Motion sickness - globalfirstaidcentre.org

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International first aid, resuscitation, and education guidelines 2020.https://www.globalfirstaidcentre.org/ Motion sickness | 1

Motion sickness

Stop travelling if possible, to allow the person time to recover and take correctiveaction.

Motion sickness is caused when the brain’s estimate of motion is different fromwhat the person is actually experiencing. The person’s eyes, balance centre of theinner ear and general perception of their body’s position and movement conflictwith the messages the brain receives. The sensitivity to motion sickness varies inindividuals, but most people will experience it if the cause is strong enough.Pregnant women, children older than two years and those with migraines are mostsusceptible. First aid care is often ineffective, and providers should emphasiseprevention instead.

Guidelines

Eating a light meal or taking in ginger before travelling may help preventmotion sickness. *Controlled breathing and distracting the ill person with an activity (e.g.listening to music) may help to reduce symptoms of motion sickness. *Looking straight ahead through the windshield, looking outside and fixing thegaze on a central point on the horizon, as well as restricting one’s view mayhelp to prevent motion sickness. Sitting in a chair with a high backrest, sittingfacing in the direction of travel, wearing a P6 acupressure or P6acustimulation wristband, and having control over the movement of the vehicle(driving oneself) may also help prevent motion sickness. *

Good practice points

Stopping the means of transport may decrease nausea.Getting fresh air during travel – with a window open and air on the face – mayreduce symptoms of motion sickness.Those that have used medications such as antihistamines to relieve motion

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sickness in the past should continue to use them if they are found to beeffective.

Guideline classifications explained

Chain of survival behaviours

Prevent and prepare

There is some evidence to show the following ways for preventing motion sickness:

Eat a light meal before travelling.Drive the vehicle yourself, if possible.Take 1 to 2 grams of ginger (e.g. tea or biscuits) before or during travel.Sit in a chair with a high backrest during travel and sit facing forward.Look outside and fix the gaze on a central point on the horizon.Wear a P6 acupressure or P6 acustimulation wristband while travelling.

Additionally, people might find it helpful to:

Take mint or peppermint before or during travel.Some people find it easier to sleep through travel (unless driving oneself).Get fresh air during travel.

Early recognition

The person is travelling in conditions that induce motion sickness, such as awinding road or rough waves on the water.

Initially, the person’s skin may become pale or ashen.The person may feel dizzy or have a headache.As symptoms progress, the person may experience nausea or vomiting.

First aid steps

Stop travelling if possible, to allow the person time to recover and take1.

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corrective action.If it is not possible to stop travelling, tell the person to face forward and to2.look straight ahead at a fixed point on the horizon.If possible, provide fresh air and encourage the person to take slow and3.regular breaths.Try to distract the person, (e.g., play some music).4.

Access help

Usually, motion sickness passes without the need to access help.

Education considerations

Context considerations

Include the types of transport and related first aid care that are relevant tolearners and their environment.Some areas may have safety considerations that prevent learners fromstopping their vehicle. The first aid education should acknowledge and discussthese considerations in a learning activity.

Learner considerations

People who travel with children (teachers, parents, coach drivers) may find ituseful to learn about motion sickness.

Facilitation tips

Focus on prevention in this topic as first aid is limited in its effectiveness andpeople may react differently to the various preventative suggestions.Ask the learners for their experience of motion sickness as this will help toestablish relevant context.Inform learners that people who take certain medications (e.g.,antidepressants, asthma medications and even ibuprofen) may be moresusceptible to motion sickness. Also inform them that some medications (e.g.,

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antihistamine) may make the person drowsy and diminish the reflexes neededfor safe driving.

Scientific foundation

Systematic reviews

The Centre for Evidence-Based Practice (CEBaP) developed evidence summaries onthe use of controlled breathing and travel activities for motion sickness, as well ason several preventative interventions.

First aid care

Controlled breathing

There is limited evidence from three randomised controlled trials in favour ofcontrolled breathing. Evidence showed that controlled breathing resulted in astatistically significant increase in time to moderate nausea and a decrease in themean symptoms of motion sickness, compared to spontaneous breathing. Evidenceis of very low certainty and results cannot be considered precise due to limitedsample size.

Activities

There is limited evidence from one randomised controlled trial in favour of listeningto music, and from one non-randomised controlled trial in favour of distraction. Therandomised controlled trial study showed that listening to music resulted in astatistically significant increase in time to moderate nausea in people experiencingmild nausea due to motion sickness. The non-randomised controlled trial showedthat distraction resulted in a statistically significant decrease of subjective misery(measuring nausea, vomiting, dizziness, headache, (cold) sweat and stomachawareness). When looking at counting compared to not counting to treat motionsickness, two randomised controlled trials could not demonstrate a statistically

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significant decrease in motion sickness symptoms. In three experimental studies, itwas shown that reading or watching a video resulted in a statistically significantincrease in motion sickness perception. All evidence is of very low certainty andresults cannot be considered precise due to limited sample size, lack of data andlarge variability of results.

