Why was splinting removed from First Aid at Work?

The above is bit of a misleading statement. At Marlin splinting never was removed from First Aid at Work training, but it seems that for many other organisations splinting protocols simply aren't being taught. "Call the ambulance" has become the 'First Aid Protocol'.

The Health and Safety (First-Aid) Regulations 1981 (amended 2018) state in "what should be in a First Aid at Work Course:

  • administer first aid to a casualty with:
    – injuries to bones, muscles and joints, including suspected spinal injuries; – chest injuries;
    – burns and scalds;
    – eye injuries;
    – sudden poisoning;
    – anaphylactic shock;
  • recognise the presence of major illness (including heart attack, stroke, epilepsy, asthma, diabetes) and provide appropriate first aid.

It should be noted that it states "administer first to bones, muscles and joints. Further this is detailed in the section with other first aid treatments, such as treating burns with water or washing something out of an eye. 

The European Resuscitation Council also give advice on splinting: European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid

"Do not straighten an angulated long bone fracture: Protect the injured limb by splinting the fracture. Realignment of fractures should only be undertaken by those specifically trained to perform this procedure."

This is clear advice to splint fractures, but not to straighten angulated fractures in a first aid setting. This is what we teach on our courses.

 The NHS also give advice on when to call an ambulance. It is clear that these should be reserved for "life threatening emergencies" and a simple fracture is NOT one of these. The NHS advice on broken bones states, "go to your nearest A&E for a broken arm or leg. Call 999 for an ambulance if the injury seems severe". It certainly does not state "just call an ambulance if you think someone has broken a bone', as seems to be advocated on so many First Aid at Work courses.

So, at Marlin we teach a pragmatic approach to broken bones and splinting:  “Do as little as you need to do, not as much as can be done”.

1.       Assessment

2.       Pain Management

3.       Treatment

Not to splint:

Let's take the example of a simple closed fracture of a forearm or ankle. It isn't bleeding externally and isn't life threatening. The patient may be in considerable pain, not want to move and be content to sit and hold it in place until an ambulance arrives. That's fine, however as a first aider it is sensible to let them know that it isn't a life threatening emergency and they might be waiting hours for an ambulance to arrive! The author's own 90 yr old step-mum spent 7 hours waiting for an ambulance to take her to hospital with a broken hip only a few months ago.


Alternatively the patient may consent to splinting the fracture:

A splint prevents further movement, stops the fracture becoming worse (or the bone popping out turning a closed fracture to an open one). It also dramatically reduces pain by preventing motion. A simple splint for a forearm or ankle can be made using a rolled up newspaper or cardboard box, both found easily in most workplaces. Once the pain has been lessened the patient may then consent to being taken in a car or taxi to the local A&E department.

In a recent scenario one of our students treated a suspected broken ankle by immobilising it with tape and pieces of a cardboard box. The patient attended A&E and staff complimented the first aider on the job they had done (using the skill taught on our FAW training).


Unfortunately despite the clear advice, many still will not teach any splinting in first aid. In some case this advice comes from large organisations themselves, whereas in other cases it is under-qualified instructors not having the confidence to teach splinting.

We are proud to be an organisation that teaches splinting routinely to our students:

 They are easy to improvises and can reduce pain dramatically. They save unnecessary 999 calls. First aiders shouldn't be frightened of them.

At Marlin we constantly look at what we teach and why we teach it.

In the last few years we have changed our protocols in many areas to offer our customers, and their staff, the most up to date and evidence based training possible. This means that at times what we teach will 'fly in the face' of what some other organisations are teaching. However, we would rather lead the way with effective evidence based training and let the others follow our lead.


Tourniquets: Debunking the Myth

On a recent course we received criticism for teaching tourniquets in First Aid at Work. It seems that many organisations, including some of the Voluntary Aid Societies still won't teach them. This blog will look at the reasons we do teach tourniquets and hopefully debunk a few myths along the way.

In the 2015 European Resuscitation Council (ERC) Resuscitation Guidelines it states:

"Use a tourniquet when direct wound pressure cannot control severe external bleeding in a limb. Training is required to ensure the safe and effective application of a tourniquet".

Subsequently to these guidelines being released  I attended a meeting of the HSE First Aid at Work Quality Partnership that looked at how this statement from the ERC could be implemented. Following pressure from some of the members of the group it was decided that tourniquets should be taught "where risk dictated their use", eg chainsaws, moving machinery, etc, not to every first aider. Many members of the group were not happy with this position, however the guidelines of the group mean I cannot say more about what was actually said at the meeting...

