Category - Training

Links in the chain of survival

Chain of survival

We spoke with Martin O’Reilly, EMS Support Officer, Dublin Fire Brigade, to discover more about the chain of survival in Dublin city and county, and how the fire-based EMS service model ensures the effectiveness of this chain.

According to the HSE, surviving a cardiac arrest at any age is “directly related to time to resuscitation and particularly defibrillation”. These are two links in what is known as the ‘chain of survival’ for out of hospital cardiac arrest: early recognition, immediate and effective cardiopulmonary resuscitation, rapid defibrillation, pre-hospital advance life support, and postresuscitation care and aftercare.

Take early and effective CPR, which can keep the brain and vital organs oxygenated, and can also buy time for effective defibrillation to take place – either by members of the public or the emergency services. Time is key, and CPR should commence as soon as possible following a cardiac arrest to provide the best chance for a positive outcome. “We know that after a patient suffers a cardiac arrest, if nothing is done then the patient’s chance of survival diminishes by between 7 and 10 per cent with every minute that passes. Providing bystander CPR gives the patient the best chance possible towards a successful outcome,” explains Martin O’Reilly, EMS Support Officer with Dublin Fire Brigade.

In Dublin and the surrounding area, Dublin Fire Brigade is a key part of this chain and regularly responds to such instances across the capital. DFB recently attended an adult male patient, whose cardiac arrest had been witnessed by a member of the public. The emergency service controller (ESC) provided CPR instruction to the caller over the phone, enabling bystander CPR to take place on scene prior to DFB’s arrival, and simultaneously dispatched the required resources to the scene. “We had paramedics quickly on scene on the fire appliance and an advanced paramedic providing advanced life support as part of the ambulance crew,” says O’Reilly. “The crew achieved a return of spontaneous circulation on scene and commenced post-resuscitation care. The patient was then transported to the nearest emergency department to continue this care. This patient benefited from all of the links in the chain of survival, which greatly increased his chances of survival and is an excellent example of an EMS system working at its best.”

Two-pronged approach

The citizens of Dublin city and county benefit from DFB’s fire-based EMS service, in which firefighters are also trained paramedics. The system is in operation in a number of jurisdictions around the world, particularly in large urban centres, including fire departments across the USA, France and several in Germany, and plays an important role in ensuring a functioning chain of survival.

As O’Reilly outlines, the fire-based EMS system in Dublin ensures the use of a structured approach when responding to cardiac arrests. The nearest fire appliance and ambulance are dispatched to a call, ensuring a sufficient number of paramedics to effectively manage a cardiac arrest. Alongside its clinical abilities, the fire appliance with paramedics onboard also facilitates a rapid response to immediately life-threatening calls – in 68 per cent of cardiac arrests the fire appliance will arrive in advance of the ambulance due to its strategic location and availability.

“Many 112/999 calls are of a medical and traumatic nature, involving single or multiple patients, and have a requirement for additional clinical resources and personnel to perform physical rescue, extrication etc. Firefighter/paramedics provide rescue/extrication skillsets as well as an additional response where needed. These additional resources also improve patient, bystander and practitioner safety on scene,” says O’Reilly.

The combined firefighting and paramedic training all DFB recruits receive proves highly useful within situations that require medical and rescue response – one response vehicle can provide both skillsets. DFB personnel are educated and trained to perform multiple functions, including hazardous materials response, road traffic collision extrication, highline rescue, swiftwater rescue, and pre-hospital emergency care.

“Firefighter/paramedics uniquely can provide patient treatment and rescue immediately on arrival. These highly trained professionals are a valuable resource and a huge benefit to the patient and the community,” O’Reilly explains. “Another important benefit of having multi-skilled FF/P within a fire-based EMS service is seen when a major incident occurs with many casualties involved. A fire-based EMS service can deploy large numbers of equipped paramedics to the scene from its fire service vehicles immediately. They can commence triage, treatment and stabilise patients on arrival at the scene.”

The ability of Dublin Fire Brigade’s fire-based EMS system to simultaneously dispatch fire and EMS resources is vital and saves precious minutes, particularly in life-threatening situations where every second counts, often making the difference between life and death in cases like cardiac arrests. This approach also reduces on scene time and helps get patients to hospital and definitive care much sooner – important links in a patient’s survival.

