The relationship between poisoning and accidental first aid

Poisoning ranks fourth among the causes of accidental injury and death in my country throughout the year. Poisoning first aid is a core subset of the accidental first aid system. The two are nested relationships of "general rules cover the basics and special logic takes precedence" - neither the ordinary accidental first aid process can be used to completely apply the poisoning scene, nor can the poisoning first aid be completely separated from the accidental first aid framework. According to the monitoring data of the National Center for Disease Control and Prevention in 2023, poisoning first aid death cases caused by improper connection between the two types of processes accounted for 41.2% of the total number of similar deaths.

When I was stationed at a suburban emergency center last month, I came across a fairly typical case: an old man mistakenly drank half a cup of toilet cleaning liquid at home. In desperation, his children remembered from the Internet that strong acidosis should be neutralized by giving milk to neutralize it, so they drank two large boxes of it. As a result, the old man was already a little confused, and the milk was choked into his trachea, causing his lips to turn purple. When we arrived at the scene, our first reaction was not to worry about poisoning. We first administered Heimlich and sputum suction to open the airway. We only gave him omeprazole and egg white neutralizer on the way to the hospital. In the end, he was rescued. His family members are still worried and say that they would have known better. You see, this is the most straightforward manifestation of the relationship between the two: poisoning is a type of accident, and the general first aid red line that should be observed cannot be exceeded by even half. When encountering a situation where vital signs are unstable, it is an iron rule to protect the person first and then deal with the poison.

Interestingly, the domestic first aid community has actually been arguing about the boundary between the two for many years. One group is a doctor with a background in comprehensive emergency care. They insist that all accidental first aid must first abide by the ABC principle (airway, breathing, circulation). They feel that no matter how urgent the poisoning is, they cannot go beyond the vital signs. The statistics in their hands are that there will be more than 1,200 poisoning patients across the country from 2021 to 2023. This is because the on-site rescuers induced vomiting and injected medicine, ignoring the patients' existing airway obstruction and shock problems, and ultimately failed to save them. The other group are researchers who specialize in poisoning. They believe that the core contradiction of poisoning is the continuous absorption of poisons. In many cases, poison control is delayed by 10 minutes, and even if the vital signs are stabilized later, they cannot be saved. For example, as long as patients with paraquat poisoning can still breathe on their own, the first priority is to instill activated charcoal and arrange gastric lavage. The data they produced is that there were more than 3,000 poisoning patients during the same period. Because they spent half an hour in the emergency room to stabilize blood pressure and insert breathing tubes, they missed the best 1-hour gastric lavage window period, and eventually suffered irreversible organ damage.

Both groups are right. I have encountered a more extreme case before: a young man had an argument with his family, drank half a bottle of dichlorvos, and drove his motorcycle into a guardrail. When he was delivered to the scene, he had an open fracture in his leg and was bleeding. He was semi-conscious and the smell of pesticides was in his mouth. Who do you think you are sending at this time? There was no way to tell the difference. Two groups of us started working at the same time. One group first performed compressions to stop the bleeding and fixed the legs. The other group inserted a gastric tube for gastric lavage and administered atropine. When he was first rushed to the emergency room, he had already shown signs of atropinization, and the bleeding from the fracture had stopped. When he was finally rescued, the doctors from the orthopedics department and the poisoning department were still arguing over who had the greater credit. Several of us in the front of the hospital were laughing beside him, saying that it would not work without either one.

When I train new first responders, I always make an analogy: Accident first aid is like a full-range emergency kit in your car. It has a jack, band-aids, and a flashlight. It can be used whether it’s a flat tire, a scratch, or if you’re stuck in the rain.； The first aid for poisoning is the exclusive bottle of car fire extinguisher in the bag. If there is a fire, you must grab the fire extinguisher first, but you can't just throw away the other tools once you have the fire extinguisher. One day the car overturns and still catches fire, you can't hold the fire extinguisher and spray it first, forgetting to pull the person out of the driver's seat first, right?

Oh, by the way, there is another common misunderstanding. Many people think that first aid for poisoning involves inducing vomiting and pouring milk, which is equivalent to completely separating it from ordinary first aid for accidents. This is actually very dangerous. Last summer, we received the police report that a family of three adults and one child had eaten poisonous red mushrooms at the farmhouse. One of the men was already unconscious, and his family members pressed his head into a bucket to induce vomiting. The vomited items were all stained with blood. As soon as we arrived, we turned the person over on his side, sucked out the vomit from his mouth and nose, and opened his airway first. Otherwise, the person would be suffocated by the vomit before the poison took effect. As for the two conscious adults, we fed them activated charcoal on the spot. The child was too young and was afraid of choking due to vomiting, so we took him directly to the hospital to have a gastric tube inserted for gastric lavage. The last four were fine. When they were discharged from the hospital, they gave us a basket of peaches grown at home.

I have been practicing pre-hospital emergency care for almost 8 years. I actually don’t agree with the practice of drawing a clear boundary between the two. When I went to the province to hold a seminar before, some experts mentioned that poisoning first aid should be listed separately from the general pre-hospital syllabus, and more than a dozen special operations should be added. I didn't speak at the time. What I was thinking was that I was actually on the front line. How could I have time to slowly classify whether it was poisoning or an ordinary accident? If you encounter someone who fell down the stairs after drinking sleeping pills, do you only deal with the poisoning and ignore the intracranial bleeding? If someone was poisoned by carbon monoxide and broke a bone, would you just give him oxygen and ignore the open wound?

After all, it is a matter of you and me. When it comes to the scene, the process that can bring people back from hell is correct - this is also the most practical principle for us to do this business.