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Topics - adi

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2
General Discussion / Merry Christmas All
« on: December 24, 2013, 09:07:44 PM »
Have a good one.

4
Satnav (GPS GLONASS COMPASS Galileo) / Sat coms
« on: November 22, 2013, 01:36:06 PM »
It's not satnav related however it is sat communication.

I recently was shown the Thureya SatSleeve by a friend who is a BBC hostile environment camera man, or better known as a war corespondent. More and and more news organisations are turning to mobile communications for making the news. It is cheaper smaller and easier to transport and the quality is often good enough for TV broadcast.

Here is a link to the Satsleeve http://www.thuraya.com/SatSleeve

<a href="http://www.youtube.com/watch?v=eTEDgc2vu44" target="_blank">http://www.youtube.com/watch?v=eTEDgc2vu44</a>

6
First Aid / Slix 100 extraction stretcher
« on: October 29, 2013, 11:58:41 AM »
I reticently ran a course in London on extracting casualties from confined spaces underground and they had a Slix 100 stretcher. What a great bit of kit for winching casualties. Very light weight although not great for carrying a casualty over long distances but perfect for helo casualty recovery ops.


7
First Aid / BLS Resuscitation Guidelines Guidelines 2010
« on: September 28, 2013, 06:50:15 PM »
Right lets try to put this to bed.. Compression only CPR should only be used if cardiac arrest is witnessed and the patent is objectionable to you i.e. signs of drub use, covered in vomit. The ambulance service may tell you to do compression only CPR if you ring them and you are not first aid trained.

Resuscitation Council (UK)

2010 RESUSCITATION GUIDELINES 15

Adult   Basic Life Support


Introduction
This chapter contains the guidelines for out-of-hospital, single rescuer, adult basic life
support (BLS). Like the other guidelines in this publication, it is based on the document
2010 International Consensus on Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science with Treatment Recommendations (CoSTR), which was
published in October 2010. Basic life support refers to maintaining airway patency and
supporting breathing and the circulation without the use of equipment other than a
protective device.

It is important that those who may be present at the scene of a cardiac arrest,
particularly lay bystanders, should have learnt the appropriate resuscitation skills and be
able to put them into practice. Simplification of the BLS sequence continues to be a
feature of these guidelines, but, in addition, there is now advice on who should be
taught what skills, particularly chest-compression-only or chest compression and
ventilation. Within this advice, allowance has been made for the rescuer who is unable
or unwilling to perform rescue breathing, and for those who are untrained and receive
telephone advice from the ambulance service.

Guidelines 2000 introduced the concept of checking for Ďsigns of a circulationí. This
change was made because of the evidence that relying on a check of the carotid pulse
to diagnose cardiac arrest is unreliable and time-consuming, mainly, but not exclusively,
when attempted by non-healthcare professionals.

 Subsequent studies have shown that
checking for breathing is also prone to error, particularly as agonal gasps are often
misdiagnosed as normal breathing.10 In Guidelines 2010 the absence of normal
breathing continues to be the main sign of cardiac arrest in a non-responsive victim.
Once cardiopulmonary resuscitation (CPR) has started, it is now recommended that the
rescuer should only stop CPR if the victim shows signs of regaining consciousness,
such as coughing, opening his eyes, speaking, or moving purposefully, as well as
breathing normally.

Guideline changes
It is well documented that interruptions in chest compression are common and are
associated with a reduced chance of survival.  The Ďperfectí solution is to deliver
continuous compressions whilst giving ventilations independently. This is possible when
the victim has an advanced airway in place, and is discussed in the adult advanced life
support (ALS) chapter. Compression-only CPR is another way to increase the number
of compressions given and will, by definition, eliminate pauses. It is effective for limited period only (probably less than 5 min) and is not recommended as the
standard management of out-of-hospital cardiac arrest.


It is also known that chest compressions, both in hospital and outside, are often
undertaken with insufficient depth and at the wrong rate.