Expecting the unexpected: Chief Fire Officers’ conference

Chief Fire Officers’ conference

The annual Chief Fire Officers’ Association conference was held in Croke Park in 2017, organised by Dublin Fire Brigade. Conor Forrest was there on the day.

Last May, Croke Park was the location for the Chief Fire Officers’ Association (CFOA) annual conference, an interesting and varied two-day event organised by Dublin Fire Brigade and which tackled the topic of expecting the unexpected. Drawing from fire services far and near, the comprehensive CFOA 2017 conference featured speakers on a broad range of topics from fire safety to media management. Washington DC Fire and EMS Chief Gregory Dean reflected on the systems in use in Seattle and Washington DC; Dublin City Council Senior Systems Officer John Lynch explained how business intelligence can be put to good use in the fire service; and Peter Holland, Chief Fire and Rescue advisor at the Home Officer provided an overview of the local and national structure of the UK’s fire services.

An opportunity to listen and learn from colleagues, not just in Ireland but around the world, and to discover best practice and innovation for the years ahead, the conference also looked to the future of fire services, with topics such as innovation, investment and funding on the agenda.

“As Minister with responsibility for policy oversight for fire safety and the provision of fire services by local authorities, my primary focus is on ensuring that local authority services are effective in achieving their objectives and meeting their statutory obligations in respect of the provision of fire services and fire safety. Key to that is to make sure that local authorities do all they can to do your great work and to give you the resources you need to be able to provide the service you provide,” said Minister for State Damien English, who opened the conference alongside Lord Mayor Cllr Brendan Carr, and reiterated his department’s commitment to fire services. “My job as your minister in this area is to work with my department and all local authorities to make sure that you get your fair share of resources to help you do what you do… If we can prove that you are spending the resources that you get in the best way, in the most effective way and stretching every Euro of that, that helps us with our business case to get more money for the service, to build on that.”

It was a theme that CFOA Chairperson and Dublin Fire Brigade Chief Fire Officer Pat Fleming picked up on later in the morning. “Funding is always an interesting one,” he said with a laugh. “In 2015, 20 new fire appliances for 16 counties were announced. Many of these are now only appearing in fire stations. Fire and rescue services are not discretionary items. Properly funded services are vital in defining a modern society and in supporting economic development and foreign direct investment.”

The issue of fire-based EMS has been in the public eye of late, with calls in some quarters to remove DFB’s ambulance call and dispatch function and to instead merge it with the National Ambulance Service (NAS). Alongside the importance of a collaborative approach to community fire safety, Minister for State Damien English touched on the topic of fire-based EMS services during his speech, noting the possibility of retained fire services assisting the National Ambulance Service in meeting the Pre-Hospital Emergency Care Council (PHECC) response targets, particularly in rural areas.

“I welcome the Minister’s comments on this today. It’s something that I’ve advocated on previous occasions, the positive benefits of providing life-saving medical intervention in support to hard-pressed colleagues in the NAS operating in rural Ireland,” said CFO Fleming. “I’m pleased that a comprehensive draft paper has been prepared under the aegis of the Keeping Communities Safe process, and I look forward to the further progressions and discussion of the feasibility of delivering this service in the interests of patient safety. Inter-agency cooperation in the public interest is not about individual agency status, but rather about delivering the best possible patient-centric service.”

CFO Pat Fleming, Brigadier General Philippe
Boutinaud, Commander of the Paris Fire Brigade and Dublin City Council Lord Mayor Brendan Carr.

Preparation

The main theme of the conference was ‘Expect the unexpected’, with a conference programme reflecting this particular topic. One of the most interesting and well-received talks was given by Brigadier General Philippe Boutinaud, Commander of the Paris Fire Brigade, the largest fire service in Europe. Brigadier General Boutinaud was in command on the night of Friday November 13th 2015, when a series of coordinated terrorist attacks killed 130 people and injured a further 368, the deadliest incident in France since World War II. Later claimed by the Islamic State of Iraq and the Levant (ISIL), the attacks began when three suicide bombers detonated outside the Stade de France during an international friendly between France and Germany, followed shortly after by shootings and bombings at several cafés and restaurants, and then a mass shooting at the Bataclan Theatre during an Eagles of Death Metal concert. Having taken hostages within the theatre, none of the attackers survived following a police raid on the building.

