It might sound strange that I’m spending New Year’s Day 2025 writing a 2000 word blog post but one look out the window tells me I’m not going anywhere today – the weather is awful!
So I’m staying in the warm and reflecting on a couple of points that came up during an Emergency First Aid at Work course in Milton Keynes right before Christmas: how our bodies have evolved over time and the advantages and shortcomings of that evolution.
It seems that we evolve in response to our environment so about 4 million years ago it became an advantage for us to stand on two feet rather than to have four and in areas where we ate lots of vegetables we developed longer intestines because vegetables take longer to process than meat. Nowadays the reverse is true with far meatier diets. Fascinatingly, many years ago I saw a tv program which discussed how we would evolve if everyone in the world smoked. We would have very squinty, watery eyes and huge chests to help process the smoke and we could even have a growth coming out of one of our elbows that would act as an ashtray!
Good evolution in first aid
Back teaching Emergency First Aid at Work in Milton Keynes we weren’t going into such details but we did mention the advantages provided to us by our collar bones specifically because collar bones are designed to break. Now that might sound strange but whilst there are several reasons that bones break:
• direct force
• twisting
• violent movement
• pathological reasons and
• indirect force
it’s the last of these that often applies here. Cyclists commonly break their collar bones when falling off bikes, even if or especially if they manage to get their hands down to cushion their fall. The force of the impact travels up the stronger bones in the arm and the energy then ‘bursts’ out of the collar bone causing it to break. If it didn’t break, that energy would continue up and probably break the neck and/or cause a serious brain injury. So the collar bone breaking protects us from far more serious injury. It’s really quite remarkable and is even mentioned in one of the Jack Reacher novels by Lee Child.
At the risk of digressing, I’m enjoying the Jack Reacher series on Amazon Prime. I’m very grateful that my wife pays for Prime and even more so because now they’ve cast Alan Ritchson as Jack Reacher, whereas in previous films it was Tom Cruise. Sorry Tom but in the books Jack Reacher is 6 foot 5 inches tall and you ain’t! Come to think of it, you’re more my height…
Case file: Marilyn
Getting back on track, I even saw this indirect breaking of the collar bone one summer when I was driving back from Tesco’s in Leighton Buzzard one hot June day although it wasn’t a cyclist who got hurt. I drove around the corner and saw a man standing over an older lady on the pavement. The scene didn’t look right so I pulled into a nearby car park and walked over to see if I could help. I couldn’t have been more surprised to see that the first aider was a chap by the name of Jason who had attended one of my first aid courses! Well done him, I thought.
The lady on the floor was called Marilyn and she’d tripped over an uneven paving stone in her open-toed shoes. Now these things are lethal, the shoes not the paving stones (although I wouldn’t like a close encounter with a moving paving stone, come to think of it). I’ve treated three women for injuries caused by open-toed shoes: one was unable to get her hand down and fell directly onto her nose ending up looking like Gene Simmons from Kiss where the bruising spread across her face, bless her.
If the best first aid is the first aid we don’t have to do because we’ve done a risk assessment, I’d suggest very strongly that no one wears open toed shoes in the summer. Or ever.
Marilyn had tried to cushion her impact by reaching her hand out but the force of the impact had obviously travelled up the stronger bones and broken her collar bone. That’s where she was experiencing the most pain and she was feeling quite sick too as the shock set in.
Don’t forget they’re going to go into shock!
You can read more about shock here
Shock can be life-threatening of course and ideally we want to elevate the patient’s legs to keep blood around the body’s core area but I thought that would just cause more pain and therefore shock so the first aid here came down to the basics: call 999, reassure the patient and monitor her breathing. I also borrowed an umbrella from a local shop because there was no shade where Marilyn was lying.
It took a full hour for the ambulance to arrive (which is better than currently) and in that time no fewer than three people came across to us from shops in the area to offer Marilyn a cup of sweet tea. I had to keep turning it down because I was pretty sure she was going to undergo surgery quite soon and having anything in the stomach can be dangerous. I’ll talk about that in another post. Sadly, no one offered me or Jason a cuppa!
After 50 minutes I looked up the road and saw a yellow van coming around the roundabout. ‘Right Marilyn, I said, ‘the ambulance has arrived.’ I looked again and realised it was the Morrisons supermarket delivery van and then had to explain my mistake. So much for being reassuring. 10 minutes later the ambulance did appear and the paramedics scooped Marilyn up on a stretcher, popped her in the ambulance and whisked her away to hospital.
Bad Evolution and first aid courses
Ah, the tongue. I really don’t like the way the tongue has evolved because it can be deadly.
Of course it has lots of functions. Without our tongues we wouldn’t be able to taste anything, including things that taste off so we can avoid eating them. It helps us move food around our mouths for chewing and swallowing and allows us to articulate around 90 words per minute. Incidentally, the fastest speaking human is Sean Shannon, who set the record at a staggering 655 words per minute!! That guy’s tongue must have been moving at a phenomenal rate. He got through all 260 words of Hamlet’s soliloquy in 23 seconds. Astonishing!
The tongue protects the body in various ways and it helps us breather by keeping our airway open. Or does it? The tongue is a muscular organ and unfortunately, as with our other muscles, the tongue relaxes when we’re unconscious. I’m going to define unconscious here as an involuntary state we can’t be woken up from. Logically then, if we’re unconscious and on our backs the tongue can very easily relax with gravity, enough to block our airway and then we’ve got about 3-4 minutes left to live.
