First Aid Re-Cert

Nail Through Arm

Nail Through Arm

Once again my three years were up. It’s almost like Logan’s Run with the light going red on my hand… Well not quite, but first aid certification in Australia only lasts three years. So last week it was back to the classroom for first aid update training!

Often the quality of basic first aid courses is pretty woeful. You sit there in front of an instructor who has the power point burning hot. He monotonously steps you through each and every pain-staking slide and reads everything to you that you could easily have read yourself. Most courses are simply the ‘compliance’ stuff you need to ‘maintain’ your qualification so you can treat a paper cut in the office or be eligible for the ‘official First Aid officer’ payment. If you can, avoid these sorts of courses at all cost, as they really teach you nothing more than CPR and how to dial 000.

Although most of the first aid you’re likely to be doing in your day to day work is going to be relatively sedate, you never know what will happen and you can get thrown in the deep end and find yourself outside your comfort zone very quickly. The reality is that most causalities don’t sit there calmly whilst you bandage their non-broken arm. If someone needs your help, there's usually going to be pain, covered in blood, collapsed, vomiting or all of the above.

Case in point, one day I was walking along the corridor outside the classrooms. One of my colleagues yelled out to me to come and help. I stepped into the room to see one of the students collapsed, fitting on the floor, frothing at the mouth and going blue in the face. Everyone in the room had frozen and didn’t know what to do. If you’re dealing with kids in particular, the reality is that something like this is eventually going to happen. You’re better to be prepared for it and not have it happen, than not to be prepared when it does. Walking into a confronting scene and being able to react appropriately is something that only training and experience can provide. The better the training, the easier it is to get your head around what needs to happen next.

I didn’t know what to expect from this course, as every course I’ve done over years has varied dramatically. Within the first hour, we were into scenarios and this was where it got interesting. Casualties were made up with some awesome looking wounds, injuries and scenes were staged with heavy machinery, vehicles and boats. With fake blood everywhere, it was scarily realistic!

First Aid Scenario

First Aid Scenario

You’re thrown into each scenario with little or no information, which will be the case if you find yourself dealing with a similar situation in real life. It's up to you to work with the resources you have to contain and respond to the situation at hand. This is generally easy when you've only got one casualty, but add in two or three and a bit of anger and conflict to the mix, then you have some tough situations with which to deal.

Smoke Signal

Smoke Signal

The course was amazing with some short sessions of instruction, followed by a variety of these intense, realistic scenarios. Each and every one of them got the adrenaline pumping! From someone running at you yelling for help, to approaching a scene that's chaotic, full of noise, smoke, casualties, blood and screams, it was challenging. Even though you know it's setup, it still has the effect of raising your heart rate and throwing you in to manage what could be a real-life situation, a workplace accident, a vehicular accident or even an accident at home.

Car Crash

Car Crash

Training in this manner is important, as it helps you to pause, check for danger and potential risks and hazards as well as assess the situation in as calm a manner as possible. Many people rush into situations, which often puts them at risk of harm as well. Making situations feel real means that your brain is being pushed to make those informed decisions before you're confronted with the complex challenge of a real situation.

The great thing about the course was the fact that everyone was pushed. No matter how experienced we were, the scenarios pushed the limits and I certainly got a lot out of it. The remote area course was far more than just completing the 3 year compliance check. It was interesting, it was challenging, but overall it was rewarding, as I've come away with more confidence in how to assess complex situations that in reality might one day happen.

As a good guide for first aid training, forget Senior First Aid, seriously what's the point? In my opinion, it's a complete waste of time and money that won't really do anything more than train you in the most basic of first aid theories, which doesn't prepare you very well for the real thing. Look for something like a Remote Area or Wilderness First Aid run by a reputable provided such as Remote Safety Solutions. It's even better if it can be tailored to your specific areas of operation. It's well worth the time and effort to do this. You and your organisation will be far better prepared if something does happen.

My 1st Real First Aid Experience

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Thinking back, can you remember the first time you had to deal with a real first aid emergency?
 
