 5 sharp blows between the shoulder blades with the heel of your hand, check between each one to see if the child has had the obstruction removed.

Please note that the object is to remove the obstruction with each blow rather than to give all 5.


Chest Thrusts:


Should the obstruction not have been cleared, follow the following steps:


Turn the baby uppermost, laying them on your arm.

Support the head and lower it below the level of the chest.

Use 2 fingers to give up to 5 chest thrusts.

Chest thrusts are similar to chest compressions but are sharper in nature and delivered at a slower rate

As with Back Blows the object is to remove the obstruction with each thrust rather than to give all 5.


NEVER perform abdominal thrusts on a baby!


If the obstruction has not been dislodged and the casualty is still choking, ensure you follow these instructions:


Keep repeating Back Blows followed by Chest Thrusts.

Shout for help!

Ask someone to call 999/112 for emergency help, do not do this yourself whilst the child is still conscious.


Start CPR, if the baby becomes unconscious.


St John Ambulance have created an easy to remember video for baby CPR view it here.


Treatment for a casualty Over 1


The first action that you should do is encourage the casualty to cough, you could use the question ‘can you cough?’


If the casualty is only choking mildly, the cough should clear the obstruction, this will then allow the casualty to speak to you, which will tell you that the casualty is able to breathe effectively.


Should the cough not work the following steps should be followed:


Back Blows:


Shout for help! – Do not leave the casualty yet.

Get the casualty to place their hands on their knees.

Give up to 5 sharp blows between the shoulder blades with the heel of your hand, check between each one to see if the child has had the obstruction removed.

Please note that the object is to remove the obstruction with each blow rather than to give all 5.


Abdominal Thrusts:


Should the obstruction not have cleared, follow the following steps:


Stand the casualty up

Ask them to place their hands on their belly button.

Stand behind casualty.

Use their arms to guide your arms around into their abdominal area.

Make a fist with one hand and place it above the casualty’s hands.

Grasp this fist with your other hand.

Pull sharply and firmly inwards and upwards.

Do this up to 5 times.

As with Back Blows the object is to remove the obstruction with each thrust rather than to give all 5.


If the obstruction has not been dislodged and the casualty is still choking, ensure you follow these instructions:


Keep repeating Back Blows followed by Abdominal Thrusts.

Shout for help!

Ask someone to call 999/112 for emergency help, do not do this yourself whilst the casualty is still conscious.


Start CPR, if the casualty becomes unconscious.


The British Heart Foundation has created a funny, easy to follow CPR video; you can view it here.


Why not watch this St John Ambulance video – The Chokeables


What should I do after successful treatment?


Should you have successfully treated a choking casualty there are things that you should do.


Firstly, should you have removed the obstruction with rescue breaths as part of CPR, you will have blown the obstruction down into the casualty’s right lung, as they are now breathing, it would be a good idea to use the recovery position, placing them onto their right-hand side.


There are occasions when you would need to make sure your casualty seeks medical attention these are:


The casualty has received abdominal thrusts.

The casualty has difficulty breathing.

They have a persistent cough.

The casualty feels that they have an object stuck in their throat.


Throughout this blog we have explored choking risks and the treatment, whilst information is important and can save lives, should this have got you thinking, could I save a life doing this? why not book a First Aid course with us, where you will have the opportunity to practise the back blows, chest thrusts and abdominal thrusts on our training mannequins.


We look forward to seeing you on one of our courses.


 

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Happy 70th Birthday, The National Health Service

Posted by Steve at 13:35 on Monday, 16th July 2018.


This month sees the National Health Service (NHS) celebrate its 70th birthday. We want to help the NHS celebrate and mark the incredible work done by the staff across the service.


‘All it takes to survive is to have folk left with faith to fight for it’

Aneurin Bevan MP


The National Health Service was born on July 5th, 1948, when the then Health Secretary Aneurin Bevan MP (pictured), also known as Nye, launched the NHS at Park Hospital, Manchester, which is today known as Trafford General Hospital. This official launch of the NHS was the culmination of a hugely ambitious plan to bring healthcare to all.


Who was Aneurin Bevan MP?


Aneurin Bevan MP - the 'Father' of the NHSAneurin Bevan was born on 15th November 1897 in Tredegar, Wales, he was the son of a coal miner. He went on to represent Ebbw Vale in South Wales in the House of Commons for the Labour Party for 31 years. During his time in Parliament he held several roles:


Minister of Health    – 03/08/1945 – 17/01/1951

Minister of Labour and National Service - 17/01/1951 – 23/04/1951

Shadow Foreign Secretary   - 22/07/1956 – 04/05/1959

          Deputy Party Leader (Labour)   - 04/05/1959 – 06/07/1960.


Obviously, the role that we will focus on throughout this month’s blog is his role as Minister of Health, where he formed the National Health Service.


Aneurin died on the 6th July 1960 but was named as the number 1 Welsh Hero on a list of 100 voted by members of the public in 2004.


Before the NHS


Prior to the NHS in Britain, healthcare was unevenly distributed across the country. If you were lucky enough to live near a teaching hospital for example St Thomas’ in London you would most probably receive wonderful resources and healthcare, however if you were having to rely on a smaller cottage hospital, you would probably receive a lesser standard in your healthcare. Not only that but, depending on where you lived in the country would depend your access to a General Practitioner (GP). For example, industrialised areas of the country suffered from a lack of doctors and healthcare.


As we know today, the NHS is a service which is free at the point of delivery, before the NHS was established sadly this was not the case. The fee you would have to pay pre-1948 in Britain would vary depending on your occupation, class, gender and age.


The 1911 National Insurance Act had gone some way to assist the fees but wasn’t fully effective. Under the Act working men would usually possess health coverage, which provided access to a ‘panel’ doctor for a contribution from their weekly wage. Sadly however, the working men’s dependants (wives and children) were not covered by this and would have to pay for their healthcare out of their own pockets, typically this would cost 3 shillings and sixpence in the 1930s, about £8.01 in today’s currency! Because of this injustice, women and children faced the harshest barriers to healthcare. Not only this but should a working man earn too much, therefore over a wage limit, he too would be barred from health services under this process and again would have to pay for his own healthcare. National Insurance depended, as we mentioned above, on occupation, and therefore the long-term unemployed struggled to access healthcare as they simply couldn’t afford the healthcare fees.


Interestingly, many people in the country felt affection for the pre-NHS system, many liked the charitable spirit of community hospitals and their place within the community. Many contributed to popular voluntary hospital contributory schemes from their wages to enjoy world-class medical care. Many local authorities ran impressive municipal hospital services, by 1939 London County Council supplied the largest number of municipal beds in the World!


The Birth of the NHS


As the idea of a National Health Service was mooted around it was met by scepticism, because of the affection that many felt in the country for the pre-NHS system. During the Second World War, polls were conducted to find out what the country felt, it was revealed that there was no clear majority for National Healthcare and many worried that they might lose their personal touch in medicine they felt they were receiving should the Government nationalise hospitals.


It is probably worth mentioning at this point that during World War 2 the Labour party entered into a coalition with the Conservative Party, led by Conservative Prime Minister (Sir) Winston Churchill.


This poll represented a problem for the Government, who thought that a state organised Health Service was the correct way forward to address the gaps in the old system and to provide free healthcare for all. On June the 10th 1941, Arthur Greenwood, a Labour MP, announced the creation of an inter-departmental committee which would, carry out a survey of Britain’s social insurance and allied services. Its main aim was:


To undertake, with special reference to the inter-relation of the schemes, a survey of the existing national schemes of social insurance and allied services, including workmen's compensation, and to make recommendations.


Its members were civil service members from:


Home Office,

Ministry of Labour and National Service,

Ministry of Pensions,

Government Actuary,

Ministry of Health,

HM Treasury,

Reconstruction Secretariat,

Board of Customs and Excise,

Assistance Board,

Department of Health for Scotland,

Registry of Friendly Societies, and

Office of the Industrial Assurance Commissioner.


The inter-departmental review published a report which was printed by Alabaster Passmore and Sons, which would have been a welcome for the printing factory in Maidstone as there was little other printing to be done. The report made three guiding principles:


1. Proposals for the future should not be limited by ‘sectional interests’. A ‘revolutionary moment in the world's history is a time for revolutions, not for patching’.

2. Social insurance is only one part of a ‘comprehensive policy of social progress’. The five giants on the road to reconstruction were Want, Disease, Ignorance, Squalor and Idleness.

3. Policies of social security ‘must be achieved by co-operation between the State and the individual’, with the State securing the service and contributions. The State ‘should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum for himself and his family’.


The report is referred to as ‘The Beveridge Report’ after the report author William Beveridge who was a Liberal MP, but the report’s real title is ‘Social Insurance and Allied Service’.


