This week, the Sydney-based team were invited down to Wollongong for an outdoor simulation extravaganza. Hosted by Wayne Cannon and the Wollongong team, the Sydney crew were treated to a feast of outdoor learning.
The take home? Environment, Personnel, Equipment
Environment
Be prepared for a challenging + changing environment – the sea state and tide predictions take on a new meaning when your patient is at the water’s edge!
Use the environment to your advantage – don’t let the environment rule you! You maybe able to rapidly move a patient to a more suitable position to complete a primary survery and get to work. Think about sun strike for intubation, 360 degree access, head elevation if possible.
Be ware potential for injury to rescuers
– never turn your back to the sea! If not directly involved in a rescue, keep a look out
– blue metal rock is especially treacherous underfoot when wet
– down wash from the helo when next to a ledge will knock you over
– eye and ear protection
– what can you do if you are being winched onto an unsafe area – various methods of communications
Personnel
Do you know what other services you have going who may be able to help?
What skills or equipment can they bring?
Mobilise them early!
Use all available resources.
Consider the safety of bystanders (sea state, slippery underfoot, downwash from helo)
Equipment
Know your kit! Do you remember the contents of all your packs including the tomb stone?
Patient packaging
– attention to detail
– easy access to drug/IVF port
– ongoing sedation/paralysis prior to winch
– avoid covering a severely injured extremity until the last moment so as to allow constant, repeated visual inspection (bleeding despite application of tourniquet)
– security of monitoring equipment (lanyard for BVM, capnometer, sats probe, ZOLL tied down if in use, O2 cylinder)
– review of SPECTER checks in a foreign environment
Ideally ongoing fluids should be guided by urine output via an indwelling catheter.
