Tag Archive | Training

Response Cycling Rant

I have worked hard to achieve my role of cycle responder. The course isn’t particularly difficult, but keeping in mind most people have done no training at all, it holds you to a particularly high standard. It also has a particular focus on working in crowds of people safely (you should see some of the maneuvers we’re expected to pull off). Just like anyone else operating an emergency vehicle, we’re supposed to be good at what we do.

Now, I freely admit that there are some idiots on bikes wandering around.  This is an unfortunate side effect of the lack of licensing of bicycles.  Not that I advocate such a license: we need to encourage people to cycle, not make it difficult for them.  (Before anyone interjects that a driving license isn’t difficult to get, I’ll point out that, at 23, I am still unable to drive a car due to the financial investment driving lessons require.)  Proper planning, a bit of common courtesy amongst road users and decent provision of dedicated cycle ways should help keep these few idiots safe and out-of-the-way, keeping all parties safe.

We, on the other hand, are response cyclists.  We are not just cycling as a means to get to work, or to the shops.  Our role has two main parts, in order of importance (in my opinion):

  1. Responding to calls for assistance from the public, other first aiders and the ambulance service
  2. Patrolling an event, forming a highly visible first aid presence that can be flagged down when needed

To a lesser degree, we also make good a good advert for the Organisation, as we are very visible and something people don’t see every day.  (This is something I think we should capitalise on more…)

Now it is fairly obvious that most of our patients will be found in areas where there are most people, and so it is almost inevitable that we mainly respond to places where there is a crowd.  This isn’t even allowing for the fact that crowds invariably form around patients.  Given that many of our patients are reported as being quite unwell, this means that we will need to respond fast through said crowds.  The most effective way of progressing quickly through a crowd is to make a lot of noise, encourage people to move out of our way (whether with noise makers, voices, “blues and twos” or whatever) and pass through the gaps that naturally form in such groups.  It is exactly the same technique as walking quickly through a crowd (which most people can do without thinking), but at higher speeds and with bigger turning circles.  It’s not perfect (it doesn’t work in very dense crowds) but it still usually gets us on scene faster than a foot patrol (we can take advantage of larger gaps to put on decent bursts of speed) or an ambulance (which can’t exactly dodge and weave in the ways we can).  Sometimes it’s only a minute or so faster, but when someone is very unwell, every minute counts.

Unfortunately, to make it work, sometimes we have to cut things fine.  Sometimes I will pass someone by inches then swerve suddenly in front of them to swing through another gap.  I try to make myself known to everyone, but sometimes I’ll catch people by surprise.  This doesn’t (and I say this with feeling) mean that I’ve nearly hit you.  Believe me, if 45 kg of bike plus 60 kg of rider nearly hit you, you’d know.  In fact, the first thing you’d know of it would be the screech of brakes as I come to a halt behind you.  Because, just like that emergency vehicle going down the road, I never go so fast I can’t stop if I need to.  I have a lot of momentum, but very good brakes and plenty of practice emergency stopping.  I’ll say it again, because I mean it: I am not going to hit you (well unless you decide to jump in front of me at the last-minute, and that, I’m afraid, would be your fault).

On the other hand, when I’m on a patrol, I’m not in a hurry.  In fact, I’m particularly keen to save energy for the times when I really need it.  This means I’m going to move slowly.  Of cause, all velocity is relative, and slow for a cyclists doesn’t always mean the same thing as slow for a pedestrian.  Sometimes the crowd sprawled across my patrol path decides they want to dawdle down the street, taking in the sights.  And why not?  After all, most of the time they are on a day out, and who wants to rush around on a day out.

This makes cycling patrols a very different activity to normal cycling.  On a clear road, we’ll move at roughly normal to slow cycling speeds, stopping sometimes to take in the sights ourselves (everyone loves a bit of people watching).  Then we hit that dense bit of dawdling crowd, and so we slow down, down to the speed of the crowd.  This takes practice; a bike are very difficult to control at such speeds, particularly given the weight of our bikes.  That is precisely why we spend so much time on cone skills and low-speed maneuvering.