 The following changes in the BLS guidelines have been made to reflect the importance
placed on chest compression, particularly good quality compressions, and to attempt to
reduce the number and duration of pauses in chest compression:
1. When obtaining help, ask for an automated external defibrillator (AED), if
one is available.
2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min-1
.
3. Give each rescue breath over 1s rather than 2s.
4. Do not stop to check the victim or discontinue CPR unless the victim starts to
show signs of regaining consciousness, such as coughing, opening his eyes,
speaking, or moving purposefully AND starts to breathe normally.
5. Teach CPR to laypeople with an emphasis on chest compression, but
include ventilation as the standard, particularly for those with a duty of care.
In addition, advice has been added on the use of oxygen, and how to manage a victim
who regurgitates stomach contents during resuscitation. Resuscitation Council (UK)

Adult basic life support algorithm
UNRESPONSIVE?
Shout for help
Open airway
NOT BREATHING NORMALLY?
Call 999
30 chest compressions
2 rescue breaths
30 compressions

Adult basic life support sequence
Basic life support consists of the following sequence of actions:
1. Make sure the victim, any bystanders, and you are safe.
2. Check the victim for a response.
Gently shake his shoulders and ask loudly, ĎAre you all right?í
3A. If he responds:
Leave him in the position in which you find him provided there is no further
danger.
Try to find out what is wrong with him and get help if needed.
Reassess him regularly.
3B. If he does not respond:
Shout for help.
Turn the victim onto his back and then open the airway using head tilt and
chin lift:
Place your hand on his forehead and gently tilt his head back.
With your fingertips under the point of the victim's chin, lift the chin
to open the airway.

4. Keeping the airway open, look, listen, and feel for normal breathing.
Look for chest movement.
Listen at the victim's mouth for breath sounds.
Feel for air on your cheek.
In the first few minutes after cardiac arrest, a victim may be barely breathing, or taking
infrequent, noisy, gasps. This is often termed agonal breathing and must not be
confused with normal breathing.
Look, listen, and feel for no more than 10s to determine if the victim is breathing
normally. If you have any doubt whether breathing is normal, act as if it is not normal.

5A. If he is breathing normally:
Turn him into the recovery position (see below).
Summon help from the ambulance service by mobile phone. If this is not
possible, send a bystander. Leave the victim only if no other way of obtaining
help is possible.
Continue to assess that breathing remains normal. If there is any doubt
about the presence of normal breathing, start CPR .

5B. If he is not breathing normally:
Ask someone to call for an ambulance and bring an AED if available. If you
are on your own, use your mobile phone to call for an ambulance. Leave the
victim only when no other option exists for getting help.
Start chest compression as follows:
Kneel by the side of the victim.
Place the heel of one hand in the centre of the victimís chest
(which is the lower half of the victimís sternum (breastbone)).
Place the heel of your other hand on top of the first hand.
Interlock the fingers of your hands and ensure that pressure is not
applied over the victim's ribs. Do not apply any pressure over the
upper abdomen or the bottom end of the sternum.
Position yourself vertically above the victim's chest and, with your
arms straight, press down on the sternum 5 - 6 cm.
After each compression, release all the pressure on the chest
without losing contact between your hands and the sternum.
Repeat at a rate of 100 - 120 min.
Compression and release should take an equal amount of time.

6A. Combine chest compression with rescue breaths:
After 30 compressions open the airway again using head tilt and chin lift.
Pinch the soft part of the victimís nose closed, using the index finger and
thumb of your hand on his forehead.
Allow his mouth to open, but maintain chin lift.
Take a normal breath and place your lips around his mouth, making sure
that you have a good seal.
Blow steadily into his mouth whilst watching for his chest to rise; take about
one second to make his chest rise as in normal breathing; this is an effective
rescue breath.
Maintaining head tilt and chin lift, take your mouth away from the victim and
watch for his chest to fall as air comes out.
Take another normal breath and blow into the victimís mouth once more to
give a total of two effective rescue breaths. The two breaths should not take
more than 5s. Then return your hands without delay to the correct position
on the sternum and give a further 30 chest compressions.
Continue with chest compressions and rescue breaths in a ratio of 30:2.
Stop to recheck the victim only if he starts to show signs of regaining
consciousness, such as coughing, opening his eyes, speaking, or moving
purposefully AND starts to breathe normally; otherwise do not interrupt
If the initial rescue breath of each sequence does not make the chest rise as in normal
breathing, then, before your next attempt:
Check the victim's mouth and remove any visible obstruction.
Recheck that there is adequate head tilt and chin lift.
Do not attempt more than two breaths each time before returning to chest
compressions.

