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:
Malcolm Gladwell – Revisionist History Podcast
Pocket Concussion Recognition Tool - updated 2017
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.
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:
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.
Now thankfully this isn't something that happens every day, but it does happen. Given the fact that my first job was at a gun club, shouldn't mean the chances of being shot increases. Whilst many bleeding hearts will tell you the dangers of shooting, it remains one of the safest sports you can do. I've had far worse injuries from hockey than anything else. Mountain biking and skiing are right up there for the most dangerous sports. However, once again, I digress and so back to the topic.
I'd got my first job as many teens do at 15. However, it wasn't a fast food joint. It was a shotgun club. My job was to put the skeets on the hopper and fire them up so that people could shoot at them. It was a fun job that paid really well. Most of the time I just sat inside a concrete bunker waiting for the buzzer. When I heard that, I'd load the clay and off it would go. This would be followed by the sound of a shot gun and depending on how good a shot they were, it either shattered the clay pigeon, or it would gracefully sail back down to land in the field nearby. The only real hazard of the job was when a clay shattered inside the bunker as it flew out. You'd be shielding your eyes as you were peppered with tiny ceramic fragments as they ricocheted off the solid concrete walls.
The job was fun and often I'd get to shoot a few clays afterwards too, which added to the excitement of it all. One day however, we were on a different range. It was the field and game range. At this range, it wasn't the traditional skeet tower and bunker configuration that we usually worked with, meaning the clay pigeons would be fired from either a tower, or the bunker. Instead, we used a whole range of different styles and sizes of clays which could be bounced along the ground, thrown up into the air, down a gully or every which way possible. It added a remarkably different sort of challenge to it all.
That day, I was stationed high up on top of this rock. When I heard the buzzer, I'd fire two clays up over this rock and the shooter would see them as if they were birds through the trees. This was no worries at all as I was high up and protected by a rock. However, the next range over, something was being fired across the gully and unfortunately I found out the hard way that this side wasn't so well protected.
There had been a few shots now and then where I'd heard the leaves in trees above getting sprayed through with shot, but thought nothing really of it. I was protected by a rock. It was way above my head as it should be. It was all good. However, just as I was loading a double clay, I heard a boom and whipping sound coming at me. My arm suddenly stung before a hot painful burning sensation took over. I grabbed my right shoulder with my hand. Looking down I could see blood, lots of blood and my upper arm dimpled with telltale signs of a spray of shotgun pellets.
I don't remember screaming or crying in pain. It all felt so surreal. One second I was loading clays. Next I'd been shot in the arm and bleeding profusely. I felt my right hand release the clay hopper and I shot the two clays up into the air. It must have surprised the range officer, as I'd let them go too early. He was on the radio to see what was happening.
I said, ‘I think I might need some help. Can you come up?’
I remember the reply was one of grumbles, as if it were so much effort to get up the hill. (Actually, for most of the club members it was, given the fact that they weren't the fittest group of individuals.)
However, when he got up there and saw the blood, his attitude changed. Thankfully, someone in the club had some idea of first aid and it wasn't long before they stopped the bleeding and revealed some nice neat pellet holes in my right shoulder.
Whilst today, I'd be seriously looking into their risk processes and procedures to find out why there was such an horrendous failing in their safety, back then. After I realised that the wounds weren't too deep, the pellets had all been removed and I was ok, it now felt so cool to have been shot at work and as compensation, they gave me and extra $50. All in all, a great day at work.
Whenever you're running trips in the field, be it outdoor expeditions or sports trips, part of your planning should include someone who’s sole role is the safety backup person. Unfortunately, this is often an overlooked roll, or one that's totally under-estimated in its importance.
Whenever you're dealing with staff, students, vehicles and equipment, no matter how careful you are in the planning process, something could go wrong. When it does, you want to be able to respond quickly and effectively to contain the incident and mitigate any damage. If all your resources are tied up with the operation itself, then your ability to respond to unforeseen events is seriously compromised.
The process we used at one school I worked at was very effective. Staff were trained in emergency and crisis response management, had been on every single expedition we ran and rotated in and out of the safety office position throughout the year. This meant they always had their finger on the pulse as to what ‘normal’ operations should look like and they knew the local area extremely well, so when contingency plans needed to be enacted, they were able to form a swift and appropriate response.