Once we’re down to the speed of a dawdle, we can quite happily sit there indefinitely.  We’re happy to wait until the crowd disperses, a gap in the crowd forms naturally, or we have a reason to speed up (usually a job from control).  Of cause, if people move aside to let us through (which happens fairly often once people notice us), we do appreciate it, and we’ll pop through any gap that forms (naturally or otherwise) to move from behind a crowd if the timing is right.  We know that sitting behind people makes them uncomfortable.  That said, if that’s where we have to stay, so be it.  We’ll wait.

Yet again, and I say this with more feeling this time, you are NOT going to get run over.  If we have to stop, we will, no problems, no arguments.

People often mention that we should get off and walk when we’re doing this, often adding that they think we’ll get through faster.  There are a couple of problems with that argument.

First, while we are riding our bikes, they are surprisingly manoeuvrable and easy to handle.  These bikes are HEAVY (have I mentioned this enough yet…) and being able to use your body weight to balance them is extremely useful.  As soon as I get off my bike, I exchange 45 kg of well-balanced bicycle for 45 kg of unstable dead weight.  More than once I have lost my bike when I have had to get off and push, and when those bikes go, they go big style.  I am much more likely to drop that bike on your (and my) shins when I push it than I am to run you over or collide with you while cycling.

Second, these bikes are a real pain to mount and dismount in a crowd.  During these times, that 60 kg of rider that could be used to balance the bike is attempting to swing his leg over the bike and position himself on his saddle, all while trying to keep that 45 kg of bike upright during the inherently unstable procedure.  Having to do this in a hurry, while talking to Control on the radio and keeping an eye on where he is going (not to mention where everything and everyone else is going) is a serious challenge.  We are rapid response vehicles, and like I said before, every minute can count.

In short, constantly getting on and off the bikes is a pain, and staying on is much easier, safer (and highly encouraged by our training).

I appreciate that bikes are unusual, and seeing a fully laden response bike bearing down on you is intimidating.  It is my eternal hope that people will eventually get used to response bikes and begin to understand how they behave.  If nothing else, I hope people start to realise that we are an emergency vehicle, and just like any other emergency vehicle, the operator really does now what they are doing.

I was going to leave you with two things.  The first was a relatively old advert that I really like about how to respond to an oncoming blue light vehicle (in this case, and ambulance).  Unfortunately my Google skills have let me down and I can’t find it…  The second (which I have found) is my customary musical interlude (on both YouTube and Spotify), this time a track from a band I have just started listening to again after having been forgotten for quite some time.  Enjoy.

An Update

I know I said I would do a series of posts on observations, and I still intend to, but at the moment real life is just getting in the way. This is just a quick update of what’s happening, and the next post will be about something I really need to get off of my chest.

So, I am rapidly approaching the end of my degree. My final report is due next Tuesday, and after the Thursday after that, I am done. Finished. Leaving my university and likely not coming back (except for graduation based stuff).

I’m not going to lie, it’s a scary prospect. Not accounting for my work placement, I’ve been in full-time education for 19 years. It is literally the only thing I can remember doing. As of September, I start on the beginning of what (at the moment, at least) will be a career in Engineering. Real engineering (it doesn’t get any more real than jet engines…), where the work I do actually has a real purpose.

I will be leaving behind what I know and am comfortable with, a huge number of my friends, and all the other benefits of student life. This is scary beyond belief…

In other news, I am currently bike-less again, as some idiot drove over the front wheel of my bike (fortunately while I wasn’t on it). Needless to say, this is very annoying, not least because I am currently sat on a bus that takes the most roundabout route home possible.

This year I am not going to the graduation ball. In fact, this is the first time since starting university that I’ve not been there in some kind of first aid capacity, and I have zero interest in going as a punter. I had intended to go as first aid, but I haven’t been asked yet, and the unit has upset one of my good friends, so we’ve decided to go on duty the next morning instead. The person who did the upsetting is now also not going, but I have managed to persuade my friend that it isn’t her problem any more (and so she doesn’t need to pick up the pieces after the very likely meltdown).

Speaking of meltdowns, the local adult division is currently having a very slow one. Three of the more progressive members have been made to feel very unwelcome, and so have walked away. As a result, their training program is steadily going down the pan, morale is going to drop (as people realise what they’ve lost), and its all going to go to hell. Of the units six-ish active ambulance qualified volunteers, they now have two actively refusing to do events, two prioritising county level events (me and CycleGuy), leaving two to (fail to) meet the units commitments (meaning other units have to help out).

