Debrief of 9 March 2003 Litter Training
VERY EARLY DRAFT by Tom RussoTom would very much like input from all participants and instructors. What's here is only a very, very brief show-and-tell of Tom's part in the training, and it should be more than that!
ScenarioLarry lead a discussion at the trailhead about litter handling technique, focussed mainly on the fine points of litter transport.
The litter team then dispatched to the known location of the subjects --- we were told that there were two men, one injured.
Upon arriving at the first man, David Chapstick, the team's WFR (David Dixon) began an assessment. Soon after the litter team arrived at the first subject, we heard the second one calling from a short distance away, and two team members were dispatched to locate him. It turned out that the second man was the one with more severe injuries. The subjects stated that they had been trying out a new "extreme sport" called "rock diving."
InjuriesThe first subject had abrasions on the heels of both hands, a deep abrasion to the left knee and several contusions to the left shin. Here's what he looked like.
And a close up:
The subject did not reveal until later that he was positive for Hepatitis B.
The second subject had fallen a short distance (less than 3 feet), but presented with deep abrasions to the right leg, a large hemotoma with swelling on the right shin, and abrasions to the lower shin. He was unable to put weight on the leg and was in extreme pain. The assessment was an unstable, closed fracture of the tibia and fibula. Here's what he looked like on the scene:
And a close-up:
In both cases, the make-up used to simulate the injuries would have washed off if the "wounds" were really debrided, so we simply stated that we *would* have cleansed the wounds if they were real, and moved on to the bandaging. Subject 1's palms were bandaged with gauze pads and a kling gauze wrap. His knee abrasions would also have been bandaged, but we simply stated that it would be done and didn't use up any more supplies to practice that.
Similarly, for subject 2 we did not actually bandage the simulated knee abrasion to avoid wasting members' personal medical supplies.
Subject 2's unstable leg fracture was hand-stabilized, and then splinted with SAM splints and a foam sleeping pad. Here's what it looked like after splinting. Note that in a real injury of this sort we would have removed the subject's sock and made sure that the bare foot was accessible for testing of distal circulation, sensation and motion throughout the litter haul, while also protecting it from the elements.
Lessons learnedJust a few thoughts off the top of Tom's head. THIS NEEDS TO BE AUGMENTED WITH OTHER PEOPLE'S THOUGHTS!
- Gloves should be donned upon approaching the injured subject. In a simulated environment like this one we could dispense with actually wearing gloves if necessary to conserve supplies, but in that event the medical provider should be in the habit of saying "At this point I would put on gloves." In WFR class we used rubber bands as simulated gloves, and would simply put the rubber band on our wrists to signify that we had actually thought about the biohazard issue and put on gloves.
- The team should stock an assortment of first aid supplies to use in trainings like this one. Wasting sterile medical supplies from members' packs doesn't make sense, but just saying "I'd bandage this" doesn't give members the right sort of practice. Let's buy some gauze, tape, and other essentials that we don't mind wasting on practice. It would be money well spent.
- Splinting an unstable injury is harder than it sounds. It was difficult to get that leg hand-stabilized in close quarters while the other WFR applied splinting materials. We need to practice this stuff often.
- David carries buckling straps that he used to secure the splinting materials. These were very much more usable than the plain tubular webbing. Members should consider carrying several of these in their packs, as they are light-weight and make the splinting process much, much easier.
- We need to do more trainings like this!