During a discussion on the planning, preparation and response of Paris Fire Brigade, alongside lessons learned from the events, a complete silence blanketed the room as a harrowing video shot on the night of the attacks was shown, depicting the panic-stricken calls received by the emergency service controllers, the firefighters who responded on the ground, and the confusion of the injured who wandered the scenes. “My ambition this morning is to share with you, I’m not here to deliver a speech or deliver a lesson to you,” said Brigadier General Philippe. It’s just a question of… sharing my experience with you in case the unexpected happens in your country. Obviously, I hope that will not be the case.”

Though a terrorist attack of similar proportions on Irish soil is unlikely, there’s no doubt that our emergency services need to be prepared for whatever may come. “Whatever Oscar Wilde thought about that theme, all of us who provide and manage frontline operational emergency response services are very clear as to its meaning. Our primary role is to have the necessary resources in place to protect public safety and render humanitarian aid, which sounds simple enough,” said CFO Fleming. “However, the preparation required for the expected, and the nature and complexity of the unexpected, poses major challenges for us all. The nature of the potential scenarios we now have to prepare for has moved far from a single agency response to a fire or medical incident. Indeed, the complexities of these potential scenarios test all emergency services to the limit both individually and collectively.”

Learning with leisure: The EMS Gathering

The fourth annual Emergency Gathering took place in Kinsale in May. Conor Forrest spoke with organiser Kieran Henry to discover more about this engaging and diverse two-day event.

In early May, a large group of emergency services personnel from Ireland and around the world gathered in the picturesque town of Kinsale. They were there as part of the annual EMS Gathering, a two-day event organised by a team of people including National Ambulance Service advanced paramedic Kieran Henry. It was initially inspired by The Gathering 2013, a government umbrella tourism initiative that encouraged Ireland’s diaspora to return to their homeland that year.

“Around the same time, there was a group of us involved in emergency medical services – paramedics, doctors responders etc. – and we used to head up the mountains informally, take part in activities on our time off,” Kieran explains. “We would often chat to each other and share information with each other, talking about hypothermia, drowning or various different things, as well as talking about sport, current affairs and things like that. So we thought why don’t we merge the two?”

Thus the EMS Gathering was born, organised and run on a voluntary basis with something for everyone working in the field of pre-hospital emergency care, regardless of qualification or experience. The informal nature inspired by those mountain hikes has remained – though the event includes classroom lectures given by experts in their fields, ‘Learning with Leisure’ remains a key facet of the EMS Gathering. Over the years attendees have travelled to nearby farms to learn about responding to a farm-related emergency, attended talks on drowning at Torc Waterfall outside Killarney, and taken a bus tour while learning the intricacies of dealing with sepsis.

Loading an injured person into a helicopter was one element of the TEMS workshop. Photos courtesy EMS Gathering.

Clearly, the diverse programme has worked – people have flocked to the EMS Gathering each year from all corners of the globe, from New Zealand, Poland, Canada, the United States and further afield, sharing their experiences, supporting one another and exchanging ideas on best practice. It has also inspired other events, including the OBI CPC nights established by DFB’s Glenn Ellis and the team there. “It’s a different angle on the educational aspects of the event, I suppose, and people seem to like it. They keep coming back anyway!” says Kieran. “We’ve heard of individual cases where people learned something at the EMS Gathering and they’ve put it into practice. That’s really satisfying on a personal basis.”

Shared expertise

Collaboration is another factor that drives the EMS Gathering – without so many people from different backgrounds, each with their own individual learnings and experiences, the event would not be as broad in its scope. This year the Gathering moved from Killarney to the maritime town of Kinsale, with a programme covering subjects ranging from insights into mental health emergencies and dealing with drowning incidents to workshops on crew resource management and personal resilience. The Flotilla of Learning included a workshop on silver trauma and sepsis given on the Spirit of Kinsale vessel in the harbour, while attendees learned about behaviours of concern while on a walking tour of the Charlesfort. The Irish Naval Service also gave a highly insightful talk on Operation Pontus, which saw more than 15,000 migrants rescued in the Mediterranean over the course of six three-month rotations by Navy vessels.