If there is more than one rescuer present, another should take over CPR about every
1-2 min to prevent fatigue. Ensure the minimum of delay during the changeover of
rescuers, and do not interrupt chest compressions.

6B. Compression-only CPR
If you are not trained to, or are unwilling to give rescue breaths, give chest
compressions only.
If chest compressions only are given, these should be continuous at a rate of
100 - 120 min
.
Stop to recheck the victim only if he starts to show signs of regaining
consciousness, such as coughing, opening his eyes, speaking, or moving
purposefully AND starts to breathe normally; otherwise do not interrupt
resuscitation.

7. Continue resuscitation until:
qualified help arrives and takes over,
the victim starts to show signs of regaining consciousness, such as
coughing, opening his eyes, speaking, or moving purposefully AND starts to
breathe normally, OR
you become exhausted.
Further points related to basic life support
Risks to the rescuer and victim
The safety of both the rescuer and victim are paramount during a resuscitation attempt.
There have been few incidents of rescuers suffering adverse effects from undertaking
CPR, with only isolated reports of infections such as tuberculosis (TB) and severe acute
respiratory distress syndrome (SARS). Transmission of HIV during CPR has never been
reported.

There have been no human studies to address the effectiveness of barrier devices
during CPR; however, laboratory studies have shown that certain filters, or barrier
devices with one-way valves, prevent transmission of oral bacteria from the victim to the
rescuer during mouth-to-mouth ventilation. Rescuers should take appropriate safety
precautions where feasible, especially if the victim is known to have a serious infection
such as TB or SARS. During an outbreak of a highly infectious condition (such as
SARS), full protective precautions for the rescuer are essential.
Initial rescue breaths
During the first few minutes after non-asphyxial cardiac arrest the blood oxygen content
remains high. Therefore, ventilation is less important than chest compression at this
time.

It is well recognised that skill acquisition and retention are aided by simplification of the
BLS sequence of actions. It is also recognised that rescuers are frequently unwilling to
carry out mouth-to-mouth ventilation for a variety of reasons, including fear of infection
and distaste for the procedure. For these reasons, and to emphasise the priority of
chest compressions, it is recommended that, in adults, CPR should start with chest
compressions rather than initial ventilations.

Jaw thrust
The jaw thrust technique is not recommended for lay rescuers because it is difficult to
learn and perform. Therefore, the lay rescuer should open the airway using a head-tiltchin-lift manoeuvre for both injured and non-injured victims.

Agonal gasps
Agonal gasps are present in up to 40% of cardiac arrest victims.10 Therefore laypeople
should be taught to begin CPR if the victim is unconscious (unresponsive) and not
breathing normally. It should be emphasised during training that agonal gasps occur
commonly in the first few minutes after sudden cardiac arrest; they are an indication for
starting CPR immediately and should not be confused with normal breathing.
Use of oxygen during basic life support
There is no evidence that oxygen administration is of benefit during basic life support in
the majority of cases of cardiac arrest before healthcare professionals are available with
equipment to secure the airway. Its use may lead to interruption in chest compressions,
and is not recommended, except in cases of drowning (see below).

Mouth-to-nose ventilation
Mouth-to-nose ventilation is an effective alternative to mouth-to-mouth ventilation. It
may be considered if the victimís mouth is seriously injured or cannot be opened, if the
rescuer is assisting a victim in the water, or if a mouth-to-mouth seal is difficult to
achieve.

Link to complete protocols. Adult Basic Life Support is Section 2. On page 15. 
http://www.resus.org.uk/pages/guide.htm

8
First Aid / CPR Debate
« on: September 28, 2013, 06:07:47 PM »
I have posted what the H&S regs say, which are the work place regulations,  St John's/St Andrew's/Red Cross have to follow them, after all they are first aid faculties like the two faculties I am a member of.

The resuscitation protocols are set by the Resuscitation council (UK) from guidance from International Liaison Committee on Resuscitation (ILCOR) who are responsible for overseeing a set guidance across member counties. The guidelines protocols are there to be followed. If you are a first aider, paramedic, nurse of doctor you are best to follow them.


9
First Aid / First Aid Kits
« on: September 28, 2013, 01:42:39 PM »
The distinctions of First Aid Kits (FAK)

A personal FAK is exactly that, a kit for personal use. I strongly recomend you carry one in the outdoors at all times. It's contents can be anything you choose. It is for treating small personal injuries. You can keep your personal drugs in it or anything else you wish.

