Wales Outdoors

TAKE CARE OUT THERE...

Whether gorge walking, coasteering, canoeing or simply out on a picnic - the weather would be rather nice - beware of the seasonal problems associated with drowsy and angry wasps. A paramedic friend of mine was running event cover recently and all casulties/treatments were for wasp stings....

HOW TO TREAT A WASP STING

Remove the stinger. Scrape a dull butter knife against your skin in the opposite direction of the stinger entry. It should pop out. Some sources recommend removing a stinger with tweezers. However, this method can potentially inject more venom into your skin as you attempt to pry and prod out the stinger.

Reduce pain and swelling with ice. Try to avoid putting ice directly on skin, because it can cause a flesh burn. Instead, use an ice pack or wrap a washcloth around the ice. Remove it after 10 to 15 minutes and dry the site thoroughly.

 

Use a topical antihistamine, such as diphenhydramine hydrochloride, available in cream, stick or gel.

 

Opt for a topical anesthetic for pain not relieved by antihistamine. Consider topical lidocaine or benzocaine.

 

Apply a topical hydrocortisone cream to reduce allergic reaction around site.

 

Take an oral analgesic, like ibuprofen, for general pain that may result from venom circulating throughout your bloodstream.

 

Consider applying moist baking soda or mud to the sting site. Although there is no scientific evidence that these remedies work, some people find that they provide relief.

TIPS AND WARNINGS

If you have experienced a severe reaction to any type of sting or bite in the past, you may be allergic to stings and bites. If you are, your doctor will provide you with a hypodermic syringe filled with epinephrine. Carry this syringe with you whenever you go outside.

If you notice pus or severe redness/swelling 24 hours after being stung, you may have an infection. See a doctor.

Go to the emergency room immediately if you have any signs of severe reaction or anaphylactic shock following any type of sting or bite: confusion; nausea and vomiting; swelling of the lips, tongue, throat, and/or area around the eyes; wheezing; difficulty breathing or talking; or loss of consciousness.

If you experience any severe reaction to a sting, or are attacked by a large number of wasps at once, get medical help immediately.

If symptoms persist or if you have specific medical conditions or concerns, we recommend you contact a physician. This information is not intended as a substitute for professional medical advice or treatment.

BARRIER DEVICES

Since offering first aid training it has become very clear to me that retention of skills learnt is good, but confidence to use these life saving techniques reduces exponentially after about six months after taking part in the training.

One piece of kit that I have in place in my personal and instructor first aid kits is the face mask barrier to aid resuscitation. This enable resus to be administered whilst keeping the face of the first aider away from the face of the injured person. Easy to use and as cheap as £5 each I recommend that all should have one of these in the glove box of the car and at the bottom of the hand or man bag....

I am glad that I made the decision to go for professional and exhaustive first aid kits and my decision, although expensive (each of my kits equates to a cash value of about £120), is confirmed by trials and ongoing experience....

"Conclusions: One year after a single episode of ventilation training, lay persons tended to hyperventilate; however, the degree of hyperventilation and resulting stomach inflation were lower when a mouth-to-mouth mask or a face shield was employed. Regular training is therefore required to retain ventilation skills; retention of skills may be better with ventilation devices."

(from an inter-European study with randomised trials in 2004/05)

Qualtech First Aid Trainer

999-Online, my first aid training company has become the first aid training provider for one of the largest training companies in South Wales, Qualtech. I featured in the in house magazine - copied here....

FIRST AID TRAINING WITH A TWIST

All businesses have to think about first aid training at some point - but does the prospect fill you with dread? Sadly the experience of learning a skill as valuable as this is often dimished by the dull training methods used.

Not any more - can you imagine a first aid training course using realistic injuries and jelly body parts? Thats exactly what Qualtech can now offer you. We hope that our innovative, interactive and memorable approach will give these HSE - accredited courses a distinctive twist.

But what about the jelly body parts? Andy Lamb, one of Qualtechs associate trainers, was happy to explain: 'we have life sized jelly moulds of some organs - for example, a heart. most people wouldn't actually know how big a heart is - so this shows them, and when the trainings over, they can eat the jelly.....'

Not satisfied with this Andy is also planning to add what hwe calls realism and gore to the trainign days: 'it would be realy useful to add some staged scenariosfor the candidates to 'stumble' uponand react to during a coffee break, or lunch. An unconscious casualty with burns and scalds, even perhaps compound fractures (with the bones protuding) and stage blood in a concealed pump.....'