Simulations are an important feature of the EMS Gathering.

“We had many agencies, both statutory and voluntary, involved. Within those agencies you have a complete multidisciplinary set of people from clinical to non-clinical,” says Kieran. “People from all different backgrounds be it the emergency medical services, military, fire service and rescue, hospitals, general practice, researchers. We had a range of national and international attendees, and they brought their own experiences.” With the dust having settled on the fourth EMS Gathering held since its foundation, Kieran is delighted with how the diverse programme for 2017 unfolded. There’s no doubt that the combination of social activities, with talks and workshops held both in the classroom and out in the locality, made for a memorable two days.

“We were delighted with the response. The feedback that we have got [for 2017] is phenomenal. Some of the nicest things that we heard [were from] the veterans, who have attended conferences for many years, and told us it’s the best one they’ve been at,” says Kieran. “Our aim was to inspire people to learn and enjoy themselves, and I think we have certainly achieved that.”

Flotilla of learning

A new concept for 2017 was the Flotilla of Learning – a range of workshops held on and around Kinsale Harbour. Those included:

■ Health & Well-being Workshop – Kayaks
■ Silver Trauma & Silver Sepsis – Spirit of Kinsale vessel
■ Deep Dive into Diving – Diving Rib
■ Ultrasound Workshop – Sea Vessel
■ Crew Resource Management – Sailboat
■ Behaviours of Concern/Great Wars & What We Have Learned – Walking Tour of Charlesfort

Training day

The OBI played host to a two-part mass casualty training exercise for Class 1/2016 last November, writes Conor Forrest.

Last November, recruits from Class 1/2016 reported to the OBI as part of their paramedic training, having graduated earlier this year and spent the intervening time in their respective stations. They would be taking part in a mass casualty training exercise that day, a test of their skills in the field based on course objectives which have been set by PHECC (the Pre-Hospital Emergency Care Council) on gathering vital information, delivering a clear picture of the scene to control and command, and designating certain areas for casualty clearance, ambulance arrival, etc.

Several years ago I had the opportunity to attend a similar exercise held in the Phoenix Park, which featured the aftermath of a house party gone wrong. This one, however, was a little different in terms of scale. Though the recruits were told they would be taking part in a mass casualty exercise, they weren’t told what to expect. The brainchild of tutor Joe Brady, one of the first practitioners to reach the scene of the recent shooting in Whitehall, onlookers watched as two vehicles entered the yard at speed, screeching to a halt. A mass of armed gardaí tumbled from the vehicles and spread out, bearing down on the rear of the building where there were reports of shooters inside a nightclub. Following an explosion, several masked men emerged from the building and engaged in a shootout with gardaí. The armed unit then moved into the building, clearing it room by room, ensuring the scene was safe for first responders to enter.

Members of the ERU arrive on scene

Once they got the go ahead, DFB crews began to arrive – some began to assess the emerging casualties, while others entered the building to assess and remove the more critically wounded. With music pumping inside the club, the responders had to focus on the tasks at hand and ignore any distractions – their instructors were looking for mental strength in the face of disorientation and pressure. Outside on the quad a casualty clearance station area was set up, with patients brought in, assessed, and then transferred into the waiting ambulances. Though some might have been expecting a different scenario, a second exercise began with the shooting of the assembled crowd from the earlier incident.

“The exercise was designed to test their response to a mass casualty incident; we were looking at their role as first practitioners on the scene, their communication skills, their ability to do what is called a triage sieve – a first look at the patient and then allocate a triage card. If they’re really badly injured they get a red, if they’re not so badly injured they get a yellow, and then the walking wounded can be brought off to a separate area and then bussed off scene,” explains Paul Lambert, EMS training coordinator in the OBI. “It’s about getting into the practice of encountering something that they won’t come across that often, it’s not normal medicine, they don’t come and treat the first person they see – their job is to categorise all of the casualties and to find out which is the highest priority.”