My first experience is something that's always stuck in my mind, as it was confronting and my reaction wasn't what it would be now. We were out on a night navigation exercise, ascending a spur under head torch light, when one of the students collapsed. As soon as I saw him go down, everything I learnt on my two day first aid course went out the window... I completely froze...
 
This left me feeling overwhelmed and helpless! I wasn't sure what I should be doing. I had this sudden debilitating feeling... I can't deal with this! Thankfully I had another really experienced teacher with me, who jumped in and took charge of the situation. The day had been ragingly hot and it turned out the boy was severely dehydrated and suffering from heat stroke.
 
It's hard to train for this sort of situation and until it actually happens, it's very hard to know what your initial reaction is going be and what it's going to feel like. It's even harder to know what to do about it. However, one important thing you can do in any situation, in the words of the Hitchhiker's Guide to the Galaxy, is 'Don't Panic'. Take a deep breath, be calm, collected and assess the situation. Run through the DRSABCD calmly in your head and look around assessing the area as you approach. This will give you time to put your gloves on, collect your thoughts and balance out the adrenaline that your brain has just shot into your body.
 
Don't let your body overwhelm you in this sort of situation. Calmness and common sense helps a great deal and first aid is not a solo effort, so if you can, call another teacher in to help manage the situation and provide support for the casualty whilst you wait for emergency services. Remember, most importantly, you're there stabilising and protecting your students from further harm until the ambulance arrives.
 
After that incident I decided I should upgrade my training beyond the basic two day course and so I studied wilderness first aid. This helped develop my confidence in treating injuries and managing casualties, but still nothing focussed and developed my skills more than the experience of a student walking up to me dripping with blood from massive cuts to his chest, hands and stomach! But that's a story for another time!

I get knocked down, but I get up again!

Head Injuries & Concussions

After talking about how awesome Twisted Sister were, I might have got you excited about the classic Chumbawamba song Tubthumping! Such a great song, but again another one-hit wonder that now occasionally finds its way to be played at awkward school reunions and trivia nights.  However, as interesting as random bands are and as pointless as school reunions are, I am not going to talk about either. Instead, let’s talk head injuries!

Whilst for many people, a head injury might be preferable to going to their school reunion, I don’t want to seem blasé about one of the most significant issues with which we have to deal  as teachers, coaches and outdoor instructors.

Concussions are what I would describe as a hidden injury. Whilst sometimes it’s extremely obvious that someone has suffered a concussion, when they’re struggling to remember what you said to them 30 seconds ago, there are also times where the injury goes quite unnoticed. Sometimes, after a hit to the head or a massive body collision, a proper assessment isn’t done and the student continues to play on.

One of the biggest problems with concussions, from a first aid point of view, is that the signs and symptoms are not blatantly obvious. If for example someone breaks an arm, especially if it’s a protruding injury, you can see it’s broken from satellite imagery. If it’s graze or laceration, there’s usually lots of blood and so it’s time to glove up and stop that bleeding. There is a reason why people say “bleedingly obvious,” and you’ll understand exactly what they mean, if you’ve treated someone with an open wound, let alone someone who’s taken a dive in a bed of oysters… but that’s a story for another time.

Head injuries and concussions however, that don’t involve lots of bleeding, aren’t always so obvious and nor is the recovery process. When you’ve broken that arm at right angles and passers by with no first aid training feel nauseated just looking at it, it’s obvious you need to get that looked at by a doctor. The process is quite clear from now on in. You go to the hospital, the triage nurse looks at you and goes ‘Oh woah! That’s broken!’ The old lady you sit down next to in the waiting room goes ‘Oh woah! That’s broken!’ and finally after a 6 hour wait in emergency, the doctor said ‘Oh woah! That’s broken, but we’d better get it X-rayed just to be sure!’