If you are leading a group (whether paid or not) then you fall within H&S first aid at work law and you need to carry a Group first aid kit. H&S advises the contents as such...

What should a first-aid box in the workplace contain?

There is no mandatory list of contents for first-aid boxes and HSE does not 'approve' or endorse particular products. Deciding what to include should be based on an employer's assessment of first-aid needs. As a guide, where work activities involve low hazards, a minimum stock of first-aid items might be:

a leaflet giving general guidance on first aid, eg HSE's leaflet: Basic advice on first aid at work;
20 individually wrapped sterile plasters (assorted sizes), appropriate to the type of work (you can provide hypoallergenic plasters, if necessary);
two sterile eye pads;
four individually wrapped triangular bandages, preferably sterile;
six safety pins;
two large, individually wrapped, sterile, unmedicated wound dressings;
six medium-sized, individually wrapped, sterile, unmedicated wound dressings;
a pair of disposable gloves, see HSE's free leaflet: Latex and you PDF.
This is only a suggested contents list.

It is recommended that you don't keep tablets and medicines in the first-aid box.

More advice is given in HSE's free leaflet: First aid at work: your questions answered.

How often should the contents of first-aid boxes be replaced?

Although there is no specified review timetable, many items, particularly sterile ones, are marked with expiry dates. They should be replaced by the dates given and expired items disposed of safely. In cases where sterile items have no dates, it would be advisable to check with the manufacturers to find out how long they can be kept. For non-sterile items without dates, it is a matter of judgement, based on whether they are fit for purpose.


What the Law says is that the workplace or activity has to be risk assessed and the contents meet those requirement. 

10
First Aid / Flat footed squat
« on: September 20, 2013, 04:01:03 PM »
As some of you know after my lung op I suffered debilitating lower back pain which plagued me for over two years. At its worse it would stop me walking any further than 100 meters. I have been given drugs, physio, sports therapy and even offered aqua-puncture to try and sort my lower back. Nothing seemed to work however a couple of months ago I was encouraged to do the flat footed squat.

We are animals and all animals sit in a squatting position. We have been squatting for millions of years. It was not long ago we started to sit in chairs which screwed up our postures. A flat footed squat stretches all the muscles and tendons in our legs and lower back.  It also tightens up our abdominal muscles. For me it has sorted out my lower back pain and associated issues within the space of a couple of weeks. It will cause some knee pain for a short time but once things start to stretch out that goes.

Again western medical advise seems to be damaging us, it says we should never squat further than 90 degrees. This does not aid our flexing abilities. Another great exercise is to kneel down on the floor and sit on our heels this has much of the same benefits.         

Here is a great explanation of the Flat footed squat. Which is not only beneficial to everyone but also as people in the outdoors who may need to take a crap outdoors from time to time it solves some of the associated dilemmas.   
<a href="http://www.youtube.com/watch?v=GqfGzbj3iU8" target="_blank">http://www.youtube.com/watch?v=GqfGzbj3iU8</a>

11
First Aid / Blister treatment
« on: September 20, 2013, 03:39:28 PM »
I have recently been asked another emotive question. How to treat blisters.

The best advice is prevention is better than cure. However from personal experience I know prevention is often not possible. Especially if you are new to walking or doing larger distances than normal.

The first thing is to break in your feet. Once your feet have been toughened up you are less likely to get blisters. There are many ways to try breaking in your feet, including peeing on them and soaking them in white spirits. I suggest you donít bother trying these. I suggest taping your feet with a good quality Zink oxide tape. Good quality tapes can stay on the skin for weeks, will not bunch up and breathe.

Secondly get good quality footwear that fit well after spending hours walking; your feet will swell up. Make sure they will accommodate your walking stocks. Take time to break in your footwear. I try to stay away from goretex lined boots because goretex boils your feet in a bag. Your feet cant breath and get moist with perspiration leaving you prone to blisters.

Thirdly is your socks. There is lots of advice about socks, such as wearing thick socks or wearing two pairs of thinner socks. Personally I have tried both and donít like either advice. I prefer a medium thickness ankle sock preferably made of wool. 