Coordination

Understandably, organising this exercise was a complex process, liaising with An Garda Síochána and the Civil Defence. “Joe Brady decided that since it was in the news and something that there is a possibility of happening – an active shooter scenario – he decided on this format. He interfaced with a number of other agencies, the Civil Defence, An Garda Síochána and the Garda Emergency Response Unit,” Lambert explains. “Logistically it was a big ask, because there are a lot of factors to take into account to develop an exercise that will run well.”

Instructor Dan Fynes readies his crew to enter the building

The first thing to consider was health and safety – designing an exercise plan, conducting a risk assessment, mitigating any potential risks that arose during the planning stage and appointing a safety officer to oversee the process. Ensuring all of the necessary equipment was in place was another challenge – given the scale and scope of the exercise, the organisers needed additional trauma bags, spinal boards, field stretchers, scoop stretchers and defibrillators, and a casualty clearing station. A number of ambulances were also requisitioned from the workshop, placed on standby for use in the exercise.

As the scenario involved a shooting at a nightclub, casualties were also required, provided through the voluntary emergency response organisations. Their varied injuries were made more realistic by the work of makeup students from Dún Laoghaire. The talented students provided moulage [applying mock injuries for emergency services training purposes) – injuries such as eviscerations, penetrating injuries, everything from bruising to a major haemorrhage and eye avulsions, making for a more realistic scene and placing increased pressure on the responders.

“Our first practitioners on scene performed very well, and then our subsequent crews performed very well. It was quite arduous – we had 53 casualties and there were two separate exercises, so it was quite physically and mentally demanding on them. They had to make rapid decisions under pressure and then physically had to remove and treat the patients. It was a lot of pressure for them but we’re very happy with how they performed, and I think they found it to be a very valuable learning experience,” Lambert explains. Thanks are due to all who volunteered their time in coordinating the two exercises, totalling over 100 casualties.

Joe Brady deserves a special mention for his hard work in bringing his idea from concept to execution, liaising with outside agencies and with various elements within DFB, organising the moulage which provided a layer of added realism, and whose effort was vindicated at the end of the day. “I was also very impressed with the tutors in the OBI and the amount of hard work they have done,” says Lambert. “It was a very well thought out exercise, and very well executed.”

Tricky triage

Among the many skills being tested through the incident was the firefighters’ ability to perform a triage sort, a more in depth way of assessing a patient. “They assess the respiratory rate, their systolic blood pressure and their Glasgow coma score, and based on those three things they apportion them a score, and then those patients are moved to the hospital first – it’s like a filtering system,” Lambert explains. “We filter through the casualty clearing station, the people that need to get off scene quickest, and then we can designate those to the hospitals to make sure that the hospitals receive the most critical patients first.”

Firefighters were also tasked with relaying a methane message – declaring a major emergency, providing the exact location, the type of incident, hazards, access, the number and severity of the injured and any extra resources required.

Europe in the OBI

An EU Civil Protection Mechanism course was recently delivered in the OBI, focusing on coordination in the event of a disaster in Europe or further afield.

The EU Civil Protection Mechanism was established back in 2001, aimed at developing and enabling cooperation between national civil protection authorities across the continent. In the event of a natural or man-made disaster, EU member states can send assistance at short notice, with deployed teams undertaking specialised tasks including search and rescue, aerial forest firefighting and advanced medical posts. Any country in the world can request assistance, with over 200 received since its establishment, such as the 2010 earthquake in Haiti, the Ebola outbreak in 2014 and the 2015 earthquake in Nepal.

Alongside coordinating a pool of resources, the Mechanism provides members with the opportunity to train their civil protection teams, allowing for the exchange of best practice and learning to increase effectiveness when responding to an emergency. The cornerstone of this training programme is the Operational Management Course (OPM), the first course specifically aimed at future deployments inside and outside Europe. The eight-day course targets national experts and European Commission representatives who seek to become potential team members or liaison officers as part of a European Civil Protection team sent by the European Commission. The course focuses on coordination and course topics include internationally agreed guidelines and procedures, planning, information management, ethics, code of conduct and the basics of safety and security. Those who graduate are equipped with the skills to function as a full member in an On-Site Operational Coordination Centre (OSOCC – outside Europe) or coordination setting (inside Europe), which facilitates coordination between the various agencies involved.

