The quality of training

You may or may not be aware that the new HLTAID health units are being introduced into the training market to replace the old HLTFA units. The initial release appears to have had some significant issues so the final cutover date has been extended until October 2014 although some RTOs have already implemented the recommendations.

The implications of the changes so far apply to the number of assessments required while not altering the time allowed for delivery. Fortunately Key2Act has been conducting a significant number of these practical activities already. One definite change is the amount of time undertaking CPR assessments. This has gone up but is still is in flux at the moment. At one stage it was going to be four minutes each on both an adult and an infant manikin. A review is being conducted by a Subject Matter Expert panel of the Community Services and Health Industry Skills Council into the various aspects of the assessments required. We will bring you updates as they are notified to us.

One aspect that we will not be skimping on is the length of delivery of our training. We will, however, be reviewing our practical scenario sessions to increase the amount of hands activities for you. When the boss took his first course in the late 1990s, a “level 2” course was mandated at 24 hours in length so three days and it was heavily practical in its content. A significant amount of practicality has been lost over the years in favour of knowledge delivery.

Realistic scenarios in competition reinforce classroom and knowledge training.

Realistic scenarios in competition reinforce classroom and knowledge training.

Key2Act maintains assessment skills by continuing to volunteer as assessors for the Minerals Council of Australia Mine Rescue Competitions in Victoria. Placing competitors in a range of realistic scenarios and by providing comprehensive feedback, rescue team members are able to improve their hands-on capabilities. Under time constraints and with the emphasis on accuracy, mine rescue teams this year were challenged against relatively simple first aid situations. It reminded them to not over engineer what they had presented to them.

Independent observation helps first aiders pick up hints and mistakes not immediately apparent.

Independent observation helps first aiders pick up hints and mistakes not immediately apparent.

While classrooms cannot always provide the realism of competitions where “casualties” are made up by moulage experts and act in accordance with real injuries, Key2Act aims to draw inspiration in creating scenarios to improve the real-world abilities of their students. To gain a better appreciation of first aid, call us to arrange your next course.

Take your body seriously

The day was windy. Extremely windy. Reports were coming in of metal roofing being torn off and landing on power lines at the Showgrounds shutting down Howitt Street near Creswick Road. My weather app indicated peak wind gusts of 93 kilometres per hour.

I was running late for my appointment, my heart rate was already up and I was agitated. Not a great way to attend my cardiac stress test. Ringing the diagnostic centre to tell them I would be running late, the staff thanked me to letting them know.

Having recently been suffering chest discomfort and with a familial history of heart problems on my fathers side, I had talked with my doctor about getting some tests done. The blood work up didn’t find anything significant although my Low Density Lipids (LDL) reading was up. Recently I had been under increased stress particularly in relation to our Bushfire earlier this year and this might have been the cause. We agreed that a cardiac stress test might be in order.

So on this windy, turbulent Friday I finally arrived bang on time at the diagnostic centre. I missed the fifteen minute arrival window but they were busy anyway. The form had said 2:45pm for a 3:00pm appointment.

After checking in, I sat comfortably in the waiting room. To fill in time, I scanned the news feeds for information about the storm. Just after 3:30, I was collected by a nurse who guided me into a consulting room. “Have you had one of these before?” she asked. “No,” I answered feeling surprisingly unphased by the experience. She gave me a quick run down on the procedure and said she would need to prepare me with the little sticky dots from which the readings would be collected.

The test would involve taking my blood pressure, 12-lead echo cardiograms, and ultrasound images of my heart. Once the initial, or baseline, information was collected, I would be placed on a treadmill that would increase in speed and inclination until I reached the target heart rate, I suffered chest discomfort, or the staff were satisfied no problems were occurring. “How long will this take?” I asked. “Usually no more than 20 minutes,” she replied. She quickly took my height and weight, scribbling them into her notes.

She broke out a brand new razor and I chuckled. There isn’t a lot of hair on my body but she said it was necessary to ensure that the dots would have uninterrupted contact with my skin. “This would avoid any unnecessary artifacts,” she said. Artifacts meaning false readings or noise that might reduce the accuracy of the measurements.