In 1944, the Conservative led coalition introduced the first parliamentary bill for a National Health Service.


In 1945 when the Labour party won the General Election, Prime Minister Clement Atlee tasked Aneurin Bevan with the challenge of acting on the Principles and so the NHS started to be born. Bevan is remembered as the Father of the NHS. Through the early days of his work, Bevan had many disagreements with the British Medical Associations with insults being hurled from both sides.


Obviously, it was not just Bevan that put the foundations into the changing of the system from the old sporadic system to what became the NHS, civil servants like Enid Russell-Smith had a huge part to play in bringing 1,143 voluntary hospitals and 1,545 municipal hospitals totalling 480,000 beds in England and Wales alone into a state-run organisation. Russell-Smith expressed anxieties as to where such numbers of hospitals and beds could come under such a service and whether the country would actually welcome it. She and her civil servants worked tirelessly to ensure that the necessary paperwork and administrative processes were put into place by appointed day, 5th July 1948.


During the setting up processes, she attended many long meetings along with Bevan with doctors and dentists to negotiate with them and put the notion of the NHS to them and bring them on board. Russell-Smith describes them as ‘bloody-minded’ doctors and ‘revolting’ dentists. During these meetings, she grew frustrated but her admiration of Bevan continued. Russell-Smith says of Bevan that ‘he really is an astonishing creature full of thunder and lightning although he lacks the quality of reasonableness which counts so much in British Life’.




As appointed day, or as we will call it the NHS Birth Day, approached, a public service leaflet was produced and circulated as shown to the right, to introduce the idea of the NHS to the publicNHS Launch leaflet and reassure the public in some respects that if they were happy with their doctor, they would need to do nothing. As the day drew close, Russell-Smith articulated her sense of concern over the success or otherwise of the NHS. She wrote:


‘We shan’t really know how badly we have done until about the 6th July when no doubt an angry mob will be trying to burn down Whitehall’


With the public unsure of the NHS and the people behind it unsure of its reception, it really is a wonder that what we appreciate today as a best loved British institution ever actually came to fruition at all.


Every 24 hours the NHS treats more than 1.4 million patients


The Principles of the NHS


When Aneurin Bevan set up the NHS on July 5th, 1948 he set out 3 core principles which were:


1. That it meets the needs of everyone.

2. That it be free at the point of delivery.

3. That it be based on clinical need and not ability to pay.


These 3 core principles still exist today and have guided the work the NHS has done in its 70 years. Although the NHS has changed over the years, it still holds these core principles at its heart today and long may this continue. In 2011, the Government published the NHS Constitution which has 7 principles which built upon the 3 core principles as follows:


1. The NHS provides a comprehensive service available for all.

2. Access to NHS services is based on clinical need, not an individual's ability to pay.

3. The NHS aspires to the highest standards of excellence and professionalism.

4. The NHS aspires to put patients at the heart of everything it does.

5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population.

6. The NHS is committed to providing best value for taxpayers' money and the most effective, fair and sustainable use of finite resources.

7. The NHS is accountable to the public, communities and patients that it serves.


In addition to the NHS Principles from the NHS Constitution there is a series of Values the NHS works under as follows:


Working together for patients.

Respect and dignity.

Commitment to quality of care.

Compassion.

Improving lives.

Everyone Counts.


It is fair to say that the NHS was set up as a force for good to ensure that everyone could access healthcare free at the point of delivery regardless of age, gender, employment status and class. If you needed healthcare, you got healthcare, paid for from central Government taxation. 70 years on this is still the cornerstone of the NHS.


1948 compared to today


Population


1948: 50,033,200,

2018: 65,640,000


Life Expectancy


1948: Men: 66 years Women: 71 years

2018: Men: 84.4 years Women: 87.6 years


Childbirth


1948: 34 deaths per 1,000 births

2018: 3.8 deaths per 1,000 births


Budget


1948: £437,000,000 (437 million)

2018: £110,000,000,000 (110 billion)


Prescriptions


When Bevan set up the NHS, he set it up to be entirely free at the point of delivery, this was to include free prescriptions and free glasses. In the NHS Amendment Act 1949 the power to charge was introduced, this was a key factor in the resignation of Aneurin Bevan from the Labour Government in 1951.


The first NHS Prescription to be charged was in 1952.


1948: Free

1952: 1 Shilling (£1.56)

2018: £8.80


GPs


1948: 16,864

2018: 41,817


How has the NHS changed lives?


Over the last 70 years the NHS has changed the lives of the people of the UK in many ways. Obviously the first way that the NHS has changed lives, is by being able to offer healthcare to everyone, regardless of age, gender and employment status, free at the point of delivery. This has enabled life to go on, and in many cases go on longer than ever before as health needs can be treated.


Although vaccination outdates the NHS, in today’s world a vaccination schedule exists to offer the best care for people in the United Kingdom. In 1958, under the NHS a polio and diptheria vaccinations’ programme was launched, prior to this programme diptheria caused up to 5,000 deaths, due to the vaccinations’ programme a dramatic decrease in both diseases followed!


The NHS, through medical advances and its funding for people to access good quality healthcare free at the point of delivery, has helped to reduce pain that patients suffer and in particularly long-term pain. Operations like hip replacements first took place in 1962 on the NHS, since then they have undertaken around 77,000 hip operations each year. This is something that would never have occurred in the pre-NHS era, as the operation would be too expensive for the patient to pay for and therefore would decide not to undergo the operation and suffer with the pain.


For couples who are unable to have babies, the NHS has been good for them since 1978, when the world’s first test-tube baby was born. In 2016 there were over 68,000 IVF treatment cycles on the NHS resulting in 20,028 births. Since our NHS successfully created the first test-tube baby in 1978 over 5 million babies have been born through assisted reproduction worldwide, an amazing statistic for our world-renowned NHS.


The NHS over the years has worked closely with cancer charities to help identify, diagnose, and treat many different types of cancers. Should the NHS not be around supporting patients and working hard to research cancer with the charities, many more people would die.


Since its foundation, the NHS has provided many people with a second chance, and in some cases helped people to cheat death. I am of course referring to transplants, the NHS carries out a wide range of transplants across its working day, from heart transplants through to hand transplants. That of course is in addition to all the emergency life-saving operations they conduct every day. This cannot be done however without the help of others, the donors. Some people donate their blood, others have signed the donor register and have donated their organs for transplant once their life expires.


For more information on the donor register visit:

https://www.organdonation.nhs.uk/register-to-donate/register-your-details/


What challenges lie ahead for the NHS?


Many challenges lie ahead of the NHS, not just in the next 30 years in the run up to the centenary of this amazing, extraordinary institution, but beyond that through the next 70 years, but of course there are more pressing challenges in the immediate years ahead.


Rightly, the public has a high expectation of the quality and performance of the NHS, but of course the general public can help take the pressures off the NHS by thinking about what service they actually require before calling for an ambulance or presenting at the A&E departments which are already pushed to the limits.


Let’s consider the challenges that lie ahead for this amazing public service:


Ageing Society


Studies suggest that the majority of health expenditure is from older patients, that of course doesn’t bode well when the nation is living longer and longer. However, it is good news that we are living longer. Studies show however that nearly two thirds of people who are admitted to hospital are over 64 years old. When they are admitted to hospital, typically 2 million people every year, they stay longer and then are more likely to be readmitted to hospital.


In the coming decades all research suggests that the healthcare needs for the ageing society is likely to grow markedly, it is most likely to be in the number of 85 or over age range who are the most intensive users of health and social care.


Rise of long-term conditions


People who have one or more long-term conditions are already the most important source of demand for the NHS services. Some reports suggest that the 30% of people who have one or more long-term conditions, accounting for £7 out of every £10 spent on health and care in England, fall into this bracket.


Other reports suggest that one long-term illness is more expensive for the NHS than those with three of more conditions, the financial comparison suggests one long-term illness costs the NHS £3,000 per year whereas those with 3 or more long-term illnesses cost nearly £8,000 per year.


The NHS says that multiple long-term conditions must be managed differently, their remark being that a hospital-centred delivery system made sense in the 20th Century for the diseases that were being faced then but going forward, patients could be managing their own care at home, supported by technology and supported by a range of professionals.


Lifestyle risk factors in the young


It is commonly understood that personal circumstances greatly increase the risk of developing debilitating diseases. Risk factors have been examined over many years, with the NHS quoting unhealthy behaviours such as:


Drinking,

Smoking,

Poor Diet, and

Lack of exercise.


Should the studies and predictions be correct 46% of men and 40% of women will be obese by 2035, this is likely to result in 550,000 additional cases of diabetes and 400,000 additional stroke and heart disease cases. This going forward is likely to add further financial challenges for the NHS.


Increasing Expectations


In their own words, NHS England says that patients and the public have high expectations for the standards of care in the NHS. Patients are increasingly demanding access to the latest therapies, more information and more involvement in decisions about their care.


