FIRST AID - Help!

A snowHead

I need to expand and bring my First Aid skills up to date. I have coped with incidents on pistes this season, up to finding one person unconscious. While on piste one has the luxury of a pretty impressive service from the Postes de Secours, but off-piste is a very different matter.

I need some help and advice in selecting the best possible course to get the necessary skills. I have looked at the British Red Cross Standard Certificate as being fairly comprehensive, but most courses run by this and other organisations appear to be geared more to Health & Safety in the workplace, rather that the great outdoors. What training/qualifications do Mountain Guides, Leaders, etc obtain? Can anyone 'guide' me?

A snowHead

BernardC, careful there - I thought you'd injured yourself and were seeking immediate assistance wink

Well, the person's real but it's just a made up name, see?

Yes, I came rushing to the thread, plasters in hand...

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BernardC, I'd recommend the Emergency First Aid course run by The British Association of Ski Patrollers. It's a two day emergency first aid course with particular emphasis on mountain/outdoor pursuits & it's the course that BASI/ASSI students are required to take before an instructor qualification is awarded. http://www.basp.org.uk

I have to have a H&SE first aid qualification for work but you're right in that the majority of it is not applicable to the slopes.

I can recommend the BASP course unreservedly. I did mine at the Tamworth Snowdome & found the instruction/content to be superb with plenty of time spent on the slope doing accident/situation role playing etc. I can remember walking through the changing room with my face covered in artificial blood looking like an extra off Casualty which caused a few concerned looks Shocked

.

Anyway, snowHeads is much more fun if you do.

Ian & DavidS - Stand down plasters & defibrilluator - nothing works faster than Anadin - so I took nothing....

spyderjon, Thnaks for that very helpful link. I have e-mailed BASP for further information on content and location for their 4 day Standard First Aid Course. Their on-line course content descriptions are not as detailed as say the British Red Cross Standard Certificate, probably due to space constraints. What course did you do & in your opinion are the basic components of the BASP courses, as detailed & comprehensive as the Red Cross, or even better?

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I did the two day BASP course some years ago as part of the SCGB reps training. I highly recommend it.

It covers all the things you would expect in a normal first aid course with a bit more emphasis on the things you would be likely to get in the mountains such as hypothermia, frost nip and frost bite. You still get the slide show of people with bits of swarf sticking out of their eyeballs etc., presumably on the principle that any injury or illness can happen anywhere.

We also did some good outdoor exercises with multi casualty situations, for example six casualties and four rescuers. How do you prioritise and who do you leave to die if you have to - yes it covers that as well.

Then you can post your own questions or snow reports...

BernardC, I did the two day course. Although all areas of first aid were covered it was very much geared towards skiing/boarding, ie, relatively quick coverage on the subject of burns but a lot of time on head injuries & breaks etc. A considerable amount of time was spent learning how to 'handle' injured patients on the mountain with all the difficulties of steep & cold terrain etc. The course handbook is also excellent for use as a memory jogger.

After all it is free

BernardC, BASP is the very best course for mountain situations. Excellent, comprehensive and targeted. Try asking a regular red cross guy whether to keep a severely bleeding patient warm if you have to wait poss 30 mins for the pisteurs... Which is more dangerous? blood loss or shock? The poor person will really struggle as they haven't (mostly) had any experience in these sort of situations. (we invented the worst accident we could think of)!

I did a specialised course when I did my riding instructors exams too - very good indeed.

If any of the courses try to teach CPR take it with a huge pinch of salt. Although CPR is very fashionable it is also fairly useless under most circumstances.

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john wells, true, current survival rates for out of hospital cardiac arrest are approx 3 - 5 %. But that is partly due to the fact that most rescuers give ineffective CPR, or worse none at all. Effective compressions buy time, rapid defibrillation means survival rates can reach approx 60%.
Sir Ranolph Fiennes suffered a cardiac arrest at an airport and a few weeks later mangaed to run one or two marathons!!
I personally wouldnt choose to use the word fashionable to describe something that is attempting to resuscitate someone. Learn all you can, there is no greater reward than saving a life (talking from personal experience Little Angel

)

Edit: to include the word fashionable

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Kramer, Aah - so do you keep them warm to help with the shock, or cold to stop the blood flow??

