Advanced Casualty Assessment

[Callum]

Clearly explained Lyle:)

The mandatory interval for our staff to attend first aid refresher courses at our centres, is every three years. This is in compliance with HSE (Health & Safety Executive) guidelines. From experience we know that skills fade can occur much quicker and as a consequence we have adopted the practice of annual formal refresher courses, where all staff are re-certificated, in addition to frequent reminders, in the form of first aid questions at staff briefings, to keep us all up to speed.

Practice makes Perfect

[adi]

The recommendation is to take a refresher course one every 12 month, this is not mandatory but if your organisation has a serious incident then they best have a good excuse when questioned at the Tribunal to why the organisation did not do annual refresher courses.

When we used to do the big night exercises during our remote course we used multiple casualties spread out over a couple of acres of land. I always played the confused aggressive mild Hypothermia casualty and I would be relatively easy to find, once I was found I would start to strip of my clothing and would become increasingly difficult to handle. Soaking up man power and causing general confusion. If I found the opportunity to wonder off I did and I would keep going and never stop. I never went too fast but it was amazing how many times I got clean away with no one noticing and I would rarely be found again.   

Command and control is Key. I tell my students it does not matter if you can't remember what you are supposed to do but by appearing that you know what you are doing people will listen to you and do what you want then to. Never ask people to help, tell them to do things. You ring the Emergency Services, Tell them where, what, when, risks and danger, numbers of casualties, injury's. ect.

When I responded to a toddler under a car the other person on seen was an off duty paramedic, he made the call whilst I started first aid. I knew he the right person to make the call and pass on the correct details and he could see I knew what I was doing if things had taken a turn for the worst he could step in and assist. A Paramedic has far more experience of seen safety than I do so it made scene assessed the casualty.

If Lyle creates an area for First Aid I am happy to add relevant threads from time to time and try and answer any questions.                 

[Callum]

"I always played the confused aggressive mild Hypothermia casualty"
Bet you weren't acting Adi

[adi]

I did find it enjoyable Callum

[captain paranoia]

As well as doing mental rehearsals, I'll be converting Adi's original list into a form I can understand, to add to my pocket aide memoire.  Having done the first aid course, the list makes more sense now...

[adi]

CP my original list is very advanced and well beyond that of a First Aid course, Just try to remember what you was taught on your course and build on that. If you have any questions please feel free to ask, I will try and answer them for you.

[captain paranoia]

Actually, there's not much in your list that wasn't covered to some extent; the detailed airway stuff, and bloods (glucose, etc), but most of the other stuff makes sense from the training we did (18 hr outdoor FA course; we also covered AED and epipen).

I don't like mnemonics, as I can't remember what they mean, but I'll use the basic information to add to my aide memoire.  I'm sure that I will need a checklist of things to do, and, given a few words that mean something to me, I'll remember what to do.  It's just something to get myself past the mental block/freeze; a prompt, or cue.  Once I've got familiar with my aide memoire, it'll stick in my head, and I'll be able to recite what I need to do without it; I think the vocalisation will be useful.  That's the way my brain works.

I know I won't be carrying the aide memoire all the time, but I will when I'm doing DofE, which is what the training was for.

I also know from past experience that I stay passive for a while, but my brain eventually wakes up and I take charge if needed.

[adi]

I am crap with mnemonics too and pre hospital care is full of them. Far more than the military use. I make memory cards to help me memories them.   

[Lyle Brotherton]

You First Aid knowledge is invaluable Adi and I most certainly have learned a lot from it. As requested, the new board is at http://micronavigation.com/forum/index.php?board=25.0

[adi]

All in all, a very chastening experience.  Besides the obvious of doing more scenarios, does anyone have suggestions for mental training exercises to help stay calm, assess and, well, do a better job?

Practice practice practice. I can do chest compression's to the correct rhythm and depth whilst still talking to my students with no loss of performance or breath. I taught myself the correct rhythm not on a dummy but by portending to do it whilst doing other things.

Flip cards are great too.

Get some cards and write some key phrases on each. On the reverse write the answer. When testing yourself look at the phrase and try and giv the answer then check your answer.     

For instance. just a couple of examples.

Sprains & strains
R
I
C
E

Rest
Ice
Compression
Elevation 

or

Signs of Stroke
F
A
S
T

Face is it showing signs of dropping
Arms ask person to close arms help them hold arms out in front of them and let go, does one arm drop?
Speech, do they have slurred speech
Transport

and

Primery assesment
D
R
SH
A
B
999

Danger to you or cas
response, noting level off
Shouting for Help
Airway is it open?
Breathing? Are they and how effective?
999 call 999 or 112

and lastly and my favorite
F
I
S
H
S
H
A
P
E
D

Faint
Infection including temperature
Shock
Head injury
Stroke
Heart attack
Asphyxia
Poisoning
Epilepsy or any seizure
Diabetes
     

[captain paranoia]

> I need to revise my aide memoire, and do some 'mental training'...

Well, three years on, and we have a refresher course. And I'm not sure I did much better in the exercises than last time... Still very focussed on me doing basic first aid, rather than dealing with the situation as a whole.

I've taken to watching the various emergency services TV programmes, and seeing how they deal with incidents. And the thing that strikes me most is the obvious (that I failed to do): say who you are, and ask who they are; ask them what happened. Then you quickly find out their basic state (AVPU), and get a clue to what injuries they may have, how many are in the party, whether there are other casualties, etc.

If only I could get my brain to react calmly like this. Back to the mental exercises to try to din this approach into my brain...