I get this question a bit during my training courses and kept thinking while I would continue to resuscitate the patient, I really must look into this. No need to do that now after the great article below arrived in my inbox from the guru’s at Royal Lifesaving WA. So here is the answer to this often asked question.
What would you do if you came across an unconscious person needing CPR, but they had a tattoo that said, ‘DO NOT RESUSCITATE’? Would you ignore the tattoo and continue treatment of the casualty? Would there be any legal ramifications of ignoring the tattoo? How would you know if the tattoo genuinely represents the person’s wishes, or if it’s just a joke?
These were questions faced by a team of doctors in the US when a patient was brought into a hospital emergency department. They discovered the words ‘DO NOT RESUSCITATE’ clearly tattooed across his chest, with the ‘Not’ underlined and what they presumed was his signature tattooed underneath the statement.
Faced with the dilemma of not knowing whether the tattoo was sincere, the doctors initially decided to administer some treatment while consulting with their hospital ethics team. The ethics team reviewed the case and advised the doctors to honour the tattoo, because it was reasonable to infer that it expressed the man’s wishes.
The man later died without being resuscitated, and it was discovered that he had, in fact, completed a form expressing his wishes which were consistent with the tattoo. The case sparked international discussion around the validity of these tattoos and whether they are legally binding. So what would happen in Australia?
Hospitals in Australia typically don’t have an ethics team on call to review individual cases. Advance care planning does exist here; however, the laws differ between states and territories. Generally, treating doctors must be satisfied that the person was competent when they made the directive, that they understood the risks of refusing care and that it applies to the current situation – all virtually impossible for a first responder to determine when coming across an unconscious person in need of CPR.
While a Do Not Resuscitate tattoo could in fact represent a person’s wishes, without sighting documentation to verify this we cannot know for sure. Perhaps it was their wish at the time of getting the tattoo, but they have since changed their mind. Perhaps the tattoo was done in jest, or while under the influence. Additionally, the shorter version that simply states the initials ‘DNR’ presents even more ambiguity – it could stand for something else entirely.
First responders in Australia are trained that consent is implied if a casualty is unconscious. We cannot assume to know what the person would want at the time of needing care. It is important to always follow your training and provide CPR if it is required.
A great article from National Geographic: https://www.nationalgeographic.com/animals/invertebrates/group/box-jellyfish/
About Box Jellyfish
The infamous box jellyfish developed its frighteningly powerful venom to instantly stun or kill prey, like fish and shrimp, so their struggle to escape wouldn’t damage its delicate tentacles.
Their venom is considered to be among the most deadly in the world, containing toxins that attack the heart, nervous system, and skin cells. It is so overpoweringly painful, human victims have been known to go into shock and drown or die of heart failure before even reaching shore. Survivors can experience considerable pain for weeks and often have significant scarring where the tentacles made contact.
Range and Appearance
Box jellies, also called sea wasps and marine stingers, live primarily in coastal waters off Northern Australia and throughout the Indo-Pacific. They are pale blue and transparent in color and get their name from the cube-like shape of their bell.
Up to 15 tentacles grow from each corner of the bell and can reach 10 feet in length. Each tentacle has about 5,000 stinging cells, which are triggered not by touch but by the presence of a chemical on the outer layer of its prey.
Box jellies are highly advanced among jellyfish. They have developed the ability to move rather than just drift, jetting at up to four knots through the water. They also have eyes grouped in clusters of six on the four sides of their bell. Each cluster includes a pair of eyes with a sophisticated lens, retina, iris and cornea, although without a central nervous system, scientists aren’t sure how they process what they see.
Everyone loves to read the feedback people receive just to be sure you are dealing with a person & business that can deliver the goods for your next training or PD sessions. So here are few from our latest professional development session (PD) covering Provide CPR and Provide First Aid for high school teachers.
Thanks mate – was a great little PD. Thanks for running it, I have picked up some good context from your presentation to add to my own with the kids.
I’ll let my boss know about the upgrade costing and let you know if we will go ahead
Thank you for getting in touch with this information. The PD was really engaging and given the current circumstances that we find ourselves in I feel that you did a top job on both the theory and practical delivery of the course. Thanks!
Hope to attend another one of your courses one day.
The course was great and entertaining!
Thank you, Dean
I was at your course on Friday. in 25 years of nursing it was one of the best I have i have attended thanks
I had another teacher, Rick also comment on the program and how he was impressed by your knowledge and presentation.