Dublin delivery

There is a consortium of five organisations involved in the delivery of OPM training, the German Federal Agency for Technical Relief (THW), the Danish Emergency Management Agency (DEMA); Italy’s Protezione Civile (Civil Protection) department; the Icelandic police service and Dublin Fire Brigade. Ireland, Germany and Italy have been selected as course venues for this cycle of training.

Though the course is normally split into two – theoretical and practical – with each strand taking place in a different country, in 2016 (for the first time) both sections were delivered in Dublin in Dublin Fire Brigade’s O’Brien Institute in Marino. Assistant CFO Dennis Keeley was assigned the overall responsibility for the delivery of the seven day course, with D/O Derek Cheevers managing the logistical aspects of the course. A number of senior personnel from civil protection agencies across Europe took part in the course, which involved a fictitious emergency scenario in a country outside of Europe, known as a ‘third country’. During the exercise the coordination team was deployed to this outside country, met with the local emergency management authority and then coordinated the arrival of dedicated taskforce teams, or modules.

“There are a range of modules within the EU Civil Protection Mechanism, and their deployment to a country is dependent on the type of disaster involved. For earthquakes there are urban search and rescue (USAR) modules, for flooding there are high capacity pumping and flood containment modules,” D/O Cheevers explains. “If there are a large number of people that have been internally displaced and require shelter there are emergency temporary camp modules, if the drinking water supply has been affected there are water purification modules and if a large number of people require medical assistance there are advanced medical field post modules that can be supplied. These are just some of the modules available; there is an extensive list that can be applied to any disaster scenario.”

A member of the coordination team in the OBI.

Replicating field conditions is a big part of the course. Over time the exercise becomes more complex, testing the stamina and resolve of the team members, who sleep on camp beds and eat only MREs (meals ready to eat), as many affected countries will lack vital infrastructure. Course participants were required to develop a number of plans covering media queries, safety and security. The exercise also involved the coordination of a controlled evacuation, and meeting with people in the host country in positions of power. “It’s all about preparation, preparing them for a real incident. We try and replicate that as much as possible,” says D/O Cheevers. “They were not outside at any time, it all took place within the building, primarily around communications, meetings and coordination of incoming assistance.”

Though the number of Dublin Fire Brigade personnel who have been deployed under the EU mechanism remains quite small, D/O Cheevers notes that there is still a clear benefit in taking part in the course. Should Ireland find itself in the grips of a disaster beyond our control, and a request for assistance is made, those here who have completed the course could operate as host nation support officers with knowledge of the format of the incoming support – a member could be embedded within one of the incoming teams, acting as the liaison officer between, for example, Dublin Fire Brigade and a search and rescue team.

D/O Cheevers also notes a litany of people without whom the course would not have been such a success. Ably assisted by firefighters Troy Taylor and Darren O’Connor, he also highlighted the fantastic work of James McConnell and Dublin Civil Defence in providing much of the transport over the seven days.

“There are a number of people in the OBI that I need to thank – Brigade Training Officer Gerry Stanley and Assistant Brigade Training Officer Mark Wilson, Breeda Melvin and her colleagues in the office; Jim O’Brien who assisted with a lot of the transfers; Richie (Red) McDonnell who has been fantastic in preparing many of the exercise locations; S/O Martin Cooke who facilitated transport to Dublin city centre using our new double-decker bus for a walking tour of the city and social evening; Caroline Timmons from the IT department in Dublin City Council who worked with the IT experts from Germany in providing the extensive support required for such a course; and Lisa and her crew in the kitchen for the catering, with firefighter Simon Finglas also assisting in this area,” says D/O Cheevers. “We have two courses planned for next year, and the OBI will be a key part of that. It was very much a team effort – we worked long days, but overall it has been hugely successful.”

 

First on the scene

First aid

Firecall editor Conor Forrest recently took part in day one of the three-day Occupational First Aid (OFA) course at the O’Brien Training Institute, learning more than he had expected.

It’s not an entirely uncommon scenario. An ordinary member of the public is out walking through the city when they see a man collapsing to the ground, complaining of chest pain and discomfort along with shortness of breath. They might panic, unsure of what to do, apart from calling the emergency services. Or, if they have been instructed in how to give first aid, they could make the difference between life and death, stabilising the patient before the ambulance arrives.