Following this meeting we were left with the situation where many organisations subsequently taught tourniquets and some didn't.

In 2017, the Royal College of Surgeons Faculty of Pre-Hospital Care released a Position statement on the application of Tourniquets. This brought civilian protocols in line with established and proven military protocol and gave a definitive protocol for their use.

Unfortunately their are still considerable myths about the use of tourniquets: 

"They will lose the limb if you apply a tourniquet", 

"I wasn't taught tourniquets on my last course and was told they are dangerous"

"You are being irresponsible teaching them"

We have heard all of these on courses and they are all myths, not backed up by research and medical evidence.

Following extensive use in military situations, and a wealth of good research, there is now considerable evidence that tourniquets are effective, save lives and have a relatively low rate of complications following application. In a 2018 research study, Teixeira & Brown (1) examined the use of tourniquets in a Civilian Prehospital environment. They found an increased survival rate compared to those without tourniquet applied. However, perhaps more importantly there was no increased likelihood of amputation as a result of tourniquet application.

In 2017 Citizen Aid was launched. This award winning initiative was designed to teach the public what to do in case of a terror attack. The founders are legends in UK medicine and include Brigadier Professor Tim Hoggetts (Senior Health Advisor to the British Army and Honorary Professor of Emergency Medicine at the University of Birmingham) and Professor Sir Keith Porter (Clinical Professor of Traumatology at the University of Birmingham and Head of Traumacare).  Professor Sir Keith Porter also heads up "Traumacare" an organisation set up to "Increase Survival from Roadside to Recovery".

CitizenAid tackle the problem of not teaching tourniquets in an article on their website:  CitizenAid: Debunking the tourniquet myth

This article is well worth a read as it shows the clear frustrations of the UK's top trauma surgeons and founders of CitizenAid over torniquets in First Aid.

"The dogma that tourniquets can never be used is one that is still deep-rooted in the first aid community, despite the work of the informed to dig this out. The reality is that tourniquets are used in the operating theatres of our hospitals every day, to control blood loss while undertaking surgical procedures on limbs. In addition, the use of tourniquets during contemporary military operations has saved many lives from otherwise uncontrollable bleeding in amputated or mangled limbs. The evidence is published. And the soldiers who have survived blast injury having suffered single, double and even triple limb amputations are a testament to this.

So why does this mythology persist? The rationale for a tourniquet is life-threatening limb bleeding that cannot be controlled by other means. If this rationale is followed, a tourniquet can only ever do good. The alternative is that the patient will die.

The argument of harm assumes that tourniquets will be applied inappropriately, for injuries that are not life-threatening and that there will be no means of reassessing this within a time period in which avoidable harm occurs.

Unfortunately, the inverted logic of preventing the use of life-saving equipment disenfranchises the very patients that can be saved by the public in the early minutes following severe injury. It is a lazy logic of risk aversion, with the assumed belief that there will be no blame attached to withholding a tourniquet. This is a dangerous assumption. With the wealth of evidence that now surrounds the value of using a tourniquet, it will be difficult to argue that a death attributed to limb bleeding is anything other than avoidable. Where an active decision has been taken to dissuade the use of a tourniquet in these circumstances, how will that decision be justified morally and legally?"

We stand wholeheartedly by this statement from CitizenAid.
CitizenAid was designed to help the public perform lifesaving first aid in terror incidents and there is evidence that it has worked. We are proud to support the principles of CitizenAid in our training. Download the App and tell your friends/colleagues too!

We understand that a tourniquet was applied in the Manchester Arena bombing using the CitizenAid app as advice.

In the London Bridge terror attack again an improvised tourniquet was applied.

In both cases lives were saved due to the quick thinking of bystanders, who didn't listen to the myths about tourniquets.

Let's be frank, if they had not applied improvised tourniquets quickly, then the casualties would most likely have died before medical assistance arrived. Major bleeding can result in death in a matter of minutes and certainly before an ambulance arrives!

So, we are proud to be an organisation that teaches tourniquets routinely to our students:

 They are easy to apply and first aiders shouldn't be frightened of them.

At Marlin we constantly look at what we teach and why we teach it.

In the last few years we have changed our protocols in many areas to offer our customers, and their staff, the most up to date and evidence based training possible. This means that at times what we teach will 'fly in the face' of what some other organisaions are teaching. However, we would rather lead the way with effective evidence based training and let the others follow our lead.