Patients want a 7-day access to primary care provided to them near to their homes, place of work or even their local shop or pharmacy. They also want a co-ordinated health and social care service tailored to their own needs; this going forward for the NHS will need them to carefully rethink where and how they provide the services the public seems to want.


I do wonder however, how the public requirements would have worked under the old system, and in reflection it goes to show that the NHS is a victim of its own success.


Increasing costs of providing care


It is no secret that the cost of providing care is getting more and more expensive, but at the same time, the NHS now offers a much more extensive and sophisticated range of treatments and procedures that in fairness Aneurin Bevan could never have envisaged when he founded the NHS.


The NHS is now able to treat conditions that would have potentially gone undiagnosed, or simply untreated, it has access to new drugs, technologies, and therapies that make a major contribution to curing diseases and extending the length of life.


It goes without saying that these are good things and that the NHS is doing a wonderful job, but the cost of new technologies is more expensive than what they are replacing.


Going forward the NHS managers are going to have to ensure that they invest in technology and drugs that demonstrate the best value for money and that will make a difference to the people they are designed to care for.  


Constrained public resources


The sad thing for the NHS and other public-funded services is that they are facing fresh new challenges like the ones we have discussed above at the same time as the country is facing one of the most serious economic crises since the 1930s, again something the NHS founder Aneurin Bevan couldn’t have envisaged.


The Government has ring fenced the NHS budget to try to at least keep the budget where it is or at the least to increase with the overall GDP growth; this presents the managers with a challenge to ensure they can meet the continuing needs of the public. It is true to say however that just a few weeks ago, the Prime Minister Theresa May has pledged an extra £20 billion for the NHS going forward into 2023.















The NHS is a great institution and one that is respected around the world. I would like to thank it for everything it has done for my family and myself over the years, hope it enjoys its 70th birthday celebrations and may it live long into the future with the 3 core principles that Aneurin Bevan founded it on in 1948. In summary, to remind you these are:


1. That it meets the needs of everyone.

2. That it be free at the point of delivery.

3. That it be based on clinical need and not ability to pay.



Happy 70th Birthday NHS

Thank you to all the great GPs, Nurses, Doctors, Paramedics for all you have done for my family and me over the years.

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Sepsis

Posted by Steve at 14:10 on Wednesday 15th August 2018.


As sepsis cases appear to be on the rise, this month we thought we would take a look at the illness and see if we can shed some light on the symptoms and what action to take. Throughout this blog we will show you when to call 999/112 as well as when to use the NHS 111 service.


History of the term Sepsis


Hippocrates first used the term ‘σήψις’ (sepsis) in the 4th century BC. He used it to mean the process of decay or decomposition of organic matter. Hippocrates was the first person to use the term, which has been used over many years, along with other terminology to describe the same thing.


Avicenna, the father of early modern medicine, during the 11th century used the term ‘blood rot’ to describe diseases linked to the severe purulent (the discharging of pus) process and it wasn’t until the 19th century that the term sepsis was used to describe severe systemic toxicity.


So, having explored the origins of the term sepsis the obvious question is What is Sepsis?


Sepsis, according to the dictionary, is ‘the presence in tissues of harmful bacteria and their toxins, typically through infection of a wound’. Further than this, sepsis is a rare life-threatening serious complication of an infection; without quick treatment sepsis can lead to multiple organ failure and death!


What does Septic Shock mean?


Septic shock is when your blood pressure drops to a dangerously low level.


Who is at risk of sepsis?


Typically, the people most at risk of sepsis are:


Already in hospital with a serious injury,

Very young or very old,

Having had surgery or have wounds or injuries as a result of an accident, or

With a medical condition or receiving treatment for a condition which weakens the immune system.


Before we look deeper into the causes of sepsis, it may be prudent to mention that there are around 123,000 cases of sepsis in the UK each year. According to a leading safety expert earlier this month, the number of deaths recorded as a result of sepsis have risen by a third in 2 years. In the year ending April 2017 there were 15,722 deaths where sepsis was the leading cause, either in hospital or within 30 days of discharge. Professor Sir Brian Jarman believes that staff shortages and overcrowding on wards are to blame. NHS England says that more conditions are being classed as sepsis than ever before.


Causes of Sepsis


The most common primary sources of infection in sepsis are the lungs, the abdomen and the urinary tract. Typically, 50% of all sepsis cases start as an infection in the lungs, with no definitive cause identified in a third to a half of all cases.


Sepsis can be caused by viral or fungal infections although bacterial infections are far more common.


What is the Difference between Septicaemia and Sepsis?


Sepsis is often referred to as either blood poisoning or septicaemia, however both of these terms generally refer to the invasion of bacteria into the bloodstream, which is not solely what sepsis does. Sepsis can affect multiple organs and tissue, not just the blood, and can be present without any blood poisoning or septicaemia.


Signs and Symptoms


So, what should we be looking for if we suspect sepsis; this will depend on the age of the casualty as follows:


Is the sepsis suspected casualty under 5 years old? If so:


Go straight to A&E or call 999/112 if the casualty:


Looks mottled, bluish or pale,

Is very lethargic or difficult to wake,

Feels abnormally cold to touch,

Is breathing very fast,

Has a rash that does not fade when you press it, the glass test will work,

Has a seizure or a convulsion.


The NHS advises using the NHS 111 service should the child have any of the symptoms listed below, is getting worse or is sicker than you would expect; this is the case even if the child’s temperature falls. The signs and symptoms to be aware of are as follows and are split into different areas of concern.


Temperature concerns:


You will need to check your child’s temperature and if their temperature reaches the following, you should call NHS 111 Service for advice:


A child under 3 months has a temperature of over 38˚C,

A child between 3 and 6 months has a temperature of over 39˚C,

Any high temperature in a child who cannot be encouraged to show an interest in anything, or

A child has a low temperature, below 36˚C, which you will need to check 3 times in a 10-minute period.


Breathing concerns:


Is the child:


Finding it much harder to breathe than normal, does it look like the child is working harder than normal to breathe?

Making a grunting sound with each breath,

Struggling to say more than a few words at once,

Having obvious pauses in breathing.


Toileting/Nappy concerns:


You will need to consider whether the child has not had a wee or a wet nappy for 12 hours.


Eating and drinking concerns:


Should you experience the following, it is advised that you contact the NHS 111 service for advice, has the child:


Who is under 1 month old got no interest in feeding?

Not had a drink or shown interest in drinking for more than 8 waking hours,

Got bile-stained (green coloured), bloody or black vomit.


Activity and Body concerns:


Carefully consider the following, has the child:


Got a bulging soft spot on the top of their head,

Eyes gone sunken or appear to be sunken,

Lost interest in anything and cannot be encouraged to show any interest,

Gone floppy,

Gone weak,

Got a whine or continuous crying in younger children,

Become confused (older child),

Started to be unresponsive or very irritable,

Got a stiff neck, particularly when trying to look up or down.


We would highly recommend that parents trust their instincts and seek medical advice urgently from the NHS 111 service should they spot any of the symptoms listed above.


Early sepsis symptoms in children over 5 and adults:


The following signs and symptoms should be considered in children who are over 5 years old and/or adults:


High temperature or a low body temperature,

Chills and shivering,

A fast heartbeat,

Fast breathing.


In some cases, symptoms of more severe sepsis or septic shock develop soon after, these signs and symptoms include:


Feeling dizzy and or faint,

Diarrhoea,

Nausea and vomiting,

Slurred speech,

Severe muscle pain,

Severe breathlessness,

Less urine production than normal, for example, not urinating for a day,

Cold, clammy, pale or mottled skin,

Change in mental state – which includes confusion or disorientation,

Unconsciousness.


Signs and symptoms based on the NHS Choices website with thanks.


When should I get Medical Help?


Should you, or the person you are concerned about, have recently had an infection or injury and are showing the early signs of sepsis it is important that you seek medical advice urgently from the NHS 111 service. If the operator at the end of the telephone believes that sepsis is a possibility they will usually refer you to the hospital for further diagnosis and treatment.


Please note:


Severe sepsis and septic shock ARE medical emergencies. If you believe that you or somebody in your care has one of these conditions it is vital you go straight to the A&E department or call 999/112.


For more information, you can visit the UK Sepsis Trust whose vision is to end preventable deaths from sepsis. They have a number of campaigns ongoing which you can view on their website:


https://sepsistrust.org


In summary, the UK Sepsis Trust advises asking, ‘Could it be Sepsis?’ By asking this question with casualties who, as we discussed earlier, are at risk of sepsis you could save a life. We will leave this blog with the signs’ acronym that the UK Sepsis Trust has compiled for suspected sepsis in adults:


S Slurred speech or confusion

E Extreme shivering or muscle pain

P Passing no urine (in a day)

S Severe breathlessness

I It feels like you are going to die

S Skin mottled or discoloured.

