Essay on the relationship between first aid and emergency health

First aid is the core front-end contact point for emergency health. Its popularity and standardization directly determine the upper limit of emergency treatment in emergency health scenarios.； The construction of the entire chain of emergency health is the underlying support for the actual value of first aid operations. Neither can form a complete public health and safety barrier without either one.

Speaking of which, this conclusion is really not something I came up with while sitting in a laboratory and patting my head. It was something I encountered in real life when I was doing emergency education in the community last summer. At almost six o'clock that afternoon, Uncle Zhang, who was walking at the north gate of the community, suddenly fell down from heatstroke. No one in the circle dared to move. A mother who had just received the Red Cross first aid certificate happened to be passing by carrying vegetables. She squatted down and moved him under the shade of a tree. He untied his collar to physically cool down and called 120. By the way, I asked the family whether Uncle Zhang had diabetes or high blood pressure, and handed him half a cup of warm salt water. Eight minutes had passed by the time 120 arrived. The doctor who received the examination said that if he were five minutes later, he would most likely develop heat stroke, and he might have any sequelae later. That mother threw the vegetable bag next to her and didn’t bother to pick up the eggplants when they rolled out. Later, she told me, “When I was taking the examination, the teacher said that it is much more useful to find out the person’s basic diseases before rescuing someone than to just pinch someone.” You see, this is actually the simplest scene of combining first aid and emergency health: first aid operation is the first step, and basic health information mastered in advance and subsequent medical connection are the key to truly saving the person.

Regarding the relationship between the two, there are actually two completely different practical ideas in the industry, and there has been no absolute right or wrong for so many years. One group is the "first aid priority group", most of whom are front-line emergency practitioners and public health science workers. Their core basis is the 2023 survey data of "Chinese Emergency Medicine": the golden treatment window for cardiac arrest patients is only 4 minutes, and standard cardiopulmonary resuscitation must be implemented within 4 minutes. The survival rate can reach 50%, but the average arrival time of 120 in most cities in China is more than 12 minutes. By the time medical care arrives, the best opportunity has been missed. This school of thought is very practical: put everything else aside and first increase the public first aid penetration rate, which can solve 80% of sudden health risks. Shenzhen is a typical practitioner of this school. Now the city's public first aid certification rate has exceeded 10%, and more than 3 AEDs are equipped per square kilometer in public places. The rescue rate of patients who died suddenly in public places in 2023 will be 3.2 times higher than in 2018. The data presented here is indeed convincing.

The other group is the "system-first group", most of whom are researchers in emergency management and public health systems. They pay more attention to the implementation support of first aid. I have previously read the public health survey data after the heavy rain disaster in Henan in 2021. At that time, the proportion of personnel with basic first aid skills at the disaster relief site had reached 8%, which was much higher than the national average. However, due to the lack of supporting emergency health support system: insufficient trauma disinfection supplies, disaster-stricken The personnel's basic health records were not connected, and there was no follow-up health follow-up for patients after first aid. In the end, the on-site trauma infection rate was 37% higher than expected. There were also 12 patients who had successful cardiopulmonary resuscitation and left with varying degrees of neurological sequelae because there was no subsequent targeted brain protection intervention. This school of thought is also very realistic: even if you can do cardiopulmonary resuscitation again, if you can’t find an AED at the scene, you don’t know what drugs the patient is allergic to after resuscitation, and there is no follow-up recovery follow-up, most of the previous operations will be in vain.

To be honest, I used to give priority to first aid and thought that as long as the skills were popularized, everything would be fine. It wasn’t until I had a trip with Dr. Li from the city’s emergency center the year before last that I changed my mind. That time, a young man was hit on the head while playing ball. Someone at the scene knew first aid and stopped the bleeding. Seeing that the young man woke up and could talk, everyone thought he was fine and let him go home. As a result, the young man fainted at home that night and was sent to the hospital to be diagnosed as delayed intracranial hemorrhage. It took three hours of resuscitation to save him. Dr. Li sighed to me at the time and said that this kind of thing happened too many times. Everyone thought that first aid was just "just waking up and it's over". They didn't know that there was another half of emergency health: risk assessment within 72 hours after trauma, follow-up indicator monitoring for patients with underlying diseases, and traceability of triggers after sudden illness. These seemingly non-urgent things are the key to determining whether the patient can fully recover.

In the past two years, practices in various places have slowly brought the two ideas together. For example, the "15-minute emergency health circle" now launched in Shanghai no longer separates first aid and emergency health into two projects: it has the hardware configuration of at least 2 AEDs per square kilometer, and the skills popularization of more than 2 certified first aid propagandists in each community. It is also equipped with residents' emergency health files and regular health care for the elderly living alone. The service provided health follow-up and 72-hour on-site evaluation after first aid. During the lockdown period last year, this circle helped many people. An old aunt who lived alone fell at home. The community first responder came to her home to perform trauma fixation, and simultaneously transferred her diabetes history to a designated hospital. Later, they also came to her home for a week to test her blood sugar and change wound dressings. This is equivalent to tying together the preparatory links of first aid and the follow-up services of emergency health.

In fact, to put it bluntly, the relationship between the two is like the first aid kit you keep at home: you will not pack the tourniquet, CPR operation card and spare antihypertensive drugs and ibuprofen separately. When you encounter an accident, you will use whatever can save your life. There is no need to separate "first aid" and "emergency health" into two distinct concepts. First aid is the hand that reaches out to the front of the emergency health and can grab the person immediately, while emergency health is the entire safety cushion held by the back. Once grabbed, it will not fall again. Without either of them, this safety line of defense is not complete.