At first glance, the title of the news “Ministry of Health: the elderly fell to help or not to help depends on the situation”, many people have doubts in their minds: how can the Ministry of Health so released? Help a fallen old man still have to be divided into circumstances? Help a fallen old man is a traditional Chinese virtue ah! This is the kind of education we have received since we were young. This kind of reaction reveals the lack of first aid knowledge and even ignorance of the public. When I opened the text, it turned out that the Ministry of Health issued the “Falls Intervention Technical Guidelines for the Elderly”, which suggests: do not rush to help up, but deal with the situation. See the old man fell to the ground, if rashly to help, to pull, let the old man eat pain is a small matter, in case of exacerbation of his condition, leading to adverse consequences, that is a tragedy. The phrase “don’t rush to help” is not the same as being indifferent. The following is a detailed description of the Technical Guidelines for Falls Intervention for the Elderly, which explains what should be done when an elderly person falls. 1, the hazards of elderly falls China has entered an aging society, the elderly aged 65 and above has reached 150 million. With economic development and social progress, human beings live longer. Longevity is a good thing for human progress, but how to live a healthy, high-quality life is the challenge faced by every long-lived elderly. Falls, on the other hand, are one of the common injuries in the elderly population and are defined as any part of a person’s body (excluding the feet) accidentally touching the ground. About 30% of older adults fall one or more times each year, and the probability of falling increases with age, with an annual incidence of falls as high as 50% for those over 80 years of age. Falls not only cause multi-organ injuries such as brain, soft tissue, fractures and dislocated joints or death, they also hurt the dignity and self-confidence of older people. In addition, a number of elderly patients with limb injuries are often bedridden for too long causing complications such as bedsores, pneumonia, urinary tract infections, vascular embolism, constipation and intestinal obstruction. Falls reduce the mobility of the elderly and can lead to serious physical, psychological and social dysfunction, which is one of the important causes of disability, death and increased economic burden of the elderly. According to statistics, there are at least 20 million elderly people in China every year, and 25 million falls result in hospitalization, with a direct medical cost of more than 5 billion RMB and a social cost of 16 to 80 billion RMB. Falls are the number one cause of injury and death among the elderly, and are a geriatric healthcare issue that must be emphasized. It can lead to poor quality of life and living for the elderly in a split second. 2.Why older people are prone to falls The older the older the person, the more likely they are to fall. Surveys show that people aged 65 and 80 have a 30% and 50% chance of falling each year respectively. The causes of falls in the elderly include physiological factors, psychological factors, environmental factors, behavioral factors, drug factors and disease factors, among which disease factors include: neurological diseases, skeletal system diseases, sensory disorders, cardiovascular diseases, blood metabolism diseases, psychiatric disorders and other chronic diseases. The common causes are mainly as follows: (1) Vision loss. The visual organs of the elderly begin to degenerate, and some of them also suffer from cataract, glaucoma, macular degenerative disease and other diseases, resulting in weakening of the sensitivity of their vision or reduced vision at night, which will easily make them trip over obstacles. (2) Gait disorder. Older people often lean forward and shift their center of gravity when walking, forming a waddling gait, which makes them easy to fall. Elderly people suffering from cerebellar tumors, cerebral hemorrhage or vestibular disorders may also fall easily because of gait disorders. (3) Cardiovascular diseases. Elderly people often suffer from cardiovascular and cerebrovascular diseases, such as hypertension, coronary heart disease, cerebral arteriosclerosis, insufficient blood supply of vertebral basilar artery, cardiac arrhythmia and so on. These diseases can lead to transient insufficient blood supply to the brain, resulting in cerebral ischemia and hypoxia, causing sudden brain dysfunction, loss of consciousness and fainting. (4) Osteoporosis Elderly people with osteoporosis are prone to fall or fracture due to poor joint function. (5) Effects of drugs. Most of the elderly often suffer from a variety of chronic diseases, need to take a variety of long-term drug treatment. Such as sedative-hypnotic drugs, antihypertensive and diuretic drugs, vasodilator drugs, etc. can affect the patient’s mental, spiritual, visual, gait, balance, blood sugar, blood pressure and so on, which can easily cause the fall of elderly patients. (6) Environmental factors. Elderly people go out from home, unfamiliar with the temporary residence or activity place, especially the uneven road surface, water, insufficient light, irregular staircase, loose carpet, broken, cluttered environment, roadside demarcation is not clear, the floor is too slippery outside, toilets, bathrooms, corridors, no