Nells, The value of CPR is to keep blood flowing when the heart has stopped functioning in order to keep the brain alive. CPR does not restart the heart - mouth to mouth resuscitation will sometimes restart the heart and sometimes it will restart on its own. The CPR training includes mouth to mouth and this training is useful but heart compressions are not very useful.

In most first aid situations keeping the brain alive by heart compressions until the patient gets to a hospital is just not practical.

Whenever I get to talk to an accident and emergency doctor I ask about CPR. Not one of these doctors have ever said that they consider heart compressions of any value in first aid. The last doctor that I spoke to was not happy for his trained nurses to use it but he would use it himself occasionally in the hospital.

If heart compressions are done effectively you are going to break ribs - I consider that it is extremely irresponsible to encourage amateurs to start breaking ribs when it may not even be required for treatment (this is not really a problem as most amateurs will not use enough pressure so they do not do damage but they are not doing effective heart compressions either). Heart compressions do not restart the heart.

I guess that heart compressions are considered so useful because patients have recovered when someone has been giving heart compressions but the patient would have recovered anyway regardless of or even despite the compressions.

Thought that I would get a bite on this one.

You know it makes sense.

john wells,
I don't think this is entirely accurate.
CPR stands for cardiopulmonary resuscitation the different elements are useful in different situations. If you have someone who has stopped breathing because they have been caught in an avalanche or something clearing there airway and giving them mouth to mouth may be lifesaving, this is part of CPR

If you come accross someone in the street or on a piste who has had a heart attack and whose heart has stopped full CPR with cardiac masage may be lifesaving if a defibrillator can be brought quickly to the scene. Occasionally chest compression may restart a heart.

If someone is in the wilderness it is true that prolonged efforts at CPR are unlikely to be sucessful, this does not mean you shouldn't start though. Breaking ribs is always possible but someone whose heart has stopped is unlikely to complain and they will definatley die without CPR.

Otherwise you'll just go on seeing the one name:

easiski,
Keep them warm getting them cold will do nothing to stop blood loss.

A snowHead

john wells,

A snowHead

T Bar, Well, there you are - our guy said if they'd suffered major traumatic injury (arm torn off) then cold would stop resultant blood loss, but decided in the end that we should keep the patient warm as he felt the patient was more likely to die from shock following this trauma. So that's a regular Red Cross guy - not the BASP peeps....

Well, the person's real but it's just a made up name, see?

I'd go for warm, but I'm a bit confuesed...which is it....?

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An interesting debate is developing and as it befits this hallowed place, some great contributions and ideas are appearing. I hope to hear back from BASP and Red Cross after the EoSB, AKA 'Last Ski at the Proms' and hope to get one of these courses done as soon as possible. If there are any other course suggestions, do mention them. I will travel to get the best! Armed with a good grasp of the basics will, I imagine, allow me to get more to grips with the more detail techniques being discussed.

The three major casualties that I encountered all survived on very basic aid, but were attended to by professionals fairly quickly. I suppose the most serious one was a cardiac arrest on the Grand Motte above Tignes, which was attended to PDQ - literally what seemed like minutes by Rescue & then airlifted following a phone call. It's difficult sometimes when skiing to differentiate when a person has a simple tumble, or goes down with a heart attack.

On a lighter note though, regarding recovery - a few collision-dazed skiers for whom we stopped to help, were moaning & groaning, with some blood on the ground. I was unsure if they were near death, life, or just winded & so went for my first Aid Kit, which is one of those Orthovox bags which fits snugly into the shovel blade in my backpack. The casualties on seing me first produce a shovel seemed to achieve a fairly remarkable recovery on their own... Toofy Grin

Anyway, snowHeads is much more fun if you do.

john wells, the benefit of prolonged CPR is likely to be enhanced in the mountain environment as it is highly likely that the person that you are performing it on may have been caught in an avalanche and may be suffering from severe hypothermia, and so CPR may be effective for a very long period of time (hours even!) whilst transferring the casualty to an environment where they can be successfully warmed. "You aint dead till you're warm and dead."

easiski, JT, dealing with blood loss comes before keeping the patient warm in the list of priorities, C (for circulation) coming before E (for environment).

To me, part of the problem is how first aid is taught to the general public. Usually it's taught by amateurs, most of whom have never been in the actual situation themselves and (IMO) don't really have the knowledge to give people realistic training, hence the red cross guy not being sure what to do in the scenario given to him above. IMO unless you are dealing with these things on a regular basis then when the actual situation arises most people will be so paralysed by fear that they can hardly look after themselves rather than anyone else. Even amateurs who've made a hobby out of practicing first aid techniques (St John's ambulance) are pretty useless in dealing with a major casualty (again IMO), so I'm not sure what chance someone who went on a two day course N years ago has.

