Has it been over 2 months since the last post? Yikes... I've not been keeping up with things. I should probably write up Bristol Blast and Caves bceause there's a lot to cover there in terms of gear and other bits. However, before I get to that I promised a good friend I'd throw together some thoughts in response to their podcast. The wonderful Archer has started their Fast Track'd podcast talking about all things Nerf foam hobby related. This episode, which you can see below, talks about medical cover within events and how we can keep ourselves safe.
So I'll answer the first question first: who am I? And why do I get to have an opinion? I'm a (fairly recently) qualified UK paramedic which makes me an Advanced Life Support responder that carries both a bachelor's and master's degree in healthcare related fields as well as multiple years in hospitals in various healthcare and nursing support roles. I've got the full gamut of assessment skills that come with the day job as well as a good chunk of experience dealing with illness, injury and everything in between. I can chuck drugs at you (legally) and have the authority to carry and adminster some medicines not available to the public without the need for a doctor's oversight. I also have medical liability insurance baked into my professional body membership for any volunteer work I do. That said, without my big yellow van and my drugs I'm mostly a very over qualified first aider. It will become very clear why that sentence is important over the course of this post.
Quick note on terminology
I will avoid using the term medics in this post and instead will use the term first aider to refer to non-registered healthcare providers offering their services at events. The reason for that is two part. First, medics is the shorthand we use at work for paramedics. In the UK that is a legally protected title that creates a specific set of legal duties of care and requires us to carry specific insurance when we are practicing to protect ourselves, our patients and the public. The second is to keep in mind the role that these volunteers are filling: that of a first responder dealing with low acuity injury and anything else needs to be escalated to those of us with the training and experience to manage it.
UK Context
For a quick context reminder, the UK has the National Health Service (NHS) where all healthcare is free at the point of delivery (well, for now, the Tories are doing their best to scupper it). That changes the dynamics since it's free to call an ambulance or stumble into a minor injury unit. The assumption in the podcast is that volunteer embedded first aiders patch folks up to allow them to keep playing. That's a powerful motivator to manage things on site but health insurance being a requirement in the US for care is probably a key difference worth noting.
UK Legal Framework - Organisers Edition
So event organisers here in the UK have a duty of care to reasonably ensure the safety of their attendees and that can be fulfilled with risk assessments and generally paying mind to the risk of injury and ensuring safety. We also require event insurance for most things that will cover liability up to a certain point. Insurance needs risk assessment and mitigation to be valid. Player on player injury isn't usually covered in the insurance since it's beholden to the player to act reasonably. However, if the injury arises from the failure of the organiser to take due safeguards then that's when claims arise. Interestingly, there isn't a set number of first aiders or other cover needed for specific events. Organisers just need to create a system that any reasonable person would consider safe. The courts have lots of opinions on what consitutes reasonable so when we get to larger events, event medical companies sell their services because they've taken the time to go into all that and do their thing.UK Game Organisers (GOs) are welcome to reach out to me if they need advice on medical cover for events.
UK Legal Framework - Responders edition
For most volunteer first aiders, the main thing you need to remember is your own scope of practice. If you've been trained to a thing, you can do a thing provided you're able to do it to a reasonable standard that your instructor would agree is reasonable. If you saw it on telly and try it, you're a mug and the courts will take a dim view of it. You have a duty of care to the person you're attending so if you fuck it up, you're liable.
When the courts consider things going wrong, they hold you to the standard of the training you say you've had. That can cause some hesitancy for us medical professionals to step forward to volunteer because we're expected to operate reasonably within our day job's level of professional competance but we don't have our gear, we don't have our systems of governance or the back up we get from operating within an institution. It doesn't mean we won't pitch in but it does mean that we have to be mindful of those factors.
Medicines
The podcast made an interesting point that I think bears expanding here. One of the folks mentioned about carrying aspirin and paracetamol (well, he called it Tylenol but we'll forgive him). Here in the UK, there's a common misconception that you can't give meds as a first aider. You absolutely bloody can give folks two categories of medication. First, their own prescribed oral medications. If it's got their name on it and it's been prescribed by a doctor for them and they're awake and able to swallow, you can give them their own meds (injectibles are a little different so please don't). Second, any over the counter medications you can buy without a prescription. Someone is in pain? Chuck 'em some paracetamol! Low blood sugar? Suck on a glucogel! Hayfever? Cetirizine down the hatch! Obviously, read the back of the box, make sure it's in date and follow the instructions accordingly. It also pays to ask if they've ever been allergic to the medicine before you give it to them. If you ever wanted brownie points from an ambulance crew or triage nurse, you can score them easily with self-administered pain relief and a good effort at self care.