The safety officer was the central command for all communications in and out to the groups. He monitored the group’s location, progress and knew of any specific needs of the group. All contact in and out was logged so there was a complete record of communication with the group.
Most of the time, this just meant the safety officer was sitting in the office and didn't have much to do. However, when something didn't go to plan, he was ready with a vehicle, comms and equipment to respond swiftly and in the most effective manner possible. No scratching of the head, no running around to grab supplies, they were ready to go immediately.
Why is it so important to have a person in this role? Why can't the person on the ground just deal with it? I've also worked for a school that thought this should be the case and their idea of someone on safety, was a person who was on-call on their day off, 2.5 hours drive away. Now I’ll let you be judge on how negligent this approach is. The reality is if you limit the resources to manage contingencies or not even have contingencies, then you seriously increase the risk of harm to staff and students.
The safety officer needs to actively monitor weather conditions, notify groups of any changes, or the issuance of extreme weather warnings. They need to remain appraised of other potential environmental hazards, such as bush fires, flash flooding, lightning, high winds, feral animal control or even other groups in operational areas.
I always enjoy the variety that this role brings. At times, it's a great way to have a quiet day in the office, simply checking weather, fire danger and logging communications. However, other times you're on the go all day, sorting out logistical and operational issues to smooth out daily activities, or occasionally taking a student to hospital (and sometimes a staff member).
The bottom line is that the safety officer is a vital, available resource that's ready to respond, provide additional support or effectively co-ordinate a larger scale operation in the event of an emergency or crisis. It's not just a cushy role for some inexperienced staff member to have a quiet ‘admin day’ in the office. You need to use your most capable staff because the difference that can make to the speed and effectiveness of the response, impacts significantly on the containment and mitigation of the incident.
In first aid training, it should be drilled into students more and more that Danger is the No. 1 consideration for First Aiders. It's often mentioned, but the massive importance of the issue is not always effectively addressed. Personal safety and personal protective equipment should be dominant factors in your decision-making process of, ‘To help or not to help!’ The tough reality is that if you're going to be at risk, then you always have the choice not to involve yourself. It's a hard decision, especially when you're trained and have a desire to help others, but sometimes it's the only choice possible if you’re going to end up in danger yourself.
One situation I found myself in where the danger to me proved far too great, was when I was in Colorado, in the US. I was skiing at Breckenridge, and coming down a home trail that links two of the peaks together, when a movement out of the corner of my eye caught my attention. I skidded to a stop. Glancing back I saw two figures scrambling desperately to get out of a creek bed next to the trail.
The first one popped up onto the side of the track. ‘Are you ok?’ I asked, seeing that he was a snowboarder.
‘Yeah, I'm fine,’ he panted.
He seemed distracted, turned back and scrambled towards the creek. I skated up and took a closer look. I could see his friend half way up the snow covered embankment, his head covered in blood.
‘Oh…’ I thought, suddenly switching modes and quickly assessing the area, the people and everything around me.
The guy who'd climbed out first was now becoming increasingly distressed.
I looked directly at him and calmly said, ‘Would you like me to call ski patrol?’
‘Oh yeah man… yeah… I need to get him out!’ he replied sounding confused and now appearing disorientated.
That was about the best indication I could get that this guy wanted help, so I called ski patrol and gave them a quick description of the situation and my location. At this point however, I’d only just seen the scrambling up, some blood and heard a bit of noise. I didn't quite understand the full extent of the injuries or anything like that.
As I got off the phone, I could see the second snowboarder grab the edge of the track and push himself up. I clicked out of my skis and stepped forward. Staggered to his feet, the snowboarder stumbled toward me. Taking one look, I stepped back. Blood was pouring down his face like a bubbling brook.
Taking another defensive half-step back I said, ‘My name’s David, I’ve called ski patrol and they're on their way.’
I got a mumbled somewhat confused response that at some point included an acknowledgement.