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I am not sure why first aid started to be called CPR - probably our friends across the pond. By naming first aid as CPR an emphasis is being put on the heart compression aspect of first aid and I consider that this is an unnecessary bias which is focussing on a minor and debateable aspect of first aid.

If you break ribs by administering compression when it is not necessary I consider that there is a major problem here. Alive with broken ribs or dead without is not the true alternative choices - alive without broken ribs would be a much more frequent occurance.

As Kramer says above - dealing with these things on a regular basis might be an important aspect and people administering first aid are not usually dealing with heart compression on a regular basis. Teaching something which needs a fair bit of practise and expertise as an important basic part of first aid does not seem to me to be very effective or efficient.

A semi-automatic defribulator is the way to go for first aid but carrying one into the wilderness could be a bit of a problem.

Anyway how do the experts know that first aid heart compression has saved many lives? I would have thought that most of the information is theory or anecdotal.

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john wells, would you mind backing up your views with your qualifications?

After all it is free

john wells,
I think the reason why CPR is taught is that it has been demonstrated to work. The evidence basis comes theoretically from animal models and practically from populatoin studies where large numbers have been taught CPR such as in Seattle. Cardiac compression is an important part of CPR and if your heart stops broken ribs are trivial.

Help me out here please. I am having my usual trouble with Pubmed. The reference 2 in the resuscitation guidelines - Effects of interrupting precordial compressions ....... - I can only find the journal with a search engine which wants payment to see even the abstract - any suggestions as to how I can view this journal entry?

Kramer - I am the person who asks why? and gets fobbed off with generalisations and not research data.

This is not personal to any of you - if you can guide me to a better understanding which means that I am less critical of CPR all the better although you will struggle to convince me that first aid should not be called first aid but instead CPR.

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Kramer, Exactly why the BASP course is so much better - they do know and have had the T shirt! I've been dead lucky - whenever there's been a casualty anywhere near me, there's been a much more qualified person on hand to deal with it. All I've had to do is put peeps in the recovery position, and persuade their friends not to move them while waiting for the pisteurs. Little Angel

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CPR is only one element of first aid and there are lots of studies to show that CPR improves survival (can provide a multitude of references if you really want them !! Puzzled

) . Again I am not sure that a technique that can save a life should be described as a minor part of first aid

The new guidelines from the resus council (link above) hopefully go some way in relieving the anxiety for first aider's who are concerned they may be giving compressions inappropriately. The assessment for NORMAL breathing is all that is required before commencing compressions, the view being that if some one is collapsed without normal breathing their heart will stop and they will benefit from CPR. Compressions should continue until normal breathing resumes. I apologise for being flipant about broken ribs, it is obviously not ideal but the concern should not stop a rescuer from giving CPR to someone who needs it (no normal breathing)

With regard to training and retraining, john wells, i am not sure if you are aware that all health care workers are expected to undergo retraining in CPR on a regular basis (about every 12 months for most). This is in recognition that most of us dont have to perform CPR frequently and therfore our skills deteriorate over time.

For the inexperienced first aider who may be expected to respond (works places etc) i think it is unreasonable to expect them to be confident in their skills when they only retrain every three years. AFAIK the Health and Safety Exec are going to review this and hopefully recommend annual updates.

On the whole first aiders do a good job, dont be put off by the thought of doing it wrong, ultimately if they arent breathing they are goingto die and there is nothing you can do to make that situation worse. Little Angel

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john wells,

www.resus.org.uk
all you need to know about resuscitation and what is current, the info is free so no need to subscribe

Good point(s) well made Nells if you do nothing they're dead. BASP BASP BASP all the way for mountain specific first aid. Good courses well run by people who work a patrollers and therefore have hands on experience of the sort of situations you could encounter. If anyone has a more technical question I'll try and ask a friend who works in a hoispital A&E and is qualified as a Trainer in Trauma treatment.

You know it makes sense.

On the Resuscitation site under research there are reports from the Jan 2006 Scientific Symposium the most relevant of which is a report on the evaluation of ambulance telephone-CPR advice for adult cardiac arrests. This report cites only one journal abstract - JAMA 1995 Dec; 274 - Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. This is a report concerning data from the Bronx, New York.