However, with head injuries, it’s not so clear cut. Because we can’t see an obvious trauma, we can often risk not even considering that an injury has occurred. The student after all got back up and is playing again. The student might not feel too bad, just a little dazed… but can ‘walk it off’. Unfortunately, inside the student’s head, the brain has just been bounced around and is suffering the effects of a mild concussion. If however, a student has a major concussion, it’s far easier to notice and remove the student from the field or activity. Thankfully, our awareness of and attention to major concussions has improved dramatically in recent years. However, it’s the mild concussions that worry me, as they can remain hidden for an extended period of time.

When someone suffers a concussion, they should seek medical advice and have a clear recovery plan laid out for them. However, with a mild concussion, medical advice is not always sought and the student doesn’t rest and recover, but instead, goes to the next training session increasing the risk of more significant trauma and then onto the next game, once again at increased risk. A concussion on top of another concussion, on top of another one can have a massive multiplier effect and lead to further damage to the brain being caused. Traumatic brain injury and/or CTE (Chronic Traumatic Encephalopathy) can result.

As I’m not a doctor, and there’s far better medical information and advice on the specifics around TBI and CTE I won’t go into all the details here. But as a first teacher, coach or instructor and often the first responder, we should be ensuring we are baseline testing our students prior to commencing high risk activists such as extreme sports and contact sports. We should be mandating helmets or head gear wherever possible and also remaining situationally aware throughout the activity or game looking for big hits to the body or head that might result in the mild concussion that can be so easily overlooked as it’s not bleedingly obvious to the old lady in the emergency department. It’s easy to test for a concussion, but much much harder to deal with the fallout if you don’t.

As educators, we want to challenge our students and help them get the most out of sports, the outdoors and every other opportunity that school affords them. We want them to out-live us and be forced to go to those awkward school reunions, so they can pretend to be far more successful than all the people they hated at school and claim they invented the ‘Post It Note’ or are now an internet Billionaire having invented ‘Fake Block’. Making our students suffer awkward conversations at school reunions to which we don’t have to go, is good! However, letting them suffer from a traumatic brain injury or CTE from multiple concussions when we can so easily check with something like the International Diagnostic tool, is unacceptable.

We do have a very high duty of care for our students and being aware of the risks involved in concussions and also how we can effectively respond and manage them, is vital for us as teachers, coaches and instructors. If you haven’t done so already, do some research, go to a seminar or listen to a podcast on this. The more we understand about concussions, the more we can do to recognise and treat them as we would any other traumatic injury.

For more clinic information speak with your doctor and a few useful resources below:

CTE

https://concussionfoundation.org/CTE-resources/what-is-CTE

 

Malcolm Gladwell – Revisionist History Podcast

https://itunes.apple.com/au/podcast/burden-of-proof/id1119389968?i=1000412178526&mt=2

 

Pocket Concussion Recognition Tool - updated 2017

http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097508CRT5.full.pdf

Snake Season!

Australian Inland Taipan - The Deadliest Snake In the World!! Yes Everything in Australia is Trying To Kill You!

Australian Inland Taipan - The Deadliest Snake In the World!! Yes Everything in Australia is Trying To Kill You!

It’s back to school for the year and as always, due to the beautifully warm weather, it's one of the most popular times of the year for outdoor ed trips. It's also prime snake season and given the fact that Australia has the world’s greatest collection of deadly snakes, including the deadliest and second deadliest that can kill you within an hour, if you're bushwalking or camping, it's one risk that seriously needs to be addressed.

Australia has around 140 different species of snake and about 100 of these are venomous. Yes, we do indeed have the most poisonous creatures in the world. However, out of all of these, only a few are likely to inflict a wound that could kill you. These include, but are not limited to the Inland Taipan (Fierce Snake), Brown snake, Tiger snake, Death adder, Black snake, Copperhead and Rough Scaled snake.

Each year in Australia, there are around 3000 snake bite injuries, of which 400 - 500 casualties receive anti-venom. A fact is that snakes don't always envenom their victims and more often than not, it's a dry bite. However, you must assume if bitten, that every bite is venomous and treated as such until otherwise proven. Also be aware that baby snakes are more likely to inject a massive dose of venom into you if they bite, as they don’t have the maturity to decide to venom or not to venom, that's the question on all snake’s fangs.

