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Do Know Harm

This week, we've taken some time to sit down and pick the brain of Mike W, a specialist RN working in the Middle East about what works, and what needs attention, in first aid, especially as it pertains to Emergency First Response (EFR). Mike's had an interesting and diverse career so far, and is constantly forward-focused.


MS: Mike, great to catch you again. Before we get into first aid and your thoughts on trauma field care, can you tell us a little about yourself?


Mike: Sure - I'm a Registered Nurse, and am currently undertaking the process to become a Registered Paramedic. I’m also an Army Reserve medic with a couple of operational deployments under my belt. Most of my clinical experience has been in Emergency and Trauma working in Major Teaching Hospitals around Australia; however during my career I’ve been lucky enough to work on a Counter-Disaster Team for the Olympics, on set as an RN/Paramedic for a couple of large reality TV shows, in the Middle East as a medic on a private security team, on Mines Rescue Teams and as an Operations Coordinator for a medical and rescue company. I’ve also been a trainer for some of the best tactical medicine training companies in Australia; primarily preparing numerous Government, Non-Government and Law Enforcement agencies for domestic and international deployments. Now, I am the RN running a clinic for an Australian Embassy in the Middle East.


MS: That's a pretty hefty CV - what's been the most positive take-away from your career so far?


Mike: On the positive side, getting to work with like-minded individuals who are committed to helping others, whether they be professionals or volunteers, is enormously satisfying, both personally and professionally.There are always problems, of course, and often there isn't the support from management - like we had on the mine sites - to maintain and enhance your professional currency.


MS: Yeah, we certainly are on board with that message about ongoing PD and continuous improvement - I think it resonates across industries! Speaking of training, what do you think has been your best achievement in EFR capability development?


Mike: It’s not really an achievement, however, my greatest satisfaction has been training government and law enforcement personnel in first aid and tactical medicine. Their quiet contribution to our (Australia’s) safety and security cannot be understated; I am proud to have contributed to building this capability for these agencies.


Mike puts the protective skill-sets of his job through their paces on a range in Baghdad

MS: Mate that is certainly something to be proud of. You touched on building capabilities in tactical care and first aid: what has been the biggest change you've seen in the first aid/EFR sphere?


Mike: I'd have to say it would be seeing arterial tourniquets be accepted into first aid; seeing evidence-based data break well established stigmas, their gradual integration into first responders’ protocols and their increased access to the general public.

I think the significance of this cannot be understated; I remember when Kerry Packer went into cardiac arrest playing Polo and the Paramedics turned up and defibrillated him successfully. This really was a catalyst, at least in Australia, for all Ambulances to have defibrillators and then ultimately, greater public access to AED’s.


In the last five years or so, we have seen the same momentum building for bleeding control in the same way as Defibrillators did back when Kerry was successfully resuscitated. We now have “Stop the Bleed,” campaigns and are now seeing Bleeding Control Kits co-located next to AED’s in public spaces.


Virtually all of Australia’s professional and volunteer first responder organisations are using tourniquets (and haemostatics) as part of their treatment plans for severe bleeding. The Australian Resus Council supports their use: This change in attitudes towards tourniquets through education, training and access has meant that a significant number of people have been saved globally. I think that this is just awesome.


MS: I think that's something we can definitely see reticence in across the board for training and general attitudes toward haemorrhage control - it's great that you get the sense of change. Of course, our world bridge the gap between the tactical and general - or "WHS" sides of first aid: Do you have any thoughts about the differences/similarities between protocols? Is there too much confusion?


Mike: Really, apart from their origins (military vs civilian), the process of addressing reversible causes of death in a systematic way is the same. Obviously, S-MARCHE is threat/tactically focused Vs DRSABCD; however, your safety as the First Responder is always the highest priority, irrespective of which acronym you follow.


In the military/security context, the decision to treat will be driven by the tactical commander and/or the need to neutralize the stimulus (threat) so you can safely treat a casualty. In the civilian context, it will be driven by your own safety, skill level and access to emergency services. If in doubt, always follow your SOPs or training guidelines.


MS: That's a great way to look at it - moving on to treatment, we know the carriage and makeup of personal, duty, and site first aid kits can vary dramatically - what do you consider essential in an Individual First Aid Kit (IFAK)?


Mike: My top-10 for anyone in a high-threat environment, or working in security and law enforcement IFAK would have to be:


  1. Arterial Tourniquet. Make sure it is endorsed by the Committee on Tactical Combat Casualty Care and make sure it is not a cheap and dodgy airsoft knock-off! Counterfeit ones have flooded the market. Only buy from a reputable company.