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The Heart

Posted by Steve at 15:55 on Monday 17th September 2018.


The human heart is the second most important organ in the human body. Without the human heart pumping, the body would not receive blood to the other organs and systems of the body that keep it alive and working. The heart is so important that while you are alive it should never stop, even while you are resting and asleep!


Did you know…...?


The heart beats (on average):


72 times per minute,

100,000 times per day,

36,500,000 times a year,

2,500,000,000,000 times in a lifetime (that’s 2.5 billion!).


This goes to show how important the heart is and what an amazing job it does, even while we are asleep.




Where is the heart located?


There is an age-old myth that the heart is located on the left side of the chest, this however is not factually accurate, and if it was on the left-hand side of the chest, it would mean that Cardio-Pulmonary Resuscitation (CPR) would be ineffective as the First Aider’s hands would be missing the heart!


In fact, the heart is situated right in the middle of the chest, and roughly in line with the thoracic vertebrae of the spine covering T5 to T8. The thoracic vertebrae are the middle segment of the vertebral column as shown in the diagram to the right, coloured blue for easy recognition. The vertebral column is important as the back of the heart sits near to this, with the front of the heart sitting behind the sternum and the ribs. This is why we place our hands on the sternum to apply pressure to the heart during CPR.


The largest part of the heart usually hangs to the left-hand side, which now makes the age-old myth make sense! However, there are times when the heart will hang to the right-hand side of the human body. To accommodate the heart the 2 lungs are different sizes, with the left-hand lung being smaller with a cardiac notch in its border to ensure the heart can be accommodated. Typically, the left-hand side of the heart is stronger than the right and this also explains why the heart is felt more predominantly on the left-hand side of the body, this is the part of the heart that delivers blood to all parts of the human body.


Shape of the heart



The heart is often seen by many to represent the centre of the body because of its importance as well as representing love and other such emotions. It is generally drawn and depicted like the representation above, however the heart is not this shape. A more accurate description of the heart would be cone-shaped, with its base positioned upward and the point tapering down to the apex of the heart.


An adult heart has a mass of 250 to 350 grams (9 to 12 oz). It is often described as the size of the fist which roughly measures 12 cm (5 in) in length, 8 cm (3.5 in) wide and 6 cm (2.5 in) thick, however the description of the heart as a fist is often disputed as the heart is likely to appear slightly larger than this. It is true that well-trained athletes may have larger hearts than this description as well, due to the effects of exercise on the heart muscle.


Below, is a more accurate diagram of the heart:



Anatomy of the heart



The heart has 4 chambers contained inside, as well as 4 heart-valves. These consist of 2 upper atria and 2 lower ventricles. What is the purpose of the atria and ventricles?


Atria – The chambers that receives blood.

Ventricles – The chambers that dispense blood.


Each atrium and ventricle are separated by an atrioventricular valve, while the other 2 valves rest at the exit of the ventricle.


Often the left ventricle and left atrium are referred to as the left heart, and similarly the right ventricle and right atrium are referred to as the right heart.


The Heart Valves


The main function of the heart valves is to ensure that the blood only flows one way through the heart. It is the opening and closing of the heart valves that give the heart its very familiar du-dum sound. The 4 valves in the heart are called:


Atrioventricular Valves (separating the ventricle and atria):


Mitral Valve,

Tricuspid Valve.


Semilunar Valves (at the exit of the ventricles, in the arteries leaving the heart):


Aortic Valve,

Pulmonary Valve.


The mitral and aortic valves are located in the left heart, and the tricuspid and pulmonary valves are located in the right heart.


The diagram below shows you how the blood enters the heart and is then processed through the heart to be redelivered round the body again:


Used with thanks to Wapcaplet- Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=830253


How many times a minute does the heart beat per First Aid age range?


As discussed earlier the heart is constantly beating, and although we have given the average beats per minute above it is important to remember that the heart will beat differently according to your age and body size as follows:


Baby: 110 – 140 beats per minute

Child: 90 – 110 beats per minute

Adult: 60 – 90 beats per minute.


Heart Complications


The heart is an amazing piece of kit as we have highlighted, however it does often suffer from complications. Here we look at 5 different complications:


Coronary Heart Disease

Heart Failure

Atrial Fibrillation (AF)

Angina Pectoris

Heart Attack.


Coronary Heart Disease


Coronary Heart Disease (CHD) is a major killer in both the UK and worldwide. It is sometimes called Ischaemic Heart Disease. The main symptoms of CHD are:


Angina Pectoris,

Heart Attacks and

Heart Failure.


We will consider these main symptoms in due course. It is also important to note not all people will have the same symptoms as another person and some may have no symptoms before CHD is diagnosed.


Coronary heart disease describes the heart’s blood supply being blocked or interrupted by a build up of fatty substances in the coronary arteries. This is generally caused by a number of factors including lifestyle choices as follows:


Smoking,

High cholesterol,

High blood pressure,

Diabetes.


This list is not exhaustive.


It is important that if you feel that you are unwell, and unsure what is going on with your heart, that you make an appointment to see your GP as s/he will be able to refer you to specialists who will carry out tests to diagnose, or otherwise, CHD and then can advise how to keep your heart well, which may include simple lifestyle changes and/or medication.


It has been noted in many medical articles over recent times that maintaining a healthy heart can also help to avoid other life illnesses which include stroke and dementia.


Heart Failure


Heart failure is a horrible sounding term which doesn’t accurately describe what is happening to the heart.


Heart failure means that the heart is unable to pump blood around the body properly, usually because it has become stiff or too weak to function in its normal way. The name suggests that the heart has failed to work or stopped which is actually incorrect. It just means that the heart needs some help for it to work better, most commonly affecting older people.


Sadly, heart failure is not an illness that can be cured, however it can be controlled for many years.


Heart failure can develop quickly which is called acute heart failure or can develop over a long period of time usually referred to as chronic heart failure. Normal signs and symptoms are:


Breathlessness after exercise or at rest,

Feeling tired most of the time,

Swollen legs/ankles,

Finding exercise physically exhausting,

Persistent cough,

Dizziness,

Fast heart rate.


It is advisable for you to see a GP if you experience persistent or worsening heart failure symptoms, however you should call 999/112 for an ambulance or go straight to A&E should you experience sudden or very severe symptoms.


Like coronary heart disease, treatments can be simply lifestyle changes or sometimes the casualty will require an operation to help allay the symptoms of heart failure.


Atrial Fibrillation (AF)


Atrial fibrillation (AF) is a heart condition that causes an irregular and often an abnormally fast heart rate, sometimes an atrial fibrillation event can cause the heart rate to be over 100 beats per minute. This can cause:


Dizziness,

Shortness of breath,

Tiredness.


The person who has atrial fibrillation may notice heart palpitations, where the heart feels like it is pounding, fluttering or beating irregularly, which may last for a few seconds or even minutes. However, some people may not even feel any symptoms at all.


Atrial fibrillation is the most common heart disturbance illness in the UK with around 1 million people affected by it. Atrial fibrillation can affect anyone of any age, however it is more likely to affect older people with the statistics showing that it affects 7 in a 100 people over the age of 65; it is more common in men than women.


When in atrial fibrillation the heart’s upper chambers (atria) contract randomly and sometimes so fast that the muscle wall is unable to relax properly between its usual contractions, reducing the efficiency and performance of the heart. It occurs when abnormal electrical impulses start firing in the atria, overriding the heart’s pacemaker, who can no longer control the heart rhythm.


The good news is that atrial fibrillation is not life-threatening but can be very uncomfortable and will require treatment. The best way to help atrial fibrillation is to see a doctor who can then suggest the best course of treatment for the condition.


Angina Pectoris


Angina is a condition which is usually caused by a build-up of cholesterol plaque on the inner lining of the coronary artery.


What is Cholesterol?


Cholesterol is a fatty chemical which is a part of the outer lining of the cells of the body. Cholesterol Plaque however is a hard, thick substance caused by deposits of cholesterol onto the artery wall, which over time builds up causing a narrowing and hardening of the coronary artery.


During periods of excitement and/or exercise the heart, to maintain its normal function, needs more oxygen; the problem however is that the coronary artery is now narrower and therefore cannot increase the blood supply to the heart to meet the heart’s requirement. As a result of this an area of the heart will now suffer from a lack of oxygen, causing the casualty to experience chest pains and other symptoms.


Usually, an angina pectoris attack occurs with exertion and will subside with rest. However, if the narrowing of the artery reaches a critical level, angina at rest may occur, this is called unstable angina. A casualty who has unstable angina has a high risk of having a heart attack in the near future.


We will examine the symptoms and treatments of angina below along with heart attack.


