First aid is something we tend to leave to others, isnt it? After all, the chances of witnessing something bad happening are too remote to contemplate. Besides, most people will instinctively leave casualty care to someone else on the scene who appears to be better qualified. But what if that someone else isnt there? What if your best friend is lying on the hill or in the field right next to you? He will make it, but only if you know what to do. Do you?
Having just experienced the intensive First Aid Rural Medicine course, which is organised by 7 Medical Support Team (7MST), based in Hereford, I have paused to reflect on my own shooting and fishing experiences in the UK. While these isles do not offer up the most remote countryside in the world, Shooting Times readers will certainly be among the few who find the least accessible terrain, for that is where the best sport can be found.
Right, now pay attention! Do you always know the OS map reference for your location? Does your mobile phone work? Where is the nearest Accident and Emergency? Can an air ambulance land at your location and, given the nature of the injury (for example, spinal), do you actually want it to? Are all access routes clear? Do you know how to spot hypothermia? How are your rapid extrication techniques from a 4×4? Finally, can you deal with gunshot wounds and extreme trauma?
My thoughts exactly. And thats why I visited the Rural Skills Centre at the Royal Agricultural College, in Gloucestershire, to give my full attention to a man named Steve Benbow. A former military and Subaru World Rally Team paramedic, Steve is one of the best medics in the business and has dealt with most types of injury. He keeps his eye in as an NHS paramedic while training a variety of organisations and services, including the Special Forces.
Your aim is to promote recovery and practise a systematic approach to stop the casualty deteriorating further, Steve said, addressing a dozen course participants, including a gamekeeper, an arborist, a marine engineer and a sporting agent. We were all working towards the self-explanatory First Person on Scene (FPOS) award, so it was imperative to ensure that we could use our knowledge from that point until professional help arrives.
The FPOS award is extremely relevant for shooters, gamekeepers and in fact all rural workers, because in remote situations the biggest problem is the delay in getting medical assistance to the casualty, Steve said. The police and fire services elect to use FPOS, which is recognised internationally because it is endorsed by The Royal College of Surgeons in Edinburgh.
A good eye and a good pair of hands can deal with most situations, according to Steve and his two able assistants, Cain and Andy, both ex-military and now working for 7MST. Planning and preparation mean that you develop muscle memory, which mean you will know what to do in a given situation. Steve surprised me by informing us that humans can operate seven sets of data information at the same time my wife has always told me that men can only operate one at a time. For example, said Steve, if you are in a car you can drive, talk to your partner, talk to your children, look in the rear view mirror, check the side mirror, look ahead and listen to the radio. When stress hits and you are confronted with a casualty situation, Bang! You go down from seven to just two. How many of you have turned the car radio off to concentrate? Its all about keeping calm when stress hits.
Know your location
During the day, we carried out a number of exercises, including a simple but clever map exercise, which demonstrated that most of us did not know where we were so how would we expect the emergency services to find us? Many estates will no doubt already have a map with named sections, access routes and clearly marked areas where it is possible to get a signal for mobile phones, but not everyone will have this information to hand, particularly individual stalkers, game and roughshooters or wildfowlers.
Participants were also told about ETHANE, a useful acronym for what you need to remember, especially if you are in contact with the emergency services. E: exact location; T: type of incident injury; H: hazards, such as livestock or
darkness falling; A: access, as farms are notorious for bolted gates; N: number of casualties, remembering that by law you can have no more than one critical patient in an ambulance; E: equipment, both available and required.
The casualty will invariably go through a known pattern of behaviour, from being isolated, confused and even embarrassed to fear, anger and frustration. The casualty can lose concentration, and the language ability can fall below the usual level. In certain cases, the pain can be so severe that speech disappears completely, leading back round to confusion. It is important to be aware of these reactions so that you can take steps to reassure the casualty and take appropriate action to stabilise them.
A confident approach
Much of what we were told was commonsense, but it was well worth repeating. The injured person wants to see a confident person so no faffing and remember that the casualty may be able to hear you, even if they cannot respond, so watch what you say if you want to avoid unnecessary panic. Do not ask questions such as: Are you all right? to someone who is clearly not able to respond. Instead, give instructions such as Open your eyes!. Also give them plenty of TLC, which in these situations means Tell Lies convincingly. Hypothermia will often kill quicker than the injury, so keep the casualty warm at least put something between them and the cold ground.
During the one-and-a-half-day course, we were confronted with numerous outdoor scenarios in which the casualty had fallen from a horse, been shot, suffered lacerations or been involved in a vehicle collision. While the UK shooting communitys safety record is second to none, the section on dealing with gunshot wounds was fascinating, particularly as standard advice against using tourniquets was turned on its head. We were also shown quick and effective ways of temporarily stopping the pulse and therefore blood flow into a limb, such as shoving a fist into the armpit or gripping round and underneath the bicep from the top and then twisting. These are tips worth remembering in the unlikely event of a barrel exploding through someone using the wrong size cartridges, for example.
One thing I really liked about this course was that it was adapted to deal with realistic situations a beaters wagon that has rolled over, a drowning man, a broken leg on the hill, a cardiac arrest on the moor and many others. We were also told how to check for allergies, medication and diabetes, all of which have telltale signs and could exacerbate the dangers of a remote casualty situation were they to remain undetected. When the emergency services arrive, you also need to know what information to hand over to them. And you should have written it down, as you are likely to forget under pressure.
A favourite piece of advice for me involved the Cincinnati Wrap (pictured left), which is a technique used to extract injured racing drivers from their cars within 10 seconds. It is also used by the military for getting soldiers out of tanks, fast. Where people may have head, neck or back injuries but need to be moved immediately, the wrap is good for pulling them out of vehicles, ditches or rivers. A long, strong sheet or blanket will suffice, accompanied by a SAM Splint, an ingenious multi-purpose flexible sheet of light aluminium. The SAM Splint is used as a neck brace and the sheet wraps round the neck and under the arms, giving you a good grip at the back, yet keeping the casualtys upper body aligned.
This was a genuinely useful course, which Id certainly recommend to readers of Shooting Times or, indeed, anyone who works in the countryside. It combined the classroom with practical scenarios where participants receive proper hands-on learning.
The First Aid Rural Medicine course costs £275 for a group of four and takes place over a day and a half. To book a place, tel 0845 834 0144, email firstname.lastname@example.org, or visit www.7mst.co.uk.
The First Aid Rural Medicine Pack costs £80 (or £65 for course participants). The Millbank Bag, Blizzard vest, SAM Splint and Bothy bag can be bought from 7 Medical Support Team.
Robert Gray is the campaigns director for the Countryside Alliance.