First aid courses – a challenge
I’ve been considering my options for renewing or replacing my Standard Certificate in First Aid as mine expires early in 2008.
I’d like to do a full, standard course this time around as I’ve done nothing but refreshers and first aid at work courses for 12 years, and feel it would be better to start from scratch to get throughly up to date and rehearse/review all my skills.
However, I find myself with several serious issues to consider and a number of obstacles to be overcome.
First, the issues.
In the past, I completed a variety of certificated first courses – military, basic seagoing, lifesaving, wilderness, first aid at work, paediatric and standard.
I’m now down to standard alone and having done both St John and Red Cross first aid courses (FAW, standard certificate and refreshers) in the UK before, I’m far from convinced that they’re adequate for our circumstances.
The problem with the Standard Certificate courses is that they work from assumptions that don’t apply in country areas, where our scenarios can be more akin to wilderness or remote area first aid.
The UK courses tend to assume the first aider is in an urban or suburban area, has good communications (usually with a mobile phone), has bystanders who will phone for help if necessary (not always true in places like London), will have no more than a handful of casualties to manage, and will have ambulance service personnel on scene in 10-12 minutes at most (current target is eight minutes).
We, on the other hand, have dodgy mobile phone reception (and I don’t even have one), I can be on my own with little chance of people passing by, and it takes 18-20 minutes for ambulance to arrive on a good day.
In bad weather, with poor road conditions and heavy demands on their services, it can be 40 minutes before an ambulance arrives – or it may never come.
When the neighbouring farm burned down, I was on my own with a 16-year-old, an 11-year-old, and two three-year-olds for 30 minutes. It was a difficult but not impossible situation to manage as the teenager was very level-headed.
I was finally able to flag down a passing car – another neighbour with a first aid certificate – and it was only as I was handing off frightened children to her (one suffering smoke inhalation) that the first fire engine arrived.
The firefighters administered oxygen therapy to the child who’d suffered smoke inhalation, but an ambulance never showed.
I was lucky not to have more serious injuries on my hands as I would have been very stretched.
Similarly with road crashes. There was a fatality here in 2001 and there’s been a fair number of non-fatal crashes since then, but we’ve been lucky to only have one or two casualties at a time.
The worst case scenario was averted by a few feet when a mini-bus with 15 people on board crashed and rolled onto its side, narrowly missing substantial trees.
Somehow, the driver and all the passengers escaped with no more than bruising.
But if the bus had hit the trees or gone over the drop into the burn?
Then the scenario becomes hellish with one or two first aiders, depending on whether one or the both of the neighbour and I are present, dealing with up to 15 serious casualties for at least 20 minutes.
Now, people will say the emergency services will mobilise a substantial number of resources for a situation like this, but you have to factor in that the crash happened in the early hours of the morning, it was winter, it was blowing a gale and it was raining hard.
On top of that, there’s just one ambulance covering this part of the region – with the EMT on call from home at night – so more would have to come from further afield while wind, power lines and livestock would make helicopter operations hazardous, if not unfeasible.
These are just a few of the scenarios we have to contend with. We have people working in outdoor jobs, with livestock, with chainsaws, with tractors and agricultural machinery, with hazardous materials, with electricity and at heights.
And I’m afraid the Standard Certificate courses, while useful in many of the potential scenarios that arise from these, don’t cut the mustard at the extreme but still realistic end.
I also need the skills to deal with outdoor injuries in extremes of weather, to deal with mass casualty situations, and to deal with time delays of 20 minutes or more.
I’d also like to be able to provide trained medic assist to the first ambulance personnel to arrive, especially in a mass casualty situation.
Ideally, I’d do a Standard Certificate (either Red Cross or St Andrew) plus an Advanced Mountain & Outdoor REC-certificated course (business provider), but that brings me to the obstacles – cost and location.
We’d be looking at paying out at least £400 for me to do both courses and if I couldn’t find the money to replace the bike safety equipment, then I can’t see using raising that sort of money.
We could stretch to a refresher or basic emergency first course, but that’s it and that’s probably what I’ll have to settle for.