That’s bad evolution (you sometimes hear it called swallowing the tongue, which we can’t actually do) and bad news. The good news, and that’s what I like to focus on while I’m teaching, is that it’s extremely easy to sort out. With children and adults we use the head tilt, chin lift method as detailed here: https://www.youtube.com/watch?v=Y0KMpF5ztxA
We need to make sure we get the head right back though – I’m exaggerating but I tell my students to think of the casualty as a Pez dispenser. You’re only going to get the sweet out of the dispenser if you get the head back far enough and the same is true when it comes to the human tongue.
Then the best position for the casualty is the recovery position. Or is it?! Ah, that’s the second time I’ve asked a question like that in just a few paragraphs. But it’s a valid question because there are many instances where we really shouldn’t use the recovery position.
First though, let’s discuss why it’s a good idea. The recovery position is a first aid technique that:
• Keeps airway open
When someone is unconscious as we’ve said, their muscles relax, including the tongue, which can block the airway. The recovery position keeps the tongue from falling back and blocking the airway.
• Prevents choking
The recovery position prevents vomit or fluid from entering the airway and causing choking.
• Facilitates Drainage
The recovery position allows fluids to drain away from the airway without interfering with breathing
If the casualty stops breathing call 999 and start CPR
A lot of first aid instructors will advise you not to be too quick to put someone in the recovery position though, and very early on in my career I had this confirmed. In many cases the recovery position isn’t appropriate because the person has been injured. I always make a point of asking my students when they wouldn’t put a breathing person in the recovery position and almost all of them reply, ‘When the patient has a suspected neck or spinal injury.’ And that’s right of course but what if they have a possible broken leg or arm? The same thing applies because moving them would cause them pain and increase shock which can kill.
I may have written about my own mountain bike crash before but in case you haven’t yet heard (and thank you for reading this far even!) I received some quite nasty injuries when I came off my bike in August 2013 when, I believe as I have no memory of the crash happening, my front wheel slipped on a damp tree route. I crashed onto some very hard earth spraining my shoulder, breaking ribs, and spraining my right ankle (those were the most serious injuries).
The problem was that I was at the back so no one had seen me come off. I was conscious and breathing though – I’d hate to think what would have happened if I’d been knocked out and on my back – and my crash helmet was a mess. I also couldn’t stand up because my arm was a dead weight and my legs were very wobbly. My friend Tom came back up the hill to look for me after 5 minutes or so and he panicked slightly when I told him I couldn’t get up but even if he had been a first aider I would have never allowed him or anyone else to put me in the recovery position: it would have made me a whole lot worse and it’s why I left Marilyn in the position she’d been found.
Going back to a First Aid at Work course I taught in Milton Keynes early on in my career, a lady, then in her 20s, told me about how she’d been out cycling with a young lad many years before and he’d had a nasty crash. I don’t know the details of his injuries or what had caused the crash but a ‘helpful’ bystander had insisted on putting the lad in the recovery position and the shock was so bad it killed him. It was an awful thing to hear about but I mention it so that hopefully it’ll stop someone doing the same thing in future.
And when I think about all the people I’ve put into the recovery position over the years it really doesn’t add up to that many. Three people at the same time in Sharm El Sheikh airport when they got off a flight and the rest were drunk. Thinking about it, I dare say a good few people around the world ended up in the recovery position last night after their New Year revelry. I was at home doing my annual movie marathon with my wife and it was great! Shame about this weather today though. They’re saying it might even snow by the weekend.
Your Designated Body
So we’ve talked about good and bad evolution and the recovery position as well. In my research for this blog post I came across the following excerpt from Steve Laufmann’s book, Your Designated Body and I thought it so poetic that I have included it here as an epilogue. I hope that’s okay with his publishers because I want to use it to stress that my evolutionary gripe is with our tongues, not the rest of us!
‘In the human body, even a cursory look shows us that a lot is going on. Hands that wield a sledgehammer during the day can play evocative piano sonatas in the evening. In a triathlon, the same body swims, bicycles, and runs — three very different activities — in rapid succession and with extreme endurance. The same body that completed that triathlon can also climb a mountain (though perhaps on a different day).
Our bodies keep a constant internal temperature, manage our water levels effectively, and keep us going even when we eat the wrong foods. When we stand up, our blood pressure adjusts almost instantly to keep blood flowing to the brain. We know when we need food and water. Even with our eyes closed, we can sense the position of all our body parts and make detailed adjustments in movement.
Our eyes differentiate the nuances across an amazing spectrum of colors. The same eyes that work in painfully bright light can also see in almost total darkness. How do they turn light (photons) into information (electrical impulses), and how does our brain turn that into images?
Our ears face similar challenges, only they turn sound (pressure waves) into electrical signals. Further, they’re configured such that our minds can generate a three-dimensional understanding of the objects around us, just by the sounds those objects emit (or block).
When we cut our finger, the blood quickly stops and the wound scabs over and heals. When we get sick, our bodies generally do an excellent job of fixing the problem and getting well again.
While our bodies are neither the fastest, nor the biggest, nor the strongest in the animal kingdom, they are without question the most versatile. The human body’s range of capabilities boggles the mind.
On top of all this, we can make new people. Anyone who has experienced the birth of a child knows that in this astonishing process something special happens.’
If you’re looking for a first aid course in Milton Keynes or the surrounding area, contact me here
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