A fatality as a result of a snake bite is quite rare. It's roughly between 1 and 3 people out of the 3000 who receive bites year that will result in a fatality. Around 60% of recorded deaths in Australia have been due to brown snake bites; the remainder are generally shared out amongst the inland taipan (world deadliest snake), the tiger snake (super aggressive) and the death adder (scary name).

Therefore, how do you manage this risk? Well for starters “DON’T TOUCH SNAKES!” With the exception of the tiger snake, most snakes aren't aggressive. By leaving them alone, you've basically managed most of the risk involved. I've encountered countless snakes over the years and I've never even come close to getting bitten, because they tend to make a fast getaway. However, when provoked, poked, prodded and picked up, they do tend to become quite responsive. The fact that most bites occur on hands and wrists when people try to capture or kill them, should say something. Stupid people have a tendency towards picking snakes up and boys in particular find that they can't resist the temptation and on average more young males get bitten than anyone else. So again, “DON’T TOUCH SNAKES!”

To highlight just how docile they can be, one of my colleagues last year was setting up a shelter when a red belly black snake slithered over his foot. He stood still, possibly frozen from the initial shock and associated fear, and the snake just continued on its way, not even noticing that my colleague was there. If you're hiking, ensure everyone is wearing sturdy footwear and heavy long pants and/or gators. The fangs on Australian snakes can't usually penetrate through these materials that prove great protection against the fangs. The one snake bite casualty I dealt with had been hiking in reef sandals and been bitten on the arch of her foot after stepping on the snake. Had she been wearing hiking boots, she would never have been bitten.

Signs & Symptoms:

With everything, no matter how well you try to prevent these things, people still get bitten. (If only we could leave the stupid people at home). Most bites that occur when out hiking, occur when someone accidentally steps on them. The pain has been described from being struck by a baseball bat, to being like a stick flicking up at you, to people feeling nothing at all until they start showing the signs and symptoms of envenomation, which include headache, tingling, stinging, burning or abnormal feelings of the skin, feeling anxious, tachycardia (increased heart rate), irregular heartbeat, nausea (feeling sick) vomiting, stomach pain, diarrhea, dizziness, breathing difficulties, problems swallowing, muscle weakness, confusion, paralysis, coma or death in the most severe cases. You may also see redness around the area of the bite and residual venom. However, it's possible that you won't see two clean fang puncture wounds and so rely more on the signs and symptoms.

Treatment:

To treat a snake bite wound, use the pressure immobilisation method. To do this, lay the person flat and do not let the victim move or walk anywhere as this will increase the pace at which the venom travels through the body. Take a compression bandage (preferably a snake bite bandage if you have one in your kit) and apply pressure directly over the top of the bite. The bandage should be firmly on and not so tight that it restricts blood flow. Snake venom travels through the lymphatic system, not the blood stream and so the compression bandage slows this process. If you have a second bandage (which you should), start at the toes, or fingers and apply the pressure bandage all the way to the top of the limb. Use another bandage each time you run out and then test the toes or fingers for capillary refill to ensure it’s not too tight.

Once you have the entire limb bandaged, immobilise that limb. If it's a leg, tie it to the other leg. If it's an arm, splint or tie it to the body. Basically, just make sure they can't move it. Then get them to professional emergency medical care as fast as possible. To be clear, this is just a general overview and for accurate up-to-date first aid advice, check the Australian Resus Council’s Official Guidelines

It's important to be aware that snake bites can cause a severe allergic reaction, anaphylaxis in some people. If you're treating a snake bite and someone has an anaphylactic reaction, treat it in the same way you would any other anaphylaxis as it becomes the priority and then apply the pressure immobilisation bandage.
Whilst snakes are a risk when out and about in the Australian bush, the most important thing to remember in the effective management of this risk is, “DON’T TOUCH SNAKES!”

Happy summer camping season!