But it would leave my skills stretched in some of our scenarios.
The other problem is location.
The only Standard Certificate Course in these parts is offered by St Andrew in Aberdeen on Tuesday nights over three months – in winter and early spring!
That would involve driving at least an hour into Aberdeen and then an hour back, almost certainly in bad weather while still attempting to get the croft chores done.
Advanced Mountain and Outdoor courses can be held up this way, but you have to pay the providers to come to you. Not a viable option!
It looks like I’ll have to do a more basic course at lower cost and over a weekend (if there is such a thing), even though I’d like to do more.
Another option that’s been put to me is to apply to be a volunteer Community First Responder but I’d want to have my own health back first, plus it would take time. Time in which incidents can happen.
I’m here and I’m prepared to help anyone at any time, but I’d like more and better training with some help in getting it.
So, here’s my three-part challenge for first aid training providers:
- Can they make their training more accessible to people in outlying areas?
- Can they make the training more applicable to residents of rural and remote areas (people in the Highlands are far more isolated than we are)?
- Can they consider funding options that would enable people with limited disposable incomes to qualify as first aiders (perhaps with local government/NHS help)?
90% of being a good first aider is knowing the basics and having confidence in your ability to react in the face of a crisis, which i think you already. Is a basic certificate going to improve that? I think if you have done that many courses a basic course is going to teach you very little.
You seem like an outdoor person how about volunteering for one of the volunteer rescue services.
Also while you are laid up maybe you could look for an online source of info no substitute for hands on but its a start.
Final idea see the local course providers and see if you could do a course but not get a cert? As most offshore courses the aim is to get the cert not gain the knowledge?
bingo
http://www.firstaidcafe.co.uk/Forum/Default.asp
I’m just too far out of the village for the fire service, especially as I no longer have a car.
I’m looking into the Scottish Ambulance Service’s Community First Responder programme. However, the North-East division under which I’d fall only has schemes covering Peterhead, Inverurie, Aberdeen, Stonehaven and Forres. But we shall see.
The basics of first aid can and do change over time as more knowledge becomes available or techniques are refined (although ABC is always the most critical element). For instance, with CPR the guidelines changed in 2005 to put greater emphasis on chest compressions with a new ratio of 30:2 compressions to rescue breaths (under most circumstances).
That’s why it’s important to do refreshers – first to learned changed techniques and second to have a critical review of your skills. But refreshers can’t cover everything and I’d feel it would be sensible to revisit all my skills.
Oh, and I’ve always kept track of first aid techniques and changes using a variety of sources.
Thanks for the suggestions.
After assisting with the accident adjacent to your place in Oct and seeing the amount of time takien for medical support to arrive I understand the situation. The other point that you make is valid; that is refreshing ones knowledge of first aid is essential. Techniques and knowledge do change over time.
I was surprised at the amount of time it took for the ambulance to get to “your motor vehicle accident” situation; however as it is a rural area perhaps it is partly understandable. (We were also advised that they had several call outs at the same time that morning).
Is there a follow up system to cover the absence of the one ambulance vehicle when it is out on a call., i.e. a second vehicle being called forward from another area for the time necessary. It too is backed up if necessary from another station and so on.
I see this system used here at home for the NSW Fire Brigade is involved in tasks in the country areas. Ambulances also seem to follow such a system.
Perhaps an answer is for the appropriate authority to accept the responsibilty and conduct first aid and similar courses in rural areas. I would see Insch as being a suitable location for people in your area. It would be well worth the expense and time utilised.
I know I am “rusty” in my knowledge and recently had to rack my brains in a life support situation as it was a long time since I last practiced/refreshed my first aid.
Having done first aid for 30 years, yes I would agree the basic courses are more for the urnban limited casualty senerio. It is only when you get to the Mountain rescue, fire service, ambulance service that a more detailed knowledge is taught because as a rule they are more likely to come across more difficult and multiple incidents.
Slightly different but I am finding a similar sort of thing trying to find clubs for my children to go to. None in my area and I have had to travel to the next county.
