What would you do if one of your playing partners has a stroke while playing the 14th hole?
How would you know it was a stroke and not some other problem such as a cardiac arrest, described in Tony Innes’s article on resuscitation, or even loss of consciousness due to a simple faint?
The answer to the second question is in the recognition of some of the more common signs of a stroke by carrying out the FAST test described below. It won’t detect all the signs of several different types of stroke but it’s quick and easy for a non-clinical person to carry out.
Once you have done this, and your suspicion has been reinforced, then the simple answer to the first question is to ring 999 as soon as possible.
Why? Because: ‘Time is Brain’. Although we have on average about 22 billion neurons in our forebrains, for each minute a stroke is left untreated after its onset, about 2 million or 7.5 miles of these very delicate nerve fibres will die. It has been calculated that compared to the loss of neurons with the normal ageing process, in stroke our brain ages 3.6 years each hour it is left untreated or until the full extent of the damage is complete.
The key message is that because stroke is a potentially treatable condition time is critical for survival and recovery.
So how do you recognise a stroke?
Contrary to what some might think most people who experience a stroke are conscious at the time of onset. If the person collapses with loss of consciousness then I would suggest carrying out the ABC approach described in ‘Saving a Friends Life’ by Tony Innes mentioned above.
On the basis that stroke most commonly affects one side of the front 2 thirds of the brain, the most common signs will be a sudden loss of power, coordination, feeling (sensation) or vision on one side and/or a disturbance of speech (e.g. slurring) or language (e.g. word-finding, or mute).
How to do the Face, Arm and Speech test (FAST):
1. Facial movement: Ask the person to smile or show their teeth and observe whether there is weakness or asymmetry of facial movement.
2. Arm movement: Ask the person to lift up both arms and if able to do so ask them to hold them in that position for about 5 seconds noting whether there are any subtle changes in movement on one side. If unable to do this, perhaps because of paralysis or an inability to comprehend the question, then if sitting lift both their arms to about 90 degrees (45 degrees if lying down) and observe whether there is asymmetrical movement or strength when you let go.
3. Speech impairment: By talking to the person ascertain whether there has been a sudden change in their ability to speak and/or comprehend, as described above.
So having carried out this very simple assessment you may conclude that this sudden onset of weakness, numbness, or a change in speech and sometimes visual impairment, may be due to a stroke. Don’t hesitate any further and immediately call for help or ring 999 and ask for emergency services. Report that you think the person has had a stroke and include the time of onset.
If conscious it is okay to leave the person sitting supported until the ambulance arrives. If unconscious and breathing normally then lie them on one or other side.
What happens if the person recovers within a few minutes? Although this may signify that the person has had a TIA (Transient Ishaemic Attack), sometimes called a ‘mini-stroke’, or a mild stroke with a good prognosis, recommended practice is to follow the same procedure. The event should be managed as a suspected stroke until a professional assessment has been carried out.
How likely is this to going to happen during a round of golf in Eaton? I don’t know the precise answer to this question but strokes are common: about 152,000 people have a stroke each year in the UK, equivalent to 120 per 100,000 population annually. TIA affects about 46,000 people each year in the UK, or 35 per 100,000 annually. It is more common the older we get and also in men.
So the likelihood of it happening to you or your partner on the 14th or any other hole may not be that high. But neither is the likelihood of someone having a cardiac arrest. Nonetheless being prepared and knowing what to do could make a significant difference to their outcome.
Robert Fulcher August 2015
Saving a friend's life
Would you know what to do if your playing partner collapsed on the golf course? The 50 Club members who attended a presentation in the Clubhouse by Niall Pearcey, the Resuscitation Officer at the Norfolk and Norwich Hospital, are now all experts.
Niall is a great teacher and showed us all what to do in an emergency and then everyone had the chance to practise chest compression (heart massage) on manikins. We also had the opportunity of looking at, and listening to, the automatic defibrillator. Next time you go into the Clubhouse look on the wall opposite the front office. That's where the defibrillator lives, a red box on the wall.
So what do we do if there is an emergency out there on the course, or even in the car park or Clubhouse?
Firstly, check that it is Safe to approach. It almost certainly will be on the golf course but elsewhere there may be power lines, railway lines. hazardous chemicals or a host of other things
Speak to "the patient". Ask him (it is more likely to be a man who collapses but the ladies are not immune, unfortunately. Let's assume it's a man), "Are you alright?" If you get a reply and he is obviously in pain, no need to panic, make him comfortable and call for help.
Stimulate the patient gently by shaking his shoulders. If you don't get a reply and he cannot be roused,
Shout for help.
Someone must phone the Clubhouse* straight away. The numbers are below *.
Then, it's as easy as ABC.
