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Moving People

 

Moving People

 

So we’re outside, enjoying our sport when an incident happens. We then have some important decisions to make, and actions to carry out. How do we face up to the evolving challenges of our incident? How do we manage the incident through to resolution in the most careful and pragmatic way?


In an earlier article, I covered some of the important points of...

D - Dangers
R - Response
A - Airway
B - Breathing
C - Circulation
D - Disability (Level of consciousness. The AVPU scale. Alert, Verbal, Pain, or Unconscious)

If the Dangers cannot be quickly nullified by executing a plan of action, or you have an issue with any of the medical challenges then you’ll be seeking outside assistance at the earliest opportunity.

I want to move on from there, and consider the possibility that an incident has happened on dry land, maybe during a rest period, or maybe when you’ve been paddling on a river instead. Having dealt with the DRABCD there will now be two major tactical challenges to consider: -

“Shall we move?”
“How shall we move?”

As paddlers, we are generally in a remote environment, and assistance can literally be hours away. But sometimes it can just be a few minutes away. I cannot give you a prescription of what decisions you should make and when you should make them, but I will in this article try and give you some guidance.

There are three main reasons why you would want to move a casualty
 

  1. You cannot carry out effective first aid in your current position.
  2. The environmental situation has changed and you need to move for safety.
  3. The situation is under control and you are carrying out your exit strategy.
     

We’ll look at these three situations based on real life examples
 

 

Based on Real life Scenario 1

 

Gill has come out of her sea kayak, and in doing so, somehow, has sustained a cut to her forehead. There is no loss of consciousness, and as she holds onto her boat, blood is running down her face.

Dangers:    These have been managed by good group management.
Response:    The casualty is conscious.
Airway:    The casualty is able to keep her head above water, so that is good.
Breathing:    The casualty is able to talk, so her breathing is adequate.
Circulation:    She has a wound that needs to be assessed and treated.
Disability:    The casualty is Alert and able to follow instructions.  


Medical Challenge
The wound is best treated by cleaning, and stopping the flow of blood with an appropriate dressing.

Psychological Challenge
Blood running down the face can look very scary, but water dilutes bloods, so a wet face will always make the bleeding look worse. Keep calm because any anxiety that you display is likely to make the casualty feel equally anxious and possibly less able to help themselves.

Tactical Challenge
The treatment cannot be carried out with the casualty in the water. We need to complete the rescue first.

Tactical, Technical and Physical Challenge
The casualty needs to get back in their boat quickly and efficiently. In this case a deep water rescue was quickly performed.

Medical challenge
Now that Gill is back in her boat, the wound can be cleaned and dressed. The First Aid kit is kept in the day-hatch and conditions are calm enough for the wound to be cleaned, assessed for its severity, and dressed whilst rafted up. How did we get a dressing stick to wet skin? The area around the wound was dried using gauze, and the wound covered with a large adhesive dressing. A hat also helped keep the dressing in place. A roller bandage could have been used instead.
 

 

Based on Real Life, Scenario 2

 

Mark is river paddling and boofs a small drop. He suffers excruciating pain in his back, capsizes and comes out of his boat. He knows instinctively that he has a severe spinal injury. As sea kayakers we’re unlikely to have this situation, but I want you to consider the challenges, and the journey from incident to resolution.

Dangers:    Mark is in the water, in a pool. Everybody else is safe at present.  
Response:    The casualty is conscious.
Airway:    The casualty is lying on his back face up. He has a good airway.
Breathing:    The casualty is able to talk, so his breathing is good.
Circulation:    The casualty has no wounds but a spinal injury can affect your blood circulation.
Disability:    The casualty is Alert and able to follow instructions.  

Medical Challenge
The injury needs to be treated with the upmost caution. A spinal injury is suspected. Assistance from the emergency and rescue services is sought but this is going to take time.

Tactical Challenge
Mark does not want to move because of the pain. He is just lying in the water. It’s just a case of waiting for the emergency and rescue services. It will be over two hours.

Medical Challenge
Mark is becoming very cold. The danger of hypothermia needs to be addressed.

Medical Challenge
Mark needs to be moved out of the water but kept as flat as possible with minimal movement.

Tactical Challenge
The group decide to make an improvised stretcher.

