Being a 'casualty' yesterday made me realise one of the reasons I got into education in the first place. Simulations are a fantastic way to learn first aid. For a weekend or fours days you learn first aid in a classroom. You get talked at lots, try out bandaging and recovery position on each other, but it's only when you have someone screaming and crying and refusing to let you come near their broken arm that you stop and realise that there is far more to first aid than the content of the first aid manual.
Simulations don't always work though. I spent about an hour lying on a
cold floor yesterday wondering when someone was going to come and help
me - not just ask me "Am you alright" but get me a blanket to lie on,
check what was actually wrong with me, check medical conditions etc. I
did get a blanket on the ground eventually, but the relief crew and the
WRVS didn't really know what to make of me probably because they
haven't been involved in many simulation before and you need to know
the rules of the 'game'. I was asked by a WRVS woman "Are you OK, I
mean apart from this silly role play thing", which is a fair question
to ask if you don't realise that there are safe words if you are really
ill and observers watching who know that I'm a trained and often
devious casualty ;-) There also didn't seem to be a point to the last hour of the scenario, just people reading and playing cards. There was nothing new for the response teams to achieve.
As casualties, we are always assessing the treatment we are (or are
not) receiving. If the first aiders are achieving well, our condition
will deteriorate to see if they cope. It can get very annoying if the
treatment is so good that you can't believably deteriorate. On the
otherhand, if the treatment is poor (particularly if you are being
ignored) then collapsing can shock them into taking the simulation
seriously. If they haven't asked you about your medical conditions
they won't pick up that you're diabetic and suffering from low blood
sugar levels - if you're feeling nasty wander off to the toilet and
pass out there and see how long before they realise they've lost a
casualty somewhere.
Simulations need to be 'FABA' - Feasible, Achievable, Believable, and Accurate:
Feasible - do you have the equipment and people to portray the
scenario. If you're testing treatment of whiplash, then you should
have a car available to stage a car crash, and a car park, private road
or cul-de-sac so that the first aiders can work safely.
Achievable - if you are testing the skills of novice first
aiders, don't have a casualty that requires defib skills. Don't have
five casualties and just two first aiders. If you want to test
treatment of burns, have running water available. Oh and don't wander
round with a knife refusing treatment ;-)
Believable - if you are a female aged 30, don't play a 7 year
old child or a 70 year old man. If you are in a car crash, sit in a
car outside, not on a chair in a classroom. If you have a broken arm,
there should be swelling and redness; an open fracture needs fake blood
(and maybe a piece of bone sticking out). DON'T say "oh, look at all
the blood pouring out of my arm" and just have red felt tip drawn on
your arm!
Accurate - a casualty needs display the right sympoms and
respond in the right way to correct or incorrect treatment. If you are
unconscious and in shock and the first aider wraps a blanket around
you, your condition should improve. If they don't warm you, or chuck a
blanket on top of you but leave you lying on the cold ground, your
condition will get worse (preferably in a way that the first aiders can
rectify the situation, like you shiver more noticably so they have a
visual clue that you're not warm enough)
Simulations are great fun, for both 'sides', as long as everyone
takes it seriously. Yesterday everyone was told they could come out of
role for lunch, which defeats the purpose of running a simulation over
a number of hours. The first aid teams in an emergency response
situation would then have been having to think about whose been working
longest, who needs a break first, and then had to continue working with
the same number of casualties but less staff. They would also have
needed to think about feeding the casualties. There will be casualties
who can't eat in role (I had a bad stomache ache and would have been
refusing food). In that situation its important to have food set aside
for when the scenario ends.
The Red Cross (at least in Scotland) stopped running casualty
simulation weekends a number of years ago, mainly for cost and H&S
reasons, but it was a real shame. Sometimes 'camps' are arranged by
individuals, and everyone signs a waiver that we're not insured and its
all our own fault if we get hurt! It was amazing the numbers of people
signing up voluntarily, paying their own money and going for a whole
weekend to improve their first aid skills in (very) realistic
situations. There are some photos on the Napier University Red Cross Group website (the group folded years ago but the site is still up!), including photos of when we 'crashed' a Napier minibus
outside Teviot (an advantage of working for the university - they
didn't mind me borrowing a minibus, although I never told them what I
was doing with it!). We even had the paramedics turn up, which really
shocked the first aiders but added to the realism. Some of the first
aiders trained through these events are now doctors, nurses and
consultants, and every one of them said the experience doing
simulations was much more worthwhile than the lectures they had in
first aid as part of their courses.
