Saturday, 6 February 2010

Drills and automatic pilots

I attended the first half of a first aid course yesterday. It was because of my job and how I can often be working in isolation, in transit between places, responsible for a `vip`. It was something of a refresher for me as I had attended quite a few such courses as a police officer and some were of quite an advanced nature during my tactical firearms years. You can never get enough of this stuff in my opinion because, unless you are a professional practitioner of life saving techniques, the times you may be called upon to get stuck in to a life-saving procedure as a first aider are few and far between. This is all the more reason why there should be regular `refresher input` in between the 3 years re-certification period, because no matter how well the training is delivered you cannot re-create the intensity of a real incident, with a real person who may be highly dependent on you doing the right thing, quickly. As human beings, we need well practised drills in such circumstances, because without drills we can so easily be sidetracked, spooked, panic or simply `freeze`. Drills were the bread and butter of my days as a tactical firearms officer. They helped us handle our weapons safely and helped us to function when under extreme stress. By the time I took over the running of the unit our training had advanced to the point where we were working with our own clinical psychologist and would, for certain exercises, build our officers up into a state of high stress-arousal before introducing them into the desired training scenario in order for them to understand the physiological aspects of the experience and to learn to work with it. As any experienced military combatant will tell you, drills are vital for you to function correctly when part of your brain starts telling you to just dig yourself a hole and jump in it, whilst your motor functions conveniently require your body to evacuate its bowel or stomach contents, or both - that's when you really need drills. Certainly, as a young parent, I could never have forgiven myself if my dependant son or daughter needed me to keep them alive and I let them down because I didn't know what to do or just flipped out because they were my nearest and dearest and I lost my nerve. Is this stuff covered in `parenting` or pre natal classes these days? If it isn't, then it should be. My recollection of how adrenaline, fear and life saving drills affected me took me back to when, as a patrol sergeant in the police, I received a call to a dwelling house in a south coast urban sprawl. There had been a garbled `999` call from a man who said his wife had collapsed in bed and had stopped breathing. The ambulance was en route but often in cases like this they will tell us as well in case one of us was nearer. Such was the case on this occasion and I arrived about 30 seconds behind my area car driver, Bob. The frantic husband was pacing up and down in a complete state of shock and Bob had already started to try and ventilate the lady. I grabbed the husband and tried to interrogate him about any medical history but he was shot away. I ordered him to the front gate and told him he was to look out for the ambulance. Bob was struggling to get any air into the lady as she was in bed. We picked her up and got her onto the floor and automatically formed into a re-sus team. I was pulse and cardio and Bob was the ventilator. There was no detectable pulse and we got to work. We were interrupted by the frantic husband who was trying to cover his poor wife's dignity (she was only wearing a short nightie, something that had not even registered with either of us). I worked around him and when I'd felt he'd done his bit I ordered him back outside to guide in the paramedics. The poor bloke. I have no idea how long we were working on her but we were going through our drills, Bob ventilating, me compressing her sternum and checking her pulse. We were sweating profusely and I was hoping the ambulance crew would hurry up. Suddenly, I got a pulse and saw her pupils twitch and I remember the excitement just like it was yesterday. I shouted out, "Fucking hell, I've got a pulse". Then a strange voice behind me said, "That's right mate, I know, stop compressions". I looked round and it was a paramedic. Again, like it was yesterday, I remember asking how he knew I'd suddenly found a pulse. He pointed to a piece of equipment, similar to a `Minuteman Resuscitator` and said that they had been monitoring us for a few minutes, pointing to electrodes that they had attached to her chest. He said we were doing just fine and so there was no need for them to intervene at that stage. Neither of us had noticed their arrival, or remembered answering their questions or had seen them attach their equipment to our casualty. We stepped back and let them intubate her, set up the ventilator, place her on a chair and carry her to the ambulance. Bob took the husband to the hospital and I locked the house up and started to contact the daughters. We heard that she had died in hospital 36 hours later. It was a cerebral haemorrhage. Two weeks later I was in the Indian restaurant opposite the police station doing a licencing enquiry and enjoying a small plate of curry with the owner. There was a group of women a couple of tables over. One of them, a young woman in her 20's, got up and came over to us. I immediately thought, `here we go, a complaint or some other inconvenience`. She said, "Are you Sergeant Hogday"? I told her I was. She said, "You tried to save my Mum the other week. The ambulance men said you were the ones who worked your socks off and got her heart started. I just wanted to tell you how grateful my family are for what you tried to do for our Mum, but the cerebral haemorrhage was massive". I told her how sorry I was. That was it. But her words of thanks, in what was ultimately a hopeless situation, stayed with me to compensate for all the other wasted words I've received at the hands of the unpleasant masses I encountered over the years. That's what drills did for me. If you told me that I was going to face the same situation tomorrow, I would be crapping myself with worry, but when it happens, it usually comes under your radar and lands in your lap and its only then you hope the drills kick in. But thankfully I didn't have to hope because I had been trained and sufficiently re-drilled. I have heard that this sort of training is being thinned out and that various departmental managers and their accountants see this and other training simply as a resource implication and a potential cost saving if they don't implicate it beyond the minimum, rather than see it as an investment. They do the minimum in order to satisfy the Health and Safety Executive and no more. I hope this isn't so.