This whole time, I was still assessing the scene and evaluating the injured snowboarder. I'd determined the scene was safe. Given the mechanism of injury appeared to be snowboarding into a creek without a helmet, I wasn't that concerned about that happening to me. The next danger was that the snowboarder was now standing in the middle of a ski run and other skiers and snowboarders were riding past at speed. To manage this danger, after I took my skis off, I’d crossed them up hill from our location, so I was happy with the fact that I wasn't going to get hit where I was standing.
Next I moved to the human factor in my ongoing Danger assessment. I’d already determined that there was significant personal risk involved in providing First Aid. There was blood everywhere, I didn't know the person, he appeared to be under the influence of drugs and I had no personal protective equipment (gloves). This was too much danger for my liking and there was no way I was going to put myself at risk of a blood borne infection through providing assistance in this situation. At the same time, I also decided that I wasn't going to just walk away. I was going to be entirely ‘hands off’ as the casualty was at least able to do things for himself and help was on its way.
From a safe distance, I provided clear instructions to him and his friend, who was still wandering around in a panic. ‘Okay, ski patrol isn't far away,’ I said again to reassure the casualty. ‘What I suggest you do whilst you wait is just sit down on the side of the track and with your glove, press down on your head.’ I pointed to where I wanted him to sit, out of the way of others and demonstrated with my hand on my head to show him what I wanted him to do.
The blood kept streaming down the snowboarder’s face unabated, but there was little else I could or would do in this situation. He sat down and at least put some pressure on his wound. For at least 2 minutes, he was sitting there doing what I'd suggested he do.
This is where it became weird. His friend is still walking about in a panic and I was trying my best to calm him and reassure him. Then the casualty starts reacting to his idiot friend’s panic. ‘I've gotta get outta here man!’ he said.
‘Oh no,’ I thought. ‘Here we go!’
Now dealing with profusely bleeding drug tripping snowboarders isn't my idea of a good day on the snow, but I still had to try my best until I could hand this bloody mess over to ski patrol.
‘It's okay,’ I said again, ‘ski patrol is on its way. Just stay where you are, keep pressure on your head and you’ll be taken care of shortly.’
‘Nah, man I gotta go!’ he said, taking his hand off the head wound. Suddenly more blood streamed from his head as the pressure released. He proceeded to strap on his snowboard.
I tried reasoning with him some more, and when that didn't work, I tried reasoning with his friend. Not an easy thing to do with stoners! Dave definitely wasn't their man!
No matter what I tried, the guy was determined to go, so I certainly wasn't going to try and stop him. He skated off woosily, his friend chasing after him yelling, ‘You gotta see a doctor man!’
I quickly got back on the phone to ski patrol and explained the situation. ‘Do you know where he’s going?’ they asked.
‘No, sorry I don't know, but there's a pretty clear trail of blood leaving my location. Follow that and you're bound to find him.’
With that, it was the end of my involvement. Even though I provided some level of assistance, I remained completely hands off to protect myself from the clear and present danger. Having come across an injured person, I’d fulfilled my obligations under the skier’s code of responsibility, by stopping and calling ski patrol. However, in my assessment of the scene, the injury and the person involved, I’d decided very quickly during my initial danger assessment, I wasn't going to offer or provide first aid.
This can be a hard decision, as you're trained to help others in need. However, I've seen people rush in to situations and end up finding themselves covered with a stranger’s blood, which, even if you've only got a paper cut on your finger, could mean an infection. The last time I saw this happen, the person was a first responder to a car accident. He rushed in with another, started treating a casualty, no gloves, no danger assessment done at all. The irony was that there was a well-stocked First Aid kit with plenty of gloves in the back of the responder’s vehicle. If they had taken 60 sec to calm themselves, checked for dangers and put gloves on whilst they assessed the scene and its surrounds, they wouldn't have needed to go through the stress of a number of blood tests for infectious diseases. I can't stress enough DON’T DO THIS! If you're the first responder, your No. 1 priority is always to CHECK FOR DANGER! At the end of the day, you can't afford to put yourself at risk of harm and become the second casualty of the incident.
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
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.
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.
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.
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...
What Happens When Dr Who Get's Impolite And Angry!
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 an 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...
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!
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 stablising 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!