Injured During Training!

Injured during training is a headline you read and think, man, that sucks. What could have been done to prevent this type of accident? During the Nov. 2011 ITRS conference a paper was presented which discussed a training accident and ultimately a near miss. It was the classic scenario, it was the last evolution of the day and a miss communication about who was in charge and a general complacency that seems to develop in many training situations.

If you’ve done any all-day training events you’ve been there. You’ve seen the attitudes start serious in the morning and then in the evening a cavalier attitude develops. Why this happens seems to be that people are getting comfortable with the evolution and a general expectation of how things work. This is kind of what we want, but the loss of focus especially when using live victims or putting people over the edge can have significant consequences.

I wish I had some sort of solution or suggested action to help teams prevent training accidents or even training complacency, but the only thing that comes to mind is to remain vigilant during training. Instill a sense of significance in what people are doing, especially at the end of a long day of training. In any case, keep yourself and your team safe and remind them that accidents typically happen late in the day of training. Call a “Stop” if people are not focused, anyone should be able to call a “Stop” at any time during a training or real mission.

If you have any data or solutions, please feel free to share them either  in comments below or with me directly and I’ll see about getting them to the BCR readership (emai BCReditor@gmail.com).

ITRS - 2011

This weekend I’ve been attending ITRS (International Technical Rescue Symposium). This has been a great opportunity to listen to fellow rescuers present papers on topics ranging from comparative breaking strength between basket hitches vs wrap 3 pull 2 anchors, to reports from IKAR (International Commission of Alpine Rescue).

This is my first experience at ITRS and I fully plan to attend as many of these in the future as possible. The opportunity to talk with other rescuers from around country as well as other countries has been a great learning experience.  http://www.itrsonline.org/

9/11 Reflection

As we washed the rigs at the station this morning, we did so in silence. The silence was only broken by the sound of the water spraying on the rigs and the brushes moving over the metal removing the dirt from the previous day's calls. This moment of silence wasn’t planned but just happened as we prepared the rigs for the day. As I washed the rig my thoughts went to fire fighters and first responders who 10 years ago this morning were doing the same thing, preparing their rigs for the day. As they washed their rigs I don’t think any of these brave individuals could imagine the events that would unfold on that day.

This was my personal reflection on the events of 9/11 and to all of the individuals who were killed that day. Silently preparing, remembering and honoring.

Finding the Right Balance

My pager goes off for a hiker who has called for help along the Pacific Crest Trail. The page comes in around 8PM and the general location of the hiker is about 5 to 8 miles in. I'm immediately compelled to go and begin making a check list of things I might need in my pack. I also consider the possibility of being out all night and either being late for work and non-functional or missing work all together because of the unknown injuries of the hiker. At work, we are busy working to release a product and it is crunch time.

As I'm changing clothes my wife looks at me and asks about the call. Then tells me about something going on in her day or something about the kids. My mind is only focused on my packing list and what I might encounter on the trail. Then it dawns on me that I've been on a lot of rescues lately (August is busy for our team) and haven't spent much time with family. When I call the in-town operations leader for our team to tell him I can't go on the mission, I feel a sting of guilt for leaving my teamates to do all of the work. My feelings of guilt are enhanced when I learn that we have a low turnout for this mission. I briefly reconsider going, but realize that family is far more important and work plays into the mix because I need my job to help support the family.

My ultimate rationalization is that while I am a member of a SAR unit and need to be available to respond to untimely missions, I need to take care of myself first, my SAR teamates second and lastly the subject needing help.

Also, by turning down a mission, maybe it will lessen the blow over the weekend when I look at my wife and say, "there's a mission, do you mind that I bail on whatever we have planned for this weekend."

Keeping the same radio frequency in the field

I was recently on a SAR mission where base was getting inteferring radio traffic on our "dedicated" SAR frequency. We had several teams in the field and the plan was to have each team change frequency and report in. Unfortunately, my team did not have the new frequency.  In theory we all should have picked another universal frequency, unfortunately, base moved each team to the new frequency which we didn't have and kept us on the old frequency. While base has the capability to monitor multiple frequencies, our team felt quite alone.

Once we reached the search area, coordinating with the other teams became a nightmare as we had to contact base to get each team's location and assignment. Eventually, our team caught another team and borrowed one of their radios but the confusion and leaving one team essentially in the dark seemed a bit of poor form.

On the up side though, we had a nice hike and were not bombarded with a bunch of radio traffic. The good news too was that this area is well known and frequently traveled by both myself and my teammate so we were not too concerned about our location or progress moving up the 4 mile 3,500ft elevation gain mountain side.

PHTLS worth the two day course

I recently completed a Pre-Hospital Trauma Life Support (PHTLS) course taught by Backcountry Medical (www.backcountrymedical.com). This was an intensive course in trauma care which included a few things beyond my EMT-B scope of practice (cricotomy, needle thoracostomy, and endotracheal intubation). I found it good to have a knowledge and understanding of what an EMT-P would be doing so that I can better assist if needed.

The PHTLS course focuses on ABCDE’s of trauma. The “D&E” were somewhat new to the standard ABCs. The D & E stand for Disability (level of consciousness) and Exposure (visualize all the wounds, or the standard trauma, “strip & flip”). Of course the primary focus is still the ABC’s with management of the airway being paramount.

Another important focus of the course was minimizing prolonged scene times (greater than 10 min) for trauma patients. In order to pass the course, we had a scenario where we had to assess backboard & c-collar, treat major bleeding and be ready to transport in less than 10 minutes. This emphasis of reduced scene times forces the EMT to overlook distracting, non-life-threatening injuries and focus on getting the patient to definitive care.

I highly recommend the PHTLS course for EMT’s of any level. I also recommend the Backcountry Medical folks too. One of the instructors was a combat medic in Iraq with the Army and has a unique perspective on treating trauma patients. Additionally, the Backcountry Medical folks are all SAR volunteers so their understanding of the unique challenges of treating patients in the backcountry.

Well defined roles promote mission success

I was recently on a mission for a pack-out of a hiker with an injured leg. We were in the trees but above the snow line. The trail was compact snow and ice from the number of hikers on the trail the previous days. Our team treated the subject and packaged her for a long pack-out. Initially I set out roles of medical and rigging. We needed the rigging because of the steep snow/ice and management of the litter down the slope.

I quickly found myself jumping between setting up anchors, tending the main line, patient care and running the rigging. The initial patient care provider was much in the same assortment of roles as I was. Eventually, it was pointed out to me that it would be more efficient if I ran the rigging. I then appointed one team member to medical/patient care and the rest of the mission seemed to move more smoothly.

I should point out that patient care was always the primary focus but the swapping around of EMT’s providing care seemed to slow our progress.

My take away from this mission is to establish a Rescue Group Leader and have that person run the field portion of the mission ensuring the big picture is being managed. Additionally, assigning one person for medical and one for rigging would have helped in having a singular focus for each task.

Overall the mission was a success, however I felt there was room for improvement.