Knowing when you need help
The biggest, biggest point I would take away from all this discussion is that game organisers for larger games need to have a serious discussion about the trigger points for calling an ambulance or (ideally) evacuating the player from the field and taking them to hospital yourselves. They need to sit down with their first aiders and agree that this is what we can deal with, anything else we call for help. Having set an effective ceiling on the scope of practice of in-field first aiders will often make them feel more comfortable knowing the bounds of their practice. It also sets an expectation in players that they can expect a certain level of care from their first aid team.
Then break the rest up into "Can the patient walk or be helped to the car to be taken to hospital?" and "Hmm... Maybe we should call for help on this one". The latter category is basically anything where the patient isn't awake, isn't breathing or doesn't have a pulse. Most bleeding you can pack out and put them in a car, you'll get them to help faster. If you call for help then you are at the mercy of response times which in the NHS vary wildly right now. Don't get me wrong, making the call between staying and moving the casualty is tough but if you've got a car and bodies to help and you can't deal on site then moving isn't necessarily a bad thing. The A&E triage nurses would prefer you brought them a warm, slightly bloody patient fresh out the car rather than a cold, very bloody patient in the back of an ambulance because you had to wait around out in the elements for a big yellow taxi while the patient leaks everywhere.
That being said, there is one very, very, very big caveat about having awake patients move. If they have fallen from a height of more than 1.5m (excluding their standing height) or is at any point presenting with pain in their necks after a traumatic injury or has had anything fall on their head from a height then do not move them and encourage them to minimise movement. Seek help and talk to the 999 call operator for advice.
What to do when you've do called for help
This section comes from my professional experience and frustrations of dodgy security companies trying to guide us to jobs on sites and making my life harder. Essentially, if you call for help and an ambulance is dispatched then please have two people at the gate to meet them. The first leads the attending resource to the injured party while the second stays on the gate for any further resources and marhsals them down. First person once they've dropped the crew off at the patient asks them if there are any further resources en route and goes back to the gate to await the next resource (or to tell person two that there's no one else coming). Either they'll meet it en route or they'll get to the gate where they can repeat the process. In the most serious cases, you'll be expecting an ambulance and a response car so please keep someone around to meet that second resource. If you start expecting helicopters to start landing then please don't ask me how to handle that, the police deal with it in my day job.
Next keep hold of the person who witnessed the event that seems the most reliable and keep them nearby then designate one First Aider to stay with the casualty and liaise with the crew. Clear everyone else out of the way. If your site is big enough, you can move play away. Do not crowd the injured party. They're having a bad enough day as it is.
The folks on the podcast made a great point about radios. We use them in the day job for a reason: it's push button and talk. No faffing with dialling numbers, just ask for help and give location. If your event is big enough and doesn't have line of sight with more than 10m walk between spots then seriously consider investing in some radios.
The wound sterilisation myth
Another thing that popped up in the podcast is the notion that you need wound sterilisation fluid to wash out wounds. Plain old bottled or clean tap water will do. If you can safely drink it, you can wash a wound out with it. Make sure it's a gentle flow so you don't force stuff deeper into a wound. Most superficial abrasions can then be patted dry with a clean towel (don't use tissue) and only need covering if they're going to be exposed to dirt regularly. Being too keen with dressings and plasters risks more infection since you're locking potential bugs into a warm, damp and dark environment that is really good for them to grow.
Skill fade is real
Skill fade refers to the fact that skills that don't get used, fade with time. Always bear that in mind and if you are taking courses, you need to refresh them every so often. If you've not used those skills before and you're not sure, defer to the lowest risk and ask for help. The only legal requirement in the UK for bystanders is to call for help. I could talk about bandwidth and mental load all day but skill fade and knowing your limits are the most important bits.
The power of self care
Finally, I'll make a quick note about the power of self care. Each of us is a playing adult with the capacity to make decisions and as such we all bear a level of responsibility for our own health and wellbeing. Sure, there are incidents where you lose that capacity to self treat (see concussions etc). However, a small pack of plasters, a sweet snack, some water and a pack of painkillers doesn't take much space in a pouch in your bag or on your person. I'd argue everyone should carry that as a bare minimum with the expectation to self treat as far as possible. Even if you do an oopsie and have a bit of a meltdown, someone can just go through your bag and find something to help you. If everyone does that then it's just a case of grabbing your stuff from your pouch and helping someone out.
Oh and yeah, if you've got an inhaler then please carry it with you! Salbutamol won't teleport itself into your lungs!
