What to do in an Emergency

A medical emergency can present itself at any moment and at any place. Should you be faced with a medical emergency, call ER24 on 084 124 immediately for assistance and advice.

Accidents

Minor incident

  • If you are involved in a collision, stop the vehicle (in cases where you are uninjured or have sustained minor injuries and assuming that the vehicle is still in working order in cases of bumper bashings etc).
  • Do not leave/flee the scene. Get your vehicle to a safe area on the side of the road if possible to avoid further possible incidents.
  • Give your name and address, the name and address of the owner of the vehicle where necessary as well as the registration number and your driver’s licence details where required to do so. Report the incident at a police station within 24 hours.
  • While on the scene of a collision, try to stay calm. Assess the situation to determine the best way to handle it. Make use of hazard lights and an emergency triangle to alert passing motorists. There are instances where secondary collisions occur. Hence, you should ensure scene safety. Assess traffic flow and determine if it poses a danger to anyone including those involved in the collision or others around.

Serious incident

  • Ascertain the nature or extent of the incident – Is everyone who was travelling in your vehicle accounted for (people could have been ejected from the vehicle for example)? Are people who were travelling in the vehicle you were in injured? Are people in other vehicles involved in the collision injured? Are people trapped in vehicles? Is there a fire? Are patients lying on the road?
  • Call emergency services immediately or instruct someone to do so immediately. You should always have important contact details, such as emergency services and the SAPS, stored on your phone. ER24 has a dedicated, 24/7 Emergency Contact Centre that enables you to request an emergency vehicle telephonically. Call 084 124 in case of an emergency. Remember that the information you are requested to provide and the information you supply is often the first point where a life can be saved.
  • Where first aid is needed, start immediately if you are able to do so. You should always carry a first aid kit in your vehicle. If a patient you are with is unconscious, open their mouth to check if there is something inside that is causing an obstruction. Check if the person is breathing. If the patient is breathing, leave them in the position you found them in and monitor them. If the patient is not breathing and you have been trained to do so, initiate CPR.
  • If a wounded person is bleeding heavily, take gauze or sterile dressings from the first aid kit and place it on the wound. If gauze or sterile dressings are not available, use a towel, t-shirt or blanket for example. Press the gauze or other material tightly, applying direct pressure to the wound. Maintain that pressure until emergency services arrive. Do not stop pressing to check if there is continued bleeding or to look at the wound.
  • Never move an injured person unless for their own safety (for example, if the vehicle is on fire or if there are other threats). Remember that moving a person could make their condition worse, hence it is not advisable unless vital to do so.
  • If there is a fire, use a fire extinguisher. You should always carry a fire extinguisher in your vehicle and also know how to use it.
  • Remember that while it is important to assist a patient, you should also ensure your safety. Do not attempt anything that may jeopardise your own safety. You are of no use to anyone if you are injured while attempting to help others. Also remember, never touch a person’s blood or try to assist them without proper protection such as gloves.
  • Remember to guard children or ensure that they are safe or supervised on an accident scene.

Other important information: If you are a passing motorist, pay attention to the road ahead, slow down and drive cautiously. If you stop to assist patients, ensure that you stop your vehicle in a safe area where you do not pose further danger or an obstruction. Everyone should go for first aid and CPR courses.

CPR

High quality cardio pulmonary resuscitation (CPR) improves a victim’s chance of survival.

  • When you find someone unconscious and unresponsive, try and rouse them. Check whether they are breathing. If you cannot wake them and they are not breathing or gasping, emergency help must be called immediately. Lay the person on their back on a flat surface.
  • Call ER24 on 084124
  • If possible, place the phone on speaker next to you. The emergency call taker will provide you with telephonic assistance. Remain calm and speak clearly.
  • Start compressions immediately if no signs of life.
    • Push hard and fast at a rate of 100-210 compressions per minute.
    • 5-6 cm deep for adults
    • 4 cm deep for children
  • Continue to perform chest compressions until the person revives or when professional help arrives on scene.