Heart Attack


A heart attack occurs when the surface of cholesterol plaque in the coronary artery ruptures and the contents leak out into the artery itself, this will lead to a blood clot which results in the artery becoming blocked and a death of an area of the heart muscle.


It is important that we remember that all heart attacks are different, and sometimes will not display a symptom at all, these are called silent heart attacks; these don’t even provide the casualty with chest pain. Diabetic and elderly people are more at risk of a silent heart attack.


Unlike angina pectoris, the death of the heart muscle is permanent and will not be relieved by rest.


Signs and symptoms of Angina Pectoris and Heart Attack compared:





Angina Pectoris


Heart Attack






Onset


Sudden,

Usually during exertion,

Stress,

Extreme weather.


Sudden,

Can occur at rest.







Pain


Vice like squashing pain,

Usually described as a dull pain,

Tightness or pressure on the chest,

May be mistaken for indigestion.


 Vice like squashing pain,

Usually described as a dull pain,

Tightness or pressure on the chest,

May be mistaken for indigestion.






Location of Pain


Central chest pain,

Can radiate into EITHER arm (usually the left),

Neck,

Jaw,

Back, or

Shoulders.


 Central chest pain,

Can radiate into EITHER arm (usually the left),

Neck,

Jaw,

Back, or

Shoulders.






Skin


Pale,

May be sweaty.


Pale,

Grey colour,

May sweat profusely.






Pulse  


Variable (depending on which area has lack of oxygen),

Becomes irregular,

Missing beats.


Variable (depending on which area has lack of oxygen),

Becomes irregular,

Missing beats.






Other Signs and Symptoms


Shortness of breath,

Weakness,

Anxiety.


Shortness of breath,

Dizziness,

Nausea,

Vomiting,

Sense of impending doom!






Factors giving relief


Resting,

Reducing stress,

Taking prescribed glyceryl tri-nitrate (GTN) medication (spray).


Taking prescribed glyceryl tri-nitrate (GTN) medication (spray) may give partial or no relief.


Based on the Qualsafe First Aid Made Easy grid


Treatment of Angina Pectoris and Heart Attack


Sit the casualty down, make them comfortable or use the half ‘W’ position:

Back against a wall, legs bent, feet flat on the floor (Attend one of our courses and we will demonstrate this).

If they have it, encourage them to take their own prescribed GTN medication.

Reassure the casualty, remove any causes of stress and anxiety if this possible.

IF YOU SUSPECT HEART ATTACK:

Offer the casualty an aspirin tablet to chew slowly; this may help limit damage to the heart. (Only do this if the casualty is over 16 and is NOT allergic to aspirin.)

Monitor the casualty’s Airway, Breathing and Circulation.


If the casualty has become unconscious it will usually mean that the heart has stopped altogether. You must be prepared to resuscitate.


Why does aspirin work?


Aspirin is a drug that is designed to reduce the blood’s ability to clot. By chewing the tablet, the casualty is absorbing the drug quicker into their bloodstream, allowing it to work faster. Ideally use a 150mg or a 300mg chewable or soluble aspirin.


When to call 999/112


You should call 999/112 immediately if:


You suspect a heart attack,

The casualty has not been diagnosed as having angina,

The symptoms the casualty is experiencing are worse or different to their normal attacks,

Angina pain has not been relieved from resting and taking their GTN spray after 15 minutes,

Angina pain has woken the casualty from their sleep,

Angina pain has come on whilst the casualty is at rest,

You are in any doubt.


For more information on heart attack or angina pectoris as well as for handy hints and tips, why not attend one of our adult based First Aid courses? We look forward to welcoming you on a course.


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Stroke

Posted by Steve at 13:00 on Tuesday 16th October 2018.


Stroke Strikes every 5 minutes in the UK


A stroke is a serious life-threatening condition; however, its name makes it sound like something nice. It has been said that the name makes you think of nice things like stroking a cat, which couldn’t be further from the truth.


We believe that a better description of a stroke is a brain attack.


Like a heart attack a stroke is caused when the blood supply to a part of the brain is cut off. It is important to remember at this point that the brain is the most important organ in your body, and for it to work effectively it needs the nutrients and oxygen that the blood delivers. Therefore, should the blood supply get cut off, the brain doesn’t receive the nutrients and therefore starts to get damaged and not work as effectively as it should do. Depending on where the damage occurs will have different effects on the brain.


A stroke will affect the way the body works, as well as thought, speech and the way you communicate.


What causes a stroke?


As you get older, arteries become harder and narrower which makes it easier to become blocked. However, it is not just the ageing process that aids the blocking of the arteries that feed the brain, some medical conditions and lifestyle choices can contribute to the narrowing of the arteries.


What are the different types of stroke?


The different types of stroke are:


 Ischaemic Stroke,

 Haemorrhagic Stroke,

 Transient Ischaemic Attack (TIA).


Ischaemic Stroke


Ischaemic Stroke is the most common type of stroke, where the blood vessels are being blocked, so the blood supply doesn’t reach the brain. The main cause of an Ischaemic Stroke is through a blood clot forming in an artery leading to the brain or within one of the small vessels which are deep inside the brain, this is called Cerebral Thrombosis.


This type of stroke can also be caused by something called, Cerebral Embolism, which is when a blood clot or other matter, for example an air bubble, moves through the bloodstream from another part of the body to the brain, to cause the obstruction.


There are a number of reasons why blockages can form and cause a stroke these will include:


o Atherosclerosis,

o Small Vessel Disease,

o Heart Conditions,

o Arterial Dissection


Atherosclerosis will occur when fatty deposits build up inside the arteries. They cause the arteries to become hard and narrower, enabling them to become blocked.


Small Vessel Disease is about the small arteries in the brain becoming blocked, caused by deposits collecting in the vessels and making them less flexible due to their thickening.


Heart Conditions can cause blood clots to form in the heart and then flow through the bloodstream up to the brain.


Arterial Dissection will occur when little tears appear in the lining of the artery and allow blood to get between the layers of the artery wall. This can happen for absolutely no reason as well as being a possible result of a neck injury.


Haemorrhagic Stroke


Haemorrhagic Stroke can be more serious than an Ischaemic Stroke but is less common.


These types of strokes are caused by a bleed in or around the brain.


Haemorrhagic Stroke can be caused when an artery inside the brain bursts, which causes bleeding inside the brain known as Intracerebral Haemorrhage. Other causes include bleeding on the surface of the brain. The brain sits inside a cushion of membranes that protect the brain from the skull. There is space between the layers of the membrane which is filled with fluid. Should a blood vessel burst and bleed into this space this is called Subarachnoid Haemorrhage.


There are a number of causes of Haemorrhagic Stroke, which include:


 High blood pressure,

 Cerebral amyloid angiopathy,

 Aneurysm,

 Anticoagulant medication,

 Illegal Drugs.


High blood pressure is a factor in around half of all strokes.


What is Cerebral amyloid angiopathy I hear you cry, well I can tell you that it is a condition where amyloid, which is a protein, builds up in the blood vessels. The build-up of amyloid makes it more likely that the blood vessels will tear. This is something that is more likely to occur in older people.


An Aneurysm is a weak spot on an artery where the walls have become thin and weak, making it easier for the vessels to burst particularly in patients with high blood pressure. Some aneurysms are present from birth, but some lifestyle choices can also cause aneurysms, for example smoking. Another risk factor for aneurysms is whether there is a family history of aneurysms.


The main aim of anticoagulant medication is to prevent blood clots forming. People with heart conditions like Arterial Fibrillation (AF) as discussed last month, are prescribed these medications and are then closely monitored to reduce the chance of bleeding.


Certain illegal drugs like cocaine can irritate the blood vessel walls making them weaker and more likely to rupture.


Transient Ischaemic Attack (TIA)


A Transient Ischaemic Attack, also known as a Mini-Stroke or a TIA, is the same as a stroke but the symptoms happen for a much shorter time; it is none the less as serious. A TIA can be seen as a sign of there being a problem for the patient, which is why some people call a TIA a warning stroke.


As we have already said the TIA is the same as an Ischaemic Stroke, therefore a blood clot has occurred in the vessels in the brain, however this blockage is temporary and can either dissolve on its own or move to another part of the body therefore removing the clot and the symptoms disappear.


How do you recognise a stroke?


It is highly likely that everyone is familiar with the recognition of a stroke due to some excellent TV adverts produced by the NHS.


We have included the links to the videos here:


Man in crowd Advert


Stroke Animation


Lady Stroke Advert


The Stroke Association has published some really good posters which we have included here for you to be able to download and use for awareness if you would like to:





So, what is the FAST test?


FAST is a memorable way of remembering the signs and symptoms of a stroke.


F = Facial Weakness:


Can the casualty smile? Has their mouth or eye drooped?