Prevention

View

There is limited evidence in favour of:

Looking outside: three studies showed that looking outside resulted in astatistically significant decrease in symptoms, compared to looking at theinside environment. However, this could not be shown in a fourth study.Similarly, one study showed that looking at the horizon resulted in astatistically significant decrease in motion sickness compared to not lookingoutside. However, this decrease could not be demonstrated when comparinglooking at the horizon to looking outside. Finally, in one study, it was shownthat keeping the eyes open resulted in a statistically significant decrease inmotion sickness, compared with keeping the eyes closed.Performing a task on a high-mounted tablet: in one non-randomised controlledtrial, people were asked to sit down in the passenger seat of a car and performa task on a tablet that was either mounted at eye-height (high visual display,offering considerable peripheral out-the-window views) or onto the glovecompartment (low visual display). The high visual display resulted in astatistically significant decrease in symptoms, compared to the low visualdisplay.Restricting one’s field of vision or fixating on a central point: when comparedto an unobstructed view, no fixation point or inside view only, restricting thefield of vision or fixating on a central point resulted in a statistically significantdecrease in mean illness rating and subjective symptoms of motion sicknessand nausea, based on six studies.

In addition, a statistically significant decrease in mean illness rating when looking

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inside or outside, compared to wearing a blindfold, or when having anunobstructed view compared to a narrowed forward view, could not bedemonstrated by three studies. All evidence is of very low certainty, and results areimprecise due to limited sample size and lack of data.

Seating

There is limited evidence in favour of using a high backrest and sitting in a forwardorientation, from one experimental study each. One study showed that sitting witha high backrest resulted in a statistically significant decrease in mean illnessrating, compared to a low backrest. Another study showed that forward orientationresulted in a statistically significant decrease in motion sickness, compared tobackward orientation.

Additionally, there is limited evidence neither in favour of sitting in the middle rearseat nor sitting behind the driver. Results from one study could not demonstrate astatistically significant decrease in mean illness rating when seated in the centralrear seat compared to sitting directly behind the driver. Furthermore, there was nodemonstration of a statistically significant decrease in mean illness rating whenseated in the first row of a multi-purpose vehicle, compared to sitting in the secondrow. All evidence is of very low certainty, and results are imprecise due to limitedsample size and lack of data.

Driving oneself

There is limited evidence from three experimental studies in favour of drivingoneself. One study showed that having control over the vehicle’s movementresulted in a statistically significant decrease in motion sickness symptoms andmean well-being score, compared to having no control. It also showed that being ormoving as if you were the driver (i.e. actively tilting your head instead of passivelyfollowing the motion, thereby imitating the driver), resulted in a statisticallysignificant decrease in total symptom score, compared to being a passenger ormoving as if you were a passenger. Evidence is of low certainty and results areimprecise due to limited sample size.

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Eating and drinking

There is limited evidence from four experimental studies in favour of eating beforetravelling. One study showed that eating a zero-fat meal resulted in a statisticallysignificant decrease in nausea, compared to eating a high-fat meal. A second studyshowed that compared to eating an entirely carbohydrate-based meal, or no mealat all, having a high-protein meal resulted in a statistically significant decrease inthe subjective symptoms of motion sickness.

A third study compared eating breakfast to going without it while a fourthcompared eating either a high protein and low carbohydrate meal or a low proteinand high carbohydrate meal to just drinking water. In both cases, the interventionresulted in a statistically significant decrease in the symptoms of motion sickness.However, a statistically significant decrease in the symptoms of motion sicknesswhen comparing an entirely carbohydrate-based meal, or a meal with bothmoderate carbohydrate and protein portions, to no meal or drinking water only,could not be demonstrated.

There is limited evidence from one experimental study in favour of taking gingerbefore travelling. Results showed that 1000 or 2000 mg dose of ginger had astatistically significant decrease in nausea during and after the illusion of the bodyin motion, compared to a placebo.

There is limited evidence from one experimental study neither in favour of drinkingwater or milk, nor nothing at all. When comparing drinking milk or water to notdrinking anything, a statistically significant decrease in subjective symptoms ofmotion sickness could not be demonstrated.

All evidence is of very low certainty and results of this study are imprecise due tothe limited sample size and lack of data.

Wrist bands

There is limited evidence from seven experimental studies in favour of wearing P6acupressure or P6 acustimulation wristbands. When analysing this evidence, weplaced a higher value on the outcome of subjective symptoms of motion sickness

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over peak total symptoms score or nausea (as it is one of the many symptoms ofmotion sickness). Studies showed that P6 acupressure or P6 stimulation resulted ina statistically significant decrease in subjective symptoms, compared to the control,dummy point acupressure or a placebo. Another study showed that P6 acupressurehad a statistically significant increase in time to moderate nausea, compared to thecontrol. When comparing the use of P6 acupressure or P6 acustimulation to aplacebo, the evidence did not demonstrate a statistically significant decrease insymptom severity, peak total symptoms score, subjective symptoms or nausea.Evidence is of very low certainty and results are imprecise due to limited samplesize, lack of data and large variability of results.

References

Systematic reviews

Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidencesummary Motion sickness – Travel activities. Availablefrom: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/

Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidencesummary Motion sickness – Seating position. Availablefrom: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/

Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidencesummary Motion sickness – Eating or drinking. Availablefrom: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/

Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidencesummary Motion sickness – Wristbands. Available from:https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/

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