Training For A Medical Emergency (article) Jun 15,2017

Medical ( Trauma - What you need to know prior to treating your first patient )


Training for a Medical Emergency

Patrick O’Neil, PA

 

Training for a Medical Emergency is unlike anything most people have ever had to do in their lives.  There is a simple reason for that.  At the moment something bad happens, and you need to react to that situation; you are only as good as you have trained for that event.  There is no time to open up a book, or watch a video on YouTube.  You can possibly call 911 and they might be able to talk you through a technique, but that process is very slow and cumbersome.  The best chance for your own medical success, or that of your patient, is to train properly.

To highlight the importance of proper training mindset, I am going to give you an example from the wars in Iraq and Afghanistan.  The Army has a unit called the Rangers.  If you don’t know who they are, you should probably just go ahead and drop down in the push-up position and knock out 50 for having your head buried in the sand.  The Rangers are, arguably, the most elite Infantry unit in the world.  The Ranger Regiment has a very long and proud tradition of fighting our nation’s wars, and more relevant to this discussion….They train like you have never seen training done previously.  They take it to a level that is just hard for most people to believe.  But the results speak for themselves.

The Rangers take medical training very seriously.  They believe that every Ranger should be able to take care of their wounded comrade until the medic shows up to take over.  Now, this may be hard to imagine, but Hollywood gets most war movies wrong.  There is NOT a medic with each individual element going into battle.  There may only be one medic for an entire platoon; that’s four squads, or eight fire teams.  That is a whole lot of Infantry for one medic to cover.  The Rangers know this, so they created Ranger First Responders.  These are Infantrymen that have also been given more medical training than the regular Grunt on the ground.  In addition, every Ranger was required to do a large amount of medical training so he could properly use his Individual First Aid Kit.  They then trained.  And they trained some more.  They trained in the daytime, at night, in the rain…..you name it, and they trained for it.   They incorporated medical casualties into every scenario they participated in.  They trained so much, one Ranger told me, “It kinda freaked me out when we went on an Operation and didn’t sustain a casualty.  I kept waiting for a casualty and when it didn’t happen, it felt weird.”

By now you are probably thinking, “Great, Pat, so these Rangers train a lot.  What’s the point?”  The point is this:  When I retired from the Army in 2013, up to that point in the war, the Army Rangers had not had one death on the battlefield that was deemed to be “preventable.”  In other words, they did it absolutely right, every time.  Every casualty that died had wounds that were deemed lethal even with proper treatment.  That is an incredible statistic.  The Rangers suffered a lot of casualties during these two conflicts.  Yet, EVERY Ranger that died had wounds they never would have survived.  You can’t get better than 100% on a statistic like that. 

Other units did not do as well.  There is confusion on the battlefield.  You have personnel that may not be trained as well.  There are a hundred reasons why something can go wrong when treating a casualty.  I’m not knocking other units or other Services.  That is not the intent of this article.  It is simply to point out two facts that are universal:

The more training you have, the better prepared you will be.

The better prepared that you are, the more likely you will have a good outcome.

Now that you realize the importance of training, let’s discuss how it should be done.  This one is easy.  Just remember this:

CRAWL, WALK, RUN

When you were a baby, this is how you learned to ultimately run.  You started out crawling, moving at a slow pace, and trying to get your balance.  When you progressed, you learned to walk.  It was a little faster, maybe some mistakes along the way, but you picked yourself up and kept going.  When you had mastered walking….you started running.  So why should it be different with anything else we learn?

Let’s use a tourniquet as an example.  You start off familiarizing yourself with the parts of the tourniquet.  Then you learn to apply it in a slow and deliberate manner.  You ensure you are doing correctly.  Then you start to pick up the pace and start putting it on different extremities.  Then you may practice putting it on with your non-dominant hand.  Then you do it in the dark, using only muscle memory and the “feel” of the tourniquet.  You practice and practice until it becomes second nature.

REALISTIC TRAINING

It’s easy to get it right when you are sitting in a nice classroom, full of bright light, 72 degrees, and no stress placed on you.  Yet, that probably isn’t going to be how it goes down in a real world situation.  When you are exposed to the sights and sounds of a true trauma event, your body is going to shut down on you.  Seeing all the blood, smelling the blood in the air, hearing the screams of the victim….all this is unfamiliar and foreign to most people.  Your autonomic nervous system is going to kick in and some very predictable reactions are going to occur.  This is the “Fight or Flight” response kicking in and can become overwhelming.  (See my article on this for further explanation)  The point you need to take away is that the threshold for the “Fight or Flight” reaction is normally very low in the average person.  However, that threshold can be raised through realistic training.  The more realistic the training, the more familiar and comfortable you are with the situation.  You want to train so realistically that the actual event is nothing new or scary for you.  That is when you are going to be the most effective.

And this brings me to the last item I want to bring up regarding training philosophy.  It is self-explanatory, so no further comment is necessary.

Amateurs train until they get it right.

Professionals train until they can’t get it wrong!

 

           

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