A = Arm Weakness:


Can the person raise both arms?


S = Speech Problems:


Can the person speak clearly and understand what you say?


T = Time to call 999/112:


If your casualty fails any test, call 999/112 because a stroke is a medical emergency.


There are other signs and symptoms that you could consider, these are:


o Loss of balance,

o Lack of coordination,

o Sudden severe headache,

o Sudden onset of confusion.


How do we treat a stroke?


As a First Aider there is very little that you can do to treat a medical emergency that is a stroke. However, there are things that you can do to help save the person’s brain. It is crucial that a casualty who is having a stroke is seen by a medical practitioner as soon as is possible.


The quicker you act the more of the person you can save.


As a First Aider:


 Maintain the airway and breathing,

 Call 999/112 for emergency help,

 Place the casualty in the recovery position should they be unconscious,

 Lay a conscious casualty down with head and shoulders raised,

 Reassure the casualty, do not assume they cannot understand,

 Monitor and record breathing, pulse, and levels of response.


Once the casualty is in the care of a medical practitioner they will be given an urgent scan to try to identify the cause of the stroke, so that the right treatment can be given.


REMEMBER:

Think FAST,

Act FAST,

Call 999/112 when you suspect a stroke.

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In Remembrance

Posted by Steve at 12:45 on Thursday 15th November 2018.


Listen, our guns have stopped (Capt. Darling)

You don’t think (Lt. George)

Maybe the war’s over, maybe it’s peace (Pte. Baldrick)

Oh, hoorah! the big knobs have got round the table and yanked the iron out the fire (Lt. George)

Thank God, we lived through it, the Great War – 1914 to 1917 (Capt. Darling)


Blackadder, Plan F – Goodbyeee (1989)


Of course, Capt. Darling is wrong, the Great War didn’t end in 1917 moreover it lasted another year. In this month’s blog we thought that we would take a look at the war and the remembrance of it.


This last weekend the nation came together to mark the 100th anniversary of the end of World War I, and remembered the men, women, children and animals that have fallen in many military campaigns over the years.


At 11am on Sunday, exactly 100 years since the guns fell silent, Her Majesty the Queen, led the Nation in a 2 minutes silence at the Cenotaph, London. Her Majesty watched the events from a balcony in the Commonwealth Office as members of her family laid wreaths in memory of the war dead.


Let’s now roll time back to the beginning of the Great War.


Back in 1914, the world looked very different to today. If we look at a map of Europe, for instance, you will see country borders are completely different and modern-day countries are joined together making very different countries. Each with different leaderships in comparison to modern-day for example, Germany had a monarchy being led by Wilhelm II, sometimes referred to as the German Emperor. At the end of the war the country borderlines changed into a more recognisable continent.


Assassination of Archduke Franz Ferdinand


In the lead up to the commencement of World War I there was a chain of events that led to the War, however the one event that stands out is the assassination of Archduke Franz Ferdinand, the heir assumptive to the Austro-Hungarian Empire. Archduke Franz Ferdinand was assassinated in June 28th, 1914 by Gavrilo Princip, a Bosnian Serb and member of Young Bosnia a Yugoslavist organisation seeking to end the rule of the Austro-Hungarian Empire in Bosnia and Herzegovina. During the assassination Archduke Franz Ferdinand’s wife Sophie, Duchess of Hohenberg was also assassinated.


Following the assassination, a month of diplomatic manoeuvring took place between Austria-Hungary, Germany, Russia, France and Britain; this was called the July crisis. It is interesting to note that during this time the three principle monarchs were in actual fact first cousins. The three monarchs in question are:


Britain   -  King George V

Germany -  Kaiser Wilhelm II

Russia  -  Tsar Nicholas II.


The Lead-up to War


On July the 23rd, Austria-Hungary delivered an ultimatum to Serbia, which was a set of 10 requirements needed by them to prevent war, although Austria-Hungary knew that they were totally unreasonable, however all but demand 6 were accepted by Serbia. This was the demand to allow investigators into Serbia to investigate the assassination of the Archduke. Serbia denied this request. On July 28th a whole month after the assassination, Austria-Hungary declared war on Serbia. By the 30th of July, Russia had ordered the mobilisation of their troops in support of Serbia, and the following day the Germans declared Erklärung des Kriegszustandes translated to State of Danger of war. In order to try to prevent the situation escalating, Kaiser Wilhelm II asked his cousin Tsar Nicholas II to stop their mobilisation, when this was refused, Kaiser Wilhelm II sent an ultimatum to Russia and a similar one to France, asking the French to not support the Russians. With no satisfactory answer, on August the 1st Germany mobilised their troops in support of Austria-Hungary. On the 2nd of August 1914, Germany invaded and occupied Luxembourg, declaring war on France on the 3rd August. On this same day, the Germans sent an ultimatum to the Belgian Government which demanded unimpeded right of way through the country. This was refused. The following day the Germans invaded, to which King Albert of Belgium ordered his military to resist this invasion and called for assistance under the 1839 Treaty of London.


The 1839 Treaty of London was a treaty signed by the Concert of Europe, the Kingdom of the Netherlands and the Kingdom of Belgium. Under this Treaty, European powers recognised and guaranteed the independence of Belgium and also established the full independence of the German-speaking part of Luxembourg. Article VII of the Treaty required Belgium to remain neutral and by implication committed the members of the Treaty to guard that neutrality in the event of an invasion.


Now that King Albert had invoked the 1839 Treaty of London, Britain demanded that Germany respect the neutrality of the kingdom of Belgium and therefore comply with the Treaty. With no satisfactory response from the Germans, Britain declared war on Germany at 19:00 to become effective from 23:00 on the 4th August 1914.


During the next 4 long years of war, many campaigns and battles ensued between the 2 sides. The 2 sides were:


Russia,

Belgium,

France,

Britain, and

Serbia


Lined up against:


Germany and

Austria-Hungary.


The Western Front


The First Battle of the Marne took place from the 6th to the 9th September 1914, when French and British troops confronted the German troops who were quickly approaching Paris in France as part of their quick invasion and occupation plans for France. The Allied Forces put a hold on the advance of the Germans and, importantly, counter-attacked driving the German troops back to the Aisne River. This is where both sides dug into trenches, and the Western Front became a hellish war of attrition for the next 3 long years. The First Battle of the Marne cost the Allied Forces 81,000 lives compared to 67,700 on the German side.


Battles of the Western Front include the Battle of the Somme and the Battle of Verdun.


The Battle of the Somme took place from the 1st July 1916 to the 18th November 1916. This was one of the bloodiest battles of the war, including on the first day alone the British forces suffered 57,000 casualties. It is said that by the end of the Battle of the Somme the Allied Forces had some 422,000 casualties and although the German number of casualties is controversial it is thought that they suffered some 465,000 casualties during the battle. It was the Battle of the Somme that was the first great offensive for the British Army, which saw the British see a real improvement in development of tactics and a more critical view of the war. However, it is the sheer number of casualties that the battle is remembered for.


The Eastern Front


Over on the Eastern Front, the Germans weren’t having it their way either. The Russians had invaded East Prussia and Poland, the Germans did manage to stop their progress during the battle of Tannenberg in August 1914. Although they had won this particular battle, it meant the Germans had to move some of their troops from the Battle of the Marne on the Western Front, contributing to their defeat in this battle.


The Russian resistance in the East ensured that the war was a longer gruelling conflict than the Germans had hoped in the early days, which was why they had started battles on the east and west.


The Russians had their own problems at home as well as on the Eastern Front of the First World War. Partly due to the battles on the Eastern Front, the Russian population at home were suffering from a combined economic instability and the lack of basic provisions, as well as the news of the defeat at the battle of Tannenberg. These factors increased hostility towards the Tsar, Nicholas II, and his hugely unpopular German-born wife Alexandra. During 1917 the simmering instability exploded with a revolution led by Lenin and the Bolsheviks. The revolution ended the Tsarist rule in Russia and also halted their participation in the War, reaching an armistice with the Central Powers in December 1917, thus leaving the Germans to focus on their battles on the Western Front.


The Arrival of the Americans


So far, we have looked at the World War from the point of the European continent. So how did the Americans come to join in the battles?


President Woodrow Wilson at the start of the War favoured a policy of neutrality, enabling them to continue to trade with both sides of the conflict. This was a difficult policy to maintain as the war continued especially with Germany’s submarines attacking neutral ships. In 1915 Germany declared the waters surrounding the British Isles as a warzone, and their U-boats sank several commercial and passenger ships which included that of the United States of America. When the Lusitania was sunk by the Germans there was a widespread protest in America which started to turn the tide of opinion in the States on the War. The Lusitania was travelling from New York to Liverpool with 1,266 passengers and 696 crew on board. When it was sunk by the U-boat 1,198 people died.