'That way when they're eventually faced with a real situation, that first experience will still be vivid to them and make it easier for them to cope effectively'

SUSPENSION TRAUMA

Suspension Trauma

When is first aid not first aid? - when you are dealing with suspension trauma. Basic first aid training teaches you to put an unconscious, breathing casualty into the recovery position. Do this to a person, unconscious through suspension trauma and they are likely to die - instantly! The HSE Working from Heights Directive defines safety precautions for people working from heights. It follows the basic rules of hazards, i.e. remove the hazard, of if not possible, reduce its effects. This may mean the use of fall arrest harnesses. Here, a person could be suspended in a harness until rescued. Suspension trauma results where a person is suspended in the vertical position so is not simply restricted to the use of harnesses, but could result in working in confined spaces, secured to a spine board and hoisted vertically or the most famous, or infamous, example of deliberate suspension trauma is nailing someone to a cross. What is it? Our blood supply and heart cannot cope very well with standing upright - gravity pulls blood into the tissues of our legs, and the heart cannot suck it back up. Eventually, if enough blood pools in the legs, we will faint which is the bodies way of redistributing the blood in our body. Fainting however is fine, so long as we fall over but if we can't fall over, then we die! Urgency. If your legs are vertical and perfectly still, then you can start feeling the first signs of shock in as little as three minutes. The average is between five and twenty minutes. You will faint a few minutes after that, and if you are not allowed to lie down straight away then your brain can start to die a few minutes later. Worse than that, once fainted you lose control of your airway and if your body is upright you can choke on your tongue and suffocate in a matter of seconds. Treatment. Summon medical help as soon as possible - anyone suspended for more than a few minutes should be sent to hospital for routine blood tests, even if they are not injured. Even minor suspension trauma symptoms; numbness of the legs, feeling faint or sick etc. should be considered as potentially life threatening. DO NOT lie the casualty down, instead place the patient in a sitting position with their body upright and their legs flat. The patient must not be allowed to stand up, exercise, drink or eat. If possible keep them as calm and relaxed as you can, to reduce the effects of stress on the heart rate. If the casualty is unconscious, then you will need to manage the airway at the same time as keeping the casualty in a sitting position. However, if the casualty requires CPR then this overrules the posture policy, and you must lay them flat and carryout CPR. Why not lay them down? There are two main reasons; one, due to lack of circulation the blood pooled in the legs build up toxins. These toxins together with the lack of oxygen can cause serious problems to the liver, kidneys and brain. The second reason is the sudden reflow of blood that can cause excessive blood pressure to the heart. This pressure can cause the heart to fail instantaneously! When the emergency services arrive. Suspension trauma treatment is not widely taught to paramedics and ambulance crews. So as a first aider, you will need to be sufficiently assertive to prevent the emergency crew putting the casualty on the stretcher (lying down). The HSE requires that procedures and training are put in place to handle such an incident.

The Outdoor Professionals Co-operative

I'm sorry it has been so long in posting but there has been a lot going on in my life, some fairly drastic changes, some courses and lots of development work.

I have just been putting some flesh to the bones of a new adventure activity website for a group that I am a member of. I believe that the initiative is unique in its approach and will have lasting benefit for the client, the members, the environment and the wider outdoors community.

The Outdoor Professionals Co-operative is a name that we have recently given to our professional peer group. For a year and a half now we have been meeting formally, many of us having known and worked alongside each other for very many years. This formalising of meetings and discussions has already led to some innovative projects and methods of working supported by both the BBNP and AALA.

Following the demise of the Brecon Beacons National Park Environmental Charter Group there has not been a forum for activity providers working in the private sector to meet and discuss working practices, training, changes in legislation etc. Furthermore, it can be an isolating experience being self employed or the Director of a small business in any industry, adventure activities not withstanding.

So, the co-operative meets for several meetings a year to consolidate best practice and to promote innovation as well as running peer group training where all relevent members take part, such as site specific water rescue, child protection training, casualty simulation make-up training etc.

Through working together we have seen the coming together of risk assessments and through training together we feel absolutely confident in recommending each other.

The Outdoor Professionals Co-operative is just that. We work in the outdoors, we are professional in our approach to all areas of our work and we work co-operatively. In fact we go further than that. Our group is based on trust. Without trust it would simply not exist. And this is not the norm in the industry as I have bitterly complained about in previous blogs. We are a group of multi activity providers, sessional staff and group accommodation owners who all overlap slightly into each others business areas, some of us directly competing for similar clients. But, because we are all nice guys, it works!