Having given me a cursory scraping, she disposed of the razor and attached the little sticky patches at twelve designated spots around my body. Mostly on my front, I was interested to note that she attached two on my lower back; widely set apart and just above my pelvis. The others were of no real surprise to me; both sides at the top of my chest, over my heart in a few places, and on my left side below the rib cage. The recording device was strapped around my waist and the leads clipped to the dots to begin collecting data. She was kind enough to take a couple of pictures

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There was short delay as the person before me was “fit and this might take a while.” However just before 4:00pm, I was called in. The two technicians introduced themselves and one of them began by hooking up the recorder to the main device where it downloaded the collected data into my central records. He agreed to take more pictures of the test so that I could present them here. My blood pressure was also taken.

Satisfied that current recordings were being collected, he rolled me onto my left side and began taking some ultrasounds. This is not a gentle process but it isn’t exactly painful either. Each measurement required me to take a breath which had to be neither too shallow nor too deep then hold it. It was a bit of a struggle to hold the air in but I got there in the end. The probe appeared to be placed between the fifth and sixth rib on my left side, and just to the left side of my sternum.

At this point, the cardiologist came in and introduced himself. Asking the relevant recent history (Hx), and past and family history (PHx) questions helps build the wider picture leading up to the testing procedure. My family history and the recent chest discomfort seemed to make this procedure relevant on the day. I know as a man, with a high pain tolerance too, I tend to underplay my various maladies but my years of in-field experience reminded me how important it was to preclude the more serious reasons for what I had been feeling.

I was moved across to the tread mill where the second technician again explained the process. The treadmill would start off at a slow speed and on a flat plane. Every few minutes the speed and incline would increase while they would monitor my responses. Activating the treadmill, the pace was nice and easy however I suddenly realised they were firing questions at me. These were designed to increase the pressure on me mentally while my body was being challenged as well.

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At regular intervals my blood pressure would again be monitored and this data was tagged against the ECG readings. I guess the treadmill process had taken about fifteen minutes when the first technician told me that when it stopped, I would need to slow down with the machine before hopping off then I would need to move straight back to the bed where more measurements would be taken. However there could be no delays as he only had 60 seconds to collect the next set of ultrasounds.

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While I was only mildly out of breath, it was very hard to hold my breath for the next set of images. The cardiologist and the technician discussed which information to use and I was invited to look at the comparisons between the before and after recordings. It is somewhat disconcerting if fascinating to watch the valves of my heart fluttering in motion. The differences were explained to me and I could clearly see the left ventricle having expanded in volume to compensate for the increased demand by my body for oxygenated blood.


The outcome of the day was the opinion by the cardiologist that there were no major blockages although minor ones would not be apparent with this level of testing. Further assessments of the day’s data would be made before the final report would be issued to my doctor.

I was pleasantly surprised to see only half an hour had elapsed since I had entered the room and I was leaving no increased discomfort. My phone had a range of images and a few short videos of the whole process courtesy of my friendly technicians.

The final outcome is yet to be provided but at least the worst possible problem appears to have been discounted.

Chest discomfort or pain should never be ignored. Catching problems early may prevent a potentially fatal heart attack and certainly improve outcomes in the longer term. Changes in diet, activity and lifestyle may be necessary but they are achievable. A couple of things for me to take on board are that a) I need to lose some flubbed around the middle and b) my life could be improved by increasing my physical exercise for increased cardio capability.

What do you think you could do to improve your lifestyle? What are the signs and symptoms of a cardiac emergency? Not sure? Contact Key2Act to arrange some first aid training.

Can you afford not to have it?

Following an interesting feed on social media last weekend, an interesting point was made. Someone commented that Ambulance transport is free however that is not entirely true. Indeed there are some circumstances where it might be covered and these days some private health insurance offers coverage. As another friend pointed out, being a pensioner will certainly cover you.