You should check his A for Airway. Check there is nothing in his mouth and if there is, gently remove it. Roll him onto his back, place the palm of your hand on his forehead and tilt his head back slightly, and gently lift his jaw by placing two fingers of your other hand under his chin. This will bring his tongue forward and open up his air passages.
Check to see if he is B for Breathing. Look, listen and feel for 10 seconds. (Look to see if his chest is moving, put your ear close to his mouth to listen for breathing and also see if you can feel any breath on your cheek). Count to ten. Don't rush, stay calm. Remember that if there is gasping respiration this confirms that he has had a cardiac arrest. If there is no regular breathing move on to...
Don't bother trying to feel a pulse. If he is not breathing there won't be one.
Start Chest compressions. Arms straight, palm of one hand in the middle of his chest, other hand pressing on the back of your first hand, fingers interlocking, leaning over with your shoulders directly over your hands on the centre of the patient's chest, and start pumping. You need to compress the chest by 2- 3 inches. Keep doing it. It's hard work but don't stop. If there is someone else there to help you, take it in turns to do two minutes each. Aim for about 100-120 compressions per minute. Even if you are not a Bee Gees fan, listen to their "Staying Alive" recording and you'll get the rate and the rhythm.
Carry on until help arrives. You have done your best.
*Put these numbers into your mobile phone and always take your phone on to the course, on silent mode, needless to say.
EGC OFFICE: 01603 451686, option 1
EGC PRO: 01603 251394
EGC BAR: 01603 251391
I would seriously suggest you use capital letters in your phone address book so you will have a better chance of being able to find the name and number if you are not wearing your specs.
Then say clearly, for example: "This is an emergency. So-and-so has collapsed on the 7th green. I think he has had a cardiac arrest and we are starting heart massage."
Whoever takes the message has had training. They know to call the ambulance and will then bring the defibrillator to where you are. They also know how to use the defibrillator, but it's not difficult. Open the case, press the "on" button and the mystery voice will tell you very clearly what to do.
Hopefully, the ambulance will arrive soon and the paramedics will take over.
So, in summary: S S S A B C
Safety. Is it safe to approach?
Stimulate the patient
Shout for help.
Breathing and Circulation
Some questions and anxieties answered:
Q: What is the difference between a heart attack and a cardiac arrest?
A: A heart attack is where part of the heart muscle dies because it does not have enough blood supply. The patient usually gets severe chest pain and will look ill but will not usually pass out.
A cardiac arrest is where the heart stops pumping blood around the body, usually due to an abnormal heart rhythm. Without blood going to the brain the patient will rapidly lose consciousness. The skin will be very pale, maybe blue or mottled. To all intents and purposes the patient is dead. He will look dreadful. Even if you have never seen a dead person before, you will know!
It is when the patient has had a cardiac arrest, where the heart has gone into an abnormal rhythm that an electric shock from a defibrillator can bring the heart back to a normal rhythm and the blood will start pumping around the body again.
Q: I would be frightened of doing something wrong and making things worse.
A: This is a common and understandable anxiety but this is a dire situation, as bad as it gets. If nobody does anything this man will die. By calling for help and then starting chest compression you may save his life. You are certainly giving this person the best possible chance of staying alive.
You can't make matters worse than they are, except by doing nothing.
Q: Shouldn't I be doing mouth-to-mouth ("kiss of life") as well as chest compressions?
A: No. Mouth-to-mouth is a tricky thing to do well and it is much more beneficial to concentrate on chest compression. Also, the act of compressing the chest will move enough air in to and out of the lungs.
Q: I have heard about people getting broken ribs and that would freak me out.
A: Sometimes people who are doing chest compression will break a rib or two (the patient's ribs usually). It doesn't matter, in the grand scheme of things. People recover from broken ribs. People tend not to recover from death.
Q: What is the most important thing to remember?
A: You must get help. Shout as loudly as you can, wave your arms. Someone must phone the Clubhouse. If you are on your own that someone will have to be you. Phone before you start heart massage. If you don't do it straight away you might forget to phone at all and then help, and the ambulance, will never come.
Let's hope you never find yourself in this position but, if you do, you have done your best.
This article first appeared in Fairway Clippings in December 2013 (Volume 3, Issue 3).
Enjoying the summer sun safely
Eaton member and plastic surgeon
About ten years ago I bought a tube of “Golfers defence” from Mark Allen. It is a sun cream designed for golfers, the idea being that it wans’t too greasy and didn’t leave your hands slippery so you couldn’t grip your club properly! I still have it in my bag although it is almost empty which probably demonstrates that I have not being applying it as regularly as I should. I also have in my bag a lip balm to protect against the sun. I think these items should always be in your bag alongside your pitch mark repairer and ball marker!
