Medic……!

Talking about first aid in one post immediately set me thinking a lot more about the subject, i thought at first to do a much longer post but realise that it’s one of those subjects that’s best taken in small doses….see what i did there ?

At home i am having an admin and organisation day sorting through all the kit that i have taken off the Liberty and making a new pile of stuff that i will take over to Ipswich for Inanda. I have left the boat’s ‘simple’ first aid kit aboard in its usual place but brought my more serious medical kit ashore.  Part of today’s theme is a job that i will be doing which is to go through that kit and see what needs replacing.  Although it’s not a standard approach i tend to have 2 first aid/medical kits aboard a boat, one is a simpler ‘ready’ kit often based on my paddling and bushcraft kits and the larger kit is stowed away more securely and also contains the medicines that i carry.  As an ocean sailing medic i often had a third kit which was purely the pharmacy but then we were carrying prescription medicines and occasionally controlled drugs.  In future posts i intend to talk about basic medicines especially analgesics (pain killers) for boats.

Today my main themes are twofold and relate to the last post : first aid/medical training and first aid/medical kits aboard boats.

First aid training….what’s available and useful.

First aid training for outdoors practice is largely organised into 4 levels of courses that i know of and frequently specialised as environment specific.  Its quite rare to see a level 1 course, the most basic level, ever taught in the outdoors environment because that is almost always a 1 day home or work basic first aider course. To be honest a 1 day course isn’t long enough to give a grounding in each area that should be covered and so really a 2 day and level 2 course is for me the logical starting point.  What you get on a well organised 2 day course should be a mixture of classroom time, hands-on teaching, some scenario’s to play with and properly a mini-exam at the end to at least check out your CPR skills.   The level 2 course can be taught over 3 days and often is in the better outdoor centres where the course will tend to be environment specific, thus a mountain first aid course should be at least partially delivered out there on the hill and a paddlers course likewise around water.  Once again i would like to highlight the Uk national mountain centre at Plas-y-Brenin as an excellent provider.  Confusingly it is the Uk mountain centre but actually in north Wales !.  I did my actual first aid training there and became a first aid instructor there and went on to run a few courses for them.

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

Jumping up a level is the level 3 course which is the equivalent of a recognised first aid at work provider course and is regulated by the HSE (health and safety executive).  I won’t go into all the legislation surrounding first aid provision at work here but the level 3 course is often the standard course for say an instructor working in outdoors centres just as it is for a primary first aid provider in a large employer.  I happen to think that it’s a better course than the level 2 course for having longer exposure time and an outside assessment often by a healthcare professional at the end.  On the courses at this level that i ran i was twice assessed by a HSE inspector during the course so they do keep standards up.  This used to be a 4 day course and some centres did useful sessions on basic risk management which is often a new area to many people.  Holding a FAW was than a requirement for the advanced first aid course and to take a first aid trainer/instructor course.  I don’t know what is now taught on an advanced first aid course as i haven’t been involved with one for many years.

Another provider that i would like to highlight here in the UK is Training Expertise, link below.  They are a more generic training provider that can do just about any course to your own requirements as well as the standard REC (rescue emergency care) style courses.  I know that they run generic expedition first aid courses and wilderness medicine courses for people going to remote locations and are well respected in the industry.  Once again i have bee involved in working on their courses and it was their trainer-trainers who taught my instructor course.  Above the advanced first aid and expedition first aid we are getting into the area of wilderness medicine which is a big jump but certainly appropriate for anyone going a long way from easy access to medical help.

https://www.training-expertise.co.uk/courses/first-aid/

When it comes to sailing i am much less impressed by the RYA’s approach in that their endorsed course is only, to my way of thinking, a level 1 equivalent course and in my opinion cannot adequately cover even what it claims to properly.  To the best of my knowledge many RYA recognised schools do run a 1 day course and it does seem to fulfill certain requirements for example in the professional sailing racing scene. It is purely my own opinion that it’s no way comprehensive enough for someone sailing offshore and part of my reasoning for that goes back to my comments about duration of incident…that you can be left ‘holding the baby’ for a long while until help arrives.  I also happen to think that sailing has some specific problems which are at a much higher level of difficulty to deal with similar to the falls/spinal injuries in mountaineering.

http://www.rya.org.uk/courses-training/courses/specialist/Pages/first-aid.aspx

Outside the RYA courses there are some excellent boat based first aid /medical training providers often providing bespoke training in the superyacht and professional sailing industry. I haven’t had much contact with that world so i won’t jump to suggesting a provider that i know well.