But it should be pointed out that coverage is not absolute. There will be exclusions. You should always make yourself aware of what exclusions apply otherwise a very nasty surprise will be in the mail for you. The more resources, the bigger the distance covered, the greater the care, or including a helicopter in the journey and the bill can total into the thousands.

A good friend and teacher swears by the need to have Ambulance cover after requiring hospitalisation following a vehicle collision. A former supervisor of mine recounted one bill for a roughly five block trip to hospital came in at well over $1,000.

As a trainer, I have always talked about the need to ensure adequate coverage. As a first responder I would shout it from the roof tops. I have seen some very badly injured people requiring multiple Ambulance Paramedics, numerous essential medications and helicopter transport toting up bills into five figures in value.

This makes paying less than $79.00 a year to cover your family a worthwhile expense.

So why don’t people spend the money? It’s too expensive? Well I think we covered that.

There is no need, I’ll never use it. That seems to be a huge gamble. We never know what could happen to us. Chest pain, kidney stones, a broken ankle, a vehicle collision, breathing difficulties. They can happen without warning.

My insurance has Ambulance cover included. Again I urge you read the fine print. What will they cover and what is not included? You don’t want to get caught out. Some health insurance packages actually provide for a reimbursement of Ambulance cover. This seems to me to be a worthwhile option.

My pension covers me. True unless you hold a Commonwealth Seniors Card. Even my own parents keep up their coverage for that same reason.

Membership of the Ambulance Membership coverage give you reciprocal rights in other states.

So don’t think about it, sign up today. Go to Ambulance Victoria‘s website and sign up now.

http://www.ambulance.vic.gov.au/Membership.html

Sorry I have been quiet

It has been quiet around here, hasn’t it. That’s ok, it has been worth it. Another project that I have worked on has now reached completion.

Several years ago, I was invited to go on a trek in Nepal. During that time, I learnt about the state of healthcare there. What I learned affected me deeply. In conjunction with others from Australia, we had a plan to aid one village in setting up their own health post. Why one village, I hear you ask? The answer is a case of pure economics. There are roughly 29 Million residents in Nepal. We just don’t have the funds.

I became a trustee for the health post after making a visit to the village in 2011 to discuss the logistics of the project. We needed to source donations to cover the day-to-day running costs, set up and administration fees.

Because of my earlier trip in 2009, I struck on the idea of writing a book of our journey. The book has now been released. ‘A Little Bit Up: Meandering in Nepal‘ takes the reader around the Annapurna Circuit as part of a small group with mixed trekking backgrounds.

I urge you to buy a copy since a percentage of the profits go towards funding the health post.  It is currently available on Lulu.com, and Amazon (all sites) and will follow soon for Nook and iBooks.

A Little Bit Up: Meandering in Nepal now available in paperback and e-book formats.

The importance of CPR

In the last little while a friend of mine had a near miss. Their recent training in CPR had been put to use in saving their son. At their request, another friend blogged about this event. Instead of saying more, I direct your attention to Hespera’s Garden

To breath or not to breath: The ongoing debate

During the last couple of years, debate has been ongoing regarding the delivery of breaths during resuscitation efforts. Quite often it gets raised during my classes and it seemed timely to bring it up as a blog post.

Perhaps a little history is in order first. In the first half of 2006 improvements were introduced to the way CPR was trained and delivered. The ratio between compressions and breaths was standardised across age groups and numbers of rescuers. Overall the process was simplified to remove confusion and to increase the numbers of people prepared to attempt resuscitation. In December of 2010, the first two Rescue Breaths prior to compressions were removed and an extra step to remind people to ring for assistance was included.

The American Heart Association had made some recommendations about the removal of all Rescue Breaths which have been reported beyond the original intent of the recommendations.

On the Australian Resuscitation Council website FAQ page, this matter was raised for further clarification. It was emphasised that Compressions Only CPR was recommended for use by Emergency Medical Service dispatchers (911) in the United States of America when speaking with an untrained rescuer. I have been made aware that similar advice has been given by a 000 Call Taker to rescuers within the last few years. When queried with Ambulance dispatchers at the time, it was the practice to ensure compressions were given for the best possible effect of a casualty.