  1. Teixeira PGR, Brown CVR et al.  (2018) "Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury".  Journal of the American College of Surgeons.  226(5), 769 - 776.e1


New Store Open

We are please to launch a new webstore for first aid kits. Click on the new tab in the top bar!

Lots of new items going on soon!

Defibrillator Drones - Ambulance of the Future

A graduate in Holland has invented the 'Ambulance Drone'. Bypassing traffic jams, this can can get to an emergency scene 10 times quicker than an ambulance and has a portable defibrillatro on board.

I's all still in 'drawing board stages yet, but it sounds qute likely a manufacturer will take this up.

There is a promotional video of the drone in action if you follow the link. Very cool.


A Tick Bite Could turn you Vegetarian!

An Article on iO9 today quotes a new research study. This indicates that a tick bite can cause the body to release antibodies making you allergic to eating meat.

Another reason why we teach about tick bite on our outdoor/fieldwork first aid courses and promote the OTom tick remover in kits - get them off you before they feed!

Full details and link below:

Ticks are known for transmitting disease, but they've also been known to make people deathly allergic to meat.


Amazing new solution to bleeding!

Celox™ is an amazing new compound that stops bleeding fast.

It has been extensively tested by the US Military and it works! Surprisingly though it is actually made here in the UK.

At Marlin we have been looking into the research surrounding Celox™. We believe that it is extremely effective and easy to use. Just tip it on a major wound and then apply pressure with a bandage. It clots virtually instantly and will control even major arterial bleeds. For this reason we would strongly recommend it's inclusion in outdoor and fieldwork first aid kits, particularly those to be used on remote trips.

Follow these links to learn more:

Celox™ stops bleeding and saves lives on the battlefield

Celox™ from Sam Medical

We have now been appointed an agent for Celox by the UK manufacturer. A pack costs as little as £15 and could just save someone's life.

You can download a data sheet and order form below.

Girl Dies at Swimming Pool in Leicestershire - Lifeguard Training Criticised by Coroner

 A sixteen year old swimmer died in a pool in Braunstone Leisure Centre in Leicestershire last September. The Mail, BBC news and other have reported that she could have been saved with better training.

The Mail reports:


Miss Butler (the lifeguard) who had never tried to revive a swimmer before, believed she had saved Sophie when she started breathing again.However, she did not take the crucial step of checking for a pulse - to determine whether the heart had restarted - and unwittingly left Sophie dying on the wet floor. Paramedics arrived four minutes later and resumed CPR, only to be asked by one of the lifeguards: 'Why are you doing CPR? She's alive,' the hearing was told. As a paramedic gave evidence to the inquest, the teenager's distraught mother, Lesley, 46, broke down in tears and cried out: 'It's my child's life, why didn't anybody do anything?


'How could you just leave her lying there? She would have survived.'

The ambulance crew tried to revive Sophie, a talented swimmer who dreamed of winning an Olympic gold, with a defibrillator at the leisure centre in Braunstone, Leicester, on September 15 last year. However, she was pronounced dead shortly afterwards at the city's Royal Infirmary. The inquest heard Sophie's initial cardiac arrest was caused by an undiagnosed heart condition.

Heart expert Dr Christopher Duke said Sophie 'would have survived' if she had received continuous CPR. He said: 'You don't stop resuscitation just because a patient appears to be breathing. You only stop if there's breathing and a pulse. The inquest on Wednesday heard that Miss Butler, who was employed by Leicester City Council and was performing CPR for the first time, spent four minutes trying to revive Sophie and believed she had succeeded when the teenager began breathing.

She said: 'If a person is breathing we're told to stop CPR and put them in the recovery position.' Sophie's heart was not restarted by defibrillator until 4.52pm - 14 minutes after she was pulled out of the pool. The inquest heard the lifeguards had been trained by the Royal Life Saving Society, a charity which provides training and education in lifesaving. Recording a narrative verdict, coroner Catherine Mason said she would write to the Resuscitation Council of the UK, which provides guidelines for life-saving techniques, to ask it to amend its training guidelines to include checking for a pulse. Mrs Mason, coroner for Leicester and South Leicestershire, said: 'The crucial point of this is that the CPR was stopped.


'The guidelines should be changed so that from when CPR commences it is conducted until a medically qualified person arrives or the patient regains consciousness.'

