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!

Establishing An Operational Management Plan

Operational Plan - Risk Management

An operational management plan is essentially the standard operating procedures for your program. Now I hate the term SOP, because it always feels like it's a set of rules that's written down, which ultimately guarantees that nobody ever reads it. So what's the point? Like anything involving people, logistics and risk, it needs to be a living, breathing process that all staff are part of. It has to be clear in the minds of all staff what the process is to run a safe and effective program.

With any experiential education, you need to have some very clear structures in place to both ensure the smooth operation of activities, as well as contingency plans if something goes wrong. Some organisations are obsessed with risk management plans and waivers, thinking this is all the planning they need. They've kept their lawyers happy and there's a document they can produce to prove they at least thought about something before leading the group into the valley of death. Well, there's quite a lot more to it than that and this is where many organisations go wrong.

You’d think it goes without saying that you need a plan, an itinerary, a schedule, risk assessment, student medicals, permission notes, or at the very least a class roll! However, I’ve regularly seen the focus of planning to be on only one or two of these components, rather than properly addressing them all. You must address them all! There's no point in having an itinerary and risk assessment written and not having the logistics and staffing in place to execute your plans.

You always need a functional end-to-end operational plan, that is flexible enough to handle multiple contingencies. Therefore, you need to plan for everything from the perfect operation to various “what ifs” for minor hurdles, emergencies and full crisis response. An effective response though has more to do with the staff’s mental state and ability to respond and adapt to a fluid situation, rather than a rigid written plan that's immediately forgotten when confronted with a complex crisis.

I've seen this done very well, but also extraordinarily poorly, especially when people aren't operating programs all the time and they feel they need to make things up as they go. There's a huge difference between being adaptable and making stuff up on the run. So one massive hint here, Don't Make It Up As You Go! Have a well-structured, executable plan that everyone’s part of that can be quickly enacted if something goes wrong.

What if the weather changes? What if an emergency happens? What if a crisis happens? Are you prepared to switch it up and respond quickly and effectively? I've seen some great written risk assessments where I have mused, ‘wow they've thought of everything!’ but then looking further on, no contingency plans nor any real idea as to how to manage an emergency or crisis.

Emergency Services

Emergency Services

It's Never Nice Getting Hit By This

It's Never Nice Getting Hit By This

I've seen and worked on programs (thankfully not run them) where the organisation had a ‘nothing will ever go wrong’ approach. This is where everything is done on razor thin staffing, based upon the idea that everything will go exactly to plan and I mean exactly to plan! The danger of this, is firstly, it's idiotic in the extreme. When you're dealing with groups of students and staff in different locations and involving vehicles and equipment, something could eventually go wrong. If you have no flexibility and adaptability factored in, then you're asking for a lawsuit and in fact, you deserve the horrendous experience of being dragged through the courts for your stupidity. I never felt safe, nor comfortable on this program. Thankfully, when I brought it to the attention of the organisation and they couldn't see the problem with it, I left and found another place to work that did.

This ‘razor thin’ notion, usually done to ‘save money,’ that works off the basis that everything will go exactly to plan, just increases the pressure, stress and fatigue on staff, which adds to the inevitability of something going wrong. Philip of Macedon (Alexander The Great’s father) put it very nicely. ‘No plan survives contact with the enemy.’

So with that in mind, here's an outline of how I develop an operational management plan:

  1. Establish a clear well-formed plan and ensure staff are briefed on it.

  2. Ensure you have sufficient staff to student ratios for the activities and have factored in a ‘margin for error.’

  3. Ensure you have backup available if something does go wrong, so the rest of the group can continue without disruption.

  4. Have student permissions, waivers and medicals submitted in a timely manner to ensure adequate time for review, assessment and contingency planning.

  5. Ensure medical conditions are worked into the plan and any specific needs met with tailored contingencies and action plans.

  6. Develop the risk assessment in conjunction with all your staff so they’re not only aware of risks, but actively contribute to the planning and mitigation process.

  7. Note nearest emergency services and ensure contact and communication in some form is readily available (mobile, sat phone, radios, EPERB). NB: When running programs in remote areas, I also directly notify Police, Ambulance and National Parks of our plan.

  8. As part of the plan, ensure staff are briefed on contingency plans and are clear on strategies for managing any issues that fall outside ‘normal’ operations.

  9. Ensure you have a clear point of contact for safety backup and management of anything that's outside of the ‘normal’ plan. There must be an experienced and capable staff member who’s prepared and ready to respond quickly if needed.

  10. Have set check-in times when each group makes contact to provide a brief update and weather forecasts or any other information that can be conveyed back to the group.


If you plan around these 10 steps, then you're well on the way to having a safe, enjoyable and rewarding experience for everyone involved.

