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"Real" first aid - a story and a case study

I want to take you on a journey of why this picture of me pulling a face in the middle of a woodland makes me smile.

30 years ago I got a ticket to captain 2000 tonne vessels at sea. And with it came a huge responsibility to look after my "team". So, I duly went off and did quite a big first aid ticket known as "Ships Captains Medical" Being young and naïve I embarked on this course believing that when I came away being able to stitch, inject, diagnose and all sorts of other wonderful things, I'd be some kind of "medicool" kid. Fortunately, the instructor (submariner) soon got me back on the right track. I remember him telling a story of a nurse, Lyn Robertson, who kept her family of five alive in the ocean for 38 days, with next to no water. Of course, I tittered at the 15 minutes spent on the merits of rectal rehydration in amongst a flood of other skills.

Over the next few decades I found myself in some great locations around the world, and had the chance to put into practice, along with some other courses, things I had learnt. And, it also became obvious that training varies massively. Some first aid incidents were harder to cope with than others, but because I always wanted to do the best for my team, I always found a way through those things.

What became really obvious is that first aid, or first responding is seldom improved by "staying and playing". I haven't ever done doctors training, and actually in a lot of situations it's next to useless. Clinical medicine needs a lot of kit, and a big team. And where I like to go, needs moving quickly, efficiently and certainly not with all the tools and resources that a hospital has. My job as a first aider has always be to stop things getting worse, and if possible promote recovery.

So, I choose to move in the "swoop and scoop" world. Lots of "there, there" first aid, sprained ankles, minor cuts and of course the ever present joys of food poisoning.

"Swoop and scoop" is a herioc way of getting them to people and places where they can receive definitive care and that is in my mind "real" first aid.

Remote environments aren't generally a place where big injuries are easy to "fix". So, knowing how to stop things getting worse, and then get them out always has to be the plan.

And, the least kit you can achieve that with the better.

Remember, a doctors first job is medicine. A first aider is likely to be first and foremost, a friend, or a team mate, but could be a coach, a guide, an instructor or some other role where first aid is incidental, not the main role.

I am very honoured to deliver remote first aid for REAL first aid. - Adam (the boss) has researched and refines the course content to be REAL first aid that sits alongside current good practice. It's through REAL first aid that I became an Advanced Provider member of the Pre-Hospital Care Faculty for the Royal College of Surgeons (Edinburgh). This group of medically trained folk continue to provide development and thought about the kind of environment I like to enjoy myself in. The syllabus for Remote First Aid is relevant and covers big and little sick items.

Anyway, that story of me at the top of the page. Teaching relevant skills is always brilliant when someone lets you know it works.

On every remote first aid course I teach, I cover heat and cold illness, as in my experience, people get hot and cold in wild places, and it can be pretty easy to sort if you get in early enough. This is where first aid is something a good leader, team mate or friend does all the time - avoiding stuff is definitely preferable! Any way, I'm usually greeted after courses in a "I'm not dehydrated/hot" way - mainly because for 5 minutes out of the 16 hours, we talk about rectal rehydration. Clinicians are happier to use a canular and a drip, but I don't know many folk who can carry this as an incidental bit of kit. Folk find the concept of using a camelbak in rectum challenging - it's socially awkward to talk about, and in the majority of our lives it's not relevant. But, it does demonstrate really well, that there is a huge opportunity to apply physics and physiology in large doses in first aid.

Of the things I didn't expect to get feedback on was this unlikely element of two days worth of training, and certainly not during a Mountain Skills course in October! One of the candidates had been on a remote first aid course with me earlier in the year as she is active in a mountain bike club. And, in her day job, a vet. During the summer she was presented with a dog massively suffering from the effects of heat and exhaustion. Even in the clinic her options were limited and were unlikely to work fast enough. So, thinking through what she'd learnt on the remote first aid course, she proceeded to administer rectal rehydration to the dog. And guess, what, the dog recovered really quickly. This was done by someone who had way more resources available, but the solution was applying knowledge.

So for me, teaching first aid, REAL first aid and the remote first aid syllabus, is worth doing with humour, and using evidence based techniques for first aid and teaching. Because, though it might not mean you put letters after your name (nor should it after 16 hours), maybe it will make a huge difference to someone who is on your team.

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