  2. Pair of Gloves. Getting a blood borne disease whilst treating someone can be prevented by wearing gloves. Put them on!

  3. CPR face shield -Even though rates of infection to rescuers are low during rescue breathing, a CPR face-shield is another way of this from occurring.

  4. Wound dressing. There are a number of these on the market. The Emergency Trauma Dressing and OALES dressing are two great products; however, they each have some subtle pro and cons when measured up against each other.

  5. Adhesive Chest Seal. Again, there are several reputable brands; E.g. Hyfin, SAM, HALO; Always have a minimum of two.

  6. Permanent Marker- This is to write down the time that you applied an arterial tourniquet to a limb, and for documenting your treatment.

  7. Small notepad – For documenting your treatment. Rite in the Rain make some nice ones, including one specifically for EMS.

  8. Trauma Shears or seatbelt cutters – These can be used for a multitude of things; cutting seatbelts, cutting open dressings or cutting clothes to identify injuries.

  9. Optional -Haemostatic dressing. The reason I list these types of dressings as optional E.g. Quikclot, Celox - is that they are very expensive and require extra training to use them correctly. These types of dressings are excellent at controlling bleeding not amenable to having a tourniquet applied.


Most importantly, as number 10, and irrespective of your background, knowledge is the most important item you can have, and it weighs nothing in your IFAK. Get trained by a reputable company that has instructors who have real experience in this area. E.g. Ex-Military, Law Enforcement, Ambulance Special Operations, Protective Security experience. Make sure you also understand your responsibilities as a first responder: be knowledgeable on topics such as consent, infection control and post incident debriefing.


Once you have been trained, go and gain experience through professional or volunteer work. Once you have experience, continue to educate yourself on current treatment trends through further study. Use this experience to pass your skills and knowledge onto your colleagues. Then, repeat the process. Ensure you keep up to date with current trends by undertaking refresher courses or even upgrading your qualifications. You should never stop learning.


All the gear, no idea? The best IFAK is worthless if you don't have the practised knowledge to make it work.

MS: Excellent point for number 10. What about for civilians or off-duty/EDC?


Mike: This really comes down to your skills and knowledge level, however, apart from the shears or a safety blade, all the listed items above can be carried on an aircraft and through security checkpoints. There are great vacuum sealed kits on the market that are very compact and do not take up much more room than a small book. Alternately, you might be happy just to carry a CPR face-shield and some gloves; it really comes down to personal preference. I know Doctors that only carry a CPR face-shield, and mates of mine who won’t go anywhere without a CAT, Quikclot and a Chest Seal. Despite carrying a small IFAK for all the travel that I do, it is often band aids that I need more than anything else!


There are no real hard and fast rules on what you should or shouldn’t carry. If it’s part of your job, then follow your SOPs. You may be limited on what you can carry or have no limitations dependent on your roles and tasks, or your employer. Again, you need to get solid training from a reputable training company to employ these devices safely, efficiently and effectively.

Just remember to work within your Scope of Practice.


The importance of training in the skills you're expecting to use, in the environment you expect to use them, is critical.

MS: Before we wrap up, do you mind giving us a bit of insight into some of the best available knowledge and learning resources you know of? What books should we be reading, what podcasts are worth listening to?


Mike: I am a fan of the following podcasts (in no particular order):


PJ Medcast; Special Operations Medical Association PFC Podcast; Medic 101 podcast; Mentors for Military Podcast; Global Recon; The Unforgiving60; WarriorU; Life on the Line; The Med Shed; Australia Tactical Medical Association.


As for reading, I recommend:


The Journal of Special Operations Medicine

The Journal of High Threat and Austere Medicine

Advanced Tactical Paramedic Protocols Handbook, 10th Edition

Ranger Medic Handbook, 4th Edition

Pararescue Medical Operations Handbook, 7th Edition

Online:

ProlongedFieldCare.org – Prolonged Field Care

nextgencombatmedic.com – Next Generation Combat Medic

Litfl.com – Life in the Fast Lane

Deployedmedicine.com – Deployed Medicine.

thenewsrep.com – Newsrep

Loadoutroom.com – The Loadout Room

https://www.som-c.org/ Special Operations Medic Coalition


MS: Thanks mate. That's about all we've got time for this week - hopefully we can chat again soon about busting some of the myths in the medical/first aid world!


Mike: Yeah, that'd be great. Thanks mate - stay safe.


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