And finally we come to foot care. The most important thing I have discovered is to adjust your boots on the fly. People I walk with get upset because after a mile or so I will stop and retie my boots. In most cases I retie them a lot looser than they were. Change your socks daily and donít sleep with socks on. Your feet need time to cool down, dry and air. At the end of each day remove your boots and socks wash your feet or if in snow rub your feet into the snow. Then the most important bit is let your feet air dry. This is invaluable and I have found it to work everywhere from the high arctic to the tropical rain forest. Air your feet for at least 15 minutes to help them dry out and cool down. Then sprinkle some powder on them.  Best is an antiseptic talc but donít waste your money on expensive medicated foot powders. Never talk your feet in the morning this only attracts moisture and germs.

There is a view that you must keep your feet dry. This has led to goretex lined boots and waterproof soaks. It should be allow your feet to breath. Footwear made of a natural material that cam breath is far more effective than manmade materials that attract and hold moisture. Saying that though many approach shoes are made of aqua phobic materials that reject moister which are great but sadly many use goretex inners. If you use these try to find a foot bed made of cork. Cork is natural and is less likely you become slippery when wet stopping your foot sliding around inside the footwear causing friction blisters or de-gloving of the sole of the foot.

If you get a blister, the advice says you should not drain it or remove itís roof if intact. However I have found it is best to drain the blister, leave the roof intact and tape it with a good quality zinc oxide tape. One the tape is on leave it on, donít try removing it; it may well rip off the roof of the blister. If the blister fills up again then drain it through the tape. I carry Hypodermic needles in my kit for this reason. 

If the blister has de-roofed then clean the area and carefully cut away any lose skin. Cut a piece of gauze that will fit in the socket left by the blister and then tape up. The gauze will stop the tape sticking to the floor of the blister.

I try to make the above treatments one off treatments. I.e. I am aiming for the taping to stay on for the length of the trip and for a couple of days after the trip. The blister will start to dry out and white blood cells will start to protect the blister, gauze and tape from infection. Whereas if I were to remove the tape, I have the possibility of tearing weak tissues, introducing infection and generally effecting my general wellbeing.

It is still important to air dry and power your feet every evening though, even when covered in tape. 

Ok this flies in the face of all the medical advice however that advice is for treatment in a hospital or more correctly a civil environment. When you are on the hill you need to promote recovery whilst limiting pain and discomfort to allow you to get home.

This is what I do; I do not teach this on my expedition courses however I do discus the many options beyond medical advice. If you choose to follow the above that is own risk and I am in no way responsible. I posted this as information only to invoke thought and conversation.

If you are interested on what medical advice has to say on the subject it can be read here  http://www.nhs.uk/Conditions/Blisters/Pages/Introduction.aspx and because this is best practice this is what I would have to teach you on one of my courses. 

How do you treat blisters?
   

12
Regional SAR teams / BBC The Adventure Show 2013 Mountain Rescue
« on: August 01, 2013, 07:00:59 PM »

13
Apps / Event app's
« on: July 17, 2013, 03:20:03 PM »
Whilst I was at the Outdoor Show in Germany last week I was talking to an event app company (sorry I can't remember their name now) but they build app's for events. They started out by tracking tweets at events and public gatherings to show clusters of people for the police so police can have officers in areas where the greatest number of people are. They are able to see where groups of people are massing and where trouble is most likely to start.

From this work they started to develop app's for individual events which help people that are at that event, such information as water points, toilets, retailers and other information but the apps have another purpose, one used for public safety. If you down load the app the police gold commander can track the location of the app so it can see where everyone with the app is at any moment of time. The gold commander can then control health and safety more efficiently. I was informed that they can only track the app and have no other access to any information on your phone and the police have no access to even the individual phone numbers.

The interesting fact is that if there is an incident then the gold commander can send messages to the people with the app. Useful information of misper reports, evacuation directions and incident reports. The first event app they made was for the Lord Mayors show in London 2011 and it proved to be a huge success. It has been used around the world since and is helping to make events safer.

In future if I am at an event I will see if it has an app and will download it. It could be very useful if a major incident happens.           

14
Training tips / MOVED: Advanced Casualty Assessment
« on: July 01, 2013, 10:28:43 PM »

15
General Discussion / MOVED: Lyme disease
« on: July 01, 2013, 10:25:17 PM »

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