Recently, a colleague alerted me to the fact that at least one instructor had been teaching Compressions Only CPR instead of the ARC Guidelines. Apparently this may have become a wide-spread issue as the ARC issued a statement on October 8th 2012. It reminded all training organisations that full CPR must still be taught and assessed with Rescue Breaths and the use of protective breathing devices. The full statement can be read at http://www.resus.org.au/files/first-aid-training-organisations.pdf

“If a Statement of Attainment is to be issued, these skills must be taught, practised and assessed in accordance with the requirement of the relevant Unit of Competence.”

Key2Act ensures that training delivered complies with all ARC Guidelines on resuscitation. Should you wish further clarification, please contact either Key2Act or the Australian Resuscitation Council.

I don’t think it’s that serious

Now where did i put my coffee cup… Oh hello, I didn't see you sitting there.

In some recent discussions, I've noticed an interesting trend. People who won't go to see the doctor or hospital either straight away or at all. This can be complicated by the person having a high pain tolerance, believing that it is not serious, it actually isn't serious or my personal favourite, “I didn't want to bother anyone at this hour.”

Now I am all for people being realistic when it comes to medical matters and injuries but I am reminded of a story shared in one of my classes.

Father came home from work one. You know the type of father. Hard worker, salt of the earth type, makes everything him self, does long hours… and never takes a “sickie.” The family are familiar with this and rarely say a word about it. However this one day father comes home, sits in his usual chair straight after walking in the door. Now that's not normal. Usually he changes clothes after having a shower. He is pale and complains of a headache. One of the family members reached for the phone and rang 000. Father immediately started complain about this but the family member continued to make the call. An ambulance arrived and despite initially protesting, father agreed to go to hospital.

The outcome was that he was suffering from bi-lateral strokes. In other words, he was having two, one on each side of his brain. And the family's clue? He never complained of being ill. For him to complain, something was obviously wrong and the family acted straight away.

The message here is that we should not immediately dismiss something if it is out of the ordinary. Nor should we hold out for a “more appropriate hour of the day.”

It is also important that if you are going to drive a family member to hospital, we should consider if this is the most appropriate thing to do. What happens if they get worse and you are on a road you are not familiar with? Would you be able to accurately describe where you are to the 000 call-taker?

A patient in the care of the Paramedic's is able to take advantage of the skills, training, equipment and medication should the situation get worse.

So, tell me. Do YOU know of someone who never complains of being ill?

 

Dealing with the stubborn family member

Consider the following situation. You have been out for the evening; say to a meeting.

Coming home, you find a family member sitting on the couch. Rugged up for bed but it’s still a few hours from their normal bedtime. Their face is pale. Occasionally they give a small shudder but they greet you with their normal smile.

You know something is up. They’ve had a shower, there is a rug in their lap and the house is overly warm.

“I’m alright… Now,” they say. Sigh! “What happened?” you ask.

The family member tells you that they have been vomiting, feel light-headed, are thirsty, and nauseated. Oh and to top it all off, they fainted not long ago and believe they had been unconscious for a few seconds. You notice a small lump above their left eye which has not even begun to bruise yet.

What are your thoughts? What questions are going through your mind? You need to make some assessments but it is important not to get ahead of yourself. Before you help someone out, you need to determine what actually happened.

Do your primary survey. You remember what that is, don’t you? Of course you do and because they are talking to you, Primary Survey is done. Move on.

Now we need secondary survey. Your “head to toe” examination, Vital Signs Survey and questioning are all important in determining what is going on with this casualty.

Nothing appears obviously wrong with them, right? Perhaps. Look closely at how they look, sit and breath.

My key indicator that something is wrong is the loss of consciousness. With me, there is no argument. Off to hospital we go. “No! It’s not that serious,” they say. Think back in your training to the effects and potential injuries from head injuries. (Note the small lump over their left eye.) Backwards and forwards the discussion goes for some time about going/not going to hospital.

