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.