Hi Cheryl,
I was unfortunate enough to be first on scene at a serious RTA recently -
one of the fire crew (Essex County Fire & Rescue) came up to me and said he
was a trained 'emergency medical technician' if we needed any help. A few
years ago this was quite common (following the American model of fire crews
as first responders) but approach seems to vary massively now. In the UK
fast response paramedics are often first on scene to assess and stabilise.
Also, if any of the fire crew gets injured or into difficulty then they can
assist their colleague.
The difficulty for all fire crews, but particularly retained, factory based
fire crews is gaining real experience and maintaining competence. The risk
assessment needs to consider hazards on site, likelihood of happening and
whether in the event of an incident that individual would actually be free
to assist. The RA also needs to consider typical emergency service response
times at different times of day and night and what the local response would
be to a 999 ambulance call - this also varies between trusts.
I used to have a basic EMT qualification, oxygen admin and AED through the
voluntary services (and used them regularly at motor racing and events) - I
was taught well by NHS paramedics and trainers and we practiced regularly. I
also self-funded and attended a 5-day EMT course at Gloucestershire college
run by trauma docs and nurses. For those of you who are not aware - first
aid - DR ABC (danger, response airway, breathing, circulation), basic EMT =
DRABCC(collar)DEF (possibly a couple more letters - can't really remember
now!) First aiders tend to treat what they see but EMTs have more emphasis
on diagnosis skills, dealing with environmental issues, multiple sites of
trauma and managing a situation with multiple casualties/triage.
Bearing that in mind plus my experience as a first aid trainer - I would say
- keep it simple - the above accident reminded me about the basics of ABC -
I struggled for 5-10 minutes - all I could was hold this guys head and
airway slightly more open and encourage him to breathe (whilst mentally
willing him to breathe, looking vaguely confident to the shocked public who
were there before me and willing the emergency services to 'please hurry up
I need some help here now' - thinking 'oh shit' when the loud other casualty
goes quiet and a lady says, 'she's gone unconscious' (luckily just fainted.)
Even when the 2 EMTs arrived on scene we still never got past Airway before
the helicopter arrived - there were 3 of us - desperately trying to get this
chap with head and facial injuries to breathe more than 3 times a minute we
didn't get past collar due to struggling to suction, get an oropharyngeal
airway inserted plus oxygen via a bit of bag and mask. It was scary for me -
he had been hit by a car, was blue in the face with open fractures to his
legs and obvious internal bleeding showing in abdomen, bleeding from ears
and nose, pupils unreacting - oh, and he landed face down - do we move him,
don't we? is he breathing Or not? Darn - jaw thrust not working.... gloves,
what gloves - blood everywhere? 30 minutes after the helicopter team arrived
including 2 docs and a trauma paramedic we were still only working on A for
airway and a bit of B .......
How many times have you been on a first aid or resus course and wow, Annie
is on her back! Recovery position is done with casualty on back, no
injuries.
Talking to the member of the public who got to him first - he was really
peed off with himself as he said - "I'm an experienced first aider and I
can't believe I forgot DRABC - all I could do was dial 999 and keep talking
to him and not let anyone move him" - as far I was concerned - he did a darn
good job that day and said so. Even with all my experience I have forgotten
ABC in the past when something had happened unexpectedly - when I teach, I
say to people if all you remember is ABC and recovery position (on side,
head tilted back) then you may save someone's life (the Hillsborough
football crush disaster taught us that much) AND if you forget what to do -
then simply dial 999 fast and they will tell you what to do.........
So, with my safety hat on - the risk assessment has to really look at what
is foreseeable, both - medical conditions (asthma, stroke, seizure, MI) and
traumatic that might happen. Don't forget environmental factors particular
if confined spaces (above or below ground could be an issue.) Don't get
caught up with the HSE FAW courses as your only option - yes, you have to
have a certain number of FAWs depending on risk level etc but if you are in
a high risk industry or hazards, if realised can cause serious damage
quickly (e.g. lime in eye) or response times are slow due to geographical
location then in my opinion (and indeed the HSEs) then the training your
first aiders/fire crews have MUST be tailored, realistic and preferably
onsite with made up casualties - even better if completed over a period of
time. Not forgetting what you have in place to deal with the emotional
aspects for the response team afterwards.
Any staff no matter how much training they have will forget the obvious - I
had a lady sustain a high pressure steam injury to face and arm right next
to an emergency drench shower - they took her across site and into the
changing rooms........!
A few months back I was in a petrol station of a well-known supermarket and
a lady came in and said I've got diesel in my eye - the guy behind the
counter said I'll call a first aider and took her to the toilet, luckily I
heard and he responded quickly to my urgent - 'where's your eye wash?' Er,
petrol station and only one eye wash bottle!?? That and two litres of evian
out of the fridge later with her kneeling, head over sink and a big flood of
water on the floor - we introduced ourselves and then did another 2 litres
of warmer water! When the first aider and manager arrived they commented on
the diesel fumes (it was a little toilet! Eek, I hadn't even noticed, doh!)
The first aider that attended had her gloves on (great!), but said - "I only
did my first first-aid course last year - I would never have thought to do
it like that" (to be honest, no neither would I until I worked in a
steelworks........ dust everywhere) - realistic practical training and
scenarios are key to aiding confidence and getting the best result.
It is a hard decision to make but we can expect too much from our staff with
additional roles - some organisations still have factory based fire-crews,
personally I have to say I would expect that to be very rare and industry
specific. If an organisation has one then they should not be relying on
tradition but need a very robust risk assessment that demonstrates that they
are really necessary, and all the fors and against have been detailed and
considered, that the crew can really do what is required of them, that they
truly are fit enough (mentally and physically) to do the role and they have
an exceptional leader, who can do dynamic risk assessments - any fire
personnel will tell you that discipline on a fireground is key to ensuring
that none of the crew get hurt and that there may be times when it is too
unsafe to enter and a building is left to burn or fire or not, it is not
possible to go in and rescue someone.
If you want to chat off-line - pls contact me as below, I have contacts in
the fire service
Kind Regards,
Catherine
Catherine Tye RN SPOH PgDipOSH
Specialist Practitioner in Occupational Health and Safety Consultant/Trainer
Harmony Health & Wellbeing | mobile: 07730 985926 | email:
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-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf
Of Lawton, Cheryl (UK)
Sent: 06 August 2010 09:23
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] First aid and Fire fighters
Thank you all for your replies.
All our Firefighters are FAW trained, and the Fire service also provide
them with AED training. The Trauma course seemed vague regarding
content, and accreditation, and therefore we did not quite figure out
where it sat in the scheme of things.
Your responses have helped in that understanding, thanks again.
Regards
Cheryl
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On
Behalf Of Frank Oakes
Sent: 06 August 2010 08:35
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] First aid and Fire fighters
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I thought the training was more advanced than the HSE 4 day course, more
in line with PHTLS.
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