Analysis
Nick Triggle is a freelance journalist
Find out more Copies of the standards can be downloaded at tinyurl.com/njspmpw
EMERGENCY NURSE
Poisoning from carbon monoxide is not simply a winter problem Getty Images
numerous encounters with different healthcare professionals before presenting. One of the purposes of the standards, therefore, is to improve healthcare services in the community. Standards one to six concern the provision of safe primary care services for children, and preventing unnecessary ED attendance and admission. The other standards focus on enabling safe and speedy discharge, or on connecting the whole system. RCN Emergency Care Association chair Janet Youd thinks the standards could have a significant effect: ‘At weekends and evenings EDs are full of parents with young children. Having expert knowledge in the community is vital to reducing demand. This will require better communication between hospitals and GPs. Unfortunately, the systems do not always talk to each other, and we need to improve this.’ Ms Youd suggests, however, that these changes may have limited effect on attendances by teenagers. ‘Injuries and attendances linked to alcohol and substance misuse are quite common in this age group. This issue is different from [those that arise with] younger children.’ The report states that staff should see the standards as a ‘lever’ to improve services. Meanwhile, the colleges are committed to supporting healthcare organisations in the redesign of care services and is pushing for support at a national level. RCN head of nursing practice JP Nolan says that, for the standards to be met, specialist children’s nurses will be needed. ‘While some of the recommendations may seem aspirational, they are no more than children and young people deserve. ‘The obvious concern is that we do not have enough children’s nurses in the community to make this vision a reality. That is why our general election manifesto called for increased community resources and better workforce planning.’
Emergency nurses should be able to recognise signs and symptoms of illness caused by indoor barbecue use, writes Emma Dent WITH SUMMER on the way, emergency nurses should look out for symptoms of carbon monoxide (CO) poisoning among people using barbeques in confined spaces. Although most barbecue charcoal packaging states that the fuel should not be used in enclosed spaces, it rarely states why, which means barbecue users may be unaware of the dangers, warn experts. ‘Barbecue coals are a potent source of carbon monoxide poisoning. Just to leave it smouldering overnight in an enclosed space can cause death or serious injury,’ says accident and emergency consultant Ed Walker. Because CO is colourless and odourless, exposure to it usually goes unnoticed. Dr Walker, who works at Dewsbury and District Hospital, part of the Mid Yorkshire Hospitals NHS Trust, says that barbecue coals are safe when used in the open air, but can poison people who take barbecues into their homes or garages, for example when the weather worsens. ‘This is a dangerous thing to do. Nobody would dream of running a car engine inside a house but using a barbecue inside carries the same level of risk,’ says Dr Walker. Severe CO poisoning is likely to result in severe injury or death, Dr Walker says, while mild-to-moderate poisoning signs
and symptoms can be mistaken for those of common illnesses. Where poisoning is suspected, immediate treatment with continuous oxygen should be given immediately, and a hyperbaric oxygen therapy unit should be used as soon as possible, to avoid long-term neurological damage. Pregnant women should be referred for specialist advice because of risks to their fetuses. Signs and symptoms Dr Walker says: ‘If a person has been out in the fresh air after being exposed for a short period, the signs and symptoms, such as headache, nausea, excess lethargy, can be mistaken for those of a viral illness. ‘Children can exhibit gastrointestinal signs and symptoms, such as stomach aches, vomiting, diarrhoea, which can be easily associated with food poisoning. ‘If a whole family is taken ill after attending a barbecue in an enclosed space, it would be easy to blame what they have been eating rather than thinking that CO is the cause.’ Dr Walker warns that a recent increase in people having camping holidays in the UK has led to an increase in CO poisoning incidents. He says that people sometimes take barbecues inside their tents to keep warm, avoid the rain or because they are worried about the barbecues being stolen. ‘Over the winter, we are more likely to see these incidents occur in the home as a result of faulty cookers or boilers. But in the summer, they are often linked to people going camping, having barbecues and taking barbecues inside their tents,’ says Dr Walker. ‘There has been a spell of these deaths in recent years as more people have their holidays in the UK. Every year we hope the message will get out, but every year it happens.’ Emma Dent is a freelance journalist
Find out more Read more about the dangers of carbon monoxide at covictim.org May 2015 | Volume 23 | Number 2
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 06, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