We see that being part of a co-operative will benefit us all, perhaps not immediately, but in a year or two years, we will see that our commitment to quality provision, to the environment, to working with the statutory bodies, to staff training and welfare, to being able to collectively offer the broadest range of services and to developing lasting relationships with other similarly committed business will see genuine rewards.

Personally I am looking for the security that working with other like minded operators brings, to knowing that my staff are trained to work to the co-operatives constantly developing high benchmarks and to know that my business is attracting further premium clients because of the standards of provision.

Please visit the new site by clicking on the link www.multi-activity.co.uk to find out more about the work of the co-operative - please bear with it as I still have much to add......

Of course, as usual, your comments gratefully received.... 

NEW YEAR POSITIVE

Following a successful end to the year meeting on December the 14th of the small activity providers group that we are members of (a review of accidents and incidents, looking at progressing our environmental impact and sustainability studies and networking issues) we arranged and took part in a fun training session on January 10th 2007.

For some time now I have wanted to offer realistic scenarios to clients when delivering first aid courses. It has seemed strange to me that of all the first aid courses that I have been on, NOT ONE has managed a scenario or training tool that is in any way realistic. This is  a dreadful failing and one I am keen to correct.

I contacted THE THREE KINGS and they came down and showed us how to apply make - of the bloody kind - to enhance our management and first aid training events. Using remarkably simple techniques and the make up tools and resources supplied one can turn a clean and healthy looking person into a grotesque and bloody mess...  in a matter of minutes.

Eight of us took part and now we have each other as resources to use in scenarios that will be second to none. For the client the learning will be enhanced, assisting proper diagnosis of major problems and enabling the memory to recall information quickly and accurately. We can now show exactly what shock looks like, we can use fake glass props, have blood oozing from wounds.....

Some time ago I took a business decision to ensure that all staff working for me had taken part in a yearly first aid refresher, and this course, as it deals with the outward signs of injury will be this years first aid top up.

Wales Outdoors is the only activity company ensuring, well before legislation is in place, that yearly refreshers take place. Not only do I guarantee this but I ensure that where possible all staff take part in some of the first aid courses that I run throughout the year. This I feel is essential in feeling confident that MY staff can deal with any emergency situation that they come across with confidence.

How do other activity companies guarantee staff competency with emergency care? - especially when you consider that most people say that 6 months after a first aid course much of the learnt information is very well buried..... perhaps never to resurface!

To enquire about tailor made first aid courses or the outdoor leader course please contact me.

Andy

The Thursday Post

With the advent of new sites to discuss some of the issues that I have been blogging about here, I have had a rethink regarding the purpose of this site.

The stats have been an average of 12 unique visitors per day. Not a great deal of traffic but these visitors have been spending a fair bit of time leafing through different articles. It is therefore worth continuing and as the stats have a consistent upward trend it is interesting to me to see how many visitors this blog could finally attract.

I have therefore decided to review the way in which the info is stored, re-publish some of the important articles, such as the first aid info and kit provision blogs and maintain these as a technical resource. These pages will be clearly linked to in a re designed side bar.

I do hope that the visitors keep on coming and that the site becomes a useful resource to those looking for information on activity provision and adventures in Wales.

Once again - feel free to comment. I moderate the comments only to keep out abusive remarks. ALL comments that are not abusive are published.

Blood Transfusions

Last summer I had a young teenage girl take part in an activity with me. Nothing unusual in that. I came to find out that she was a Jehovah's Witness. This has led me to consider those who I have in my care a little more deeply. I would certainly like your comments on the following proposal:

I think that it is incumbent upon us to care for those who take part in our led activities to the best of our ability. I think that any person, no matter what age they may be, who would refuse certain types of medical or other assistance following an injury whilst taking part in an adventure session, should be refused a place on the activity.

I am considering adding a clause to my booking form that states that any participant will agree to receiving any necessary care following any accident. I do not want an instructor put into a position where a client is seriously injured and will not accept proper care.

We rarely have accidents that result in hospitalisation - the occasional grazed knee, cut finger etc. The last trip to the hospital was in 2001 and this was a short slip on a hill walk and a rather nasty cut on the shin that required good cleaning and stitching up. But this is not the point.

We must look at the worst case scenario and protect clients and staff. I certainly would not want to have on my conscience a case of a teenager who died because parents did not allow a blood transfusion.