If you have an AED, apply the AED and follow the instructions.

Drowning

What to do if someone is drowning?

  • If you are at the coast and you see a person drowning, alert a lifeguard immediately. If you decide to save the person yourself, ensure you wear a floatation device and call for help as soon as possible.
  • If you find a person drowning and are able to get them out of the water, initiate CPR if there is no pulse and breathing
  • Do not stop CPR unless the victim starts to breathe on his/her own.
  • Call for an ambulance as soon as possible and tell them what you are doing so they can send the correct level of care.
  • Do not put the person in the car and drive to hospital.
  • In case of a non-fatal drowning, seek medical attention as soon as possible and explain clearly to medical staff what has happened. The person may seem okay but may deteriorate at a later stage.
Bites and Stings

South Africa is home to a rich variety of insects and arachnids, and many are found in our homes and gardens. Bees, wasps, scorpions, hornets and spiders can pose a risk, particularly to young children.

Here’s what you need to know about common bites and stings:

Bees, wasps and hornets 

Generally, a sting from a bee or hornet will only result in a localised reaction, although it may result in life threatening symptoms in people who are highly allergic to bee venom. Local reactions include:

Burning: lasting between one and two hours then followed by itching.

Swelling: which can continue for 24 hours and only subside after seven days.

Redness: This can last up to three days and is usually not caused by infection.

Treatment for mild reactions to stings

Only bees leave a stinger behind. Some say not to squeeze the stinger when you remove the sting; but rather use tweezers or a clean credit card and ensure you remove it completely. If it is below the skin’s surface, leave it there to fall out naturally. For pain and itching, apply ice or a cool compress for 20 minutes to bring relief, and some doctors may recommend over-the-counter pain medication such as ibuprofen, or an antihistamine.

Severe allergic reactions

The biggest risk associated with bee stings is that the small amount of venom they release may trigger an allergic reaction and lead to anaphylaxis, a severe life threatening allergic reaction.

Anaphylaxis occurs when your body develops a severe allergic reaction to something, such as food, medication or stings. Symptoms include:

  • Swelling of the tongue, throat, body
  • Suddenly developing a hoarse voice
  • Rash, often itchy hives and/or redness
  • Feeling lightheaded or fainting episodes
  • Tight chest, wheezing or difficulty breathing
  • Abnormally fast heartbeat
  • Clammy skin
  • Confusion
  • Vomiting or stomach pain
  • Sense of impending doom

Treatment for severe allergic reactions to stings

If someone in your family experiences any of the above symptoms after a sting:

  • Administer auto-injectable epinephrine (adrenaline) if it has previously been prescribed and is on hand. (In some people who are high risk or suffered previous life threatening allergic events doctors will likely have given them adrenalin to keep on hand in case of emergency in the form of an EpiPen, as early intervention is imperative), and
    • Lie the person down with their feet elevated, and,
    • Call an ambulance urgently.

In severe allergic reactions, a person will likely be monitored in hospital (at times ICU or high care) until their symptoms have resolved. After recovery, the person who had the reaction would need to see a GP or a doctor specialising in allergies to formulate a treatment and prevention plan for future exposures to the insect.

Spiders and scorpions

If you are bitten by a spider or scorpion it helps to carefully catch the spider or scorpion and bring it along to the hospital so that doctors know exactly how to treat the bite or sting.

Spider bites

Fatalities from spider bites in South Africa are extremely rare. The most dangerous spiders in South Africa include black and brown button or widow spiders (Latrodectus species), sac spiders and the violin spiders. The button spiders are neurotoxic spiders as their venom causes widespread effects on the nerves and muscles. The latter two are known as cytotoxic spiders because their venom can destroy cells.

While larger spiders such as baboon and rain spiders can attack and bite if threatened, they are not poisonous. If children are bitten by larger spiders, they will require a lot of reassurance and some wound care. It is always good to check the status of your tetanus immunisation after any spider bite, as the spores of the tetanus bacteria may be found in the mouth parts of spiders. If you have not had a booster in the past 5 years this is a good time to have one.