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Nick Triggle is a freelance journalist
Find out more Copies of the standards can be downloaded at tinyurl.com/njspmpw
EMERGENCY NURSE
Poisoning from carbon monoxide is not simply a winter problem Getty Images
numerous encounters with different healthcare professionals before presenting. One of the purposes of the standards, therefore, is to improve healthcare services in the community. Standards one to six concern the provision of safe primary care services for children, and preventing unnecessary ED attendance and admission. The other standards focus on enabling safe and speedy discharge, or on connecting the whole system. RCN Emergency Care Association chair Janet Youd thinks the standards could have a significant effect: ‘At weekends and evenings EDs are full of parents with young children. Having expert knowledge in the community is vital to reducing demand. This will require better communication between hospitals and GPs. Unfortunately, the systems do not always talk to each other, and we need to improve this.’ Ms Youd suggests, however, that these changes may have limited effect on attendances by teenagers. ‘Injuries and attendances linked to alcohol and substance misuse are quite common in this age group. This issue is different from [those that arise with] younger children.’ The report states that staff should see the standards as a ‘lever’ to improve services. Meanwhile, the colleges are committed to supporting healthcare organisations in the redesign of care services and is pushing for support at a national level. RCN head of nursing practice JP Nolan says that, for the standards to be met, specialist children’s nurses will be needed. ‘While some of the recommendations may seem aspirational, they are no more than children and young people deserve. ‘The obvious concern is that we do not have enough children’s nurses in the community to make this vision a reality. That is why our general election manifesto called for increased community resources and better workforce planning.’
Emergency nurses should be able to recognise signs and symptoms of illness caused by indoor barbecue use, writes Emma Dent WITH SUMMER on the way, emergency nurses should look out for symptoms of carbon monoxide (CO) poisoning among people using barbeques in confined spaces. Although most barbecue charcoal packaging states that the fuel should not be used in enclosed spaces, it rarely states why, which means barbecue users may be unaware of the dangers, warn experts. ‘Barbecue coals are a potent source of carbon monoxide poisoning. Just to leave it smouldering overnight in an enclosed space can cause death or serious injury,’ says accident and emergency consultant Ed Walker. Because CO is colourless and odourless, exposure to it usually goes unnoticed. Dr Walker, who works at Dewsbury and District Hospital, part of the Mid Yorkshire Hospitals NHS Trust, says that barbecue coals are safe when used in the open air, but can poison people who take barbecues into their homes or garages, for example when the weather worsens. ‘This is a dangerous thing to do. Nobody would dream of running a car engine inside a house but using a barbecue inside carries the same level of risk,’ says Dr Walker. Severe CO poisoning is likely to result in severe injury or death, Dr Walker says, while mild-to-moderate poisoning signs
and symptoms can be mistaken for those of common illnesses. Where poisoning is suspected, immediate treatment with continuous oxygen should be given immediately, and a hyperbaric oxygen therapy unit should be used as soon as possible, to avoid long-term neurological damage. Pregnant women should be referred for specialist advice because of risks to their fetuses. Signs and symptoms Dr Walker says: ‘If a person has been out in the fresh air after being exposed for a short period, the signs and symptoms, such as headache, nausea, excess lethargy, can be mistaken for those of a viral illness. ‘Children can exhibit gastrointestinal signs and symptoms, such as stomach aches, vomiting, diarrhoea, which can be easily associated with food poisoning. ‘If a whole family is taken ill after attending a barbecue in an enclosed space, it would be easy to blame what they have been eating rather than thinking that CO is the cause.’ Dr Walker warns that a recent increase in people having camping holidays in the UK has led to an increase in CO poisoning incidents. He says that people sometimes take barbecues inside their tents to keep warm, avoid the rain or because they are worried about the barbecues being stolen. ‘Over the winter, we are more likely to see these incidents occur in the home as a result of faulty cookers or boilers. But in the summer, they are often linked to people going camping, having barbecues and taking barbecues inside their tents,’ says Dr Walker. ‘There has been a spell of these deaths in recent years as more people have their holidays in the UK. Every year we hope the message will get out, but every year it happens.’ Emma Dent is a freelance journalist
Find out more Read more about the dangers of carbon monoxide at covictim.org May 2015 | Volume 23 | Number 2
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 06, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
9