We all love playing golf in the summer sun and so we should. Playing Eaton when the sun shines is a real pleasure. So how dangerous is the sun? Well actually exposure to the sun is essential for good health. We need sunlight to make Vitamin D which is important to keep your bones strong and paradoxically may also help prevent skin cancer or at least minimise its effects.
However, what we also know is that too much sun and particularly sunburn is bad for the skin and may lead to the development of skin cancer. Sunburn particularly in childhood and if repeated can weaken the skin and can be a factor (there are others, mainly genetic) in the causation of malignant melanoma. This is a particularly troublesome type of skin cancer which can sometimes be very nasty and in some cases fatal. Sometimes described as “mole cancer” it usually appears as a small dark brown patch on the skin. Contrary to popular belief it is rarely due to a mole becoming cancerous but mostly appears as a new brown lesion (Fig 1). Things to watch out for are new “moles” or dark brown lesions that grow rapidly or are very irregular in colour or outline or that bleed. They can occur on any part of the body. If you have a skin lesion that fits this description then please see your GP.
Sadly, malignant melanoma is on the increase, probably due to a combination or excessive sun exposure and an ageing population. In the time I have been a member of Eaton (18 years!) I am sorry to report that the incidence in the population has doubled! Now please do not start losing sleep and become too paranoid: existing moles very rarely become cancerous.
The other types of common skin cancer are Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). Both are sun related!
BCC is quite common and I have removed them from one or two members in the past. Although much more common than melanoma these are not nearly as serious. They are more difficult to diagnose and usually appear as a very slowly enlarging raised pearly pink lesion, most commonly on the face (Fig 2). They do not spread and surgical removal is almost always curative.
SCC is the least common and usually occur in older folk, typically on the scalp in bald men (hats please!) and on the back of the hand. The top of the ear and lower lip are other areas of risk (hence lip balm!). The typical history is of a crusty hard lesion which after a while starts to ulcerate. Again the vast majority are cured by surgical removal or in some incidences by radiotherapy. Only a very few cases go on to spread and it is rarely fatal.
Now I really do not want to give you all nightmares but I would urge you all to respect the power of the sun. The Australians are at the forefront in the fight against skin cancer and in particular in its prevention. Think about how the Australian cricket team protects itself from the sun. You will note the liberal application of ointment to the face particularly the lips and nose! It looks a bit odd but these guys know about the risk of skin cancer!
I wish you all to enjoy your golf but I would encourage the following when the sun shines (even if not very strongly): sun cream to the face, particularly the nose and tops of the ears and the back of the hands and lip protection too. Bald men should apply generously to the scalp and even better wear a hat! I see far too many uncovered heads. A broad brimmed hat will also offer protection to the ears and nose.
So put some sun cream in your golf bag. Perhaps we should ask Mark to start selling it again? I would much rather see you enjoying your golf than lying on my operating table!
ABDOMINAL AORTIC ANEURYSM SCREENING TEST FOR MEN
All 65-year old men in Norfolk & Waveney can now benefit from screening for abdominal aortic aneurysms (also known as AAAs) as part of a national screening programme. Norfolk and Norwich University Hospital introduced the NHS Abdominal Aortic Aneurysm (AAA) Screening Programme in the East of England in October 2011 and men are now being invited to various screening locations in the community across Norfolk and Waveney.
An estimated 80,000 men aged between 65 and 74 are affected by the condition, which is caused when the main blood vessel in the abdomen – the aorta- weakens and starts to expand. If undetected, the condition can be fatal and around 6,000 men die every year in England from a burst Abdominal Aortic Aneurysm. Men who have an abdominal aortic aneurysm will not generally notice any symptoms, which is why screening is so important.
The NHS AAA Screening Programme will reduce deaths from the condition by up to 50 per cent by detecting AAA’s early and offering appropriate monitoring or treatment. Men aged 65 and over are most at risk from the condition so invitations for screening are being sent out to men in the year they turn 65.
Mr Matthew Armon, NNUH Consultant Vascular Surgeon, lead for the NHS AAA Screening Programme in Norfolk and Waveney and a member of Eaton Golf Club said “I am delighted that men aged 65 in Norfolk and Waveney have the opportunity to take part in this screening programme. A simple ultrasound scan of the abdominal aorta is carried out and the aortic diameter is measured. The screening test takes less than 10 minutes, is highly effective and men receive their result immediately. Vascular disease is as common as cancer and heart disease; therefore I strongly encourage everyone offered the opportunity to participate”.
Men who are older than 65 and have never had screening or treatment for an AAA can request to be screened by contacting their local programme on 01603 288218 or email the programme administrators at or