On the bright side, my unit of young people is going strong.  We have just had a very successful sponsored walk (where I got to legitimately play tag for the first time since I left junior school), and have half a dozen things planned for the near future.

Work is still being its normal irritating self (but that’s retail for you), and I’m doing far too many hours for the Organisation (no change there, then), and for the most part I’m enjoying myself.

When things start settling down, I will try to post more frequency.  For now, I will get on when I can, and I’m still on Twitter (my lifeline when drowning in my project).

Now, to finish, another musical interlude.  Enjoy 🙂

Observations Part 1 – Pulses

This was prompted by a duty a while back where I and another person ended up doing an impromptu lesson in patient monitoring to half a first aid post.  Not a promising start to the duty, but we were told afterwards by quite a few of the members that they appreciated the help.

Observations.  Obs.  Pulse and Resps.  Vital Signs.

Whatever you call them, they’re important.  And too many of us (myself included) are really bad at remembering to do them.

I was checking over a report for a patient I had treated, where I had come cycling down to back someone up.  Something simple, but significant enough to require a reasonable amount of writing to prove we’d tried to think of everything.  As I scanned through the notes, I noted that they’d put down: “patient apparently stable”.  I glanced over at the observations box: empty.  Now I agreed that the patient was stable (they wouldn’t have wondered off five minutes ago if they weren’t), but if you look at that form there was nothing to back us up.  Nothing showing that the patient’s obs were normal, or at least returning to normal, and not shooting off somewhere unpleasant.

Repeat after me: if it isn’t written down, it didn’t happen.

To prove that something isn’t changing significantly, you need at least two data points.  One tells you nothing.  And they need to be reasonably spaced out.  Two sets of obs done in two minutes tells us nothing.  A lot of things that could go very wrong happen over a relatively long period of time (at least at first).  Getting two sets of obs should be simple: one when they arrive, and one when they leave.  Obs every ten minutes or so works well, if you can (obviously life-saving stuff needs to come first).  It should only take a minute or so to do, and we don’t have to be getting precise numbers every time.  We just need to know what’s going on, and then use that information to help us make decisions (such as, do I take my time and finish tidying this bandage, or do I want to have a paramedic with me yesterday…)

Taking a pulse is a simple technique, anyone with a couple of fingers on one hand should be able to do it, but it does takes practice.  However, in my experience, it doesn’t seem to be covered as much as it should by our training. Everyone just assumes that everyone else knows what they’re doing.  I’ve been caught out a number of times in training where someone has told me they don’t know what they’re doing.  And I’ve caught out a number of people trying to cheat in an assessment by making things up (and holding the wrong part of my wrist…)

This is the method I use on a conscious patient:

  1. Decide which wrist you’re going to use.  Make sure it’s comfortable for the patient, and the arm isn’t squashed beneath them or against something (and cutting off the blood supply).
  2. Make sure your patient knows you’re going to do a pulse.  Like with any technique, if you do this without consent you could technically be assaulting your patient.
  3. Take the hand as if you are going to shake hands, and gently rotate it around so that their palm is up.  Don’t let go, but consider resting it on a hard surface (a leg works well if it isn’t shivering).  This means you have control of the arm, and you can keep it still.
  4. Using the first three fingers on your other hand (never your thumb, which has its own pulse), place your fingers on their wrist, beneath their thumb, next to their radius.  You are trying to (gently!) press their radial artery against a bone.  Hopefully you should feel their pulse.  Don’t push to hard (you may cut of the blood supply, or your patient may just hit you because it hurts), and be prepared to hunt for it.  It’ll always be on the thumb side of the arm, but sometimes you’ll have to search (and sometimes it is quite hard to find).
  5. Count the pulse for 15, 20 or 30 seconds, and then multiply it up.  You don’t need to count for an entire minute, we’re not after exact numbers here, this should give you an acceptably accurate number.  A normal pulse in an adult is about 60-80 bpm1 (though remember this depends on the patient’s fitness and what they’ve just been doing), and expect a child’s to be faster (and a baby’s faster still).  Also pay attention to the quality and regularity of the pulse.  Are they strong or weak?  Are they skipping beats?  Is it a regular pulse (or regularly irregular, or just plain irregular)?  All things that are important.