I don't wish to be disrespectful but Jehovah's Witnesses have got it wrong. Blood transfusions are not cannibalism and it is the eating of human flesh that the bible is telling us not to do. Why do these people believe in the absolute truth of the biblical word. 48% of Americans believe in creation and there is a $26 million museum being built to show the history of the earth with dinosaurs walking with humans and having a place on Noah's Ark!

I think I know who the 'dinosaurs' are! Worrying 48% though!

I look forward to your considered opinions.........

Training Me - Training You

I have just completed a 'Train the Trainer' course with CT. Learning Ltd and found that there was much to think about when considering staff training or running courses for paying clients.

Mair O'Connor who runs CT Learning says 'Train the Trainer is a two-day course that will help your trainers to understand the key concepts of training in the workplace, learn a range of training tools and techniques and learn and apply these training skills.'

I would recommend Mair if any of you are looking for a management trainer. Just click on the link above for her site.

I found that I was intuitively doing most of the stuff covered in the course. It was great to have the theory spelled out and good to go away with the tools to improve my practice. The ideas discussed do interest me and I think that I will continue with my personal development in this fascinating area.

For example did you know that as we communicate only 7% of our message is given verbally. Wow. I have looked into this a little and found the following fairly definitive and definitely thought provoking article........ Is this the key to all of us becoming Derren Browns?

Outdoor Leaders 1st Aid kit

What should we find in an Outdoor Leaders First Aid kit?

Lets start with the minimum. I once met a guy that said he could do everything with gaffer tape, a sanitary towel and a condom and that was all that he carried. Extra absorbent material could be improvised, gaffer tape can be a sling and a bandage and a condom can be stretched over fingers and hands.

Could a reasonable minimum be the contents pictured? Might take a bit of carrying!

I believe that those working in the outdoors have a special duty of care that goes far beyond the service levels that those caring for clients in 'normal' environments work to. We are not five minutes from an ambulance in a cave, forest or gorge. If we lead people into the outdoors, into sometimes remote and difficult to escape venues, where a rescue time might be as long as three or four hours, we surely must have the skills and equipment to care for an injured party to the very best of our ability. This does not advocate advanced or specialist skills but simply making full use of those skills learnt on a two day first aid course.

I carry my own firs aid kit and I have included items in this that I am happy to or have been trained to use. For example, I believe it is important to carry a blue asthma inhaler, two epi-ens, aspirin, anti-histamine and paracetamol. I helped developed the first generally available epi-pen course in the UK following an incident of bee stinging in a group I was leading. As it happens, I offered this course to local instructors and ONE signed up for it. I was only charging £10 for the session! I think that we really must try harder than this to cover the worst case scenarios that we have looked at whilst risk assessing.

Furthermore, an activity leaders 'office' is the great outdoors and this must be treated as a workplace. Legislation regarding the materials that a first aid kit should contain is vague. Currently the HSE state the following:

There is no standard list of items to put in a first aid box. It depends on what you assess the needs are. However, as a guide, and where there is no special risk in the workplace, a minimum stock of first aid items would be:

• a leaflet giving general guidance on first aid eg HSE leaflet Basic advice on first aid at work (see 'Where can i get further information?);
• 20 individually wrapped sterile adhesive dressings (assorted sizes);
• two sterile eye pads;
• four individually wrapped triangular bandages (preferably sterile);
• six safety pins;
• six medium sized (approximately 12cm X 12cm) individually wrapped sterile unmedicated wound dressings;
• two large (approximately 18cm X 18cm) sterile individually unmedicated wound dressings;
• one pair of disposable gloves

You should not keep tablets or medicines in a first aid box.

The above is a suggested list only - equivalent but different items will be considered acceptable.

I have looked at the contents of my first aid kits over the years and have worked hard to find out what a perfect kit might look like. I have discussed the issues with outdoor professionals, paramedics, first aid trainers and to those that have dealt with serious incidents in remote environments.  The outcome of years of discussion is my current kit which I part designed and part adopted. This kit is kept in sealed barrels that do not crush and are watertight. I have four sets exactly the same. I also keep a 'comfort' kit, this is plasters, wipes, small bandage etc, so as to retain the integrity of the main kit for 'real' emergencies.

Alongside this I carry the kit as detailed in my kit blog. All of this fills one an a half kit bags, the half being space to spare for lunch, drinks and cameras.

Click continue reading for our full first aid kit details......