Weird Hospital Visits

Medical Treatment Photo

Nobody really likes taking kids into hospital. Most of the time it ends up being the teacher who’s got time off, or the last person out of the room! Let’s be honest it’s a crap job that nobody wants. Firstly you have to take at least two kids with you, so you’ve got one injured and one bored. Secondly the wait… there’s no such thing as a fast track in emergency unless you’re not breathing although arguably by this point you're probably beyond the services available in the emergency ward. Thirdly have you ever been able to get a decent coffee in a hospital?

The trip to hospital all starts when an injury is more serious than your staff can manage. I've had all sorts of visits with students, from fractures, to cuts, to unknown issues each visit if often a unique experience...

Medical Treatment Photo

My longest wait was 8 hours and this gave me the opportunity to talk about all sorts of things with the student. It's amazing what you find out about life the universe and just about everything when chatting!

However, my weirdest experience was when I took one of the kids in with multiple cuts after he took a dive in a bed of oysters. I won't go into the gory details, but he was a mess to say the least. We sat and waited for some time after seeing the triage nurse, who rifled through the stack of papers which were suppose to be a medical 'summary'. When the nurse finally brought us in to the examination room, she took one look at him and proceeded to fill a tub with warm water and a dash of disinfectant. She then said to me 'here you go, take this into the waiting room and clean him up'. I looked at her for a moment wondering if she was serious... Yes she was!

I looked back at her and said 'can I at least have a pair of gloves'. She half indignantly grabbed me a pair of glove and off we went. I sat there apologising profusely to the couple sitting next to us as I cleaned out the painfully deep wounds and collected a pile of tiny oyster shells as I did. I've heard of cut backs but seriously do I get a discount on my Medicare levy for do it yourself work in hospital?

Anyway, we were there about another hour and a half and the boy ended up with stitches in his hand and bandages everywhere.

When You're On First Name Basis With The Staff Here...

When You're On First Name Basis With The Staff Here...

To be honest I still try and avoid the hospital trip (mainly because of the bad coffee), but at the end of the day when you're responsible for the kids welfare and safety, prompt action and quick decision making to get them to hospital can mean the difference between an injury becoming an extremely bad injury. So really it's always better to err on the side of caution and take them in to be sure, rather than risk it just to avoid a long wait. At the end of the day, you can always get a coffee on the way home!

Random Strangers

Royal+National+Park+-+Hiking

This week, I thought I'd talk about something that happened last week on a hike I was leading. It was in the Royal National Park. For those of you who don't know it, it's an amazing national park just south of Sydney, featuring rugged sandstone cliffs, secluded beaches and home to the famous figure 8 pools and the infamous wedding cake.

Our hike was with 27 kids heading North from Otford on the amazing coastal track. It was a hot afternoon and the 10km took us approximately 3 hours to cover. The cool coastal breeze hitting us as we reached the summit of the headland between North Era and Garie Beach was a welcome relief.

Garie Beach, NSW

Garie Beach, NSW

In at Garie beach, we'd just unpacked the trailer when I was approached by a girl in her late teens. She said to me "Hi. Sorry, ummm... I've got three questions", "Sure what's up?" I replied.
"Where's the coastal track continue?" she asked
"Just at the end of the beach here."
"Ok... Question 2, does anyone know first aid?"
"Sure! What's up?"
"My friend's rolled her ankle. Could you take a look?"
"Sure no worries. I can take a look."
I had a look and she had a sprained ankle, so I strapped it and so that was question 2 sorted!
Then for question 3!
"Where's the nearest public transport?"
Oh dear... I thought... I asked a few questions about where they'd come from and what their plans were. They'd come from Sydney via Bundeena and walked about 22km of the track, aiming to cover the whole 32km in a single day. An ambitious goal for the fittest of hikers. They were obviously tired, injured, no head torches, low on food and completely out of water... So my risk management brain started to go into overdrive, trying to do the sums of how many hours the rest of the trip would take under normal conditions, then estimating the addtional time with an injury, then add in no torches. It was late afternoon and no chance of water resupply along the way. This was not a pretty picture!

I quickly ran through a few scenarios in my head and didn't like any of them that involved the girls continuing, so after a quick chat with the other instructors, we put the offer to the girls to transport them to Waterfall station, which wasn't too far away! To everyone's relief they accepted our offer and we dropped them off at the station. 
So the question becomes what to do when you come across others in a similar situation? You've still got to consider your group as the number 1 priority. If they're all ok and supervised, then I think there's a moral obligation to help, especially if you perceive that the third party could be at risk of harm if they were to continue on. After all, the experience you have as an educator and leader can mean that you see things which others don't. It can be a complicated problem, which must be considered each time you run into someone and the circumstances surrounding your meeting them (and yes this group wasn't the first I've come across, but more about that later). At the end of the day, protect your group, but also give freely of your skills and experience to prevent harm coming to those who might not have been as well prepared as you.

Part Of The Amazing Coast Track

Part Of The Amazing Coast Track

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.