Think boils down to apathy!
The nearest ambulance is based in Huntly, but is on a 10-hour on duty, 14-hour on call system. While the A96 from Huntly to our turn-off is straightforward to drive in almost all weathers, the hill road down to the croft is about five miles of tight, winding road with steep drop in places. In wet weather with mud on the road (farm tractors), it’s hazardous. In snow, it’s impassable and anyone coming from Huntly has to take long way round – and that can also be blocked.
The next nearest ambulance in time terms would be Inverurie, then Alford but the latter would be severely hampered by bad weather as it’s a cross-country route on B and unclassified roads.
After that, it would be Elgin or Aberdeen, 40-50 minutes in good weather with clear roads.
I don’t have a huge problem with the situation. If you live in the country then slower response times are to be expected and so you make provisions to cover that.
My husband did a British Assoc of Ski Patrollers course before his winter ML training. They’re not as expensive as some, but Aviemore is the nearest centre I think. He’s done REC 5 since, but that was funded by the Scouts for their Greenland expedition.
I’ve got a Red Cross Standard qualification, slightly tailored to dealing with children but not really to the outdoors, that was required by the Scouts.
I think you’re right, if something bad did happen out where you live you’d need more than Red Cross Standard training.
Being a bit of a trauma magnet myself I can empathise with you on this one!
When I had a small business, I found it cost effective to pay for a commercial course, because I found the ones provided by the voluntary sector, rather protracted, I wanted to learn, practice and get back to work! Not wait for Joe Blogs to arrive before we start, or hear about the tutors’ holiday in Spain!
But obviously the situation here is different. I fully appreciate skills need to be kept up to date, but save you having much more extensive equipment than you have now, what can you do other than try and to stop any further injury and give what aid you can with what you have got? Maybe it is the same feeling for a solo paramedic (Wait for kingmagic to chip in here)
It’s a scary thought, but s*** happens; you can only do so much, and do no better than your best.
I think you have shown us, you have a shed load of practical skills, at your disposal, and are clear-headed enough to use them, realistically how much more would you learn? (Granted you could reinforce some of the skills you have.)
Does your community responder schemes do trauma? Many do not, the lack of a vehicle, may cramp your style when OH is not home! (Unless you can peddle VERY fast!)
But here is some blue sky thinking,
If you got a group together in the village, could the course come to you? Funding is available from many areas, many companies and organisations have community funds, that they will make payments for schemes such as this, if you were to make a pitch, or just a quiz night in the pub, people are very generous when they know that monies raised are going directly to their communities, and that they or their loved ones my benefit from the skills.
The British Heart foundation do ‘Heart Start’ Courses that are run on a train the trainer basis.
Good luck and as some one once said to me, when I was fretting about such things
‘You go in, you do your best and you learn something every time, that’s all you can do.’
One, I’d like to critically evaluate my skills base. It is extensive for a first aider, but I haven’t used some skills in a long time and some have never been called on. (When I lived in London, I used CPR fairly regularly; up here, not once in four years. In London, I dealt with trauma a handful of times in 10 years; up here it’s every couple of months. And despite doing water rescue training and first aid, I’ve never once had to deal with a drowning.)
Two, I’d like to made sure I am thoroughly up to date as procedures and protocols change. Refreshers are fine, as is keeping abreast of developments, but again nothing beats re-evaluation and re-training to discover areas that have changed.
When I did my first course 30 years ago we were taught BBB (breathing, bleeding, bones), later it became ABC (airway, breathing, circulation) and then DRABC (danger, response, airway, breathing, circulation). They’re much the same in essence and the “danger, response” elements were taught, but the emphasis has altered over the years.
Tourniquets used to be very common practice for trauma to limbs and venomous snake/insect/arachnid bites, but are now rarely used and only in very specific circumstances for severe trauma at limb extremities.
CPR has changed a lot over the past 30 years, too, with the most recent change feeding through from 2005/06. And there are some interesting developments being studied now that might changes things again in the future.