If you can’t find the radial pulse, try the brachial.  This one is on the inside of the elbow.  It can be quite challenging to find, so practicing this one is a very good idea.  If you ever learn to do manual blood pressures (which I hate doing, but we can’t use automatic BP cuffs) you’ll need to know about this one, as this is the one you listen to.  As a last resort you can use the carotid (in the neck, next to the trachea on both sides), but this is not very comfortable for a conscious patient (take it from someone who has played at casualty as many times as I have: it is NOT fun).  The First Aid Manual has some good pictures on where you can find pulses (page 53).

Keep in mind that if you expect your patient’s blood pressure to be very low (for example when shock is starting to get bad), pulses do start to disappear (radial first).  It is worth noting if you can’t find a pulse (don’t be embarrassed or afraid to say you can’t do something), and it is very important to note if a pulse disappears.

Get used to making this one of the first things you do for a patient (after your primary survey, of cause).  Not only does it give you a baseline to work from later, but it starts to tell you something of what is going on, and it makes you look like you know what you’re doing (and you have a plan).  Finally, if you’re patient is distressed, the act of taking their hand can be very reassuring (I know this one from experience).

Naturally, be alert for people who aren’t comfortable with you touching them (holding hands can be seen as being quite personal) and be prepared to alter your technique to fit.  If they won’t let you take a pulse, note that down and move on.  It’s not worth alienating someone over.  First aid is all about taking the perfect solution and the real world injury and making the two fit.

And don’t do what someone did in an assessment, and move a ‘broken’ arm to take a pulse.  Needless to say, they got an earful from their casualty.

The most important things are, in my humble opinion, practice, practice and more practice.  Every time you get a patient who’s with you for any length of time (we’re not talking the plaster dispenser ones here), take a pulse. Every time you do a scenario in training, take a pulse.  Pester your friends to let you practice on them.  Develop your own method of taking a pulse, one that works for you (or pinch mine, that’s what I did).  Whatever it takes to get yourself confident in taking pulses.

I’ll cover respiration rates in my next post.  These are more difficult to get, but form the other part of the most basic observations we can all do as first aiders.

1 – The First Aid Manual, 9th Edition

Hitting the Speed Bumps

English: Scottish Ambulance Service: mercedes ...

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As an organisation (or, at least, in my part of the organisation), we are very keen at helping out the local ambulance service. By this I mean we will send out crews on ambulances (and occasionally on bikes) to help the service respond to 999 calls. Understandably, this could only be done by experienced members, and one of the criteria for the ambulance work was a certain number of hours third crewing on those shifts. This means working with two experienced members to build up some experience dealing with patients potentially more serious than anything I’ve ever dealt with before, which I’m strongly in favour of.  I don’t think I’d be happy going out on a shift without doing this first.

Unfortunately, since I qualified, it is no longer possible to third crew on any of our vehicles. Something to do with weight limits on the vehicles (which, given many of them are  transit vans modified into ambulances, not necessarily their original design role). This is very frustrating for me, as it means I can’t gain the experience needed to do NHS support.

To make matters worse, there are very few of us in this position (probably about 3 or 4), and so nobody at county level cares enough to do something about it. As far as they’re concerned, there are enough people to cover the shifts, and so there isn’t a problem.  This leaves me, and those few others, in a catch-22 situation: without having the needed experience, we aren’t able to gain the experience.

Needless to say, this is very frustrating.

A little while back, there was a possible solution. Our CRU lead sent us an email looking for interest in doing NHS cover on the bikes over Christmas. The roads get very busy in BigCity when everyone is doing their Christmas shopping, and the bikes can get around a lot easier than road ambulances. A load of us (apparently) applied, and it looked like it would go ahead. I even delayed heading home for Christmas around this.  A couple of us entertained the thought that this might count towards us getting some experience towards the ambulance work.

Of cause, it never happened. And we only found that out for certain a couple of days before the period was due to end. The reasons given was lack of  interest (yeah right), other duty commitments (*looks at depressingly empty duties book*) and lack of funding (*sigh*). Some of the more cynical amongst us suspect our useless County CRU lead is also to blame, but ho-hum.

All I’ve got to hope, in the nicest possible way to my patients, is that I get something interesting to do on the normal shift. Which, given my track record on a vehicle (nine or ten shifts, one patient transported for a minor injury) seems rather unlikely.  The only time I might have had an interesting job, someone kicked me off my truck (story to follow).

