Medical Rescue – Just how much do we need to know?
I have always said that having some knowledge of the medical aspects of rescue is important, but just how much should we know?
When I was an operational firefighter I had a very keen interest in the trauma aspect of my job. However there is very little resources available (and I mean this with the greatest of respect) ‘at our level’.
We are not paramedics (although in some countries rescuers are paramedic trained) and we are certainly not doctors. The fact is there is very little in terms of literature and training that is designed for firefighters and rescuers to allow them to develop their trauma skills. The last 10 years or so there has been some development to fill this gap and thankfully things are changing.
With such an academic subject, it is very difficult to establish even a minimum standard when it comes to trauma care and I am aware of many countries around the world where no minimum standard exists and rescue services are doing the best they can to develop and maintain their own standards in terms of protocol, equipment and training.
Of course you may well ask why it is necessary for rescuers to develop themselves in this area. Surely they should stick to using the tools, right? Well, there are several reasons why I believe this should never be the case. Firstly, arriving on scene before the paramedics instantly places a burden of responsibility on the technical rescuer. This burden is more likely to be a moral (rather than a legal) one, but they must be able to perform basic lifesaving interventions such as managing an airway or dealing with massive haemorrhage. I think this is an absolute minimum.
In addition, an understanding of trauma allows the technical rescuer to think, plan and act in the most appropriate way. How many times have you seen someone ram a car with the spreaders? It is important to understand that every part of the technical rescue process directly affects the medical outcome.
The technical aspects of the rescue directly affect the medical outcome.
I have met a lot of rescuers in my career who say they are not interested in the medical aspects of the rescue and they are just ‘tool operators’. I believe this has to change if we are to be fully patient focussed, but we must have access to reference material and training at the level at which we operate.
It is vital that rescuers should be able to identify time critical, life threatening injuries and learn the basic lifesaving interventions that can be performed on scene. My experience leads me to believe that firefighters/rescuers can learn these skills; they will make a difference on scene. Basic manoeuvres such as a jaw thrust or chin lift (to preserve an airway) are essentials ‘tools’ to have.
Medical skills are, just like your rescue equipment, essential 'tools' at the scene of an incident.
There are of course patients who have massive internal trauma and some rescuers may think there is little that can be done to assist in such circumstances. On the contrary, the ability to recognise such injuries will allow the rescuer to plan an extrication that may allow a rapid removal due to the serious nature of the victims’ injuries.
Whatever your understanding of trauma, the technical and medical aspects of the rescue are linked and one cannot be performed efficiently without at least a basic understanding of the other.
As ever I welcome your feedback!
Ian Dunbar