I’m awaiting responses from the Scottish Ambulance Service about local responder schemes (and I can get to the village on my bike much faster than an ambulance can get here from Huntly), from the Red Cross and St Andrew to various queries.
I decided to turn my musings into a post after Nee Naw asked for topics to blog about and first aid came up.
And don’t worry, I’m not the sort to fret! I just like to maintain my edge.
I’m with you entirely on the greater suitability of most general first aid courses to urban environments – I took my first one in a youth organisation over 40 years ago and kept it up to date until fairly recently….
Also, yes first aid has certainly changed over the years, but you know what…in the event of a really bad bleed out I’d still break all the rules and smack on a tourniquet (slackening every twenty minutes or so)…why?…because I KNOW at first hand, in extreme cases, it saves lives…In extreme circumstances it’s surely better to risk a limb than die outright? And to a terrified tyro, possibly faced with multiple casualties, a TA is far easier to do than prolonged direct pressure, especially if other casualties are waiting…A principle of triage, I’d have thought…
In my time we prioritised by Breathing, Bleeding, Shock…the latter being (in my humble opinion) as a potential killer, being far more important than mere bones…
Over the years I’ve heard too many pratts arguing against CPR methods as well – “because they can cause un-necessary injury” etc …As a pure civilian I’ve sadly had to use (and in an urban environment too!) “cardiac thump” (as we nicknamed it) and mouth to mouth four times…(out of interest two lived, one died later in hospital, one was DOA and had apparently been for twenty minutes before I arrived, but you have to try)…I say, if in doubt, go with the tested method…it’s better to live with a broken rib (as one of mine did) – than die for lack of attention….
I really think the time has come when some form of first aid should be compulsory in school – let’s be honest – it’s more vital (in the true sense of the word) than most of the crap they try to put between our ears!
I’ve the name of a mountain rescue guy who is certified to teach first aid. I know he often does “tailored” courses, so he might be able to help – I’ll email you his details.
I would stop worrying, firstly. Not everyone in an accident does well, even in a hospital. We are always urged to remember the basics – you can have all the Gucci kit in the world, but if you don’t protect the airway/stop the bleeding, there’s not a lot of point. You can only do the best you can with what you’ve got.
Bloody hell cogidubnus, with the skills like that, will you pick my lottery numbers?
you could work 30 years in the ambulance service and not get that many ‘back’
I’ve got a few back, too, a chap in his late 40s on the Tube and a lady in her 60s in Oxford Street. There was also an elderly gent back in Australia. I don’t know if the two in the UK made it after that, but the gent back in Australia did survive. The other people I’ve done CPR on, bar one, didn’t make it into the ambulance alive.
The one that still amazes me was outside the row of shops at the back of Waterloo station in London. I was having lunch in the Japanese restaurant when a lady dashed in, said a man had collapsed and asked if anyone could help.
I went out and there was man in his 50s on the pavement, with a petite lady, nurse’s uniform visible under a coat, opening his airway. I told her I was a first aider and she said “He’s in arrest. I’ve done 30 quick compressions. How confident are you with chest compression?”
I said good, that I’d just done a refresher and had done CPR for real before.
She said “Right, you’ve got the strength, do the compressions while I maintain his airway and do rescue breathing. I’ll tell you if there’s any problems or changes. Ambulance has been called.”
Then we were into it. Get the right position, find my focus, start “Nellie the Elephant” in my head for the timing and away.
Nellie the Elephant packed her trunk
And said goodbye to the circus
Off she went with a trumpety-trump
Trump, trump, trump
Nellie the Elephant packed her trunk
And trundled off to the jungle
Off she rode with a trumpety trump
Trump trump trump
It was a bit strange to be doing CPR as a team, because I’d instinctively start to pause at the end of the second pass to do rescue breathing, then remember I had someone doing that already.
Nellie the Elephant packed her trunk
And said goodbye to the circus
Off she went with a trumpety-trump
Trump, trump, trump
And on, and on, and on.
Then someone put a hand on my shoulder and said, “It’s alright lad, we’ve got him now”.
It was one of the Gods in Green. In fact, there were three of them.
