NIMASA STCW EFA common mistakes
NIMASA STCW EFA · Understand the traps and how to avoid them.
Checking for a pulse by pressing the fingertips against the side of the neck for a few seconds, then declaring the casualty 'pulseless' and starting chest compressions.
Candidates copy film and television CPR instead of the taught landmark. Fingertips cannot reliably detect a carotid pulse, and a check of only 2–3 seconds is too short to confirm cardiac arrest, so a breathing casualty with a slow, weak pulse may be given compressions.
What to do instead
Practise the taught sequence until it is automatic: locate the Adam's apple with two fingers, slide them into the groove between the trachea and the neck muscle on the side nearest you, press gently with the flat of the fingers, and count for at least 5 and no more than 10 seconds while also looking for normal breathing. State aloud what you find before acting.
Placing the hands too low, over the lower tip of the breastbone or the upper abdomen, when positioning for chest compressions.
Candidates estimate the hand position by eye or by feeling for the ribs rather than using the taught landmark, and compression depth then drives the breastbone tip into the liver or stomach, causing injury and making compressions ineffective.
What to do instead
Use the landmark every time: find the lower half of the breastbone, place the heel of one hand there, the second hand on top, and interlock the fingers so they do not press on the ribs. Rehearse on a manikin with an instructor confirming placement before you are signed off.
Delivering compressions at a fast, shallow rate with bent elbows, so the chest barely moves and the rescuer tires within a minute.
Candidates confuse speed with effectiveness and are nervous about pressing hard on a person. Without straight arms and body weight behind the hands, depth falls well short of the required compression and no effective circulation is produced.
What to do instead
Lock the elbows, keep the shoulders directly over the hands, and push down at least 5 cm but no more than 6 cm at a rate of 100–120 per minute. Practise to a metronome or count aloud, and swap with another rescuer every 2 minutes to limit fatigue.
Tilting the head and lifting the chin on a casualty with a suspected neck injury from a fall or a heavy object, without considering a jaw thrust.
Candidates learn one airway manoeuvre for every situation and apply it mechanically. In a suspected spinal injury, excessive head tilt can worsen cord damage, yet the airway must still be opened.
What to do instead
In suspected spinal injury, use the jaw thrust: kneel at the head, place fingers behind the angles of the jaw and lift it forward while stabilising the head in line with the spine. If that does not open the airway, open it with the minimum tilt needed and record what you did.
Giving rescue breaths by blowing hard and fast for a second or less, watching the chest barely rise, then continuing compressions regardless.
Candidates rush because they fear delay in compressions, and they do not connect the visible chest rise to the adequacy of the breath. Shallow breaths deliver no oxygen, and forceful ones inflate the stomach and cause vomiting.
What to do instead
Deliver each breath steadily over about 1 second, just enough to see the chest rise, then release and let the chest fall. If the chest does not rise, reposition the head, re-check the airway and try again before resuming compressions at 30:2.
Leaving a casualty in the recovery position and walking away without re-checking breathing, or rolling an unconscious breathing casualty onto their back 'to monitor them'.
Candidates treat the recovery position as a finished task rather than a monitored state. The airway can still obstruct, and vomiting or deterioration can go unnoticed, especially if the rescuer leaves to fetch help.
What to do instead
After placing the casualty in the recovery position, keep the head tilted back and the mouth directed downwards, stay with them, and re-check breathing at frequent intervals until handover. Send someone else for help rather than leaving the casualty unattended.
Treating a severe external bleed by pressing on the wound with a dressing held only lightly, then lifting the dressing repeatedly to look at the wound.
Candidates are anxious about causing pain and want to see whether bleeding has stopped. Light pressure does not compress the vessel, and lifting the dressing tears away the forming clot and restarts bleeding.
What to do instead
Apply firm direct pressure with a sterile dressing or clean pad, using the flat of the hand and body weight, and maintain it without interruption. If blood soaks through, add another dressing on top rather than removing the first, and elevate the limb if no fracture is suspected.
Handling a casualty with a suspected fracture by trying to straighten the limb or move it to see the injury before splinting.
Candidates want to 'set things right' or check the extent of injury, not realising that movement can turn a closed fracture into an open one, damage nerves and vessels, and worsen pain and shock.
What to do instead
Immobilise in the position found using a splint that supports the joints above and below the fracture, check circulation beyond the injury before and after splinting, and cover any open wound with a sterile dressing before splinting. Do not attempt to reduce or straighten the deformity.
Treating a burn with ice, butter, oil or by bursting blisters, and then wrapping the area tightly in a dry dressing.
Candidates rely on home remedies or on making the injury look tidy. Ice causes further tissue damage, greasy substances trap heat and complicate later medical care, and bursting blisters invites infection.
What to do instead
Cool the burn with clean, cool running water for at least 10 minutes, remove rings and tight items before swelling, cover loosely with a sterile non-adherent dressing, and leave blisters intact. Never apply ice or ointments, and seek medical advice for large or deep burns.
Recognising shock only when the casualty is already unconscious, and giving food or drink to a pale, clammy, restless casualty.
Candidates look for dramatic signs rather than the early ones - pale clammy skin, rapid weak pulse, rapid shallow breathing, thirst, restlessness - and offer water as comfort, which risks vomiting and aspiration if the casualty deteriorates.
What to do instead
Look actively for the early signs, lay the casualty down, raise the legs if no spinal or leg injury is suspected, keep them warm with a blanket, loosen tight clothing, and give nothing by mouth. Monitor breathing and pulse and hand over early.