Coronavirus has all of us questioning if that sniffle or runny nose is something much more sinister. And with good reason.
The chart above should give you some clarity. It’s the
symptoms experienced by 55,000 patients in China who tested positive for
The most common symptom? A fever.
The main difference between a cold and COVID-19 is the
likelihood of fever: most people with COVID-19 develop a high temperature.
In contrast, while people with a cold can develop a fever, it happens only rarely, according to the US Centres for Disease Control and Prevention.
Coronavirus symptoms have even more in common with influenza
— that other, sometimes deadly virus often confused with the common cold.
So while that sniffle is probably just the usual upper respiratory tract infection, you can’t be sure. If you think you might have been exposed to COVID-19, call the Coronavirus Health Information Hotline at any time on 1800 020 080. And before visiting your GP or hospital, call ahead and call them about your symptoms.
Do you have a number of people, friends, students, associates that you need to check? – Our new non contact infrared thermometers are the answer.
West Coast First Aid Training (WCFAT) takes the Coronavirus (2019-nCoV) and the spreading of it very seriously. As a result we are now providing all students, on all first aid courses with their own individual resuscitation mask & first aid kit (to keep) included in the price of the course.
Your own individual lung set will be supplied (to be disposed of at completion of training by you instructor). An individual manikin face will be provided per student but do need to be returned these for disinfecting and reuse. If you would like your own brand new face to keep we can provide one for $25.
All manikins are thoroughly disinfected with alcohol and bleach prior to and during every class. Alcohol wipes and disinfection solution are available at all times during the course.
How can I help prevent the spread of 2019-nCoV?
• teach and encourage your children/family to wash their hands often with soap and water before and after eating as well as after attending the toilet; • avoid contact with others by keeping children home if they are unwell; • teaching children to cough and sneeze into their elbow; and • while it’s not possible to avoid touching, kissing, and hugging children, parents and guardians should do their best to follow these steps too.
Call the Public Health Information Line on 1800 004 599.
Contact your state or territory public health agency: • ACT call 02 5124 9213 during business hours or (02) 9962 4155 after hours • NSW call 1300 066 055 • NT call 08 8922 8044 • Qld call 13HEALTH (13 43 25 84) • SA call 1300 232 272 • Tas call 1800 671 738 • Vic call 1300 651 160 • WA visit https://www.healthywa.wa.gov.au/ or call your local public health unit
Summer is fast approaching and so is the season for drowning deaths and near drowning incidents of West Australian children.
Homeowners need to check now to make ensure that pool barriers comply with Australian Standards and current state regulations. Make sure fences are secure and gates self close and securely latch. Very importantly ensure there is nothing leaning up against the fence or able to dragged over to the fence and used as a step ladder. These are your kids, they are just like you, cunning and smart!
Make sure this summer (and every summer actually) that all children, your own and those of visitors to your home are supervised when in and around water. If you are holding a party and your home has a pool ensure it is securely locked, or, if you plan to use your pool ensure a qualified / competent adult that knows CPR is on duty in the pool area at all times. If you prefer, West Coast Water Safety can provide nationally qualified lifeguards, with Working with Children (WWC) and National Police Clearance, that will not only watch your pool for you but actually get in the water with the kids and entertain them. Imagine that a pool party where all you have to do is entertain the adult guests and relax. Leave the kids and water safety to us!
Children under 5 years of age are the most at risk of drowning. Between 1995 and 1999, 50 children under the age of 14 years drowned in Western Australia, about half of these were under 5 years age. For the same period, 247 children were admitted to WA hospitals after an immersion incident or near drowning.
Maybe you need to think about hiring a professional Lifeguard for the duration of your party. Crazy? Not really, imagine the medical bills, $900+ for the ambulance alone. How much is a life worth?
Need a lifeguard? Let me know and I will arrange it all for you.
Minimise the risk, make sure no one drowns in your pool and make this a good summer for all of us.
Professional Lifeguard West Coast Water Safety www.wcws.com.au
BLUE-BOTTLES: The Portuguese man o’ war (Blue Bottle) is composed of three types of medusoids (gonophores, siphosomal nectophores, and vestigial siphosomal nectophores) and four types of polypoids (free gastrozooids, gastrozooids with tentacles, gonozooids, and gonopalpons), grouped into cormidia beneath the pneumatophore, a sail shaped structure filled with gas.The pneumatophore should probably not be considered a polyp, as it develops from the planula, unlike the other polyps. This sail is bilaterally symmetrical, with the tentacles at one end. It is translucent, and is tinged blue, purple, pink, or mauve. It may be 9 to 30 cm (3.5 to 11.8 in) long and may extend as much as 15 cm (5.9 in) above the water. The sail is equipped with a siphon. In the event of a surface attack, the sail can be deflated, allowing the organism to briefly submerge.
