Medical Skills Refresher

CPR is one of the more perishable skills SAR members learn. Because it is not something that you use everyday (or perhaps ever), the techniques and procedures can easily slip from memory. The American Red Cross recognizes this and has developed a series of quick and free on-line refresher courses. They recommend you complete a refresher every three months to keep your knowledge and skills sharp.

The American Red Cross website is: http://www.redcrossrefresher.com/ There you’ll find refresher courses for both the lay responder and for “Professional Rescuers and Health Care Providers” (that’s us). There are four breathing and cardiac emergencies sessions covering professional rescuer scenarios.

You are also welcome to take the first aid scenarios. If you take the lay responder (for workplace, school, and individuals) CPR refresher, keep in mind that there are some differences between that course and CPR for professional rescuers (for example, lay responders don’t check for a pulse, we do).

For those who have CPR/AED skills down pat, there are other on-line quizzes you can take. A good one is the Wilderness Medicine Institute’s wilderness medicine quiz http://wmiquiz.com/wmi/index.asp  You can choose from six categories: anatomy, assessment, environmental, medical, trauma, or other (or a random mix). This site has 150 questions so it’s one you might want to come back to every once in a while.

So take a minute or two and refresh your CPR/AED and first aid knowledge before it slips away.

Wilderness EMT Training

By Joe Keyser

So my EMT class was great! I learned a ton of new skills. But as we SAR folks know, you don’t always have an ambulance next to you on a search. How do you manage care when the ambulance isn’t right next to you? To begin learning the answers, I enrolled in a wilderness EMT course taught by the Wilderness Medical Institute (WMI). The course focuses on providing emergency medical care in situations where help is hours—or even days—away.

The class was 48 hours of instruction held over 5 days in a beautiful spot on the Marin Headlands. It was called Wilderness Upgrade For Medical Professionals, offering education credits for EMTs, paramedics and medical practitioners. My fellow students included several doctors, several registered nurses, two physician assistants, a nurse practitioner, an Army Medic recently returned from Afghanistan, and several working paramedics and EMTs. Interestingly, the doctors were not the best students. That designation fell to the working EMTs, probably because they do emergency patient assessments every day.

We spent a good mix of time in the classroom and outside, working through medical scenarios. Some of the scenarios students were presented with included a variety of broken bones and wounds, burns (apparently people spill their cooking water on themselves all the time), hypothermia, altitude sickness, abdominal illness, cardiac issues, an unresponsive patient, and an interesting mental health case. I especially liked the course’s focus on evacuation criteria. All the topics came down to a 3 part decision: can this be handled in the field, is this a slow evac, or do we push the big red switch and get the patient out quickly?

In addition to the simple scenarios, we did two mass casualty incident (MCI) scenarios. The first involved actually throwing 5 students in the Pacific Ocean to simulate a boat wreck. The rest of us had to organize and co-ordinate the rescue and treatment of 5 people who were all hypothermic and had various types of injuries. Working with scene safety as a real consideration was pretty exciting. We also did a night MCI involving patients we were led to believe were not part of the simulation.

Overall the class was an excellent experience. The venue was beautiful. The WMI instructors were highly experienced; both had spent extensive amounts of time working in the field all over the world. I learned new skills, met some amazing people, and got in a tremendous amount of practice with wilderness medicine.

Alzheimer’s and SAR

The Alzheimer’s Association’s Safe Return® guide describes Alzheimer’s disease as a progressive brain disorder that gradually destroys a person’s memory and ability to learn, reason, make judgments, communicate, and carry out daily activities. As Alzheimer’s progresses, individuals may also experience changes in personality and behavior such as anxiety, suspiciousness or agitation, and delusions or hallucinations.

Alzheimer’s is the most common form of dementia, a group of conditions that gradually destroys brain cells and leads to progressive decline in mental function.
 
Six out of 10 people with Alzheimer’s will wander. Alzheimer’s disease causes millions of people in the United States to lose their ability to recognize familiar places and faces, or to even remember their names or addresses. They may become disoriented and lost, even in their own neighborhood. They may wander by foot, as well as by car or other form of transportation.
 
Although common, wandering can be dangerous—if not found within 24 hours, up to half of those who wander risk serious injury or death. Inclement weather, busy roads, and landscape trouble-spots pose a greater risk to the wandering individual.
 
Brad Dennis, Director for the Klaas Kids Foundation, outlines typical behaviors exhibited by a missing person with Alzheimer’s or dementia:
  • Will usually (89%) be found within one mile of the Point Last Seen (PLS); half found within 0.5 miles. 
  • Will usually be found a short distance from road (50% within 33 yards)
  • May attempt to travel to former residence or favorite place.
  • Will not leave many physical clues.
  • Only 1% will cry-out for help, and only 1% will respond to shouts.
  • Will succumb to the environment (hypothermia, drowning, and dehydration).
  • Will go until stuck; appear to lack the ability to turn around.
  • Will usually be found in a creek or drainage and/or caught in briars/bushes (63%)
  • Leaves own residence or nursing home, possibly with last sighting on a roadway. May cross or depart from roads (67%).
  • Commonly has coexisting medical problems that limit mobility.
  • Has previous history of wandering (72%).
Due to the changes that occur in the brain, people with dementia may have trouble understanding directions and communicating. SAR members should consider the TALK tactics developed by the Alzheimer’s Association when coming in contact with an Alzheimer’s subject.
 
Take it slow: Approach the person slowly from the front, and speak slowly. Identify yourself and explain why you’ve approached the person.
 
Ask simple questions: Use questions with one-word answers, and be patient when waiting for a response. Ask one question at a time, allowing plenty of time for response. If necessary, repeat your question using the exact wording.
 
Limit reality checks: Avoid correcting the person if they answer a question incorrectly. (When checking AxO questions, if they say it’s 1967 and they are in Michigan, accept it).
 
Keep eye contact: Eye contact and good nonverbal communication will help put the person at ease. Instead of speaking, try non-verbal communication. Prompting with action works well.
 
 
 
The Alzheimer’s Association has developed the Safe Return® program, a 24-hour nationwide identification, support, and enrollment program. The organization works with law enforcement to quickly identify and return to safety a person with Alzheimer’s or a related dementia who has wandered, locally or far from home. Visit the Alzheimer’s Association website for additional information on the disease.