Funny how the same instruction from a health professional will be treated differently. Even if you do actually know what you are talking about. Persist with convincing the family member to go for medical assessment. If it’s not apparently too serious, try the likes of Nurse on Call (in Victoria) but if you have any concerns, ring triple zero straight away.

Never take head injuries, loss of consciousness or fainting for unknown reasons lightly.

Not just a bump on the head

When it comes to head injuries, we often dismiss a whack to the head as a tad embarrassing. Certainly they may be of no significance but they should never be underestimated.

Elderly casualties may, however, be at risk of greater injury from seemingly simple events. Sports players, being at a high risk of multiple blows, also are potential candidates for harm. Young children are often bumping into things. Really, when you think about it, we are all at risk.

Apart from my pet bugbear of the now rare situation of sports players being sent back onto the ground after being struck in the head, any one with first aid training should consider what they may be presented with. BTW, rural sports teams are unlikely to have a neurologist or GP on staff although it may be possible.

Understand the incident and what happened to the patient. Consider the mechanism of injury applied to the casualties body and what it may have done to the brain. Be wary of the potential of spinal insults along with the impact to the head.

Any loss of consciousness should be considered an immediate cause for professional medical assessment; even if it is for a few seconds. Use your questioning techniques to determine if the patient remembers hitting the ground, for example. Ask open ended questions rather than yes/no ones. Allow the casualty to show you how alert they are.

Fluid loss from eyes, ears or nose are immediate causes for concern along with blood loss on the outside of the scalp or bruising under the skin. Treat any casualty with bruising behind the ears combined with bruising under the eyes and/or fluid loss as potential spinal injuries.

Watch for nausea, vomiting, seizures or reports of seizures before you get to them, depressed breathing rates, slow heart rates, loss of or reduced sensation, headaches, drowsiness, or difficulties with vision. There are a range of other things and your first aid instructor will be able to help you recognise them.

All are causes for concern and require immediate assessment. Don’t ever worry if you have been over cautious. There is an old and valid saying “treat for the worst, hope for the best.” Meaning if you treat for the worst case scenario and it’s not that bad then you will have still done your very best for them.

Stay calm, remember your DRSABCD and you will be well on your way.

Burns, Scalds and Scorches

A very recent incident involving a friend of mine and the subsquent discussions online in social media between several current and ex first aid instructors highlighted some important factors to consider when dealing with burns.

Severity of Burns

All burns should be immediately assessed to determine the depth to which a burn has occurred.

  • Superficial burns only affect the outer most layers of skin. The injured area will be sore and bright red. Contact can be painful. No blistering is present and the skin is still intact.
  • Partial thickness burns have penetrated down into deeper tissue. The skin can blister and peel leaving the body wide open to infection.
  • Full thickness burns are painless. They can be moist, oozing, dry or cracked. The skin may be scorched and blackened, white and waxy, or they can be a combination of both.

Amount of Burn

The best method of determining the total body surface area of the burn is using the “Rule of 9’s”. This rule is internationally recognised and allows hospitals and paramedics to manage fluid support for patients. A reasonable assessment of the burn by a first aider goes a long way to helping paramedics plan their treatment prior to arrival. For further information, try the following link Emedicine Health – Rule of Nines. Any burn bigger than the size of a 50 cent piece should be medically assessed for serverity and potential depth of the burn.

Cause of Burn

Consider how the burn ocurred as it may increase the severity for the patient. For example, chemicals can be absorbed and become a poisoning as well as being a potential hazard to everyone dealing with them. Electrical burns often can include full thickness burns to internal organs. Tar or even jam will trap high temperatures against the skin and can be hard to remove without causing severe damage. Burns completely circling a limb can swell and cut off blood supply.

Burns should never be underestimated. Treat with a minimum of 20 minutes of cool or tepid flowing water. Personal experience has shown that the use of cold water can send a patient into shock. Ice should never be used as it can also lead to burns.

Always follow your first aid training with regard to burns and if in any doubt, dial 000 and ask for Ambulance.

My thanks to Caroline E and Stephen S for discussion and review of similar teachings from Australia and the UK.

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