I think, as far as possible, I’ll try to stick with the bikes. At least on them I get something to do (and some useful exercise), giving me some experience treating, even if it’s not transporting someone…

My friend and I are already planning what out of county events we want to do.  Hopefully we’ll have a good yeah helping out our colleagues in the big city. At least there they know how well a bike unit can work…

Cycle Response

Okay, I’m possibly a little excited.  Actually, scratch that, I’m acting like a kid on Christmas morning.

The last parts of my cycle responder uniform turned up this morning.  This is (and yes, I say it again) extremely exciting.

I’ve wanted to join the cycle responders for years now.  The first time I tried to get on the course, it was cancelled two days before.  The next time, after I’d spent some quality time with the cycle response policy, I didn’t think I had a hope of meeting the fitness requirement. That, and the high price for the uniform, I nearly gave up on it.

Somehow I persuaded myself I could do it.  Somehow, we’d raise the money.  Somehow, I’d pass the fitness test.

And I did it.  I passed the tests.  I am planning fundraising with a fellow responder.

This just left waiting for the uniform.  It’s special purpose uniform, so doesn’t get ordered often, and usually has a long lead time. I fully anticipated having to miss some events because I didn’t have the right uniform.

It’s now here.  All of it, in its hi-visibility yellow glory.  Now I feel like a proper cycle responder.

And just in time.  My first event is in just over a week and a half from now.  I can’t wait!

This sounds a little sad, but it feels like a dream come true.  I never thought I’d get to do this.  This is so much more important to me than the upcoming ambulance aid course I’ve been invited to.  True I might be able to go around in an ambulance soon, but I can go out on a bike now.

So yes.  A little excited, I think.

Cycle Response Training–Part 2

The first day of training was to prove that we could control the bikes, and that we were safe enough to be let loose on the roads.  The second day was for demonstrating that would could cycle safely in real traffic, and the fitness tests.

First up was the cycle in traffic.  As campus is on the top of a hill, this first involved a cycle down the hill.  Oh, and the glorious weather yesterday had turned in to pouring rain.

I was riding one of the response bikes.  Complete with an almost full load-out of equipment (including a full O2 cylinder).  Down a steep hill.  A wet, steep hill.  That was an interesting experience.

To save time, our instructor combined the endurance test with the proficiency assessment.  The requirements changed depending on age and gender, but we were all aiming for 10km in 40 minutes, the young male target.  This is a fairly comfortable patrol speed, and even before allowing for the traffic and the rain, we did fine.

We had a lunch-break in town, just about hiding from the rain while keeping a close eye on the response bikes.

The next assessment was a 1km sprint, followed by a six-minute scenario including CPR.  Except, this had to take place on campus, where we wouldn’t have as much traffic to deal with.

Remember that hill.  We were now headed the other way.  With our bikes, so no cheating by taking the bus.

Four of us tried to ride our bikes up the hill, two on response bikes (me and one other) and two on their own bikes.  Everyone else decided not to even try to cycle, walking up instead.

It was a slog, more so considering the fact that I was already soaked through, and was lugging a gas cylinder.  And I made it.  Once I’d got my breath back, and decided I wasn’t about to have a heart attack, I was very pleased with myself.  I’ve never managed that hill before, but this bike had a decent set of gears.

Of cause, I then had to do the sprint.  Along a road on campus, and up and down another one, including two hard turns and an automated barrier to navigate.  I had to aim for 2 minutes 40 seconds, from the end of the radio call.  Oh, and still have enough breath to do CPR for six minutes, and enough sense through the adrenaline to run an AED without ‘killing’ myself.

I made the time, just about.  Felt like I was going to keel over when I skidded to a halt by the ‘patient’, but some how managed to survive.

The scenario wasn’t textbook.  I forgot to check if the patient was breathing, but otherwise did okay.

Only then did we find out that we didn’t need to do the manoeuvres again (a great relief), and we had all passed.  After a small amount of paperwork, a quick round of presentations, and then we headed home. Dripping wet, absolutely knackered, but pleased, and more importantly, now all qualified Cycle Responders.

Oh, and that hill climb…  I felt that one for days.