打麻將 said...

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Anonymous said...

"If you told me that I was going to face the same situation tomorrow, I would be crapping myself with worry, but when it happens, it usually comes under your radar and lands in your lap and its only then you hope the drills kick in. But thankfully I didn't have to hope because I had been trained and sufficiently re-drilled."

So true. There are various situations which I have been really apprehensive about facing for the first time, but each time when it has finally "happened" I have managed to deal with it adequately. I always thought that "the training kicks in" was a cliche but it's absolutely true.

CI-Roller Dude said...

Wow, Good job!
about 30 years ago, the department I used to work for was trying to have cops do it all. We were firemen, ambulance drivers and dog catchers. So, we responded to all emergency calls.
In my first year as a rookie copper, I did CPR 12 times. Too bad in those days we did not yet have "911 emergency" when grandma keeled over and from a heart attack, the citizens had to look in the phone book to figure out what phone number to dial up. Usually, by the time we got called, it was too late--- so I breathed into a lot of dead folks.

A few times, we did save em'....but it wasn't enough. I never ever had anybody say "thank you for trying."
Later, I went to EMT training and became a CPR instructor. But the entire time I was certified with all the good training-- I never had to do CPR one time.

After I let the certificates expire, I again had to do CPR--- but in the last few years, the victims were too far gone to save.
Still, I'd always try.

And I've seen not only cops, but a few firemen/women freeze and not know what to do. Usually with gun shot victims.

Anonymous said...

What a wonderful story. I should imagine that once you are trained then 'instict' kicks in when someone stops breathing. You probably don't even think about it until after.

Stressed Out Cop said...

That's why I love Ambo's - I'm not set up for what you did .... you're right about drills though

adrian said...

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powdergirl said...

Forgive me, I hate hate hated first aid training. I always told my crew that the first guy to get hurt would get beat up by a girl. Me.
I was nauseous just at the descriptions of the wounds we might treat.

I'm glad there's people out there who can do it, I've ridden in the big white ambulance my self once, but I'm not who you'd hope to have around in the event of a life threatening injury. I mean I'd try, and I've done all right when I had to, but damn, I didn't like it at all!

Nice work on your part though, and I'm glad you got the thanks you deserved.

archytas said...

The winner of the first aid prize at Bruche was an ex-cadet, posted to the same station as me. I played cricket and missed the lessons, 'strangely' coming in second in the exam having never seen a triangular bandage.
One of our first jobs together was at a bad RTA. I tuned to hand him the first aid kit (empty as it turned out)and to say he might do more with it. He had fainted.
You're right more MOPs should put in a decent word of thanks, and a few did in my case. I have over some good work too.
Sadly, my letter to our current farce Chief on allcoppedout is rarely pleasant. There is a downside that needs revealing too.
I hated drills, but owe my life to them. My FT was 35 rounds with a .38 and I didn't get any more until I moved on to Guildford in a later job. It was only then I realised just how much danger I and the public had been put in. No return to the old days in this area I hope.

Anonymous said...

"I was nauseous just at the descriptions of the wounds we might treat"

During our initial "life support" training the trainer was taking us through how we might deal with a stab wound which had caused someone's intestines to fall out. I'm afraid I have rather a vivid imagination and started to feel quite unwell. The trainer noticed and I could tell he was thinking "not sure how well this bloke is going to handle it on the streets!"...

