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 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!