Technical Challenge
A stretcher is rigged up using paddles, ropes and slings. It is tested first. A route is devised which will minimise the risks of slipping or dropping the casualty!
 
Physical Challenge
The makeshift stretcher is passed under Mark. There are four people who can help with the lift and carry.

Psychological Challenge.
Everybody is feeling apprehensive, but they know it needs to be done. The move has been planned and prepared which is reassuring. Mark has consented to be moved and the group can justify their actions.

Technical Challenge
The lift needs to be coordinated so that Mark is kept as flat as possible throughout.

Medical Challenge
Even out of the water, Mark is still hypothermic, so a group shelter is set up. Mark is eventually airlifted to hospital.
 

 

Based on Real Life, Scenario 3

 

Whilst taking a break on an island, Phil has slipped on some rocks and sustained an ankle injury.

Dangers.    Everybody needs to take care as they move around on wet slippery rocks.  
Response:    The casualty is conscious.
Airway:    The casualty is able to talk, so has a good airway.
Breathing:    The casualty is able to talk, so his breathing is good.
Circulation:    The casualty has an injury that needs to be assessed and treated.
Disability:    The casualty is Alert and able to follow instructions.  

Tactical Challenge
A group shelter is erected. Phil can now keep warm as the injury is examined.

Medical Challenge
The injury needs to be examined. It may be dislocated and the blood supply to the foot could be disrupted, in which case the affected foot may be paler and feel colder than the good foot. It may be a fracture and the bone could have punctured the skin. Both cases are serious and require immediate evacuation by the emergency services.
Both legs are compared at the same time. Anatomically they look equal. Both legs are of equal length, with no gross deformity. Phil has equal sensation in his toes and is able to wiggle his toes. The injured ankle is swollen, painful and there is reduced movement. Phil reckons he’s ok to continue paddling and declines to have clothing cut or removed to examine the injury in any further detail. Pain relief is managed by Phil taking some of his own medication. The area is cooled with a damp roller bandage that also provides a bit of support. It was Phil’s decision to paddle with this injury.

Tactical Challenge
The journey back across to the mainland is assessed for the risk. The return journey and landing are predicted to be easy. The group leader details the new plan for the journey back.
 
Physical Challenge
Phil is assisted back to his boat. It was safest for Phil to shuffle on his bottom than to hobble on slippery uneven rocks. A bothy bag was used to support his leg and stop his ankle hitting the ground. Phil is assisted back into his boat.

Tactical Challenge.
Phil is assessed for his ability to control his boat and paddle effectively before the group commit to the paddle back.

Technical Challenge
The group paddle back according to the plan. The plan for landing and assisting Phil out of his boat is also executed well.

Psychological Challenge
Everybody is feeling good because they have managed this incident without having to call in emergency and rescue services.

Medical Challenge
Phil is taken by car to A+E so that the injury can be further assessed and treated.
 

 

Some General Principals

 

DO NOT move a casualty with major injuries unless SAFETY is now threatened. If the dangers are increasing, a move may be imperative. Your priority is to get everyone as safe as can be expected, call the emergency services and manage the situation.

DO NOT move a casualty with a suspected heart attack or stroke unless SAFETY is now threatened. The exertion and stress that movement creates for the casualty may be catastrophic. Your priority is to get everyone as safe as can be expected, call the emergency services and manage the situation.

A group leader is needed to give clear instructions so that you work as a team.

Can the casualty with an injury move themselves? Shuffling a short distance on their bottom could be quicker and safer than helping them to hobble or be carried.
 
If you have to move the casualty, then plan the move and review your route. Is there anything you can do to make it more safe?

If you have to improvise kit to assist with moving a casualty, can you test it first? Talk through your plan with the group, share ideas and concerns. Is everybody happy with the plan. Is the risk of moving a casualty justifiable?

If you have to lift someone think about safe lifting and carrying techniques.

Always face forwards when moving someone, so that you can see any trip hazards.

Avoid twisting, leaning back or stooping.

It is preferable to have one hand free so that you can use it for balance and support.

DO NOT grab limbs to lift a casualty! Always use their clothing such as pfd, spraydeck or simply a handful of drysuit.

Listen to your casualty. If a move is increasing the pain, then STOP and re-assess.


Further reading regarding the safe principals of manual handling can be found at http://www.hse.gov.uk/pubns/indg143.pdf

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