handrails, beds without guardrails, get in and out of the car, etc., encountered the above situation, a little inattention to the fall is prone to fall. (7) Psychological factors. Elderly people live alone, more alone, easy to frustration and anxiety, not enough attention to themselves and their surroundings, not easy to find dangerous situations, thus increasing the chance of falling. (8) Other factors. Elderly people can also fall after drinking, especially after drunkenness; in addition, the hot water bath time is too long, long time bedridden, squatting stool suddenly change position, etc., can also cause transient cerebral anemia and fall. 3, met to the elderly after the fall how to rescue Once found the elderly fell, do not rush to help, otherwise it may “help”. The correct way to deal with is “four judgment”, according to the judgment results for the correct treatment. (1) to determine whether the consciousness is awake If the old man is not conscious, the people present should immediately call the emergency telephone. If there is trauma or bleeding, the bleeding should be stopped and bandaged immediately; if there is vomiting, the head should be tilted to one side and the mouth and nose should be cleaned of vomitus to ensure that the whistle flows freely; if there is convulsions, the person should be moved to a flat and soft ground or padded with soft objects under the body to prevent touching and bruising, and if necessary, padded with hard objects between the teeth to prevent tongue bites, and do not break a twitching limb to prevent muscular and skeletal injuries; if the heart stops beating and breathing, chest compressions, mouth-to-mouth artificial respiration and chest compressions should be carried out immediately. If the heartbeat stops, chest compressions should be performed immediately, and mouth-to-mouth artificial respiration and other first aid measures should be taken; if it is necessary to move the body, it should be ensured that the body is stable and lying down. If he/she is conscious, ask him/her why he/she fell and then give him/her help. ① ask the elderly fall and whether the fall process memory, if you can not remember the fall process, may be fainting or cerebrovascular accident, should immediately escort the elderly to the hospital or call the emergency number; ② ask whether there is a severe headache or crooked corners of the mouth, speech is not good, weakness of the arms and legs and other indications of stroke, such as, if there is, and immediately help the elderly may aggravate the cerebral hemorrhage or cerebral ischemia, so that the condition is aggravated. If there is any trauma or bleeding, immediately stop bleeding, bandage and escort the elderly to the hospital for further treatment; ④ Check whether there is any limb pain, deformity, joint abnormality, limb position abnormality, etc. that suggests fracture, such as no relevant professional knowledge, don’t move casually, so as not to aggravate the condition, and immediately call the emergency number; ⑤ Inquire about lumbar and back pain, abnormal movement or sensation of the legs, and incontinence, etc. that suggests lumbar spine damage; ⑤ Inquire about lumbar and back pain, abnormal movement or sensation of legs, and incontinence. ⑤ Inquire whether there is lumbar or back pain, abnormal movement or sensation in both legs, incontinence, etc. that suggests damage to lumbar vertebrae; if there is no relevant professional knowledge, don’t move casually to avoid aggravation of the condition, and call the emergency number immediately; ⑥ If it is the attack of angina pectoris, you can assist the elderly to take the emergency medicines that are with him/her, and then observe his/her condition after the use of the medicines before deciding whether or not to send him/her to hospital. (7) If the old man tries to stand up by himself, he can be assisted to get up slowly, sit or lie down to rest and observe, and confirm that there is no obstacle before leaving; (8) If you need to move, make sure that it is smooth and try to lie down to rest. (2) to determine whether the sudden death [example 1] 68-year-old Mr. Wang some time ago due to acute myocardial infarction, was sent to the hospital in an emergency, after more than 10 days of full rescue, finally recovered from the hospital. After this encounter with the disease, Mr. Wang cherished life even more. The first time I saw this, I was able to get to the school and start running every day. On this day, while running, Mr. Wang suddenly felt pain in the chest area, pale, difficult to breathe, sweating profusely, and then fell headlong to the ground. The good people in the campus rushed to carry Mr. Wang to the side of the infirmary, the doctor a check, Mr. Wang has been no heartbeat. Comment: In our daily life, we often come across the situation of the elderly falling down. In this case, we have to stay calm and deal with the situation. If you find that the patient has fallen unconscious, first of all to determine whether sudden death. Like Mr. Wang may be sudden cardiac death, after finding this situation, we should be a simple examination, if found that his heartbeat, breathing stops, should be carried out on the spot cardiopulmonary resuscitation, percussion anterior region of the heart, chest cardiac compression and mouth-to-mouth artificial whistling, etc., and timely contact with the emergency center, to fight for time to rescue the patient. If there