I would assume that this is the most relevant piece of research but there is only the one and it is 5 years old.

Of 2071 cases it accepts that there was effective CPR undertaken on 305 for which the survival rate was 14 (4.6%). A further 357 received ineffectual CPR for which the survival rate was 5 (1.4%). Judgement as to the effectiveness of the CPR was as reported by the first paramedics on the scene - a subjective judgement. There are no figures for the survival rate of those who did not receive any CPR - this would have been a useful figure. These survival rates are not good.

One bit of information - after 4 to 5 minutes of vetricular fibrillation using a defribrillator is not recommended - news to me; you need to get the machine to the patient pretty quickly!

There are a few more studies quoted in other journals at which I shall take a look.

Otherwise you'll just go on seeing the one name:

Kramer,

If someone is bleeding to death I can see that is more important that warmth.... its never going to be as easy as a,b,c... so all that amateurs can do is not make it worse.

My general feeling would be something on the lines of saftey, warmth and comfort... and wait for the professionals

A snowHead

BernardC,

Bernard, to go back to your original question, last autumn, my son attended a two-day first-aid course at Plas-y-Brenin which he said dealt with mountain emergencies as well as general first aid. He thought it a good course and more useful for ski-related injures, than the general St John's course he had done through school.

PYB also do a three day course which is aimed at mountain leaders etc.

Link here: http://www.pyb.co.uk/courses/first-aid.php

I think Glenmore may do something similar, if that is more convenient for you. Hope that helps and happy to try to answer any follow-up questions.

A snowHead

Apologies to everyone especially the professionals who pulled me up. Chest compressions would appear to be the most effective means for keeping the brain going, more so than mouth to mouth.

Caveats based on the published journals
- even trained paramedics and nurses do not appear to do a very good job of chest compressions,
- action within a few minutes of seeing someone go down with a heart attack is fairly essential,
- survival is not good (<10%),
- most of the advice is based on best practise and anecdotal - not much science involved,
- if the patient cannot be hospitalised fairly quickly, fatigue will inhibit effective chest compressions and delays greatly reduce the possibilities of survival - not good if in the mountains.

I stand by my thoughts on the relative importance of CPR in a first aid course but accept that chest compressions would be the most effective aspect of CPR.

Well, the person's real but it's just a made up name, see?

john wells,

now your getting there Very Happy

its a bit late at night (plus a few beers!!) for all the references, so trust me i'm a ..........

in response to your points
- most health care workers need regular training
- survival rates drop by 7 - 10 % for every min the casualty waits for defibrillation( but effective cpr means you may have longer, every minute counts)
- (as per my first post here), surivival currently 3 - 5 %, a grim prospect for the biggest killer..
- bystander cpr can reduce mortality by one half
- your right, chances of survival in remote locations is slim, but.... see Kramer, point re. hypothermia buying extra time, a real possibility in the mountains.
I assume that in this kind of situation you may know your casualty, would you stand doing nothing and wait for help to arrive or try and buy them some time?

(Really sorry, this is my hobby horse!!!!!!)

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Stick with it Nells you'll get there in the end. At least I'm comforted that if/when I keel over and you're there you might do something about me rather than just watching me goldfish on the ground.

Anyway, snowHeads is much more fun if you do.

snoflake, thanks, always willing to give it a go Very Happy

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Haven't studies shown that the average person can't sustain effective compressions for much more than 1 minute?

Then you can post your own questions or snow reports...

After all it is free

and.................yes it's not ideal (in fact difficult) but the alternative is???????

john wells,
Any one thing taught in isolation on a first aid course is unlikely to equip you for all possibliities but as judging from newspaper reports heart attacks are a relatively common thing for the rescue services to be called out for I would think CPR deserves its place.

One thing that does seem to have confused you though is the relative importance of the aspects of CPR. Traditionally CPR placed primary emphasis on the airway and then the breathing then cardiac massage. Modern evidence suggests that for the arrested victim emphasis should be placed on effective cardiac massage.

This does not mean that for a patient suffering from major injuries cardiac massage is the most important aspect of their care, attending to the airway looking after thier breathing and stopping any bleeding remain the most important things.

There again major injuries are only one aspect of first aid. snowHead

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nordicfan, Thanks for the pyb link. I have had a look on their website and will contact them after Easter to get more details.

Kramer, wrote

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