Risk Management

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

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.

Rock Climb The Arapiles

Rock Climb Mount Arapiles - Outdoor Education

For the adventurous rock climber, Mount Arapiles in Tooan State Park Victoria is an absolute must! This is a world class climbing spot and regarded as the best in Australia, attracting locals and international climbers alike. Four hours North West of Melbourne, the mountain range suddenly rises up out of the near dead-flat Wimmera plains, a stunning sight in itself, but wait till you get to the top!

The nearest regional centre to the Arapiles, is Horsham . Head west from there on the Wimmera Highway until you get to the small township of Natimuk. There’s a really good general store there for some basic last minute supplies. From there, you can’t miss the mountain range. It’s dramatic, stunning and rises up out of the Wimmera plains to dominate the landscape.

There are over 2,500 different routes to climb on this mountain, which provides a massive range of options for the beginner, right through to the advanced lead climber. Even though you’re bound to find other climbers around, there’s plenty of options from which to choose.

To get started, there’s a number of small, short climbs with easy road access and simple to setup top belays without having to lead climb up. These are perfect for the whole family, training the kids, or just bouldering to improve your own technique.

Further in, the mountain opens up into a massive collection of climbing routes for all skill levels and abilities. There’s an abundance of multi-pitch lead climbs up challenging rock faces, chimneys and stand-alone rock pillars. For less experienced climbers, guided climbs are available from the local area. For the experts, grab yourself a route map and get climbing!

The views from the top are stunning. The mountain is a stand-alone feature on the landscape, so all around you it drops down to the beautiful agricultural plains of Western Victoria as far as the eye can see.

There’s way too much to do here for just one day, so plan to make a trip of it. If you want to stay onsite, you must book camping in advance via the Parks Victoria Website. The camp ground has a great international atmosphere, with people from all over world hanging out and taking on the variety of challenging rock faces. Whilst this is an all year round location, Summer here does get really hot, so from a risk point of view just keep that in mind. 

If you love climbing, then this is by far the best place to do it Australia!

 

PACK LIST:

•         Tent

•         Sleeping Bags

•         Sleeping Mat

•         Food

•         Gummy Bears (because you just can’t go wrong with them)

•         Camping Stove

•         Firewood (You're not allowed to collect wood from the site.)

•         Water

•         Lanterns

•         Sunscreen

•         Insect Repellent

•         Clothes for hot midday and cold nights

•         Climbing Gear (helmet, ropes, harness, devices, shoes)

•         First Aid Kit

•         Camera

Getting Audited

Audit - Risk Management

Whenever you mention the word ‘audit,’ it gets everyone on edge! Visions of tax audits rush to the front of our minds with suit clad accountants sporting thick rimmed glasses slinking into your office to quietly demand to see your books. With a stern, set expressionless face, they shuffle through crumpled receipts and punch digits on their oversized calculators, only occasionally glancing up to inquire, “Was that mountain bike really for work purposes? Are you just pretending to be a mountain bike instructor?”

It really is an unsettling feeling for people, as nobody likes to have strangers come through and make judgements about their finances or work. However, what if we’re looking at this from the wrong point of view? For the moment forget about tax audits and think about workplace audits. What are they? What should they be for? What benefit can they bring?

An audit within the workplace can be for many reasons, but basically they’re to test and assess if what’s being done, is the most effective and safe way of doing things. As a result, this can bring huge benefits to the organisation. However, it needs to involve an experienced and impartial third party. This not only helps remove internal personal agendas, but also allows for a fresh look at processes and procedures which we are often too close to as program developers and managers to see for ourselves.

From a safety and risk management point of view, it’s excellent (and essential) to have your programs and systems regularly audited. This is not to strike fear into people and ‘keep everyone on their toes,’ it’s to ensure your organisation is doing the best work possible in the safest manner possible.

Having worked for a number of dysfunctional organisations in the past, I’ve seen first hand how desperately they needed someone to come in and ask, ‘What the hell is going on?’ Sometimes, this can work internally. However, it’s always far more powerful to have an independent point of view expressed.

Unfortunately for the places I worked, with a sense of such misguided self-confidence and arrogance, they refused to let anyone take a serious look at what was going on and in two cases it just got worse. This lack of transparency and idea that everything’s ok because someone with a boss hat on said so, only added to the risk profile of the organisations. The reality was that the more they tried to internalise everything, the greater the risks became.

Thankfully, most organisations aren’t as bad as this and what an audit will usually find is that there are some great things happening. This reinforcement of what you’re doing well as instructors and program directors, is an excellent morale boost for everyone and a wonderful validation of the great work you’re doing.

There are also always going to be areas in which you can improve and the audit can cut through a lot of the organisational blindness to reveal some key areas that have been missed, fallen by the wayside or simply can be improved upon. Again, in most cases, this is just part of a continuous improvement process and shouldn’t be seen as anything personal or daunting.

As an outdoor ed professional, I’ve had my work audited and I’ve also conducted external audits on other schools and organisations. The end result of each and every one of these was reinforcement and positive improvement for the programs.

Unless you’re an absolute buffoon and have been pretending you can run a program when you have no idea what you’re doing nor any real experience, there’s absolutely nothing to fear from an external audit of your program. For any school or organisation running outdoor programs, it’s essential to have your work regularly reviewed to ensure the best risk management and operational management practices possible, because at the end of the day, you’re better off having an experienced outdoor ed professional coming in, working with you and reviewing your work to help reduce risks and prevent incidents, rather than a team of lawyers soullessly trawling through everything and interrogating you after something has gone seriously wrong!