Transcript Extended Care Module and the Benefits to Small Remote Patrols

www.skipatrol.org.au
Australia Ski Patrol
Association
Proudly Supported
By
Extended Care
Module
and the
Benefits to
Small Remote
Patrols
Presented by:
Rocky Findlater
Jacobs Ladder - Ben Lomond Tasmania
Australia Ski Patrol Association
• One of ASPA’s main roles is as a training
organization
• There are three main courses made
available to its Patroller members:
1. AEC (Advanced Emergency Care Course)
2. National on Snow
3. ECM (Extended Care Module)
Patrols in Australia
• There are three States where skiing is
possible in Australia
• All three States have Patrols members of
ASPA (Australian Ski Patrol Association)
these are:
– New South Wales
– Victoria
– Tasmania
New South Wales
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Perisher
Thredbo
Mt. Selwyn
Charlottes Pass
NSW, Australia photo
Victoria
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Falls Creek
Lake Mountain
Mt Baw Baw
Mt Buffalo
Mt Buller
Mt Hotham
Mt St Gwinear
Mt Stirling
On Snow Exams – Falls Creek - Sept 2008
NSW & Victoria
Tasmania
• Ben Lomond
• Mt. Mawson
Medical Centre
• Some Patrols have
– Local Medical Centre (larger resorts)
– No Medical Centre (smaller resorts)
Medical Centre
• Smaller Patrols are
remote and are longer
distances from a Medical
Centre
(several hrs by Ambulance)
• Some Mountains have Summer
Recreation
(Medical Centre are closed in Summer)
Medical Centre
• Smaller Patrols are
remote and are longer
distances from a Medical
Centre
(several hrs by Ambulance)
• Some Mountains have Summer
Recreation
(Medical Centre are closed in Summer)
On Ben Lomond
• We are a minimum of two hours (round trip)
from a Medical centre by Ambulance,
Extended Care Module
• Was the Brainchild of
Peter Hoyle
from Ben Lomond Patrol
Tasmania
(previous Captain
1992 to 2004)
and
• ASPA VP Education
2005 - Now Retired.
Peter Hoyle
Ben Lomond Patrol HQ – 2005
Background and Intent
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The ASPA ‘Advanced Emergency Care (AEC) Course’ trains Ski Patrollers to
care for people injured on the Ski Slopes.
In large resorts the patroller’s duty of care ceases when they can hand over to
the medical centre at the bottom of the slopes.
In small resorts, (both alpine and cross-country), there is often no medical centre.
Patrollers have the responsibility to care for a casualty until they can handover to
Ambulance or other medical care, which may involve a wait of several hours or
more.
The ASPA project was to develop a module to provide general guidelines for
Patrollers who have that ‘extended care’ responsibility.
It is not the intent to extend the patrollers competencies to paramedic level, but it
will emphasize on important aspects of patient care that are within the
competencies taught in the AEC Course, as well as focus on assistance to
friends and relatives, evacuation of the casualty and interaction with medical
personnel.
It is envisaged that the module will be used as a resource for training at the
patrol level, with local protocols added.
The module was in its first draft prior to 2005 season and was continued to be
developed that season, with input from the Ben Lomond and Mt Mawson patrols,
It was also hoped that Peter would go on the road in September, to Baw Baw,
Mt Buffalo and as many other small patrols as possible to gain input, feedback
and support .
Feedback from other Patrols
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In September of 2005, Peter visited all of the patrols in Victoria & Tasmania,
and spoke with them on the concept of the ECM
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Objective to get feedback from members about their extended care issues.
Baw Baw
Raul Picot, Paul Picot
St Gwinear
Allan Wood, Craig Oldis, Andy Gillam,
Mark Connor,
John
Sunderland, Dr Margaret Sunderland
Lake Mountain
Andrew Paul
Mt Stirling
Stapleton
Peter Madden, Martin Burney, Mick
Mt Buller
Sam McDougall, Ossie Ramp
My Buffalo
Chris Beach
Falls Creek
Glenn McIlroy, Dr Mark Zagorski
Mt Hotham
Larry Doyle.
Ben Lomond
John Marshall, Phil Harris, Rocky Findlater,
Dr Alex
Thompson
Mt Mawson
Andrew Davey, Liz Caldwell
Benefits Issues and feedback:
• Medications
– Doctors bag medications
• Responsibility of supplying doctor
• Security, kept in a safe, key access limited, Patrol director or Mt
Manager
• Some patrols will not have medications because of security
concerns.
• Must be kept in date
• Records must be kept
– Patrollers should only have access to those medications for
which they are certified
– There should be a minimum requirement for the facilities needed
in a ‘Remote Area’ first aid room
– Panadol should not be offered by Patrollers, but:• If a patient asks for it, it should be readily available
• Nothing by mouth
Benefits Issues and feedback:
• Duty of Care & Insurance
– Doctors who assist in the ski patrol should be sure that they are
covered by their professional indemnity for ‘good Samaritan’
voluntary work
– Standard advice sheets to give patients who are not ambulance
cases
– waiver forms to be signed
– when does our duty of care end?