By February 1917, Congress had passed a $250 million appropriations’ bill intended to prepare the country for war. In the following month the German U-boats sank a further 4 US merchant navy ships. President Wilson Woodrow stood up in Congress on the 2nd April 1917 and called for a declaration of war, which was granted, and he then led the country into war against Germany, something which he had won an election a few years earlier for not doing!


Winston Churchill and the First World War


During the First World War, a young Winston Churchill was the First Lord of the British Admiralty. During his leadership, the Allies turned some attention from the stagnant battle in Europe to the Ottoman Empire who had entered the war in late 1914 on the German side. The first attack failed and was focused on the Dardanelles. As this had failed the Allies turned their attention to a land invasion on the Gallipoli peninsula in April 1915. Sadly, this invasion also turned out to be an epic failure, and so in January 1916 the Allies performed a full retreat having suffered 250,000 casualties.


First Lord of the British Admiralty Churchill then resigned his post and accepted a commission with an infantry battalion in France.


The War on the Seas


Prior to World War I it is fair to say that the British Royal Navy was far superior to any other Navy in the world. Although the Germans were taking strides to catch up, they still had a long way to go at the start of the war. Germany’s main threat on the seas came from their fleet of U-boats as explored a little earlier.


Having successfully attacked the coastal towns of Hartlepool and Scarborough in December 1914 with their navy in a surprise attack, the Germans decided to mount another attack. This time on the morning of January 24th 1915 the Allies intercepted the approaching ships. The German Admiral turned his boats around, thinking that they could outpace the British naval ships, he was however mistaken and at 9am his lead ship had been shot at and hit from more than 20,000 yards away. Of the 4 ships sent by the Germans 1 was sunk and the other 3 damaged, whilst the British Navy was successful in defending the country despite, they too suffering from casualties and damage to the ships. This battle which lasted just 1 day was called Battle of Dogger Bank.


It was almost a year after the Battle of Dogger Bank before the Germans attacked on the sea again with the Battle of Jutland which secured the superiority of the British Navy in May 1916, as well as ensuring that the German Navy would not try again to attack an allied naval blockade for the rest of the war.


The Second Battle of The Marne


Now that the revolution of Russia had occurred and consequently an armistice reached on the Eastern Front, the Germans were able to focus fully on the Western Front where the Allied Forces were struggling to hold off the German approach until the promised American reinforcements could arrive. Little did the World know that on July 15th 1918, the Germans launched their last offensive of the war.


The Germans attacked French forces who were by this time joined by 85,000 American troops as well as the British Expeditionary Force in the Second Battle of the Marne. The Germans failed in their attack and, having suffered 139,000 wounded or dead troops, were forced to retreat. The allied troops themselves suffered casualties and deaths which amounted to 112,617 troops.


Having lost so many troops, the Germans were forced to call off their planned attack further north, in the Flanders region between Belgium and France which they had identified as their best chance of victory.


Armistice


Armistice came swiftly. Within a matter of weeks, the various countries fighting on the German side had surrendered and sought armistice.


The Armistice process began on the 29th September 1918 when Bulgaria first signed armistice in the Armistice of Salonica. By the 11th November 1918, all but Germany had effectively surrendered and sought armistice.


At 5am on the 11th of November 1918, armistice with Germany was signed in a train carriage at Compiègne. Who signed the Armistice?


The Signatories were:


On behalf of the Allies:


Marshal of France Ferdinand Foch, the Allied Supreme Commander

First Sea Lord Admiral Rosslyn Wemyss, the British representative.


Other members of the Allied delegation included:


General Maxime Weygand, Foch's chief of staff (later French Commander-in-Chief in 1940)

Rear-Admiral George Hope, Deputy First Sea Lord

Captain Jack Marriott, British naval officer, Naval Assistant to the First Sea Lord.


On behalf of Germany:


Matthias Erzberger, a civilian politician

Count Alfred von Oberndorff, from the Foreign Ministry

Major General Detlof von Winterfeldt, Army

Captain Ernst Vanselow, Navy.


The signed Armistice declared that the period of Armistice should commence at 12 noon German time. This makes it 11AM in Britain. It is because of this that we hear the phrase:


‘The eleventh hour of the eleventh day of the eleventh month’


Remembrance


As we started this month’s blog with the fact that this last weekend was the 100th anniversary of the Armistice of the First World War, as has become tradition, Her Majesty the Queen led the country in a 2-minute silence in memory of all the war dead, wounded and active servicemen and women. As with last year however, Her Majesty had asked her son and heir, Prince Charles, to lay her wreath at the foot of the Cenotaph. Her Majesty was proudly wearing a collection of poppies on her coat.


Why do we wear a poppy?


Poppies are worn to remember the lives lost in war, alongside the injured service personnel, as well as those that are in active service. The main reason behind the poppy is that the poppy is the flower that grew in the war-torn fields of Flanders after the war. John McCrae in his poem In Flanders Fields refers to them:


In Flanders fields the poppies blow

Between the crosses, row on row,

That mark our place; and in the sky

The larks, still bravely singing, fly

Scarce heard amid the guns below.


We are the Dead. Short days ago

We lived, felt dawn, saw sunset glow,

Loved and were loved, and now we lie

In Flanders fields.


Take up our quarrel with the foe:

To you from failing hands we throw

The torch; be yours to hold it high.

If ye break faith with us who die

We shall not sleep, though poppies grow

In Flanders fields.


The first time that poppies were worn to remember those who had fought for us was in 1921, when the Royal British Legion had been founded in the May of that year. Subtle changes have occurred to poppies that we wear over the years. When they were first introduced, they were made of silk, unlike the paper ones the majority of us wear each year. Another big change to the poppy over recent years is that the majority of them are now sold with a leaf, whereas the leaf used to be an optional extra. Some poppies are available with a stick pad on the back of them which negates the need for a pin, this is a good idea particularly for children.


Wearing a Poppy FAQs


Do I have to wear a poppy?


Absolutely not, no one should be forced to wear a poppy and nor is this the idea behind the poppy, The Royal British Legion says ‘It’s a matter of personal choice whether someone chooses to wear a poppy and how they choose to wear it. The best way to wear a poppy is simply with pride.’


Does wearing a poppy mean I support war?


No! poppies are not a symbol of supporting war, they are actually a symbol of respect for those who have sacrificed everything for our safety. However, as Churchill once said, ‘Those who fail to learn from history are doomed to repeat it’, therefore if we didn’t commemorate past wars it would mean we don’t learn from history.


Does the poppy symbolise bloodshed?


No, they symbolise remembrance.


Is the selling of poppies banned in certain communities?


The Royal British Legion says, ‘this is a rumour that circulates each and every year, and every year it has been untrue.’ They continue ‘No communities have banned the selling of poppies at remembrance or any other time.’


Is there a right way or a wrong way to wear a poppy?


The very simple answer to this question is NO! wearing of the poppy is a personal choice, and should you wish to wear a poppy in remembrance then you are free to wear it as you see fit, whether it be a red, white, purple or any other colour of poppy.


In the words of Rudyard Kipling:


Lest we forget


Just like every city and town in the country on Sunday morning, Cirencester our home town fell silent for 2 minutes to remember. During Sunday afternoon the town came together to try to break a record all in the name of Remembrance. The idea was to create a human poppy in the centre of the town, with people coming out to wear a coloured poncho, being asked to stand in a particular spot and then, when looked at from above, the result would be a poppy seen from above.


Whilst it will take a few weeks for Guinness to officially confirm, it is believed that 3,300 people made up the poppy, breaking the previous world record of 3,000 people. Below we have included a photograph taken from the sky to show what it looked like. We would like to thank the person who is attributed to the photograph, Chris Cleal, for this picture which has been shared on social media:



From all of us here at Fox Towers, Well done Cirencester.



They shall grow not old, as we that are left grow old:

Age shall not weary them, nor the years condemn.

At the going down of the sun and in the morning

We will remember them.

Robert Laurence Binyon


We Will Remember Them

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The Nativity Story

Posted by Steve at 12:45 on Fridayday 14th December 2018.


As we are now halfway through the advent season, half the chocolates behind the doors have been eaten and preparations for the big family celebrations are busily being made, we thought we would take a look at the Christmas story.


Chestnuts roasting on an open fire
Jack Frost nipping at your nose
Yuletide carols being sung by a choir
And folks dressed up like Eskimos


Robert Wells and Mel Tormé


The story of the birth of Jesus Christ is one that is known across the world, even by people who have never read the story or even touched a copy of the Bible. It is one of the most well-known and most told stories ever.


You can find the story written in the Bible in the Gospel of Matthew as well as a slightly different version of the story as told by Luke. Both of these Gospels tell the story from different angles, as they were writing their story for different audiences. Matthew wrote for the Jews whereas Luke was writing for the non-Jews also known as Gentiles. The Nativity (the word used for the story of the birth of Jesus Christ) is put together from both accounts of the Gospels.