This though is the kind of level that an offshore skipper should aspire to and is an MCA recognised course.  I happen to know that they also teach the 5 day ship captains medical course which is the dogs bollocks….(technical term)  This is a 4 day course and the one i would recommend to any sailor going on a long offshore/ocean voyage or going for a long period of cruising.

https://www.hamble.co.uk/mca-stcw-proficiency-in-medical-first-aid-on-board-ship

Now lets move onto talking about first aid kits.

Many commercially available and nice-looking first aid kits are next to useless in real-world problems…..and you can quote me on that.   With boat problems just as an example there is very rarely a big enough gauze pad to deal with a nasty cut and i have never seen wire cutters for cutting off embedded fish hooks in a standard ‘boaters’ over the counter kit.

I know that it is very tempting to go out there and with all good intentions buy a posh kit over the counter and think ‘job done’…..the problem though is more like walking into say a generic DIY store here and buying a budget ‘house’ toolkit and expecting to pull your boat’s engine out just using the tools in that kit !.   When i taught longer first aid courses i often used a teaching ‘aide memoire’ technique which used not one but 3 whiteboards or parallel flip charts.  Down one side i would have the useful A-E structure written out and next to that the things that we had covered within that particular letter (A=airway by the way). Thus in ‘A’ airway we might have ‘HTCL’ (head-tilt and chin-lift) as a technique covered and then directly next to that a list of any kit that we used.  Now, its pretty stunning but many critical techniques are accomplished with no kit except for a pair of hands, eyes and maybe some gloves.  Given that hands and eyes are usually provided it becomes rapidly apparent in the third list that the things there are the things we then really need.   With my courses being partially taught in their proper environment and often needing a high level of improvisation we would usually re-group after an outdoor session and write up anything that we had used.  I can definitely say that gaffer tape, roll-mat, tarps, breakdown paddles etc and so on all got used as make-do splints, dressings, evacuation aids and so on.  Some medical things are specifically essential : big gauze dressings for example (the military ones are excellent) , bandages are another. What we did usually in a round-up session was then to ‘design’ the first aid kit that contained the core essentials that actually would be used….and that kit didn’t then look much like something that you would buy off the shelf at Boots the chemist.  Did you know that a single ketchup pre-pack is as good a recovery medicine for a hypoglycaemic diabetic for example ?

At the end of this post i would like to leave you with a first look at some of my own kits here and explain why i have so many different first aid kits set up.001

Red pouch. Is a commercially available first-aid pouch that can be bought just as an empty bag. That’s one of 2 identical ones that i have set up for our cars so we each have one.

Blue pouch. Started off life as an over the counter sports first aid kit which i bought as a demonstrator aid for when i ran courses. As standard there was a lot of useless stuff in there and we had a lot of fun on those courses deciding what to keep and what to throw out and then add-in essential stuff. That kit subsequently became my canoeing instructor first aid kit and is now the ‘ready’ kit that i would carry in my sailing bag.

Ziplok bag top left. Is the very simple kit that lives right on my bench in the garage. All it really has is enough to contain a stupid accident with something sharp until i can get back to the house without leaving a trail of blood on the floor !

The small ziplok bag on the plastic box is a simple kit that i carry in my pocket whenever i am working in the woods with axe, saw or knife but mostly lives in the top of my work rucksack. Once again its just enough to deal with a cut in the field. That got used last year when my greenwood saw jumped and i got a nasty and dirty cut.  Note here that i almost always carry a full water bottle even close to home and on the day that became the wound irrigation to wash out the green debris from the saw.

Plastic box. Is currently the house first aid kit minus the house medicines. This is pretty much the same as my main boat medical kit and is made up completely from scratch. The full roll of gaffer tape is a useful reminder and gives a sense of scale. The boat version has ‘MEDICAL KIT’ written on the lid in big marker pen.

In a follow-up post i will empty some kits out and show you the kind of stuff i like to carry and why.  For now i would really like you guys to have a think about just some of the things i have said, have a think about the kind of injuries you might have to contain and then take a look at your own kit. It would be good to get some honest feedback on these posts because of all my posts these are the ones that just might really help you one day.

Handy hint…big gloves, big dressing pad.

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1 Comment

  1. Steve, this series of posts is turning out to be very useful — thanks for sharing your knowledge and experience. Looking forward to more.

    My First Aid training comprises some military stuff from decades ago and, more recently, a good old St. John’s occupational first aid thing which I suspect is about the level of the RYA course you mention. Intrestingly, this came in handy out in the forest in a work incident involving a chainsaw, no protective pants and a calf muscle. Lots of blood and a back-breaking casualty evactuation on a make-shift stretcher followed. Thankfully we had a basic first aid kit with plenty of big gauze pads on hand and half a clue what to do thanks to St. John’s. Goes to show the importance of training, even at a basic level, plus having a decent first aid kit and a strong stomach. Don’t panic!

    Like

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