Black button spider bites

Black and brown widow button spiders are fairly common in homes and particularly in gardens across South Africa.

Symptoms: Immediate, burning pain that spreads to the lymph nodes within 15 minutes. Generalised and often intense muscular pain and cramps develop within an hour. Anxiety, sweating and a general feeling of weakness also follow. Other symptoms may include rigid muscles, a racing pulse, involuntary movement of the limbs and a flushed face. In one in three cases there is no detectable bite.

Treatment: It is important to take the victim to their GP or the emergency room if they have any systemic symptoms. Antivenom to these spider bites is available at hospitals and depending on the severity of symptoms may be administered in the Emergency Unit in hospital. Other treatments and procedures also include intravenous fluid, performing and ECG and if antivenom is given, being monitored for allergic reactions or side effects to the antivenom itself. The elderly and small children are most at risk of complications. Fortunately, there have been no reported deaths from black button bites in South Africa since the 1960s.

Brown button spider bites

Symptoms: The reaction to a brown button/widow spider bite is usually milder than the reaction to a black button/widow spider bite. For adults, this includes a burning sensation at the site of the bite and pain in the regional lymph nodes. The surrounding muscles may feel stiff while the skin presents with a tingling sensation. Some patients experience muscular pain and weakness in the legs and a low-grade fever. Children may present with restlessness and hyperactivity.

Treatment: A bite is detectable but does not normally require treatment. The reaction, while unpleasant, should clear up within three days. However, small children and the elderly should receive medical observation as a precaution because they may experience more severe symptoms.

Cytotoxic spiders

Cytotoxic spiders such as sac and violin spiders are widely distributed in South Africa. Sac spiders are often found in the home and are known to be aggressive while violin spiders are rarely found in urban areas and will tend to hide in crevices.

Symptoms: Most often the patient is unaware of being bitten although fang marks are often present and a red mark usually appears. The bite becomes painful between 12 and 24 hours and may develop blisters. Usually, these spider bites heal spontaneously. In rare cases, however, the bite results in systemic illness including fever and malaise between 3 and 5 days after the bite. The tissue around the bite may die off and leave a slow-healing ulcer that can take weeks to heal.

Treatment: Patients should seek medical attention if they suspect that a cytotoxic spider has bitten them. Treatment is usually symptomatic and focused on preventing and treating secondary infections and complications. However, patients will often recover without medical intervention.

Scorpions

Most scorpions are harmless but a few species can cause life-threatening systemic envenoming (poisoning in the body).

One useful rule of thumb is that scorpions with thick tails and slender pincers are more venomous than those with slender tails and large pincers, as scorpions that use big, strong pincers to catch their prey, seldom have a very venomous sting at the end of their tail! A second important feature is the size of the scorpion. A scorpion smaller than 4 cm in length (when uncurled) is very unlikely to cause serious envenomation. The two most dangerous scorpions are the amber-coloured Parabuthus granulatus and the black-coloured Parabuthus transvaalicus.

Most deaths are attributed to the Parabuthus granulatus. Small children are especially at risk from scorpion stings, as they can develop respiratory failure and may die. It is essential to seek urgent medical attention if a scorpion sting occurs, especially in children. Symptoms are similar to those associated with a button spider bite although the burning pain is more severe, there is often associated pins-and-needles, sweating, agitation, and generalized muscle pain. Difficulty breathing and visual disturbance can also occur. Children most often develop marked restlessness and irritability. Antivenom to these scorpions is available at hospitals and may be administered, if required, in the Emergency Unit or High Care ward.

If you’re unsure of what to do about a bite or sting, the best option is to call the Poison Information Helpline (0861 555 777) or visit your closest emergency room or GP, especially if the patient is a small child. Home remedies are best avoided unless recommended by your doctor.