In this month’s article we thought we would have a look at the characters involved in the story and how they fit together.


Angel Gabriel


The Angel Gabriel visited Jesus’ mum, Mary, in the months prior to his birth to tell her that she is with child. This amazed and surprised Mary as she told Gabriel that she was a virgin and therefore couldn’t be with child. The angel told Mary that the child was the son of God and would be named Jesus otherwise known as Emmanuel which means God with us. The detail of the visit can be found in the Gospel of Luke Chapter 1.


Mary and Joseph


It is thought that Mary was a virgin of about the age of 16 and she was engaged to be married to an older man Joseph. Some believe he would be about the age of 30 which in biblical times would have been the case for young girls to be engaged to marry an older man. At the time, the couple would have been the average couple in Israel, a quite poor pair. Joseph was a carpenter, which was a job by some religious leaders of the time as a religious duty and not that of a profession. Both Mary and Joseph were descendants of King David of Israel, and Mary was also related via her cousin Elizabeth to the traditional priest families of Israel.


For Mary to tell Joseph, was a scary thing for her, as in the biblical days according to God’s Law a woman who is engaged to one man but who willingly has sexual relations with another man is to be stoned to death. Therefore, telling Joseph and having her pregnancy start to show scared her. Mary knew that she hadn’t been immoral, but she was apprehensive as to how to tell Joseph and also what would happen. When Joseph was told by Mary that she was pregnant by means of God’s Holy Spirit, understandably he didn’t believe her and believed that she had been unfaithful. Joseph, however, knew that Mary was a decent woman, and that she had a good reputation. He also loved her dearly and didn’t want her to be stoned to death or publicly humiliated, so he resolved to divorce her privately. Back in the Bible days, engaged people were seen as married and the only way to end the relationship was via divorce.


During his sleep, according to the Gospel of Matthew, Joseph got a visit from Jehovah’s angel, who told him ‘to not be afraid’, the angel then went on to confirm everything that Mary had told him and again said the child would be called Jesus.


The visit from the angel cleared up the situation for Joseph and he vowed to support Mary, he publicly took her into his house, a sign that the couple are married, however he didn’t have sexual relations with Mary whilst she was pregnant with Jesus.


The couple lived in a town called Nazareth.


Where is Nazareth?


Nazareth is located in the north of Israel. It is at the most southerly point of the Lebanon Mountain range, about 25km (15.5 miles) west of the Sea of Galilee (Lake Tiberias). Nazareth has a population of about 70,00 people, predominantly Palestinian Arab citizens of Israel. The official language of Nazareth is Hebrew and Arabic.


In modern day Nazareth there is a tourist attraction called Nazareth Village which is an open-air museum which re-enacts village life in Galilee at the time of Jesus.


Heading to Bethlehem


Caesar Augustus decreed that everyone should be registered, so Joseph and a heavily pregnant Mary must travel to his birth town of Bethlehem, to register.


The Journey to Bethlehem


Bethlehem is 73kms (45 miles) north-east of Gaza City situated in Palestine.


The journey from Nazareth to Bethlehem is 157.1km (97.6 miles), according to Google Maps the journey today would take some 33 hours on foot to walk. The Bible tells us that they went on a donkey Joseph walking, so we can assume that it took at least 33 hours to walk with the addition of rest time.


When they arrived in Bethlehem, the town was particularly busy with people returning to register. Mary and Joseph needed a place to stay while in the town, all the guest houses were busy, yet an innkeeper offered them a stable to stay in.


The rest of their story, as they say, is history; we move on to consider their son.


Jesus


Jesus it could be said is the main character of the Nativity story.


The 2 Gospels both agree that Jesus was born in Bethlehem. It is Luke however that clearly states that Jesus was placed in a manger because there was no safe place to lie him, especially as we realised earlier Mary and Joseph were staying in a stable, thanks to a kindly innkeeper who offered them that as he had nothing else available.


As per the Angel Gabriel’s words Mary and Joseph called their son Jesus, or Emmanuel. Jesus was visited by the Wise Men (Kings) and shepherds whilst staying in the stable.


Jesus, as the Bible tells us, went on to perform many miracles, founded the Church and died by crucifixion, before rising again 2 days later.


In the calendar, Jesus’ birth is remembered by the dates before his birth being known as BC, Before Christ, and those after are known as AD, Anno Domini, which is medieval latin and translates as in the year of the Lord.


King Herod


King Herod was also known as Herod the Great and Herod I Roman King of Judea. He became King in 37BC. The Gospel of Matthew has the only reference to Herod’s killing of infants in Bethlehem after the birth of Jesus.


Then Herod, when he saw that he was mocked of the wise men,

was exceeding wroth, and sent forth,

and slew all the children that were in Bethlehem,

 and in all the coasts thereof,

from two years old and under,

 according to the time which he had diligently inquired of the wise men.

Matthew 2:16


There is a thought based on demographic clues of the time of the first century that the population of Bethlehem was only between 300 and 1,000 people and therefore Herod’s cull of children would have probably only amounted to between 7 and 20 children under 2. This is a much smaller number than the Bible’s Gospel leads its reader to believe.


The 3 Wise Men


The first thing to say about the Wise Men is that they do not actually visit the new born King on the day of his birth according to the Bible. Moreover, in fact they visit the house he is living in and only his mother is present. This contradicts the Nativity plays, but at the same time the Nativity plays allow both visits, the shepherds and the Wise Men to be included easily and without prolonging the show. Some believe the visit of the 3 Wise Men took place on the 6th January, therefore the same winter as that of the new born King’s birth.


We are obviously referring to the men as Wise Men however they are sometimes referred to as 3 Kings, there is nothing in the religious text to suggest that these men were rulers of any kind. The Bible in fact refers to them as Wise Men, with no number stated.


Why do we refer to them as 3?


Tradition has started to depict there being 3 Wise Men in the Nativity story, however, all the text states is ‘Wise Men from the East’. Due to the number of presents that are listed in the text, it has over the years made people think that there must have been 3 of them. Another term used for these men is Magi, this a term which is plural of the word Magus, therefore there must have been more than 1 man, but could have simply been 2.


Do the Wise Men have names?


If you go by the Bible text, then the answer to the question very simply is no they did not. This also ties in with the fact the Magi aren’t stated as to how many there were. Traditionally however, the Wise Men (Magi) have been named, in the Western Christian Church they have been all regarded as saints and are commonly known as:


Melchior – A Persian Scholar

Casper

Balthazar – A Babylonian Scholar.


The Encyclopaedia Britannica states them as having a different role as follows:


Melchior – King of Persia

Gasper – King of India

Baltahasar – King of Arabia.


Legends have also described the biblical Magi as follows:


Melchior


The present Melchior delivered to Jesus was Gold.


He is described as having long white hair, with a white beard and wearing a gold cloak.


Casper (Gasper)


Casper’s present was Frankincense.


He is described as having brown hair and a brown beard, although sometimes he is depicted as not having a beard at all. Casper wears a green cloak and a gold crown with green jewels embedded within it.


Sometimes he is also referred to as the King of Sheba.


Balthazar (Balthasar)


Balthazar brought the baby Jesus, Myrrh.


This magus is described as having black skin with black hair and a black beard, sometimes depicted however as not having a beard. He wears a purple cloak.


Tradition also says that he is the King of Tarse and Egypt.


What is Frankincense?


Frankincense is an aromatic resin that is used in incense and perfumes. It is obtained from trees in the Burseraceae family. The word is from Old French – Franc encens. The chemical composition of Frankincense is: C20H32O


What is Myrrh?


Myrrh is a natural gum or resin extracted from a number of small, thorny tree species of the genus Commiphora. Myrrh through the years has been used in perfume, incense and medicine. Myrrh mixed with wine can also be ingested.


What do the presents signify?


The gifts themselves seem a little strange to give to children, however Christians believe that they have the following meanings:


Gold – Kings, and Christians believe that Jesus is the King of Kings.

Frankincense – sometimes used in worship in churches and showed that people would worship Jesus.

Myrrh – is a perfume that is used on dead bodies to make them smell nice and showed that Jesus would suffer and die.


It was the Wise Men that King Herod had asked to find Jesus and tell him where he was, he told them it was so he could go and visit him, but the ulterior motive was in fact to kill him!


Through this month’s article we have had a look at the characters in the Nativity story and some of the meaning behind certain aspects. We hope that you have enjoyed this look at the story.


As we bring this month’s article to a close, we thought we would look at a message the story gives us:


It doesn’t matter where you begin from in life, but it is about what you can achieve.


As we head into the Christmas period,


May we all here at The Training Fox

Wish all our customers, their and our families

A VERY Merry Christmas.

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