I moved out of the way and suddenly realised I was knackered. I just sat on the kerb for some minutes while the paramedic and ambulance crew took over CPR, administered drugs and used a defibrillator. I was then joined by the nurse.
“They’ve got a pulse now and he’s breathing, so he’s got a chance. Good job, that was almost 15 minutes but you really held it together.”
I could barely believe it.
She smiled, gave me a big hug, and said “your singing is crap, by the way!”
I’d been singing Nellie out loud…
Then it was back to the office, where people said I seemed a bit distant. To me, it was the office that felt surreal.
A quick note on the four successful CPRs. All involved a great deal of luck as I actually saw three of the people collapse so CPR was started very, very quickly. It was the same with the chap behind Waterloo, the nurse saw him go down, sent people scattering for help and was starting CPR as I got to her side.
That meant all four had just about the best chance for survival in the conditions. I might write the Tube one up as well at some point as it was also memorable, but partly for the wrong reasons. But not at the moment – it’s enough to write one such incident up.
Unfortunately for ambulance personnel, by the time they get to a scene it’s almost always too late. They may be there in under eight minutes but unless some was doing CPR within three minutes of the person going into arrest, the chances of successful resuscitation shrink very, very fast. It is always worth trying, though.
There are some specialist companies out there but can be costly as mainly ex special forces who can charge what they like for their knowledge and skills.
In a rural situation the first aid rules will differ from the urban ones…apart from the basics:
If they aint breathing…get some oxygen in!
if the hearts stopped then pump that chest!
if they are bleeding then plug it!
For anyone reading this…do not be put off by the differing ratios for respirations to chest compressions that change on an almost yearly basis for CPR…any CPR is better than no CPR at all.
As others have already commented…do what you can with the resources, skills and knowledge to hand…..
Agreed, but I’ll always seek to maintain and improve my skills and knowledge. It’s not about worrying, as Deborah said, but about having an edge because it can and does make a difference.
This is interesting – as a Londoner I’ve never really considered what I might do in a “wilderness” situation. If anything, my bugbear with first aid courses is the opposite – they assume that the first aider is going to send someone else off to call whereas in real life there is almost always a mobile phone on scene and an interaction between the emergency services and the first aider.
It also drives me mad that in EVERY first aid course you are told to tell the bystander “ring an ambulance and come back and tell me how long it will be”. Because for a 999 call taker, you are strictly forbidden to tell anyone how long the ambulance will take!
Mark, a majority of incomers to rural areas have trouble grasping the fact that they no longer have reasonably immediate access to the emergency services. They’ve come up here from major cities in the south and expect someone to be with them in eight minutes or less – after all, they’ve been told to expect it on the TV.
Their expectations are unrealistic in many circumstances in the big cities, but out here? Their expectations are so far removed from the reality as to be completely ridiculous. The gulf between expectation and reality is even more marked in parts of the Highlands where people really are isolated.
Then there’s the expectation that mobile phones will work. I’m sure the mountain rescue teams have umpteen stories about people who thought they could phone for help. It’s the same with crashes, agricultural accidents and many other emergency situations – mobile phones often don’t work or don’t work reliably. (And BT have been removing many of the old telephone boxes, too.)
What you have to do is phone the emergency in immediately if you can. If you can’t, then you have to improve the patient’s chances of survival (while hoping for a passerby) and then go for help yourself. You have to make much tougher decisions than in an urban environment, but again many incomers – and yes, some locals, too – find that very difficult to do. So they dither and haver, thereby achieving nothing.
When you consider how many urban-based people now move to rural areas or use them for recreation, it’s about time to first aid training providers caught up with the different realities out here. They can’t change everyone’s expectations, but they could make a difference with a few, and if that saves just one more person it’s worthwhile.
And here’s a paramedic’s story of getting one back – despite the odds being stacked against them.
Same paramedic, another save, and one of the best descriptions of what it’s like to be doing compressions and have the person come back.
Read the entire post to find out why knowing and doing CPR is one of the most life-changing things you can do.