Cycle Response Training – Part 1

A few weekends ago, I attended a two-day course to become a Cycle Responder for the Organisation.  As promised, I’ve written a bit to describe the course.

The first day was pretty relaxed.  The obligatory introduction to a course. A quick bit on the various levels of Cycle Responder in the Organisation, and what the course would entail.  Designating a first aider for the course (a course for first aiders who are all at least trusted to use an AED, if not medical gases, and with a doctor also attending) caused a brief session of everyone volunteering everyone else. A quick reminder that if we came across anything while cycling around on the bright yellow, Organisation branded bikes, we would need to stop and help.  Then, on to the course.

Our instructor first had to take us out to a car park and get us to show that we could actually ride our bikes.  We had to demonstrate that we could ride without wobbling, signal and look over our shoulders without problems, and perform an emergency stop from a sprint without falling off (or shooting over the handlebars).

Next up was the low-speed manoeuvring.  As a Cycle Responder on duty, it is expected that we will spend most of our time on our bikes.  Unless we’re treating or stopping, we should aim to cycle everywhere.  This includes through crowds and behind people meandering down the pavement.  Constantly mounting and dismounting looks silly, and on a bike that’s a little on the tall side, is rather awkward.

To make sure we can do this safely, we have to demonstrate that we can handle the bikes at the speed of a slow walk.  This is a pain in the arse.  It involves gearing down as low as possible, and then peddling with the rear brake partially on to give a little resistance to work against.  Doing this, while remaining balanced, is hard.

The first unofficial test is what our instructor called the slow race.  A set of cones, spread out in a triangle shape, with everyone at the wide end.  The aim was to be the last person to reach the point, without stopping.  Chaos ensued as we all moved off to fast, slowed, wobbled, collided with each other, and generally tried to move slowly.  Needless to say, none of us did well.

Next, after much more practice moving slowly, came the 10 foot box.  More cones, this time arranged in a square with sides 10 feet long.  We had to enter the box, circle inside of it three times, and then cycle out, turn around, and do the reverse.

Picture, for a minute this box.  Now add in a bike.  A bike about 5 feet long.  With two heavy panniers on. This is not an easy manoeuvre.

We spent several hours on this, by which time we were all thoroughly bored, irritated and frustrated, but everyone pulled it off, to our unified relief.  Though, when we found out that this was a practice run, and we would be assessed on it tomorrow, we were far from impressed.

Then, after a bit of a talk on bike maintenance (mainly how to take a wheel off and repair a puncture), we were done for the day.  Tired, sunburnt, a still a little dizzy from the box, we headed home.

Cycling First Aid

I have wanted to do cycle response with the Organisation for a long time now.  So much so that I would consider delaying my ambulance training to do this.

To my joy, a course is coming up.  It’s super short notice, and I don’t know if I’ll be able to get the time off of work (working weekends sucks…), but that is the least of my worries…

The requirements are simple.  For me, I need to be fit (I think I can meet the standard required), be able to cycle a bike with heavy panniers (done that before) and I need a basic First Aid qualification, with O2 and AED as a bonus (my patient transport qualification covers that and more).  This is all fine.  The catch is the last requirement: ‘Unit to agree to pay for uniform’.

The uniform costs something of the order of £140 per person.  That’s for one set of uniform.  There are three of us who want to do the training at the unit.  That’s more than £400!  This is a sizeable chunk of a youth unit’s budget, not least because we are technically a non-operational unit.  Our main source of income is the cadet subscriptions (despite being told otherwise by everyone else who doesn’t look at our statements…), and I don’t think I can justify the unit spending that much on three members in one go.  I definitely can’t ask them to do it (I certainly can’t afford that much on a single set of uniform).

So this presents me a problem.  I really really want to do this training.  But I just can’t see how I can make it work.  I’ll have to talk to my boss tomorrow.

I can feel this opportunity slowly slipping away from me as I watch.

A Hundred Options, All Wrong

I have a member of staff.  I’ll be honest from the start, I don’t like him.  I don’t think he’s a suitable person for a Youth unit.  Some of the time I wonder if he’s a suitable person for the organisation.  However, that is not my decision to make.