The other three polyp types are known as dactylozooid (defense), gonozooid (reproduction), and gastrozooid (feeding). These polyps are clustered. The dactylzooids make up the tentacles that are typically 10 m (33 ft) in length, but can reach over 30 m (98 ft). The long tentacles “fish” continuously through the water, and each tentacle bears stinging, venom-filled nematocysts (coiled, thread-like structures), which sting and kill adult or larval squids and fishes. Large groups of Portuguese man o’ war, sometimes over 1,000 individuals, may deplete fisheries. Contractile cells in each tentacle drag the prey into range of the digestive polyps, the gastrozooids, which surround and digest the food by secreting enzymes that break down proteins, carbohydrates, and fats, while the gonozooids are responsible for reproduction.
The new captain jumped from the deck, fully dressed, and sprinted through the water. A former lifeguard, he kept his eyes on his victim as he headed straight for the couple swimming between their anchored sportfisher and the beach. “I think he thinks you’re drowning,” the husband said to his wife. They had been splashing each other and she had screamed but now they were just standing, neck-deep on the sand bar. “We’re fine, what is he doing?” she asked, a little annoyed. “We’re fine!” the husband yelled, waving him off, but his captain kept swimming hard. ”Move!” he barked as he sprinted between the stunned owners. Directly behind them, not ten feet away, their nine-year-old daughter was drowning. Safely above the surface in the arms of the captain, she burst into tears, “Daddy!”
How did this captain know – from fifty feet away – what the father couldn’t recognize from just ten? Drowning is not the violent, splashing, call for help that most people expect. The captain was trained to recognize drowning by experts and years of experience. The father, on the other hand, had learned what drowning looks like by watching television. If you spend time on or near the water (hint: that’s all of us) then you should make sure that you and your crew know what to look for whenever people enter the water. Until she cried a tearful, “Daddy,” she hadn’t made a sound. As a former Coast Guard rescue swimmer, I wasn’t surprised at all by this story. Drowning is almost always a deceptively quiet event. The waving, splashing, and yelling that dramatic conditioning (television) prepares us to look for, is rarely seen in real life.
The Instinctive Drowning Response – so named by Francesco A. Pia, Ph.D., is what people do to avoid actual or perceived suffocation in the water. And it does not look like most people expect. There is very little splashing, no waving, and no yelling or calls for help of any kind. To get an idea of just how quiet and undramatic from the surface drowning can be, consider this: It is the number two cause of accidental death in children, age 15 and under (just behind vehicle accidents) – of the approximately 750 children who will drown next year, about 375 of them will do so within 25 yards of a parent or other adult. In ten percent of those drownings, the adult will actually watch them do it, having no idea it is happening. Drowning does not look like drowning – Dr. Pia, in an article in the Coast Guard’s On Scene Magazine, described the instinctive drowning response like this:
Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.
Drowning people’s mouths alternately sink below and reappear above the surface of the water. The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.
Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.
This doesn’t mean that a person that is yelling for help and thrashing isn’t in real trouble – they are experiencing aquatic distress. Not always present before the instinctive drowning response, aquatic distress doesn’t last long – but unlike true drowning, these victims can still assist in their own rescue. They can grab lifelines, throw rings, etc.
Look for these other signs of drowning when persons are in the water:
Head low in the water, mouth at water level
Head tilted back with mouth open
Eyes glassy and empty, unable to focus
Hair over forehead or eyes
Not using legs – Vertical
Hyperventilating or gasping
Trying to swim in a particular direction but not making headway
Trying to roll over on the back
Appear to be climbing an invisible ladder.
So if a crew member falls overboard and everything looks OK – don’t be too sure. Sometimes the most common indication that someone is drowning is that they don’t look like they’re drowning. They may just look like they are treading water and looking up at the deck. One way to be sure? Ask them, “Are you alright?” If they can answer at all – they probably are. If they return a blank stare, you may have less than 30 seconds to get to them. And parents – children playing in the water make noise. When they get quiet, you get to them and find out why.