Having been encouraged by a number of people over the past few months to undertake a first aid course, in the event anything might happen at Firecall HQ, I arrived bright and early at the OBI on a sunny morning last June alongside six other trainees, all of whom seemed to work in one of the city’s public libraries.

My first introduction to this new and nervousness-inducing world was courtesy of our instructor for the day, Hugh Keeley, who joined DFB in 1997 and currently serves on C watch in Donnybrook. Despite having studied biology to the Leaving Cert (not by choice), I wondered how I would manage to take in the amount of technical terms and medical information that I was sure would be fired my way throughout the day. I needn’t have worried.

Comprising a mix of practical and easily digestible information on the intricacies of patient assessment, respiratory emergencies and cardiac first response, the course was broken down in a manner that us ordinary folk on the street could understand without much difficulty. Hugh was full of interesting information and anecdotes throughout the day, including the possibility of using a crisp bag to stop air sucking in and to allow blood to drain out following a stab wound to the ribs or lungs, albeit in the absence of a more conventional medical solution.

First up was an introduction to the world of the first aider, from the responsibility of those practicing first aid to regulations and legislation, and we were warned about acting negligently and the need to secure a scene before you begin your work, a lesson which is undoubtedly part and parcel of everyday life in DFB, but may be less than second nature to us civilians. Next up was what we had all been waiting for, the practical demonstrations – checking for a response, carrying out primary and secondary surveys, hauling our makeshift patients into the recovery position, and best practice when dealing with a patient suffering from spinal injuries, among others.

Sobering lessons

Perhaps one of the more striking lessons learned that day was about fibrillation, and the actual use of the defibrillator. From the point of view of the general public, it’s probably fair to say that the defibrillator is seen as a tool to fix all manner of problems. One of the attendees (naming no names) was particularly shocked by the revelation that the heart itself is not restarted by the defibrillator; the defibrillator stops ventricular fibrillation which is a useless quivering of the heart that results in no output – blame Hollywood for that misconception.

First aid

The course includes both theoretical and practical aspects

Speaking to me afterwards, Hugh was very vocal on the need for people on the street with first aider skills, as they provide a vital stopgap while the emergency services are en route. “They are vital. They are the first three links in the chain of survival, and what we do adds to what they have done already. If they’ve got stuck in and they know first aid and they’re able to do as much as they can for the sick, ill or injured person before we arrive, it makes a massive difference to the outcome of the health and wellbeing of the patient. If nobody does anything for the patient or if they’re just left lying on the ground, when we arrive we have a hard job to make things right again,” he states. “The first aider is vital and it’s very important that [they are] in the workplace, in schools and community centres etc. And that they have the equipment – ideally, if the budget will run to it, if there’s a defibrillator in the centre or the school or the workplace, the first aider can start using that long before we even get there, and it might make the difference between life or death.”

As for the course itself, Hugh notes that anybody can do it, with just a few simple prerequisites. “You don’t need anything apart from an enthusiasm and a willingness to learn,” he adds. “So long as you come with the right attitude then we can show you all of the skills over the three days, and you’ll learn a lot.”

While the librarians continued their studies for another two days, my fi rst day was also unfortunately my last. However, it’s fair to say that in that day I learned more about first aid and life saving techniques than I have in my entire life, from the correct way to do CPR to the use of aspirin in cardiac cases. I hope to return some day in the not so distant future to complete the full three-day course and receive my certificate as a qualified first aider – from what I’ve seen and learned, it could be worth its weight in gold.

Revolutionary

The portable defibrillator was the brainchild of Professor James ‘Frank’ Pantridge, a doctor and cardiologist who was awarded the British Military Cross for his role in defending Singapore from the Japanese during World War II, and later became a prisoner-of-war. Appointed as a cardiac consultant to the Royal Victoria Hospital, Belfast in 1950, Pantridge introduced cardiopulmonary resuscitation (CPR) with his colleague Dr John Geddes by 1957. Recognising that thousands of deaths were occurring due to ventricular defibrillation, with many taking place in the first hour, Pantridge developed a portable defibrillator along with Geddes and a technician at the Royal Victoria Hospital, Alfred Mawhinney.