I have sat in some of his training sessions for our young people.  Some of them are very good, particularly the youth led ones.  A couple of sessions where he had his group discussing different types of punishment, I’m told were excellent.  However, some of them really aren’t.  On more than one occasion, when I’ve been in the room while he’s been training first aid, or event while I’ve been training and he’s been sitting in, I’ve encountered areas of his knowledge that are sorely lacking.  The last time it happened, I did something about it: I have made it so that he always has another qualified member in the room when he’s training, to support him (or so I put it).

Of cause, he’s not happy, and I’ve heard (gah, the organisation is terrible for gossip and rumour) that he’s been grumbling in the presence of some important people in the county.  Not people in my direct line of management, but close enough to cause me problems.  And of cause, all the certainty I had about the decision at the time has evaporated.  I know that I don’t like him training first aid.  I know that there are gaps in his knowledge.  But, I can’t be specific enough to justify what I did, or to solve the problem.  And now, I’m starting to second guess myself, and I’m not even sure how I separate my gut feelings from the objective things I can actually put on paper.

This isn’t the first time this has happened.  Previously I’ve made a decision about someone (well, two someones in this case) doing something that I thought was wrong.  I acted on this decision, attempted to get them to stop doing it, and had the whole thing slapped back in my face.  So hard, in fact, that I vowed never to be on the committee of that unit again.

I think what I did was the right thing to do.  However, I just don’t think I can justify it anymore, or at least not in a way that would convince me, if I was some other person.  I don’t know if I can even convince them that it’s not just a personal issue between me and him, or that I’m not just trying to bully him in to leaving the unit.

This has really thrown me in to a spin.  I’m not helping myself, as I’m now questioning my ability to make these, and other, decisions.  I have a duty coming up where I’m supposed to be in charge, and I can’t shake the feeling that I’ll muck that up as well.

Arrrrrrrgggggggghhhhhhhhhh….

I can’t everything I’m feeling in to words.  It’s all going round and round and I’m just getting in to a mess.

Arrrrrrrgggggggghhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh…

That doesn’t help as much as I’d hoped…

Young People and Difficult Subjects

I have just got back from one of the more challenging Youth meetings I’ve been to.

I’m currently teaching a small group of our members about what is involved in going on duty.  A bit on Event Management, a bit on Risk Assessment, some duty planning.  Nothing particularly controversial or difficult.  Today, one of the things we discussed was conduct on duty.

It was all going fine.  We had the normal things like being respectful, and professional.  I was pleased to see a note mentioning about patient consent, something some adults tend to forget about, and was surprised to have someone mention mental capacity.  Most of them didn’t know what this meant, so I explained how, before we allow a patient to decline treatment, we have to ensure that they are in a fit state to make that decision.  It can be quite black and white (i.e. fully aware patient: full capacity, unresponsive patient: no capacity).  However, there are also a million shades of grey that can easily trip you up if you’re not careful.  I explained this to them all, and how, for example, a young child is not normally considered to have capacity.  This of cause raised the issue of people with mental disabilities, so I had to explain that as well.

This wasn’t going quite to my plan, but they were all listening, and asking the questions in a sensible manner, so I didn’t foresee any reason not to allow it to continue.  Yes it’s a difficult subject to explain, but I think they understood.

That is, of cause, until one of them raised the issue of DNRs (Do Not Resuscitate orders).  These are basically an advance decision made by the patient (or someone with suitable powers to act on their behalf) that instructs us to not attempt resuscitation if someone stops breathing.  It is essentially an order to allow someone to go in peace if they’re dyeing.  It is very uncommon to come across them in the first aid field (not least because most of our patients aren’t this unwell), and we don’t normally search for them.  In all honesty, it has never really come up in my training.  However, I do know enough about them to know that, if I know about a genuine DNR, I need to respect it.

This is difficult enough to explain to some adult members.  The decision to just let someone go is very hard to make, and when we are trained to act quickly to save lives, it goes a little against the grain.

Now try explaining this to a small group of young people who are drinking in every word I say.  I’ve let the conversation go this far, so I can’t really back out now, and I have no good reason not to explain.  I just have to go for it.  So I go on for a good ten minutes on what they are, when they are typically used, and explain how we have to respect a patients decision in these matters, no matter how hard it is.  I’m honest, and explain how I would find it difficult to handle, and that I would never expect them to be put in that situation.  I think they understood it.

I hope they did.

I also hope I can keep off of these subjects in the future.

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