After the inquest, Mrs Konderak and Sophie's father, John, said the 'shortfall in the level of training and equipment' contributed to their daughter's death. They added: 'We hope the coroner's recommendations will lead to an improvement in lifesaving training and no further lives will be lost.'



The Association of First Aiders have also been asked to comment on this incident. They have stated:

The casualty could have easily re-arrested causing death. Detecting a pulse (or the absence of one) would have identified the need to continue CPR. However, it is feasible the first aider misinterpreted 'Agonal' breathing (which is a sign of dying) with 'Normal' breathing (a sign of life). If this is the case, ineffective training may be the problem not the first aider or the Resuscitation Councils' guidelines.



After the inquest, Mrs Konderak and Sophie's father, John, said the 'shortfall in the level of training and equipment' contributed to their daughter's death. They added: 'We hope the coroner's recommendations will lead to an improvement in lifesaving training and no further lives will be lost.'

I would like to believe that students on our courses would not make the same mistake. The resuscitation council changed the guideline to remove the pulse check a few years ago because bystanders were not starting CPR when they needed to. First Aiders often thought they detected a pulse when one was not present. In our experience pulse checks are very difficult when you are panicking!

Stuart Marshall, Director of Marlin Training says: On our courses we always stress the importance of checking for 'normal breathing'. The girl in this case was exhibiting 'agonal breathing (the last death throws). Agonal breathing is present in up to 40% of pre-hospital cardiac arrests. Agonal breathing can sound like gasping, snorting, gurgling, moaning or laboured breathing. It is NOT 'normal' breathing. For several years now we have recognised the importance of first aiders recognising agonal breathing and have shown  videos of 'agonal gasps' so that our students know that these are not normal breathing and continue CPR. We have also said ; "It's probably best to continue CPR until either you are exhausted, someone else takes over, or the patient kicks you off their chest".

If you want to see agonal breathing watch these two videos and remember not to stop until NORMAL breathing returns.







FREE First Aid Kit or iPod for recommending us!

At Marlin we get much of our business by recommendation. If you have been on one of our courses you know all about the 'Marlin Difference'. If you subsequently recommend Marlin to another company (and they book a course) we will provide you with either a suitable first aid kit or an iPod shuffle.

Dr Natasha Lee had previously taken a course with us at Edinburgh University and recommended us to her new employer the Hereford & Worcester Earth Heritage Trust. She is pictured receiving her comprehensive Outdoor First Aid Kit worth £80 from Stuart Marshall, the course tutor and one of Marlin's directors. Thanks again for your recommendation Natasha!

Are they really approved to teach you?

Unfortunately we seem to keep coming across students who have taken courses with other training providers only to find out later that it is not worth the paper it is printed on.

In 2013 the HSE deregulated first aid, leading to a "free for all" in First Aid training. There is now no longer such a thing as "HSE Approved" First Aid Training (although many still advertise as such).

We are members of the First Aid Industry Body.

This organisation monitors training using ex-HSE inspectors, including doctors and nurses to physically monitor the quality of courses.

Marlin passed monitoring recently with flying colours.

Unfortunately since deregulation many bodies are so keen to sell certificates that they will approve almost anyone to teach first aid, and providing the QA forms say the course was OK, then it must have been...

We would advise that you look at the pedigree of the training company, and not just the approvals they hold. Our staff have many years of experience, advanced qualifications and undertake regular CPD with organisations such as Traumacare.

One of our directors also sits on the board of the First Aid Industry Body and attends industry meetings with the HSE, etc. This translates into the most up to date training for your staff.

Association of First Aiders

Marlin has recently upgraded to Full Corporate Training Membership with Association of First Aiders (AoFA). The AoFA is now the UK's LARGEST first aid association with over 2,000 first aiders, first aid trainers and training providers. Upgrading to our current status means that our certificates now gain National Recognition and HSE Approval from the AoFA. The AoFA also monitor the quality of all courses to ensure that they meet the highest standards.

The HSE have stated that they strongly support the formation of the Association of First Aiders (Dr Richard Elliott. HSE Corporate Medical Unit).

The AoFA is also linked to mainly national associations, including the Stroke Association and also the Royal College of Surgeons (Edinburgh). This means that Marlin is able to keep our courses bang up to date with the latest medical advice. We also have £2 million liability and indemnity insurance via the AoFA - something that many training organisations just cannot get, but often essential for working with most companies - or your own insurance may not be valid should something go wrong on a course!

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