is trauma or bleeding, stop bleeding and bandage immediately; if there is vomiting, tilt the head to one side and clean up the vomit in the mouth and nasal cavity to ensure that the whistle flows freely; if there is convulsions, move to a flat soft ground or cushion soft objects under the body to prevent touching and abrasion, and cushion hard objects between the teeth if necessary to prevent tongue bite, do not break a twitching limb, to prevent muscular and skeletal injuries; if you need to move, make sure that it is smooth and lie down as flat as possible. This may be able to save his life, rather than rush to carry the patient to the hospital. (3) Determine whether there is a stroke [example 2] has been over the age of the old master Liu, at first glance, still looks like a person just out of the early fifties. He has a great body, except for high blood pressure, almost no headaches throughout the year. After retirement, he insisted on going to the park every day for morning exercise. Early one morning, he was practicing, suddenly blurred vision, limbs weak, holding the sword fell to the ground, people also fell to the ground, the old partners rushed him to the hospital. CT examination, the results of a large number of brain hemorrhage, that is, cerebral stroke. After more than a month of rescue treatment, ultimately failed to retain the life of Mr. Liu. Comment: High blood pressure and stroke are one of the common causes of falls in the elderly, so it is important to determine whether it is a transient ischemic attack or a stroke. Transient cerebral ischemia is a transient limited neurological dysfunction or injury caused by lesions of the carotid artery, vertebral artery and large arteries in the brain. Stroke is further divided into hemorrhagic and ischemic. Ischemic stroke is caused by cerebral thrombosis, cerebral vasospasm and cerebral embolism. It is often manifested as headache, dizziness, weakness of one side of the limbs, hemiparesis, movement disorder, etc. Hemorrhagic stroke is caused by rupture of cerebral blood vessels, which can be divided into cerebral hemorrhage and subretinal hemorrhage. The former condition is dangerous, the patient mostly has a history of hypertension, mostly in the emotional or exertion of the onset of the situation, the condition progresses quickly, often within a few hours to reach the peak, the onset of the signs before the onset. Patients can immediately lose consciousness, snoring-like whistle, one side of the limbs paralyzed, incontinence, if not timely first aid, can die in a few hours. At this time, if whistling, patting, immediately lifting them up or blindly carrying and bumps, will make the ruptured cerebral blood vessel fissure increase, bleeding increased, which will lead to aggravation or deterioration of the condition, so that the patient to the God of death. Elderly people who have fainted due to insufficient blood supply to the brain, if they can lie down, it is more conducive to improving the blood supply to the brain tissues; if they are lifted up, it will aggravate the symptoms of ischemia in the brain. The correct approach is: if the patient is sitting on the ground and has not yet completely collapsed, you can move a chair to support him/her, or directly go forward to support him/her. If the patient has completely collapsed, slowly adjust him/her to the supine position, while carefully tilting his/her head and face to one side to prevent asphyxiation due to vomitus entering the airway. If necessary, use gauze to wrap the patient’s tongue and pull it outward to prevent asphyxiation. Do not slap, cry or turn the patient. While giving first aid at the scene, contact with 120 emergency center and send the patient to the nearest hospital as soon as possible. (4) Determine whether he has a fracture 【Example 3】 On a foggy morning, Mr. Wu rode his bicycle to the vegetable market to buy food as usual. When he was riding his bicycle to the market as usual, he was caught in a sharp turn and fell on the road because he was dodging a car. The first thing you need to do is to get your hands on some of the most popular products in the world, and you’ll be able to do it all in one place. The surrounding goodwill rushed to help, we pull the arm I lifted the leg of the Wu grandfather helped up, and also for him to do a “massage”, but also advised him to twist waist in order to relax and revitalize. The first time he felt the waist “click” a sound, the pain is more and more powerful, simply can not stand, and then legs also lost consciousness. Sent to the hospital for a checkup: lumbar vertebrae burst fracture, crest medulla transverse injury, loss of motor function and sensory function below the waist, paralysis of both lower limbs. Comment: the elderly is the high incidence of osteoporosis, fall after rushing to pick up, can aggravate the damage and bone dislocation, but also damage to the soft tissue around the fracture nerves. And special parts of the fracture, such as crest fracture may also damage the crest marrow, resulting in paraplegia. The fracture site usually has pain, swelling, deformity, dysfunction and other manifestations, and hemorrhage may occur when the fracture end pierces the large blood vessels. Careful examination should be made to clarify the fracture site, keep the patient quiet and keep him/her warm. In case of fracture or suspected fracture, according to the principle of fracture treatment, stop bleeding, stop