Emergency Planning

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.

The Right Person For Safety

Right Person For Safety

I've previously written about the need for having a designated safety officer as part of your operational management plan. The safety officer is your backup and support for all field operations and as such, should be a key component of your risk management strategy.
 
However, this isn't a token honorary role for someone to sit around and do nothing, or ‘do admin’. The person has to be experienced, competent and switched on, ready to respond to anything from small hurdles and emergencies, to full-blown crisis and critical incident management.
 
When do incidents happen? Any time, any place and to anybody! Consequently, the safety officer role must be taken extremely seriously and be done by someone who is capable of quickly responding and adapting to what can be fluid, chaotic and evolving situations.
 
Unfortunately, I've seen the other side where organisations and individuals haven't valued the safety officer role, nor taken it seriously and those put in the position of safety officer have thought it to be a nice, cushy, quiet ‘day off,’ which it's not. I could run through several examples of the disastrous mess that's occurred when organisations and individuals have taken this approach, however, I’ll stick with just one for now.

It was a weekend like any other at our residential outdoor education campus. We had 60 students in the field and 20 onsite. My group was the one onsite, so I had an insight into everything that was going on. I was told my help wasn't needed, but I made sure I remained informed and kept my finger on the pulse, just in case things changed.
 
I'd seen the safety officer, who was part of the admin staff and not really experienced in field operations. He'd been causally wandering around campus and saying how he was looking forward to finishing up and going home, as he didn't like working weekends. It had basically been a trade off. He had to work a weekend as did everyone else, but rather than be out on a trip, he decided the best place for him was in the office ‘doing safety.’
 
At around 3pm, a call came in from one of the groups. One of the boys had been bitten by a snake… They weren't sure what sort…

The near comedic chaos that followed demonstrated that not only do you need someone on safety. You  need someone who is switched on and competent. Maps were being pulled out, madly opened and juggled about to work out which way was up. A worried and panicked expression had set into the safety officer’s face and a general state of confusion gripped the air.
 
This really wasn't the confident basis for a swift response and to say things took a long time, would be a serious understatement. The lack of mental preparation by the safety officer and the limitation of knowledge and understanding as to what was going on became immediately apparent.
 
Fumbling through the whole messy process, what should've been a simple pickup from a trailhead ran from 3pm until just after 8pm when the boy was finally transported to hospital. There was no hiking. No 4WDing involved. Everything was accessible via sealed roads and the nearest town was 20mins away. As evacuations go, it was a fairly simple and straightforward one. So why did it take so long?
 
The main factor was the safety officer wasn't switched on to the fact that something could go wrong. He had the attitude that all he was doing was having a nice quiet day in the office, where he might have to answer the occasional phone call. He was also already thinking about going home. Because he wasn't mentally prepared, when circumstances changed, he didn't shift his thinking into response mode. Instead, he immediately went into panic mode, which consequently turned everything into a chaotic mess, dramatically increasing the potential for further harm.
 
At the end of the day, the boy finally got to hospital and thankfully, after tests were done (and the fact that it had been hours since the bite and no obvious signs of envenomation had emerged), the doctors found he hadn't been poisoned and was treated for the puncture wounds and sent home. This result was sheer dumb luck and if the boy had been poisoned, the outcome could have been far worse.
 
The bottom line is, don't rely on dumb luck, or inexperienced staff to get you through an emergency or crisis. If they're not experienced enough to be in the field, then they're the last person you want acting as backup and operational support. As part of your standard operations, you need to effectively plan and prepare for contingencies and most of all, ensure your safety officer is the right person for the job. When things go wrong, they go wrong quickly and your safety officer needs to be able to react and respond just as quickly and effectively.
 
By doing this, you ensure the right framework and resources are in place so that in the unlikely event something adverse happens, it can be swiftly contained. Good response can prevent any further injury or damage can be minimised. Right person, right place, right time, isn't dumb luck, it's good planning.

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.

Preparing For Camp

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There’s always a lot to think about when preparing for an outdoor ed camp. Assuming you know where you’re going and what you’re doing sorted, then it’s time to prepare the finer details.
 
For most teachers, this is where it can become overwhelming. Often the feeling is, “I want to run an enjoyable and safe trip… but where do I start?”
 
The first thing to do is develop your risk management plan. Many other things will simply fall into place once this is done. Although the bane of many teachers’ existence, a good risk management plan can save you considerable time and effort down the line.
 
When building your plan, look at your daily routine and work out what the key risks are for each activity and how you will accept, eliminate or mitigate these risks. You’ll need to consider things such as time of year (season), weather, temperatures, location and emergency exit points. Add to this the specific risks for each activity in those locations at that time of the year and you’ll start to build a picture of what your key risks are and how you’re going to address them.
 
With your risk management strategy created, remember, this is a living document not a copy and paste job which just makes up part of the ‘annoying paperwork.’ All staff need to be aware of risks and mitigation strategies and be prepared to react and respond if and when it’s needed.
 
The next step is to sort permission notes, get updated medicals and provide a student packing list with all the items they need to bring (and things they shouldn’t). Have a detailed plan ready to go before you send this out to parents. You’re bound to get lots of questions so the more detailed the itinerary you can provide upfront, the better.
 
For the equipment list, clearly specify quantity and quality of what’s required. Whilst I know some parents might not be able to supply this, as a matter of safety, it’s important that you’re able to cater for any shortfall. One of the most important pieces of equipment is a set of thermals. Even in warmer months, it’s good safety practice to carry some thermals in case of emergency and if you’re running an autumn or winter camp, it’s essential that all students have a set. The reason being (not just to support our great wool industry), hypothermia is always a significant environmental risk due to wet and windy conditions in Australia.
 
With permissions notes, medicals and gear all sorted, it’s time to brief everyone! This is often overlooked, but it’s vitally important to run a pre-camp briefing for staff and students. This goes back to pro-active risk management. Set the scene, set the expectations and build the excitement for camp. After all, you’ve just spent weeks preparing something very special it’s now time to tell everyone about it! Showing images from a previous camp and location on a map, is a great way to put into perspective some of the experiences they’re about to have.
 
With all this done, it’s down to the last items and you’re ready to go! First Aid kits, spare Asthma Puffer, spare EpiPen, any medications, groups lists, medical summaries, food and you’re good to go! By the way… did anyone book the buses?