Hogday said...

SC: Even when you've no idea, look as though you have :) As for blood and guts - its `orrible and you've got to be weird if it doesn't get to you in some small way.

CI-RD: Good job we never expect thanks. If I'd wanted to be loved I'd have joined the fire service ;) Even then they get things chucked at them sometimes - WTF?

Technogran: Hello again! Nice to see you. I didn't make a habit of this sort of thing. Maybe a dozen tops, in 30 years. Lots of bandages used though!

SOC: Agreed. At least in the cities we didn't have to wait too long. I loved the sight of an arriving Ambo.

Adrian: I'm unaware of ever doing CPR on a Marxist but it may well have happened.

PG: It's not something I look forward too either. At least in this story there was no blood, guts and snot to get in the way, ugh!

Archytas: Greetings. I had an exact similar experience with a proby/St John's ambo. I rather cruelly used to tell my tac team that if I was ever shot in the line of duty and they saw him coming towards me with his kit, they should remove my gun from its holster and finish me off. I've had much better experiences of the great St Johns guys since.

打麻將 : I looked in and appear to have got some sort of oriental sex site. If that was you, thanks for looking in and the offer, but I've already got some :)

Area Trace No Search said...

I'm strangely proud in a "bloody-minded-I'm-a-copper-and-need-a-sense-of-humour-transplant" way, that I've had a 100% failure rate with all my CPR attempts.

I suppose it means that I was right about there being no pulse...

powdergirl said...

Please include ATNS on the list of people you don't ever want to have show up when you're laid-low. LOL at the 100 % failure rate humor!

Hogday said...

Area and PG: How true. The only thing remotely close to a CPR `success` for me (apart from the subject of my post who sadly died anyway) was a totally wasted, hopelessly addicted druggie who I found in a bush in St James's Park, having collapsed after choking on his own puke. I punched him between the shoulder blades a few times and he spluttered up more puke then started breathing. An MOP came up and accused me of assaulting him. I have, however, worked under a few senior officers who, if they flaked out across their desks in front of me, I would be tempted to walk into town to find a t/k to phone for the ambulance.

Blue Eyes said...

I do realise that Area is "joking", but the thing is, the chest compressions and breathing aren't supposed to "revive", in fact it's virtually impossible for them to do so. You can't fix someone's heart problem by squeezing it.

The point is to keep a bare minimum of oxygen going to the brain while you wait for the defibrillator. Even with the defib there is only a tiny chance of success.

Hogday said...

My defibbing training starts on Friday, unlike prisoner Desai, who I suspect will never be fully de-fibbed.

Anonymous said...

I seem to remember, from those now hazy days of rugby league (then a winter game), that I recovered from all kinds of injury at the sight of the trainer running on having just cracked the ice of the sponge bucket. Knowing this was about to be thrust down your nether regions as cure was cure indeed!
Maybe we should return to low-tech?

Area Trace No Search said...

Sadly, I'm not joking about my 100% failure rate, every real attempt at CPR has resulted eventually in death.

However, this is expected - it's something they don't show you on Casualty or The Bill.

I'm actually relatively well off in first aid and initial lifesaving, as the Met has paid for me to do certain extra training courses on it, as well as our standard life support training.

Defib is brilliant, has a much higher success rate and is pretty much Policeman Proof.

Hopefully they'll show you some videos about it - there's a great one of a guy pulled out of the water by lifeguards, and after unsuccessful CPR and then numerous defib, he pings back to life and wakes up conscious.

As I said, a great piece of kit. We're not allowed to have them in our cars though...

Blue Eyes said...

I have seen that video it is awesome.

Hogday said...

You'll read about my de-fibbing in a future instalment, i'm sure. As Area said, nerd-proof. In fact, at our local pools they have decided that they would remove the sign on the box that said, `only to be used by trained personnel` as it might cost a life! There's bottle in this day and age, n`est pas?

Blue Eyes said...

A de-fib next to a swimming pool? You might get a new hairstyle if you use that!!

Hogday said...

I understand that defibs actually IN the swimming pool is how the Chinese olympic swimmers are trained