pain, bandage and fixation; avoid moving the injured person or the injured limb, fix and support the injured limb (if there is bleeding, stop bleeding first and then fix it), so that the injured person will not be injured by the broken bone piercing the blood vessels and nerves due to the handling and bumps in the process of transportation, avoiding the additional injuries and aggravation of the condition. For patients suspected of fracture of the vertebral column, during transportation, the body should not be flexed or twisted, and the patient should not be allowed to walk or sit, otherwise the fractured vertebrae will be displaced, resulting in or aggravating the damage to the vertebral medulla. For patients suspected of cervical vertebral dislocation and fracture, most often accompanied by crural injury, quadriplegia. The emergency center must be notified at the first opportunity to come quickly to rescue. On-site first aid, the injured person should be allowed to lie on the ground or placed on a hard wooden board, sandbags placed on both sides of the neck, so that the cervical spine is in a stable state, to keep the cervical spine and thoracic vertebrae axis is the same, do not over-extension, over-flexion or rotation. It is strictly prohibited to hold the head of one and lift the feet of the other wrong action, after the initial treatment, and then sent to the hospital for treatment. 4.How to prevent the elderly from falling? Elderly people should correct unhealthy lifestyles and behaviors, avoid or eliminate risk factors in the environment, and make sure to take precautions to prevent falls at an early stage. Specific preventive measures are as follows: (1) Enhance the awareness of fall prevention and strengthen the knowledge and skills of fall prevention. (2) Adhere to regular physical exercise to enhance muscle strength, flexibility, coordination, balance, gait stability and agility, so as to reduce the occurrence of falls. (3) Treat related diseases. For elderly people who fall repeatedly, even if they have not caused serious injuries, the cause of the fall should be carefully searched for and a timely diagnosis should be made. Once the potential causes of falls are found, these factors should be removed as soon as possible in order to reduce or prevent recurrent falls, such as controlling cardiac arrhythmia, diabetes, hyperthyroidism, seizures and discontinuing medications that cause low blood pressure. (4) Reasonable use of medication: Ask your doctor to check all the medications you are taking, take them correctly according to the doctor’s instructions, don’t use medication randomly, avoid taking multiple medications at the same time, and minimize the dosage of medication, understand the side effects of the medication, pay attention to the reaction after using the medication, and move slowly after using the medication in order to prevent the occurrence of falls. (5) Choose appropriate aids. Elderly people should use crutches with appropriate length and large top area. Keep crutches, walking aids and frequently used objects within easy reach. (6) Adjust your lifestyle. Avoid steep stairs or steps, use handrails when going up and down the stairs and going to the toilet; turn around and turn your head slowly; keep a steady gait when walking, walk as slowly as possible, and avoid carrying heavy objects; avoid going to crowded and slippery places; when using transportation, wait for the vehicle to stop before getting on and off; slow down the speed of getting up and getting out of bed, and avoid drinking too much water before bedtime, so that you get up many times in the night; put a urinal next to the bed at night as much as possible; avoid using a urinal next to the bed at night; and avoid using a handrail when others are in the bed; and avoid using a urinal next to the bed. Put a urinal beside the bed at night. Avoid moving alone in places where others cannot see you. (7) Clothes should be comfortable. Try to wear loose-fitting clothes. Shoes should be suitable, shoes for the elderly, in maintaining the stability of the body has a very important role. Too small will compress the nerves and blood vessels of the feet, affecting the normal function of the feet and toes, too big or slippery soles will cause inconvenience and easy to fall. Therefore, it is appropriate to wear shoes and socks that fit well, are lightweight, soft, sweat-absorbent, breathable and have non-slip soles. Elderly people should avoid wearing high heels, slippers, shoes with too soft soles and shoes that are easy to slip when wearing. (8) Elderly people with visual, hearing and other perceptual disabilities should wear vision compensation facilities, hearing aids and other compensation facilities. (9) Preventing osteoporosis: Hip fracture is the most harmful injury caused by fall, especially for the elderly with osteoporosis. Therefore, the elderly should strengthen dietary nutrition, maintain a balanced diet, and take appropriate vitamin D and calcium supplements; menopausal elderly women should undergo hormone replacement therapy when necessary to enhance bone strength and reduce the severity of injuries after falls. (10) Place frequently used things in a position where they can be easily reached without the need for a step stool. Try not to climb up to get things at home; if you have to use a step stool, you can use a special step stool with armrests, and never use a chair as a step stool.