• Care Room Issues
– Toileting
• Output should be measured, test strips used
– Clean up and disposal of blood waste is important
– Peer Support and debrief strategies should be in place
– Abusive, uncooperative patient
Benefits Issues and feedback:
• Training
– ASPA should offer extended competencies, eg:• O2 Nebuliser, Angenine, Sucking, Epipen, Gadel Airways,
O2 Bagging
– Knowledge of specialized dressings, eg for abrasions, burns
together with maintaining an A septic field is important
– ASPA AEC course concerns
• Length of attendance at the full course, 3 weekends are difficult
• Can more competencies be tested at the patrol level by ASPA
accredited assessors?
• Can the short course concept be extended?
• Can more of the course and testing be on-line?
• Agreement that the prac component should be maintained
• Pre course workbooks are good.
• More 4 day courses?
Benefits Issues and feedback:
• Ambulance
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Payment and patient refusal
Advice on likely destination (which Medical Centre ?)
When is an ambulance necessary?
Briefing Ambulance Staff and handover
• Documentation - needs more information
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Form for doctors to use, their personal qualifications, history etc
Every intervention should be recorded
Abdominal girth to be recorded for internal injuries
Oximeter readings.
Changes in pupil size.
Frequency of observations guide is needed
Duplicate documents for both hand on and patrol records.
Benefits Issues and feedback:
• Other issues
– Patients need to be advised when surgery might be likely and
anesthetics may be required.
– Who do you let go? What do you say or advise to the walk out
patient who seems to have got better?
– Involving family and friends in what is going on, give them
something to do, how do they feel? Don’t cause unnecessary
concerns or worry.
– Planning the evacuation from the hill as well as from the
mountain
– Methods of evacuation
• Own transport car or Bus
• Ambulance
• Helicopter
– Returning gear and finding and advising other group members
Managing Long Term Care
• Planning the care from the time first
Patroller arrives on scene
• What are likely
scenarios ?
improve
or
deteriorate
• How to keep
Casualty calm and
confident in our
management &
their outcome
– What is going
through their mind
• How does the family or team members
with them feel? Keep them informed. How
can they help or be involved?
• What evacuation plan?
www.skipatrol.org.au
Australia Ski Patrol
Association
Proudly Supported
By
Thank you:
Peter (Rocky) Findlater
Treasurer
Australian Ski Patrol Association
Captain - Ben Lomond Patrol
PO Box 616
FORTH Tas 7310
[email protected]
Ph (home) (03) 64282221
Mob (priv) 0418128827
Skype Name: Rocky Findlater
Sandy Findlater with Ben Lomond Gnome
Discussion paper - October 2005
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INTRODUCTION
ASPA Emergency Care Course trains Ski Patrollers to care for people injured on the Ski Slopes. In large resorts the patroller’s duty of care ceases when he can hand
over to the medical centre at the bottom of the slopes. However in small resorts, both alpine and cross-country, there is often no medical centre. Consequently, patrollers
often have the responsibility to care for a casualty until they can handover to Ambulance or other medical care. This may involve a wait of several hours or more.
This module is intended to provide general guidelines for Patrollers who have that extended care responsibility. Operational protocols and details of
equipment will vary between patrols.
The module does not extend the patrollers competencies to paramedic level, but it does emphasize important aspects of casualty care that are within the
competencies taught in the Emergency Care Course, as well as focusing on reassurance of the casualty, family and friends, evacuation and interaction with medical
personnel.
CONTENT
Action to be taken when the casualty is brought into the First Aid room
Introduction to the Ski patrol
Explain to the casualty where he is
Introduce yourself and others who will be carers
Obtain permission to care for the casualty
Vital signs
Check DRABC
Observe BP, Pulse, Conscious state, Skin condition, Temperature
Determine frequency of Observations
Recording
Enter personal details, details of accident previous observations on the required Report Form.
Accurately record all observations and actions taken.
Secondary Survey
Locate and check the presented injury
Conduct standard Secondary survey with an intensity according to the casualty’s state of consciousness, the history of the accident and the extent of the survey that was
done on the slopes. If the casualty’s condition deteriorates, secondary survey may need to be reassessed.
Splints, bandages and RICE
Check splints and bandages for effectiveness and comfort.
Continue RICE regime for Sprains and Contusions
Comfort and warmth
Close doors, turn up heaters, restrict movement of people through doors
Blankets, pillow, hotwater bottles
Remove boots if possible
Warm drink unless contraindicated.
Check on the need for toileting
Do not remove wet clothes until the person is warmed up
Do not sit a cold person close to a radiant heater, Do not rewarm too quickly
Do not allow alcohol to be given
Do not locate O2 near a heater
Do not give food or extensive drinks if the casualty may need surgery.
Pain relief
Check for contraindications
Be aware that the wait may be beyond the effectiveness of Penthrane/Entonox if too much is given too soon. Casualty can be educated in economic self administration.
Stabilize the injury, create a comfortable, warm and calm atmosphere
Establish the need by observing the casualty and asking “ how much is your pain on a scale of 10”
O2 therapy helps to relieve pain